Aviation noise, health and wellbeing research prioritisation – progress reportMay 2021

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Contents

Contents 1

Background 2

Prioritisation process 3

Stakeholders 4

Survey 5

Workshop 9

Next steps 10

References 11

Acknowledgments 12

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Background

Aviation noise affects the quality of life and health of many people living close to airports or under flightpaths. Before the pandemic, over a million people in the UK were being impacted significantly by aviation noise. As people start to fly again and planes start to return to our skies in greater numbers over the coming months and years, the issue of how aircraft noise affects people’s health will return.

In January 2019 the UK Government established the Independent Commission on Civil Aviation Noise (ICCAN), a new non-statutory advisory arm’s length body, to act as a credible and impartial voice on civil aviation noise. As stated in our recently published ICCAN corporate strategy 2021-2024, one of our goals is to put people’s health at the heart of aviation noise policy. ICCAN will do this through progressing research into the health and wellbeing impacts of aviation noise as a robust evidence base on the relationship between aviation noise and health is crucial to fully understanding these impacts. To make any recommendations on the future of aviation noise management, including potential changes to the way it is regulated, an evidence-based understanding of the impacts of aviation noise is essential.

In early 2020, ICCAN commissioned the National Centre for Social Research (NatCen) to complete a rapid evidence assessment (REA) to better understand the quality of the evidence relating to aviation noise specifically and identify gaps in the evidence base. This work builds on the reviews conducted by the World Health Organisation (WHO) and the UK government Department for Environment Food & Rural Affairs (Defra). This REA summarises the quality of the evidence relating to a wide range of health outcomes, from the WHO and Defra reviews and from the evidence published since those reviews. It also summarises the measurement metrics and research methodologies that might be used to fill identified evidence gaps. ICCAN’s report and covering note can be found on our website.

Our review showed there is no single clearly defined evidence gap in the health research and there are several options to decide which health and wellbeing outcomes are most important and where best to seek higher quality evidence. Different health effects may need different research approaches. ICCAN has therefore developed a strategy on how best to expand and improve the existing evidence base to inform policy. In recent months, we have used an established method to help identify priorities for future research.

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Prioritisation process

Health prioritisation is a complex and uncertain process. Several different structured approaches are used globally and their use has increased over time, but with no one method being an accepted best practice. Following a review of commonly used processes, we decided on a proportionate hybrid approach based on a combination of the James Lind (NIHR, n.d.) and Delphi (Wikipedia, n.d.) methods. We checked this against the WHO’s elements of a well-run prioritisation which include assessments of aims, context and resources available (Viergever, 2010).

Flow chart 1: Flow chart showing the steps ICCAN took to prioritise areas of future research on aviation noise, health and wellbeing. This includes how we engaged with stakeholders.

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Stakeholders

Stakeholder groups were identified by a combination of desk research and running an in-house stakeholder mapping workshop to capture institutional knowledge of those with an interest and influence in the health impacts of aviation noise.

Stakeholders identified included:

• community groups and individuals affected by noise, • experts in noise-health research, • government officials with an interest in aviation noise and health impacts, • airports and other aviation industry representatives.

Groups and individuals from these broad areas were identified from previous engagement and desk research aiming to cover a range of geographical areas and health expertise. A larger group was approached to complete a survey on a longlist of research priorities (see below) and invited to attend a workshop.

All Directors of Public Health in the UK were also approached but immediate engagement was not expected since at the time of writing we were at the height of the Covid-19 pandemic.

Those who responded to the survey with an interest in the workshop were then invited to attend an online meeting.

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Survey

Process As part of the prioritisation process, ICCAN sent a survey to stakeholders alongside some guidance to assist with completing the survey. The guidance briefly explained the background to the project, the prioritisation process and a summary of the sources for the prioritisation longlist for stakeholders to consider.

The longlist was compiled by collating existing major reviews of aviation noise and health including a recent rapid evidence assessment by NatCen, commissioned by ICCAN, and earlier recommendations by WHO, Defra and the European Network on Noise and Health (ENNAH). We also collated comments from an ICCAN survey of its stakeholders [link]. This asked for views on the importance of “putting people’s health and wellbeing at the heart of aviation noise policy”. The main sources in the longlist included:

• The European Network on Noise and Health Report (ENNAH, 2013) • Environmental Noise Guidelines for the European Region. World Health Organization

(WHO, 2018) • Review of Evidence Relating to Environmental Noise Exposure. National Institute for

Public Health and the Environment of the Netherlands (RIVM) and Arup (2020) • Aviation Noise and Public Health: a rapid evidence assessment. National Centre for

Social Research (NatCen, 2020)

The final longlist included health and educational outcomes such as sleep, cardiovascular disease and cognition, along with other study factors such as noise measures, operational factors, design types including economic analysis, and specific sub-populations.

Respondents were asked to choose up to ten priorities from any health, noise and study design option from the guidance, as well as other suggestions, with an indication of their importance in their opinion, giving their reasons.

In total the online survey was sent to 42 stakeholders from a range of interest groups. We received 16 responses from community group members, health-noise experts, government officials and aviation industry representatives. In a qualitative analysis of the results ICCAN coded the responses into themes to identify the key health outcomes of interest and other study factors.

Responses In total ICCAN identified 14 themes that were seen as ‘very important’ or ‘quite important’ covering:

• Sleep • Cardiovascular and metabolic • General health (including non-cardiovascular health)

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• Cancer • Mental health, quality of life and wellbeing • Cognition and children’s learning/development • Burden of disease • Annoyance (being addressed through separate ICCAN project) • Mitigation intervention • Noise metrics and maps • Impact on specific population groups • Longitudinal cohort studies and epidemiologic studies • Non-aviation noise risk factors • Effect of Covid

Sleep was one of the more predominant health outcome themes mentioned by respondents. Reasons respondents gave for selecting sleep as important included that sleep deprivation can affect other areas of health (such as the cardiovascular system) and is inescapable for communities. Mental health, quality of life and wellbeing were also seen as important health outcomes by respondents, since these could impact other health areas as well as impacting those most vulnerable.

Other study factors, outside of health outcomes, were also mentioned as important, such as health impacts of aviation noise mitigation interventions. Reasons for this included that research could determine causality between aviation noise and health, and assess the effectiveness of the mitigation intervention. Further information on reasons why respondents saw certain themes as important for health outcomes and other study factors can be seen in Figures 1 and 2.

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Figure 1: Health outcomes

Sleep

• Measure of how communities feel about night noise; inescapable for those affected • Sleep deprivation affects other areas of health including cardiovascular system • Essential for physical and mental wellbeing • Economic effect from loss of productivity due to sleep deprivation • Lack of UK study • Subjective and objective sleep disturbance

Cardiovascular and metabolic

• Academic evidence demonstrates negative impact but need further research to provide certainty to policy makers

• Obesity is third highest contributor, stroke fifth and diabetes sixth to death and disability in UK

• Comparing aircraft noise exposure to short-term cardio-metabolic changes, including using different metrics

• Compare data of affected and non-affected areas

General health (including non-cardiovascular health)

• Noise affects more than just cardiovascular health • Impact on existing health conditions

Cancer

• Lack of UK study/evidence

Mental health, quality of life and wellbeing

• Current evidence is mixed and very little data from UK study • Could affect those most vulnerable • Quality of life questionnaires are a non-invasive tool to look at those who live under

flight paths and compare to those who do not • Exacerbates other health areas • Stress caused by aviation noise damages the body • Complex bidirectional relationships with noise annoyance.

Cognition and children’s learning/development

• Disadvantage affected communities • Life-long impact on children • Previous research suggests children exposed to aviation noise have impaired

reading comprehension • How effects develop over time (longitudinal study) • Aviation noise could affect pregnant women

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Burden of disease

• To feed into noise calculations and statistics in the UK • Policy makers need to understand the economic impact of their decisions

Figure 2: Other study factors

Mitigation intervention

• Determine causality (if an intervention is mitigating aviation noise) • Before and after studies are currently limited • Inform airspace decisions • Impact of concentrated flight paths compared to multiple routes

Noise metrics and maps

• Quantify effect of number of events on health (N-above metrics) • How different metrics relate to different health outcomes • Need accurate mapping and measuring of real noise levels • Noise maps do not accurately reflect what is heard on the ground Impact on specific population groups

• Aviation noise could have larger impact on certain groups • Groups not previously overflown • Vulnerable people, those with existing conditions

Longitudinal cohort studies and epidemiologic studies

• Will improve the quality of evidence • Lack of cohort studies focusing on noise and health in UK • Measures effects of change • Measures the incidence of poor health to be examined over prevalence of poor

health

Non-aviation noise risk factors

• Little research on airport construction noise and health • Pollution impacts resulting in extra surface access movements • Extent of impact of ultrafine particles (may have association with cardiovascular

disease) which are emitted from aircraft on communities

Effect of Covid

• Examining associations in the post-pandemic recovery period with lower numbers of flights

• Data collected during lower number of flights could be used as a baseline

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Workshop

In March, due to national restrictions as a result of the Covid-19 pandemic, we held an online workshop . Our aims for this session were to:

• bring together a range of stakeholders giving them the opportunity to meet • collectively learn more about the considerations in building evidence to inform policy

and discuss these, and; • produce a shortlist of research prioritisation options.

We presented our qualitative analysis of the survey together with information on the complex range of factors that could be considered in prioritising further research such as summaries of existing evidence and its quality, the numbers affected by different health conditions, features of different study design types and examples of mechanisms for health evidence to drive policy impacts.

Using these as a starting point, we arranged for groups of attendees to talk together in online ‘rooms’ and invited them to consider new ideas beyond their existing priorities. This was first done in pairs and then in larger groups, to encourage everyone to reflect on and articulate their views.

Building on these initial discussions, we arranged a short series of small group discussions and whole group reviews to report consensus views on the top priorities, capturing thoughts on an online board. These included sleep and night flying, effects on mental illness and wellbeing, and cardiovascular diseases. There were also discussions focusing on research that will best inform policy or operational changes and encouraging best practice where evidence existed.

When asked to explore the challenges in choosing future priorities groups included the need to find solutions to UK-specific issues and population groups when much of the evidence has traditionally been international and the difficulties in securing sustained funding for the highest quality studies giving the most robust findings, particularly in light of the current situation in aviation.

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Next steps

Despite the challenges of running an online meeting on a complex topic, bringing a broad range of interested parties together has helped us to identify priorities for future research. The feedback from the workshop indicated that attendees found it useful and interesting to meet others with differing perspectives.

We will use the results of this workshop to finalise ICCAN’s priorities, constructing a roadmap of future research areas. We will then work with an independent advisory panel to develop detailed research proposals which we can use to commission new research. We will also work with funders to develop longer-term research opportunities working in partnership with the research community.

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References

NIHR. (n.d.). Retrieved from https://www.jla.nihr.ac.uk/ Viergever, R. e. (2010). A checklist for health research priority setting: nine common

themes of good practice. . Health Res Policy, ys 8, 36. doi:https://doi.org/10.1186/1478-4505-8-36

Wikipedia. (n.d.). Retrieved September 2020, from https://en.wikipedia.org/wiki/Delphi_method

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Acknowledgments

ICCAN is grateful for support in this work: members of our expert panel; Prof Charlotte Clark of St George’s University of London for invaluable comments on the survey and workshop materials, and Dr Ben Fenech of Public Health England for comments on the workshop materials; as well as Matthew Mezey of The Health Foundation for advising on running a consensus workshop.

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© Crown copyright 2021 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3

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Contact ICCAN: 01484 240457 | ContactICCAN@iccan.gov.uk