Around the world, people watched NASA’s Artemis II mission in awe as humans returned to lunar orbit for the first time since 1972.
As a physician and space medicine researcher, I watched life aboard the mission spacecraft Orion — where four astronauts worked, ate, exercised and managed personal hygiene in a tiny capsule — with curiosity.
Questions raced through my mind: Is this confined living environment psychologically sustainable if future missions last several months? What if there is a medical emergency during the 40-minute communications blackout when Orion passes behind the far side of the moon?
My previous research has highlighted how the environment of space itself can be disabling, and virtually every system within the human body is affected by the extremes of space flight.
As humanity prepares for its next mission to the moon and eventually onward to Mars, we need to consider how to evolve health-care delivery beyond Earth.
We need deep-space medical systems that are self-sustaining, lightweight, robust and functional with minimal maintenance or reliance on Earth-based support.
Cosmic radiation
During space flight, astronauts may experience bone loss, muscle wasting, ocular and visual changes, immune dysfunction, fluid shifts and an increased risk of thrombosis, among many other concerns.
Deep space further complicates these challenges because of both distance and the extreme environment. Radiation remains a major concern even in low-Earth orbit, where the International Space Station operates. Missions beyond Earth would expose astronauts to significantly higher levels of highly ionizing cosmic radiation.
Such exposure may increase the risks of cancer, cardiovascular disease, cognitive impairment and central nervous system injury. Emerging evidence has questioned whether the kidneys could tolerate prolonged deep-space travel to Mars.
This poses serious long-term implications for astronaut health and mission success.
(NASA)
Impossible evacuation
The increasing distance from Earth fundamentally changes how health care can be delivered in space. Communication delays remove the ability to rely on immediate guidance from Earth.
A message sent between Mars and Earth, for example, may take around 20 minutes to arrive, making real-time consultation impossible during emergencies.
Additionally, greater distances severely limit opportunities for replenishing supplies. Medical equipment, medications and consumables may expire, degrade or simply run out over time, while the possibility of rapid evacuation or medical de-orbit would no longer exist.
Earlier this year, the SpaceX Crew-11 team was evacuated from the International Space Station (ISS) because astronaut Mike Fincke experienced a 20-minute unexplained loss of speech This was the first medical evacuation from the space station in 25 years.
(NASA)
What would happen if such an event occurred on a lunar base or during transit to Mars, where immediate evacuation may not be feasible? A major neurological, cardiovascular or other medical emergency far from Earth could leave astronauts having to care for themselves.
The question therefore is whether we are prepared to evolve health-care delivery, and the ability to sustain human health, beyond Earth.
Exercise technologies
One key area involves ensuring adequate nutrition and exercise. Researchers are already exploring ways to cultivate fresh and nutritionally dense foods in extreme extraterrestrial environments, including lunar and Martian habitats.
Beyond nutrition alone, food choice may also play important psychological and social roles in supporting morale, routine and crew cohesion during isolation, including items such as maple syrup aboard Artemis II.
Exercise is equally critical in counteracting the effects of space travel on bone density and muscle mass. The compact flywheel resistance device used aboard Artemis II, reportedly capable of generating resistance equivalent to approximately 400 pounds despite being the size of a carry-on suitcase, appears particularly promising.
(NASA)
Portable yet powerful exercise technologies like these may become indispensable for future lunar bases and deep space missions.
Sustained living on the moon will require carefully designed exercise countermeasures to preserve musculoskeletal and cardiovascular health in a prolonged partial-gravity environment.
Mobile medical clinics
Provision of health in deep space will need to be fundamentally different from traditional models of space medicine, which have depended on continuous support from medical experts on Earth.
Instead, astronauts would require substantially greater medical autonomy, including the ability to assess, diagnose and manage acute and chronic issues.
(NASA)
A lunar base or Mars mission would need the crew to have access to an entire mobile medical clinic integrated within their spacecraft or habitat. Such a facility would house diagnostic and treatment capabilities sufficient to independently manage health issues over prolonged periods.
Artemis II reminded the world that humanity can once again travel into deep space. The Crew-11 medical incident reminded us that human health is paramount for all space missions. The success of these missions may ultimately depend not only on advances in engineering, but on successfully protecting and sustaining human health vast distances from Earth.
