​Everyone has a right to healthy indoor air.

​
By Bearnairdine Beaumont – 15th August 2018
 
Under the principle of the human right to health, everyone has the right to breathe healthy air. Also indoors.
The prestigious World Health Organisation WHO stated in a meeting report from the year 2000 held in Bilthoven, The Netherlands, that “Indoor air quality is an important determinant of health and wellbeing”, but that: ”The control of indoor air quality is often inadequate, one reason being the poor articulation, appreciation and understanding of basic principles underlying policies and action related to indoor air quality”.[1]

In general the public is not familiar with such reports and those principles in particular, nor with their associated rights. At the time, a WHO working group was convened to work out and agree on a set of principles and statements about  “The right to healthy indoor air”, based on the fundamental principles of human rights, biomedical ethics and ecological sustainability. The conclusion of the Working Group informs groups responsible for healthy indoor air about their rights and obligations, and individuals by bringing those rights to their attention.[2]
The statement concerning the right to an environment that improves living conditions and increases wellbeing and protects health, also applies to indoor environments.

Does it also apply to aircraft indoor environments?

WHO states in their report that: “Under the principle of respect for autonomy (“self-determination”), everyone has the right to adequate information about potentially harmful exposures, and to be provided with effective means for controlling at least part of their indoor exposures.[3]”

And this is where the problems begin: we breathe air laced with potentially dangerous fumes containing not only highly toxic organophosphates but also CO from thermally degraded chemicals and their mixtures in and of various levels inside aircraft passenger cabins. No information is provided from the industry. No warning signs, no health warning in safety brochures or on tickets.

Investigation into the reasons behind incidences now known widely as ‘fume events’ has been ongoing since the 1940’s[4]. However, although regular and in the mean time daily occurrences throughout the airline industry and in most aircraft models are becoming public knowledge, and the fact that there is science, which has proven such contamination and its dangers, it does not stop the denials to keep rolling in: based on ‘not above legal limits’. Sixty-six years ago, a professor at the Harvard School of Public Health wrote a report linking leukemia to benzene, a common solvent and an ingredient in gasoline. “It is generally considered,” he wrote, “that the only absolutely safe concentration for benzene is zero." And that applies to countless substances. 

Although, a couple of airlines are stating that they are in the process of taking measurements with specialized equipment (but never seem to find anything), or are even in the process of installing new  ‘improved’ filters they declare that they are doing it for precautionary measures only, and that they do not believe that such ‘rare’ incidents pose a problem, or can cause any ill-health. If they are talking filters and are also ‘testing’ less toxic jet engine oils, the simple question springs to mind: Why install filters and change oils if the fumes are not harmful to the occupants in the cabin?

WHO: “Under the principle of non-maleficence (“doing no harm”), no agent at a concentration that exposes any occupant to an unnecessary health risk should be introduced into indoor air.”[5]

Of course the argument is always the same. Although it has been proven and the industry has had to admit that, yes, ‘fugitive emissions’ from jet-oils and other aircraft fluids can enter the cabin  - they still insist that, of course, the levels of toxicity are always ‚below legal limits’ and therefore cannot cause any ill-health. However, it is well documented that i.e. CO can be dangerous at any level,  and  it is also well-known that ‚legal limits’ can be and have been in the past,  adjusted to fit requirements. The industry’s requirements that is.  To avoid any changes to remedy an inherently awkward situation, the following is done:

1) The permissible limit values are increased – this was i.e. successfully proposed in the field of mercury or, 2) you simply cannot find problematic values. All you have to do is use the proper method. For example, measure something that is not important at all.

There are several hundred substances in those fumes. Fumes that often don’t even smell of anything, or if they do are invisible. If we look at the list of selected substances measured on a far too small number of several ‘return’ flights with the same aircraft and company, we find yet again that the conclusions are: no levels exceed the legal limits (EASA[6] [7]). Other highly neurotoxic, cancerogenic and endocrine disrupting substances are not mentioned, not tested, and often not on any legal level limit list anyway; which means they should not be in the air at all – ever. Statements and warnings to this effect made by renowned scientists in the field, are conveniently and regularly ignored.

One research study (comissioned by the industry), which tested aircraft cabin air quality on a total of 61 test flights, states: "The results show, that the cabin/cockpit air quality is similar or better than what is observed in normal indoor environments (offices, schools, kindergardens or dwellings). No occupational exposure limits and guidelines were exceeded." 61 test flights are too few. One could speak of statistical zero-relevance. It turned out that, in addition, they often used the same aircraft from the same airline, on which - for example the consequences of no fumes from (not) leaking labyrinth seals - were measured on return flights. To use different planes on each flight would have made more sense than return flights on the same aircraft, but in view of the way too small sample it doesn't really matter anyway." (8)

"Further measurement taken on 108 flights related to the popularly quoted number of ‚only’ 1: 2.000 flights on which a serious fume event occurs, is on a statistical average 5.4 % of the quantity actually required - according to the probability calculation. In a statistics seminar such an interpretation would probably spark amusement and the book written by Professor Walter Krämer, professor of statistics: "This is how one lies with statistics" springs to mind". [8]

And of course it would make sense to compare such substances in the cabin air simultaneously with those that can be detected immediately afterwards in the "biological material", i.e. in blood and urine. And to then compare them - as epidemiologists would - with the data of an uncontaminated control group. Not just once, but several times. But, fact is, that such ‚studies’ are usually using "third-party funds from industry" and as such 'could' be biased ...

Ultimately, one does not measure what one would have to measure, if one wanted to get to the bottom of the problem.

WHO: “Under the precautionary principle, where there is a risk of harmful indoor air exposure, the presence of uncertainty shall not be used as a reason for postponing cost-effective measures to prevent such exposure.”[9]  And also: “Under the “polluter pays” principle, the polluter is accountable for any harm to health and/or welfare resulting from unhealthy indoor air exposure. In addition, the polluter is responsible for mitigation and remediation.” [10]

Tensions and conflicts often occur between individuals suffering from the consequences and ill health from indoor air pollution and those whose actions and products used negatively influence indoor air quality – it is no different in the airline industry. Countless passengers and crewmembers have already suffered ill health, ranging from mild to severe cases, to lifelong ill health with the loss of their license to fly, even death as a result from chronic and acute exposure to cabin aircraft (indoor) pollution. Low level or not. Aerotoxic Syndrome a new occupational disease? (published 'Public Health Panorama' by WHO)

What can aircraft 'indoor' air be compared to?

Certainly not to 'kindergarden' and hospital surgery rooms, a favourite comparison by the airline industry.
The general public nowadays uses air transportation as a means to get to places for business, a quick weekend trip, a one-day city hop and holidays, nearly as much as driving by car. They do not expect to be poisoned in the process.  We don’t know what levels of potential hazards in cabin air are safe for every person.

Potential cabin air hazards may include:

• Ventilation hazards, including carbon monoxide, ozone, and carbon dioxide levels
• Pesticide exposures on certain flights and that residue stuck to the interior
• Transmission of communicable diseases from sick passengers
• Cabin altitude and pressurization changes
• Low oxygen levels and low humidity
• Air contamination events, when cabin air becomes contaminated with breakdown products from heated engine oils and other substances 

Cabin air contaminants can include carbon dioxide (CO2), products of combustion such as highly toxic carbon monoxide (CO), nitrogen oxides, (nano-sized) particulates and aldehydes , fumes from fuel, de-icing fluids, and then there's the issue with the seals, which aren't really seals, but controlled leakage devices, through which jet engine oils and other substances containing organic hydrocarbons and other neurotoxic and cancerogenic substances 'escape',  not to mention: cleaning products, allergens and infectious agents such as viruses and bacteria. 
And all of this is in a confined, hermetically sealed aluminium hull with no possibility to open windows or to escape. So: 

IS YOUR AIRCRAFT A DEATHTRAP?

"Concentrations of CO exceeding one part in 20,000 parts of air (0.005 percent) are hazardous.· To prevent an airplane from becoming a deathtrap, a thorough examination of the exhaust
manifold and heater assembly should be conducted at regular intervals and whenever CO contamination of the cockpit or cabin is suspected because cracks and holes may occur in a relatively short time. Some aircraft manufacturers recommend that exhaust and heater systems be inspected as often as every 25 hours of flight time. Carbon monoxide in the cabin or cockpit has been traced to worn or defective exhaust stack slip joints, exhaust system cracks or holes, openings in the engine firewall, "blowby" at the engine breather, defective gaskets in the exhaust manifold, defective mufflers, and inadequate sealing or fairing around strut fittings on the fuselage." (©source) : FAA

Perhaps renowned organisations such as WHO should work closely with authorities and politicians to make sure that the measures required for the implementation of their principles are adopted, and follow up their implementation regularly. In the mean time an International Public Inquiry is under way, organized by the Aerotoxic Association Ltd and supported by affiliated organisations such as the Aerotoxic Team, who will together continue to bring awareness to the public and help the already affected Aerotoxic Syndrome sufferers, until this issue has been properly addressed and dealt with.
 

Reference list/cited:
[1] http://www.euro.who.int/__data/assets/pdf_file/0019/117316/E69828.pdf?ua=1
[2] http://www.euro.who.int/__data/assets/pdf_file/0019/117316/E69828.pdf?ua=1
[3] http://www.euro.who.int/__data/assets/pdf_file/0019/117316/E69828.pdf?ua=1
[4]http://www.anstageslicht.de/themen/english/aerotoxic/contaminated-cabin-air-a-health-problem-becomes-certainty-the-chronology-of-the-socalled-aerotoxic-syndrome/
[5] http://www.euro.who.int/__data/assets/pdf_file/0019/117316/E69828.pdf?ua=1
[6] EASA Cabin Air Quality onboard Large Aeroplanes
[7] EASA Preliminary cabin air quality measurment campaign
[8]An uncovering of Tricks, Methods and Strategies  - Professor J. Ludwig, DokZentrum/www.Anstageslicht.de
[9] http://www.euro.who.int/__data/assets/pdf_file/0019/117316/E69828.pdf?ua=1
[10] http://www.euro.who.int/__data/assets/pdf_file/0019/117316/E69828.pdf?ua=1
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NOTE regarding above citations/ quotes from the WHO website: © World Health Organization – 2000 states:
All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors.