This is why we need to start planning the Martian Health Service

Not a hospital in sight: Mars, as seen from the Mars Rover, 2015. Image: Getty.

In space, no one can hear you scream, as the poster for Alien helpfully reminded us. That’s bad enough in a movie, but worse if you’re a colonist on Mars, the thing you’re screaming is “Help, I think my leg is broken”, and the nearest hospital is some 34m miles away back on Earth. Without a phone network, you can’t even be put on hold to NHS Direct.

So with Elon Musk wanting to put human colonists on Mars as soon as 2024, we need to think about public services on the red planet; and this wqs the topic of a talk last week at FutureFest by Nesta’s Eddie Copeland. “It may be ridiculously premature, but unless you think these things through at the start you might end up with something we really don’t want,” he explained to me later. “Just copying and pasting Earth services feels a bit of a missed opportunity.”

Copeland explains that he'd spotted that, “There's a group of people who had been writing draft constitutions for Mars and they were saying 'what you want is the German electoral system, the US senate, British FPTP for some things' – all of them were dropping existing systems from Earth.” But, he argues, “The more interesting question is: if you're not constrained by all that historical precedent, could you do things fundamentally differently?”

Hold onto your hats, folks: he doesn’t just mean adopting the single transferable vote. “Government could shift from being the service deliverer to playing more of the role of a dating agency: it connects you with a certain set of needs with someone who could fulfil them,” he explains.

What he’s describing sounds suspiciously like the much-maligned gig economy. Is that better suited to small space communities than for the big cities into which its shoehorned here on Earth? We have, as Copeland notes, “The most efficient mechanisms in human history of revealing and then matching supply and demand.” Of course, on Earth the gig economy is exclusively for paid services: it’s hard to envisage us going back to Crassus’ ancient Roman fire service in which fees were negotiated as the building burned.

Having such a small number of early settlers both makes things easier and poses a problem. On the one hand, the planet is so sparsely populated that nimbyism won’t be a problem (build houses on the expansive red belt, go nuts). But on the other, finding someone qualified to help with your specific problem may be tricky, even with Martian Public Service Tinder at your fingertips.

In The Hitchhiker’s Guide to the Galaxy, a planet was doomed because it had too many telephone sanitisers and hairdressers, and not enough doctors and engineers. But depending on the level of public services you want, people from all backgrounds are necessary. “Maybe this will be done by robotics, but people will presumably need cleaners, cooks, childminders,” Copeland says.


“You start with a handful of people,” he goes on, “and there's talk of 200 people at a time potentially. For a while you can pretend that you're a giant cruise ship and everything you need is met by the company. How big do you have to get before that breaks?” Some sort of taxation, to Copeland, feels inevitable eventually, even if it takes decades. After all, eventually a second and third generation of colonists will be born – true Martians – and they won’t have signed a contract back on Earth.

At that point it’s just a question of what services are covered. “Do you say the baseline should also be basic education, or is that categorically different because you're only bothered about life threats?” Copeland asks. “Okay, so maybe it's just fire and health, in which case it's just emergency services, but that's a choice. If you're trying to build the most sophisticated human colony that's ever existed, would it not feel like a bit of a wasted effort unless you're designing your services to go up Maslow's hierarchy of needs to something a bit more ambitious?”

This all sounds suspiciously socialist for an endeavour whose most likely proponents are the supercapitalist giants of SpaceX or Amazon with its Blue Origin rocket. But then of course, there’s the chance that the Chinese government could get there first, and dictate its own brand of quasi-communist services as the default for life on Mars. If both take the challenge in a Space Race 2.0, we could end up with all the geopolitics of Earth mapped onto different sides of Mars in a spin off that precisely nobody asked for.

You’d hope for a more collegiate solution – but, as Copeland points out, you can trace European borders back to the original shared public services. “The only reason they became coherent countries with a coherent national identity is that the road networks connected them all together,” he explains. “Most of the symbols that we associate ourselves with as citizens of the UK are post boxes, telephone boxes, hospitals, police stations: they become icons that create our identity.” So why would we expect Martian life to be different? “I think you'd probably see similar traits if building a Martian community.”

So having given it plenty of thought, would Copeland be on the first ship to Mars? “Oh, not the first ship,” he replies. “Give it a decade for all the existential things to get sorted and then I'd be there.” It’s a fair response, but he shouldn’t wait too long: if you missed out on the London property boom, you don’t want to make the same mistake with Martian pods.

 
 
 
 

What’s killing northerners?

The Angel of the North. Image: Getty.

There is a stark disparity in wealth and health between people in the north and south of England, commonly referred to as England’s “north-south divide”. The causes of this inequality are complex; it’s influenced by the environment, jobs, migration and lifestyle factors – as well as the long-term political power imbalances, which have concentrated resources and investment in the south, especially in and around London.

Life expectancy is also lower in the north, mainly because the region is more deprived. But new analysis of national mortality data highlights a shockingly large mortality gap between young adults, aged 25 to 44, living in the north and south of England. This gap first emerged in the late 1990s, and seems to have been growing ever since.

In 1995, there were 2% more deaths among northerners aged 25 to 34 than southerners (in other words, 2% “excess mortality”). But by 2015, northerners in this age group were 29% more likely to die than their southern counterparts. Likewise, in the 35 to 44 age group, there was 3% difference in mortality between northerners and southerners in 1995. But by 2015, there were 49% more deaths among northerners than southerners in this age group.

Excess mortality in the north compared with south of England by age groups, from 1965 to 2015. Follow the lines to see that people born around 1980 are the ones most affected around 2015.

While mortality increased among northerners aged 25 to 34, and plateaued among 35 to 44-year-olds, southern mortality mainly declined across both age groups. Overall, between 2014 and 2016, northerners aged 25 to 44 were 41% more likely to die than southerners in the same age group. In real terms, this means that between 2014 and 2016, 1,881 more women and 3,530 more men aged between 25 and 44 years died in the north, than in the south.

What’s killing northerners?

To understand what’s driving this mortality gap among young adults, our team of researchers looked at the causes of death from 2014 to 2016, and sorted them into eight groups: accidents, alcohol related, cardiovascular related (heart conditions, diabetes, obesity and so on), suicide, drug related, breast cancer, other cancers and other causes.

Controlling for the age and sex of the population in the north and the south, we found that it was mostly the deaths of northern men contributing to the difference in mortality – and these deaths were caused mainly by cardiovascular conditions, alcohol and drug misuse. Accidents (for men) and cancer (for women) also played important roles.

From 2014 to 2016, northerners were 47% more likely to die for cardiovascular reasons, 109% for alcohol misuse and 60% for drug misuse, across both men and women aged 25 to 44 years old. Although the national rate of death from cardiovascular reasons has dropped since 1981, the longstanding gap between north and south remains.

Death and deprivation

The gap in life expectancy between north and south is usually put down to socioeconomic deprivation. We considered further data for 2016, to find out if this held true for deaths among young people. We found that, while two thirds of the gap were explained by the fact that people lived in deprived areas, the remaining one third could be caused by some unmeasured form of deprivation, or by differences in culture, infrastructure, migration or extreme weather.

Mortality for people aged 25 to 44 years in 2016, at small area geographical level for the whole of England.

Northern men faced a higher risk of dying young than northern women – partly because overall mortality rates are higher for men than for women, pretty much at every age, but also because men tend to be more susceptible to socioeconomic pressures. Although anachronistic, the expectation to have a job and be able to sustain a family weighs more on men. Accidents, alcohol misuse, drug misuse and suicide are all strongly associated with low socioeconomic status.

Suicide risk is twice as high among the most deprived men, compared to the most affluent. Suicide risk has also been associated with unemployment, and substantial increases in suicide have been observed during periods of recession – especially among men. Further evidence tells us that unskilled men between ages 25 and 39 are between ten and 20 times more likely to die from alcohol-related causes, compared to professionals.

Alcohol underpins the steep increase in liver cirrhosis deaths in Britain from the 1990s – which is when the north-south divide in mortality between people aged 25 to 44 also started to emerge. Previous research has shown that men in this age group, who live in the most deprived areas, are five times more likely to die from alcohol-related diseases than those in the most affluent areas. For women in deprived areas, the risk is four times greater.


It’s also widely known that mortality rates for cancer are higher in more deprived areas, and people have worse survival rates in places where smoking and alcohol abuse is more prevalent. Heroin and crack cocaine addiction and deaths from drug overdoses are also strongly associated with deprivation.

The greater number of deaths from accidents in the north should be considered in the context of transport infrastructure investment, which is heavily skewed towards the south – especially London, which enjoys the lowest mortality in the country. What’s more, if reliable and affordable public transport is not available, people will drive more and expose themselves to higher risk of an accident.

Deaths for young adults in the north of England have been increasing compared to those in the south since the late 1990s, creating new health divides between England’s regions. It seems that persistent social, economic and health inequalities are responsible for a growing trend of psychological distress, despair and risk taking among young northerners. Without major changes, the extreme concentration of power, wealth and opportunity in the south will continue to damage people’s health, and worsen the north-south divide.

The Conversation

Evangelos Kontopantelis, Professor in Data Science and Health Services Research, University of Manchester

This article is republished from The Conversation under a Creative Commons license. Read the original article.