President’s Corner 1st Quarter Issue 2024


Health in the Air – What Hazards Do We Face?

For the last several quarters, I have written about the importance of mental health in aviation safety and optimum performance.  Both the NTSB’s Navigating Mental Health in Aviation Summit and the FAA’s Aviation Rulemaking Committee on Aviation Mental Health and Medical Certification are directly addressing this on a national level.  The FAA ARC report with Recommendations is due to be published 30 March 2024.

Environmental hazards we face when in the air may potentially affect our health.  When the Occupational Health and Safety Administration (OSHA) was established in 1970 to provide guidance and standards for workplace safety and health, the FAA retained authority to manage the environmental hazards for aircraft crewmembers in a 1975 Federal Register Notice Of Proposed Rulemaking and confirmed this policy in a 2000 MOU.  In December 2000, the FAA/OSHA Aviation Health and Safety Team published its first report of application of OSHA’s requirements to Employees on Aircraft in Operation.  An aircraft in operation is defined as the first time a person enters an aircraft for a planned flight to the time when the last person exits the aircraft.  Maintenance and ground personnel fall under OSHA regulations.

In 2014, OSHA and the FAA  published an MOU establishing its authority to apply its standards for cabin crewmembers (not flight crewmembers) in three areas:  hazard communications, bloodborne pathogens and occupational noise and to investigate complaints from cabin crew.  For more historical and standards information, see the OSHA Airline Industry site.

What hazards do pilots face while flying?  Cabin crew also face similar hazards, but the FAA has retained authority for all aspects of flight crew health and safety while operating and aircraft. From an ALPA-International White Paper on Enhancing Pilots’ Occupational Health and Safety Protections, there are several significant concerns.

  • Cabin Air Quality to include smoke and fume events
  • Potable Water and Food Safety
  • Cleanliness and Sanitation – In-flight transmission of Communicable diseases
  • Radiation
  • Laser Exposures
  • Ambient Noise
  • Additional issues pilots face are irregular hours, circadian disruption

The FAA’s resources to monitor these occupational hazards are extremely thin.  Measuring, monitoring, and mitigating these hazards has not been implemented in the US.  The COVID pandemic highlighted efforts in the sanitation of aircraft and wastewater monitoring for evidence of disease transmission.  The European Union considers aircrew as radiation workers and routinely monitors and limits exposure.  The CDC/NIOSH has a page on Aircrew Safety and Health – Cosmic Ionizing Radiation to provide information and individual exposure dose estimators using the NASA CARI 7 system.  Some international airlines monitor cabin compounds, but alarms for acute exposures to substances like TCPs and VOCs are still in development. The European Union is also very active in researching cabin air quality.  There is an international coalition researching sanitation of aircraft with recent papers published on the use of UV-C radiation in aircraft for sanitation, just as it has been done in operating rooms for decades.

What is the good news on pilot health?  In general, pilots are healthier, have less disease and longer lifespans than the general public.  A recent study from the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) found that there was insufficient evidence that a toxic syndrome or disease was caused by cabin air quality variations.  Although there was an increase in melanoma, squamous cell carcinoma and leukemia, the mortality from these conditions, except melanoma, was lower than the general population.  Other studies have shown an increased incidence in pilots of melanoma, but melanoma is thought to be more related to childhood exposure to solar radiation rather than cumulative radiation exposure.

Many other cancers had a lower incidence than the general population, including lung, bladder, kidney, colon, brain, and mouth.  No conclusion could be reached regarding prostate and breast cancer.  Also, the risk of other chronic diseases, including cardiovascular, respiratory, musculoskeletal, female reproductive and psycho-social disorders, were not elevated in flight crews. 

A 2014 study reviewed previous literature on mortality among flight crew in addition to conducting a separate study and found “cockpit crew had a low all-cause, all-cancer, and cardiovascular disease mortality but elevated aircraft accident mortality. Further studies are needed to clarify the risk of CNS and other radiation-associated cancers in relation to cosmic radiation and other workplace exposures.”   There are numerous other studies for isolated diseases among flight crew and cabin crew, but definitive cause-and-effect data are rare.

Bottom line:  Flight crew generally are healthier and live longer than the general population but are at increased risk for a few conditions, primarily melanoma.  The aircraft environment in the US is poorly monitored, resulting in the inability to determine if exposures in aircrew members exceed limits set by OSHA for ground workers.  To fully protect the occupational safety of aircrew, a more robust monitoring system in the aircraft and of crew members is necessary.  Hopefully, the FAA will receive funding to carry out its responsibilities under legislation and agreements with OSHA.

Fly Safely, Stay healthy,