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.
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:
(a) the epidemiology of DVT, by a case-control
type study (see paragraph 6.25);
(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.
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:
(a) the size of seat that is on offer (see
paragraph 6.46), using unambiguous standardised definitions (see
(b) options for pre-booking seats, particularly
those with extra leg-room (see paragraph 6.46);
(c) whether smoking will be permitted on the
flight in question (see paragraph 4.31);
(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
(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
- 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).
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).
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.
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.
(a) Safety is rightly paramount in the air
travel industry, but this is effectively the sole focus of the
present national and international regulatory arrangements. Passenger
and crew health has not received the close and structured attention
(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