Fighting for Smoke-Free Skies

by John D. White and Clifford E. Douglas

THE U.S. CONGRESS PROHIBITED smoking on virtually all domestic passenger airline flights starting in February 1990. Now leading health-promotion organizations and flight attendants in the United States are working with supportive legislators and federal officials to eliminate smoking on all international flights.

 Advocates of the international smoke-free measure say that the campaign presents a new challenge. "If we thought the battle against the U.S. tobacco lobby was tough, selling this measure on an international basis is going to be even tougher," says the Congressional champion of the domestic smoke-free policy, Rep. Richard J. Durbin, D- Illinois.

 But advocates believe fighting for an international smoke-free standard will be worth the effort. Durbin says the effect of the domestic ban, which applies to all flights within the continental United States and all domestic flights of six hours or less involving Hawaii or Alaska - about 99 percent of all domestic airline travel - has extended beyond the confines of the airliner cabin and even beyond the airline industry. "Our domestic smoking ban triggered a national effort in the United States for sensible regulation of smoking in all public places," he says. "Now there are [smoke-free] policies everywhere: public buildings, schools, hospitals, you name it." When Congress first required that domestic flights of two hours or less be smoke-free in 1988, a trend already was underway to protect nonsmokers in public places and the workplace. But most advocates agree that the prominence and popularity of the first smoke-free airline measure, coupled with the more sweeping measure enacted two years later, helped power the trend by underscoring nonsmoking as the social norm.

Campaign take-off

 Last May, Durbin, who founded and co-chairs the 50-member Congressional Task Force on Tobacco and Health, joined the American Lung Association, the American Heart Association and the American Cancer Society (united as the Coalition on Smoking OR Health), former U.S. Surgeon General C. Everett Koop and a national flight attendants union to announce the kick-off of the "Campaign for Smoke-Free Skies Worldwide." Since then, advocates of international smoke-free flights have gained the support of the U.S. representative to the International Civil Aviation Organization (ICAO), Donald M. Newman, Secretary of State James Baker III, Secretary of Health and Human Services Louis W. Sullivan and former Secretary of Transportation Samuel Skinner, who was recently appointed President George Bush's chief of staff. Then-Secretary Skinner met in July 1991 at ICAO headquarters in Montreal with the ICAO council president, Dr. Assad Kotaite, to urge support for a multilateral agreement prohibiting smoking on all flights among ICAO's 164 member states. ICAO is affiliated with the United Nations.

 Smoke-free flight advocates are seeking to persuade ICAO to adopt a standard mandating elimination of all smoking in airplanes worldwide. Pointing to an increasing body of scientific evidence which shows that second-hand smoke - also known as environmental tobacco smoke (ETS) - is a carcinogen and a major cause of heart disease, former Coalition on Smoking OR Health chair and current Deputy Managing Director of the American Lung Association Fran Du Melle says that such a standard "is necessary to safeguard the health of the more than one billion passengers and hundreds of thousands of crew members who fly each year."

ETS in airplanes most severely victimizes flight attendants, since they are exposed to it on a continual basis. Patty Young, a 26-year veteran flight attendant with a major U.S. carrier, suffers from chronic bronchitis, constant headaches and other illnesses which she connects to being exposed to ETS. "We have allowed people to poison us year after year by letting them satisfy their nicotine addiction in the confines of the airplane cabin," Young says. Young is one of seven nonsmoking flight attendants who has filed a class action suit against eight U.S. tobacco manufacturers. The flight attendants are seeking more than $5 billion in punitive damages for lung cancer and other illnesses they allegedly contracted by being exposed to ETS on the job. The complaint, filed in Miami last October, says that the plaintiffs "are innocent victims who had no choice; smoke was constant in their work environment and they had to inhale it." Young says that if ICAO fails to address the problem at the global level, "many more of us will get sick and die needlessly, largely because of the power of the genocide syndicate," a reference to the tobacco industry.

 Kathryn Renz, a flight attendant for 10 years with another major carrier, represents the Independent Union of Flight Attendants, which joined other unions last May in asking the Federal Aviation Administration to prohibit smoking on international flights by U.S. carriers. She says that a worldwide airline smoking ban is justified not only by health concerns, but also by safety issues. "Lit cigarettes in the airline cabin are accidents waiting to happen," says Renz. She and other flight attendants have often encountered passengers who fell asleep with lit cigarettes in hand, she says, and some flight attendants have suddenly found themselves fighting seat cushion fires started by dropped cigarettes. Flight attendant Young echoes this concern, saying she is worried about a possible repeat of the Varig Airlines flight which crashed in a fireball while trying to land in Paris in 1973, killing 133 people. The fire which led to the crash was started by a cigarette dropped carelessly by a passenger in a rear lavatory.

Prospects for success

 Ambassador Newman, whose position at ICAO provides a good vantage point for assessing the prospects for adoption of a smoke-free standard, says, "We've got things moving in the right direction." While it may be overly ambitious to hope for adoption of a standard when ICAO next meets in plenary session in fall 1992, he adds, "We might be able to get a recommended practice [this] year." A recommended practice is voluntary, unlike the mandatory standard. Nonetheless, practices which are formally recommended by ICAO often are incorporated by member nations into their own laws, and "there is, by and large, universal compliance," says Newman.

 ICAO already is working on an agreement that would eliminate or restrict smoking in the cockpit on international flights, a proposal supported by most airline pilots, according to Newman. A report expected to be released soon by ICAO's Chief Medical Officer will recommend elimination of smoking in both the airliner cabin and the cockpit. The concern, says Newman, is one of safety, as well as health. The poisonous effect of carbon monoxide in tobacco smoke, particularly at high altitudes, hampers a pilot's performance by impeding night vision, timing and coordination.

 Now, according to Du Melle, supporters in the United States and their counterparts in Canada, where the government has already adopted a phased-in elimination of smoking on all international flights by Canadian carriers that will be completed in 1993, are spearheading a worldwide effort to lobby ICAO. "Good precedents already have been set in the 30 or more nations which have eliminated smoking on some or all domestic flights, and by the 51 major airlines which, at last count, have either partially or totally prohibited smoking in the airliner cabin for health and safety reasons," says Du Melle. "We are working closely with health leaders in those countries, as well as elsewhere, to help us take our case to [ICAO]."

 There are obstacles, however. Newman and others point out that the cumbersome decision-making apparatus of a large worldwide body like ICAO is not conducive to swift consideration of even the least controversial proposals. Durbin observes that the process is further complicated by the great diversity of social mores and provincial concerns that the ICAO membership brings to the negotiating table. "Now we must deal with different countries with different values and cultures," he says, "many of which don't have the benefit of the same health information concerning tobacco use that we do in the United States."

 And all observers appear to agree on what constitutes the other major obstruction: the extraordinary political influence of the transnational tobacco conglomerates. The tobacco industry strongly opposes smoke-free policies for air travel. In response to the kick-off of the Campaign for Smoke-Free Skies, the Tobacco Institute, the U.S. industry trade association, claimed that airplane "smoking bans, either in place or proposed, are not scientifically supportable" and that separate smoking sections ensure that nonsmoker exposure to ETS is minimal on flights where smoking is permitted. Tom Lauria, a spokesperson for the Tobacco Institute, says that "anti-smoking advocates ... pretend to know what's best for the entire world, [but] they don't."

Because they recognize that the international smoke-free standard is not likely to be enacted quickly, advocates in the United States are pursuing the interim strategy of asking U.S. government officials to seek bilateral and multilateral agreements with those countries believed to be allies on this issue, including Canada, Australia, New Zealand and Great Britain. ICAO Ambassador Newman notes that "it's a plus for the effort to have Skinner that close to the president," given Skinner's strong support for the initiative while Secretary of Transportation. Supporters expect that if the United States and several other nations agree to adopt international smoke-free flying policies and show that they are workable and popular, ICAO will be more likely to adopt its own standard eliminating airplane smoking everywhere.



Extra Troubling Smoke

WELL-PUBLICIZED REPORTS in 1986 by the U.S. Surgeon General and the National Academy of Sciences on the deadly effects of environmental tobacco smoke (ETS) are credited with sparking the momentum that led to Congress's adoption of the domestic smoke-free law - the first and only time Congress has voted to limit where people can smoke. The Surgeon General's report summarized years of study by epidemiologists, physicians and public health experts in the United States, Great Britain, Japan and elsewhere, and found that:

The National Academy of Sciences report reached similar conclusions and recommended elimination of smoking on all domestic flights.

 Additional evidence has since emerged. Last April, a panel of the Environmental Protection Agency's Science Advisory Board, comprised of independent experts, formally endorsed the chief conclusions of a draft EPA report classifying ETS as a "Class A" (known human) carcinogen, the category the agency reserves for the most toxic substances, including radon, asbestos and benzene. EPA expects to release the final report this spring. In June 1991, the National Institute on Occupational Safety and Health recommended that all employers, public and private, adopt smoke-free policies in the workplace. And earlier in the year, researchers at the University of California-San Francisco School of Medicine estimated that ETS is directly responsible for 53,000 deaths each year in the United States, including more than 37,000 from heart disease.

 - J.P.W. & C.E.D.