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.

 
 
 
 

Air pollution in London is now so bad it’s affecting lung development

Cough, splutter. Image: Getty.

Air pollution is known to contribute to early deaths from respiratory and cardiovascular disease. There is also mounting evidence to show that breathing polluted air increases the risk of dementia. Children are vulnerable, too: exposure to air pollution has been associated with babies being born underweight, as well as poorer cognitive development and lung function during childhood.

Cities including London are looking to tackle the social, economic and environmental costs of air pollution by improving urban air quality using low emission zones. In these zones, the most polluting vehicles are restricted from entering, or drivers are penalised to encourage them to take up lower emission technologies. London’s low emission zone was rolled out in four stages from February 2008 to January 2012, affecting mainly heavy and light goods vehicles, such as delivery trucks and vans.

But our new research, involving more than 2,000 children in four of London’s inner-city boroughs, reveals that while these measures are beginning to improve air quality, they do not yet protect children from the harmful effects of air pollution. It is the most detailed assessment of how a low emission zone has performed to date.

Young lungs

Our study focused mainly on the boroughs of Tower Hamlets and Hackney, but also included primary schools in the City of London and Greenwich. All of these areas experienced high levels of air pollution from traffic, and exceeded the annual EU limit for nitrogen dioxide (NO₂). What’s more, they have a very young demographic and are among the UK’s most deprived areas.

Between 2008-9 and 2013-14, we measured changes to air pollution concentrations in London, while also conducting a detailed examination of children’s lung function and respiratory symptoms in these areas.

Every year for five years, we measured the lung function in separate groups of 400 children, aged eight to nine years old. We then considered these measurements alongside the children’s estimated exposure to air pollution, which took into account where they lived, and the periods they spent at home and at school.

Our findings confirmed that long-term exposure to urban air pollution is related to smaller lung volumes among children. The average exposure for all children over the five years of our study was 40.7 micrograms of NO₂ per cubic metre of air, which was equivalent to a reduction in lung volume of approximately 5 per cent.

Changes of this magnitude would not be of immediate clinical significance; the children would be unaware of them and they would not affect their daily lives. But our results show that children’s lungs are not developing as well as they could. This is important, because failure to attain optimal lung growth by adulthood often leads to poor health in later life.

Over the course of the study, we also observed some evidence of a reduction in rhinitis (a constant runny nose). But we found no reduction in asthma symptoms, nor in the proportion of children with underdeveloped lungs.


Air pollution falls

While the introduction of the low emission zone did relatively little to improve children’s respiratory health, we did find positive signs that it was beginning to reduce pollution. Using data from the London Air Quality Network – which monitors air pollution – we detected small reductions in concentrations of NO₂, although overall levels of the pollutant remained very high in the areas we looked at.

The maximum reduction in NO₂ concentrations we detected amounted to seven micrograms per cubic metre over the five years of our study, or roughly 1.4 micrograms per cubic metre each year. For context, the EU limit for NO₂ concentrations is 40 micrograms per cubic metre. Background levels of NO₂ for inner city London, where our study was located, decreased from 50 micrograms to 45 micrograms per cubic metre, over five years. NO₂ concentrations by the roadside experienced a greater reduction, from 75 micrograms to 68 micrograms per cubic metre, over the course of our study.

By the end of our study in 2013-14, large areas of central London still weren’t compliant with EU air quality standards – and won’t be for some time at this rate of change.

We didn’t detect significant reductions in the level of particulate matter over the course of our study. But this could be because a much larger proportion of particulate matter pollution comes from tyre and brake wear, rather than tail pipe emissions, as well as other sources, so small changes due to the low emission zone would have been hard to quantify.

The route forward

Evidence from elsewhere shows that improving air quality can help ensure children’s lungs develop normally. In California, the long-running Children’s Health Study found that driving down pollution does reduce the proportion of children with clinically small lungs – though it’s pertinent to note that NO₂ concentrations in their study in the mid-1990s were already lower than those in London today.

Our findings should encourage local and national governments to take more ambitious actions to improve air quality, and ultimately public health. The ultra-low emission zone, which will be introduced in central London on 8 April 2019, seems a positive move towards this end.

The scheme, which will be expanded to the boundaries set by the North and South circular roads in October 2021, targets most vehicles in London – not just a small fraction of the fleet. The low emission zone seems to be the right treatment – now it’s time to increase the dose.

The Conversation

Ian Mudway, Lecturer in Respiratory Toxicology, King's College London and Chris Griffiths, Professor of Primary Care, Queen Mary University of London.

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