House of Lords - Science and Technology

Select Committee on Science and Technology Fifth Report

CHAPTER 9: GENERAL CONCLUSIONS

9.1 We have drawn many conclusions and made many detailed recommendations throughout this Report. To draw together some of the main threads in this wide-ranging topic, we make some concluding points below.

LACK OF BACKGROUND KNOWLEDGE

9.2 As noted in paragraph 8.17, we have been surprised to discover a substantial lack of knowledge on aircraft cabin health questions. These need to be resolved. Regulators' and the industry's policies and practices can then be demonstrably robust. Moreover, the advice available to intending passengers can also be soundly based. Parts of the picture will be filled in by CAA commissioned research on seat sizes (see paragraphs 3.51 and 6.48) and by the DVT-related studies by Mr Scurr and Dr Kesteven (see paragraph 6.18). However, as indicated in many other parts of this Report, there is still too much that is not known. We therefore welcomed the Minister's announcement at our final evidence session that, explicitly prompted by our Inquiry, DETR and DoH were initiating new wide-ranging research into air travel and health. (Q 516).

9.3 As the Minister indicated (p 196), the research was to be in three parts. Only the first two ground-clearing stages (the identification of authoritative sources and noting the gaps in knowledge they identified) have been commissioned, for completion in mid-2001. Substantial results will flow only from the third stage of various projects aimed at filling the identified gaps. While less rigorous that the DETR/DoH project, our Inquiry has already shown where the major gaps in knowledge are and we recommend the Government to commission research into the following matters as the highest priority:

(b) the demography of air travellers and the types and frequency of travel undertaken (see paragraph 8.19);

(c) real-time monitoring of air quality (see paragraph 5.50) and other aspects of the cabin environment, with a view to establishing new and clear regulatory minima for passenger cabin ventilation (see paragraph 3.36);

(d) testing, with the latest non-invasive technology, blood oxygen levels across the whole spectrum of air travellers, to validate conclusions derived from data on young healthy adults (see paragraph 4.6);

(e) exploration of the ways different aspects of the aircraft cabin environment may interact, particularly on those in less than average health (see paragraph 6.63); and

(f) extracting maximum value from available and improved medical records of aircrew concerning any long-term effects from exposure to the aircraft cabin environment (see paragraphs 8.23 and 3.48).

9.4 For completeness, we repeat here that, in paragraph 6.56, we noted CAA's and HSE's indication of the need for research into noise and low frequency vibration within the aircraft cabin.

PRE-FLIGHT INFORMATION

9.5 In the market place in which air travel is sold, it is vital that intending passengers are provided with sufficient information to make informed choices (see paragraph 8.52). We recommend the Government to require airlines and their agents to provide more information for passengers at the time of booking on the following:

(b) options for pre-booking seats, particularly those with extra leg-room (see paragraph 6.46);

(d) the need for sub-aqua divers to ensure that the effects of any recent diving will not create an additional hazard when they fly (see paragraph 5.47);

(e) the need for intending passengers to satisfy themselves that they are generally fit to fly (see paragraph 8.47) - not only for their own health (particularly in relation to DVT - see paragraph 6.29) but also for that of others (see paragraph 7.33); and

(f) in the case of long-haul passengers, measures to deal with the effects of jet-lag (see paragraph 6.64).

9.6 Providing tailored advice on "fitness to fly" issues is principally for intending passengers' personal medical advisers. As discussed in paragraphs 8.48-8.51, the priority is to ensure that all intending passengers have ready access to information to enable them to consider whether they need advice and, if they do, how that advice might be sought. While we welcome the planned revision of Health Advice for Travellers (DoH) and Flight Plan (AUC) to include suitable advice about fitness to fly (see paragraph 8.48), the danger is that this will be one more thing that busy people do not read. The importance of fitness to fly needs to be given suitable prominence. We recommend that, at every ticket sale point and in every doctor's surgery, there should be a small display card asking intending passengers, "Are you fit to fly?" To help them find the answer, this could offer a short and user-friendly note of guidance[115] - which need be little more than an extract from the suitably revised booklets.

9.7 Some flights are booked long in advance. In such cases, we consider that the fitness to fly question should be reinforced at the time tickets are delivered, in much the same way that tickets also contain brief messages about luggage and safety requirements. That would also be an appropriate opportunity to remind intending passengers about the desirability of avoiding excess alcohol and caffeine in the period shortly before the flight (see paragraph 6.29 and Box 4).

INFORMATION BEFORE TAKE-OFF

9.8 As noted in paragraph 6.29, passengers need to be reminded on boarding and in-flight about the simple measures that minimise any risk of flight-related DVT. We acknowledge the measures that some airlines already take in their in-flight media and otherwise (p 124) but we are clear that this important information needs to be promoted more actively. Passengers need also to be reminded of the simple measures to alleviate head pain from pressure changes on take-off and landing (see paragraph 5.44). We recommend the Government to require airlines to provide, immediately before take-off, a health briefing comparable to the already required safety briefing, backed up by a standardised card in seat-back pockets. We were pleased that the Minister acknowledged the merits of this (QQ 552-554).

COMPETITIVENESS

9.9 We conclude by noting that the airline industry is international and highly competitive. To avoid financial and operational disadvantage for UK airlines, we can understand DETR's reluctance to impose change applicable only in the United Kingdom (Q 70), but that is not a convincing argument. Indeed, we note that the United Kingdom already has distinctive provisions in relation to seat spacing and, as a result of a recent ruling by the Office of Fair Trading in September 2000, may also have distinctive provision on ticketing policies. We welcome the Minister's agreement that the United Kingdom could, if necessary, act unilaterally on air travel health (Q 514). It is, of course, entirely possible that positive changes could be a marketing advantage for airlines.

CONCLUSION

9.10 As noted in paragraph 2.15, we have structured this Report to provide a guide through the wide variety of inter-related medical, technical and other issues that bear on the health effects of the aircraft cabin environment. All the principal points we have made along the way are repeated in Chapter 1 and, for ease of reference to the conclusions alone, re-ordered under some key headings.

9.11 To complement the greatly simplified summary of our findings in the opening paragraphs of Chapter 1, there are four particular points we wish to emphasise here.

(b) Air travel, like all other activities, is not risk free. For the very great majority, any risks to health from the aircraft cabin environment seem very small - and certainly less than individuals accept with little or no apparent thought in other aspects of their daily lives. For a small minority, there are more significant issues, although a number of these may not be unique to air travel.

(c) As a general principle, individuals need to decide for themselves what risks they will face. It is the role of Government, regulators and the industry to ensure that the risks are properly identified, managed and communicated so that intending passengers can take properly informed choices.

(d) To that end, we have made proposals for many changes in practice. We see all of these proposals as important in their own right. However, they will yield their full benefit only if their adoption brings a change in the culture among all those involved in the regulation and provision of air travel so that, subject to the paramount need for physical safety, the whole air travel industry delivers a truly customer-focused service.

115 The National Health Service has adopted a similar approach in educating people visiting surgeries and pharmacies about seeking fewer antibiotics. Back