British Medical Journal: Experts call for stronger action on airports and health
In an editorial in a February edition of the BMJ, Professors Jangu Banatvala and Mala Rao give a stark warning once again about the direct health impacts of aviation arising from noise, pollution and the spread of communicable disease – as well as the indirect health impacts arising from greenhouse gas emissions and their effect on climate change. The impact of noise is well documented. In particular it results in poor performance at work from interrupted sleep and impaired learning development in primary school children living near airports. Stressing the importance of Health Impact Assessments (HIAs) before any policy decisions are made on major developments, so making sure that profits do not take precedence over health, Professors Banatvala and Rao say that the Government’s record on airports is ‘disappointing’. The editorial now calls on the Department of Health and the newly designated Public Health England to make their voices heard. ‘So far they have not.’
AIRPORTS AND HEALTH: EXPERTS CALL FOR STRONGER ACTION
23.2.2013 (Stop Stansted Expansion)
In an editorial in the British Medical Journal (BMJ) Professor Jangu Banatvala and Professor Mala Rao give a stark warning once again about the direct health impacts of aviation arising from noise, pollution and the spread of communicable disease and the indirect health impacts arising from greenhouse gas emissions and their effect on climate change.
Professor Banatvala (pictured below), as well as being an eminent virologist, is medical adviser to Stop Stansted Expansion. Professor Rao is a Professor of International Health with a particular interest in the effects of climate change.
The impact of noise is well documented. In particular it results in poor performance at work from interrupted sleep and impaired learning development in primary school children living near airports. The Government persists, however, in using a completely inappropriate method of measuring ‘significant community annoyance’ and in setting the standards too low. Professors Banatvala and Rao say action on this is ‘well overdue’.
They also emphasise the dangers of air pollution – the probable association with cardiovascular disease and the effects on climate change, all the greater because the impact of emissions from jet aircraft is about twice that from land-based sources.
Stressing the importance of Health Impact Assessments (HIAs) before any policy decisions are made on major developments, so making sure that profits do not take precedence over health, Professors Banatvala and Rao say that the Government’s record on airports is ‘disappointing’, the only HIA being one conducted at Stansted by the owner, BAA. In 2007 the Royal Commission on Environmental Pollution recommended that HIAs should be mandatory, and should be subject to independent review. ‘Expert Committees may occasionally produce inconvenient truths; the Commission has been disbanded and not replaced.’
The editorial now calls on the Department of Health and the newly designated Public Health England to make their voices heard. ‘So far they have not.’
The chairman of Stop Stansted Expansion, Peter Sanders, welcomed the editorial. ‘Now that airport expansion is being considered once again, it is essential that the Department of Health and Public Health England pay close and urgent attention to this editorial’s recommendations.’
NOTE TO EDITORS
The editorial can be obtained on the BMJ website at bmj.com.
A pdf version is at BMJ article Feb 2013 SSE 4.2.2013
Jangu Banatvala, Medical Adviser to Stop Stansted Expansion, email@example.com
Cite this as: BMJ 2013;346:f593
The text of the editorial is copied below (for footnotes and references see editorial):
Aviation and public Health
Are we forgetting to consult on the health implications of airport development?
Jangu Banatvala emeritus professor of clinical virology, Mala Rao professor of international health
The United Kingdom’s Department for Transport recently
drafted an Aviation Policy Framework for the UK to achieve a
balance between the economic importance of aviation and
promoting good health and quality of life in the community.1
The framework stressed transparency in decision making, and
it has been sent for consultation to the Department for
Environment, Farming and Rural Affairs; the Treasury; the
Department of Energy and Climate Change; and the Department
for Business, Innovation, and Skills but disappointingly not to
the Department of Health.
A commission chaired by Howard Davies was launched in 2012
to make recommendations on airport expansion in the UK,2 and,
most recently, a public consultation on London’s airport
expansion opened with the promise of “the fairest possible
evaluation” of the available options.3 Evidence from the public
consultation will be submitted to the commission.
Safeguarding public health in the face of industrial development
should be one of a government’s main priorities. The World
Health Organization 1999 Charter on Transport, the
Environment and Health4—still extant and adopted by the UK
government—recommended that community wellbeing be put
first in transport and infrastructure policies. It emphasised
coordination between transport, environment, and health
The major direct adverse effects of aviation on health are noise,
pollution, and the spread of communicable diseases. Indirect
effects are an increasing challenge, as growth in air travel makes
the aviation industry a major driver of climate change.
Adverse health effects from noise are well established,
particularly poor performance at work from interrupted sleep
and impaired cognitive development in primary school children
who live near airports.5 A narrative review commissioned and
funded by the US Federal Aviation Administration Office of
Environment and Energy and published in 2010 concluded that
there was a likely association between repeated exposure to
night-time aircraft noise and hypertension and ischaemic heart
disease in adults.6 A 2007 study commissioned by the
Department for Transport recommended the use of lower
thresholds for noise metrics in dose-response research,7 and
action is well overdue.
Noise from both aircraft and road transport affects health, but
aircraft noise has the greatest effect. Although modern aircraft
are less noisy, numbers of flights are increasing. Airports are
served by road, rail, and air transport, and people living nearby
are subjected to noise from all these sources, with attendant
potentially serious health outcomes. Efforts are being made to
reduce air pollution from industrial and domestic sources, but
less effort is directed at noise from aircraft.
Pollution associated with the aviation industry is also a health
hazard. Because of radiative forcing, the impact of emissions
from jet aircraft is about twice that from land based sources.
Particulate and other emissions result from aircraft and road
traffic in the vicinity of airports, and are associated with
cardiorespiratory morbidity and mortality. Landing and take-off emissions have received most attention, but recently cruise
emissions have been shown to affect human health; about 8000
premature deaths annually worldwide may be attributable to
this source.9 Regardless of whether technological advances in
aircraft design and performance will reduce noise and air
pollution, aircraft flying now may continue to be airworthy for
As for climate change, its health impacts are not confined to
national boundaries. Although the developing world may be
bearing the major brunt,10 the UK’s resilience may diminish as
climate shocks become more severe and frequent. This has to
be reconciled with the aspiration not only of the UK, but of
countries such as India and China,11 12 to facilitate growth in
business, trade, and tourism by expanding civil aviation.
Unlike Environmental Impact Assessments, Health Impact
Assessments (HIAs) are not obligatory, but should be conducted
before policy decisions are made on major developments, to
ensure that commercial interests are not placed before health.13
The government’s record on airports is disappointing. For the
major London airports only developments at Stansted had HIAs.
However, the assessments were conducted by BAA (British
Airports Authority), scarcely a transparent arrangement, because BAA, acting as the regulator and enabler, also had a major obligation to its shareholders.
The 2007 report of the Royal Commission on Environmental
Pollution recommended that HIAs should be mandatory,
incorporated explicitly in sustainability appraisals, and subject
to independent review.14 No action has been taken. It also
emphasised that restriction of further airport development was
crucial.15 Expert committees may occasionally produce
inconvenient truths; the commission has been disbanded and
In the UK the Civil Aviation Authority will be responsible for
regulating aviation and airport planning. It is essential that health
is considered when airport developments are planned. The
Department of Health and the newly designated Public Health
England must make their voice heard in the debate on the future
of aviation policy. So far they have not.
Competing interests: We have read and understood the BMJ Group
policy on declaration of interests and declare the following interests:
JEB is providing advice on health related issues to the Stop Stansted
Expansion Campaign. We have no financial conflicts of interest.
Provenance and peer review: Not commissioned; externally peer
see BMJ article Feb 2013 for full text with footnotes etc.
2010 document from the DfT and the Department for Health.
Transport and Health Resource: “Delivering Healthy Local Transport Plans”
Has a section on health impacts of civil aviation. Page 108 – 109
Part of this is copied below:
Health Issues from Civil AviationChange in Air Quality
A.106 One of the core health pathways associated with airports and their expansion is the generation of additional emissions to air from fixed plant and from aircraft (while stationary, taxing to runway and during take off, flight and landings). However, airports are required to comply with air quality standards set to protect the environment and health, and continue to address such issues through improved operational activities designed to reduce emissions and there concentration exposure to local communities, including:
the use of fixed ground electrical power (FGEP) thus avoiding the requirement for stationary aircraft on stands to power systems, with a subsequent reduction in fuel consumption and local emissions;
the minimisation of aircraft idle and taxi times prior to take off, further reducing fuel consumption and associated emissions;
the use of Combined Heat and Power (CHP) systems within airports to improve energy efficiencies and subsequent local emissions; and
the use of electric supporting vehicles, preventing the generation of local emissions.
A.107 However, the more significant contribution and community exposure route of air pollution from airports is typically associated with surface transport movements, and private vehicle movements in particular.
Change in Noise Exposure
A.108 As previously discussed there is a significant evidence base on the health effect of noise, and from aviation in particular, where the non-auditory health effects from aircraft can include:
• stress, anxiety and poor mental health;
• performance (tasks and academic);
• night time effects (sleep disturbance); and
• cardiovascular and physiological.
A.109 However, the pathways and strength of association for these are not fully understood. As such, assessments and mitigation typically concentrate on preventing and reducing annoyance, as it is typically the precursor to subsequent health outcomes and applicable to everyone (i.e. all age and socio-economic groups).
Surface Transport and Risk of Collision
A.110 The most significant airport influence to consider in the development of LTPs (local transport plans) is that of associated surface transport movements. Surface transport to and from airports will contribute towards congestion, noise, air quality and more significantly, risk of road traffic collisions along commuter routes. Wider transport and health issues to consider include:
• the potential influence upon transport behaviour and active transport modes, as an increase in local traffic volume may reduce perceptions of road safety;
• a potential impact upon the appeal and use of local amenities and facilities, impacting upon social capital, social networks, recreation and health; and
• a potential increase in fly-parking within resident areas, increasing risk of road traffic collisions, causing general disruption and creating animosity with subsequent risk of vandalism and antisocial behaviour.
A.111 Climate change issues associated with airports and their expansion are typically assessed at the project level by the proponent, and is being addressed by the aviation industry as a whole through the Sustainable Aviation Scheme and through the EU Emissions Trading Scheme.
A.112 Given the current evidence base, further consideration of the potential health impacts of climate change during the development and assessment of LTPs is not recommended. To clarify, there is insufficient evidence to assess the distribution, magnitude and likelihood of specific health outcomes from climate change. Instead, it is recommended that LTPs concentrate on the precursor to potential health outcomes, namely reducing greenhouse gas emissions.
Below are links to some publications on health effects of aviation:
Noise and Health
Noise and children: