Space health and disaster risk reduction

There is an association between remote environments and health due to limited resources and accessibility to healthcare services. Thus, people who live in a remote environment have disproportionate health inequalities in comparison to those in an urban location [1]. While it is predicted global urbanisation is set to increase during the 21st century, approximately 3.1 – 3.3 billion people will still be living in a remote environment between the years 2015 and 2050, such as the remote mountain community in Figure 1 [2]. With this in mind, remote health is an important topic of research.

Providing healthcare in the remotest environment outer space may seem worlds away from healthcare on Earth; however, limited resources and accessibility are threads that tie remote health and space health together. For example, a minor injury or illness can rapidly become a major event if the available resources do not meet the needs of the patient, and there are limited opportunities for rapid (aero)medical evacuation should the patient’s condition deteriorate [3]. With this in mind, healthcare practitioners must provide prolonged care in the field (prehospitally) and sustainably use the resources available to them; this approach to clinical practice can be described as prolonged field care (PFC) [4,5].

It is important to note that when providing PFC in a remote environment or outer space, healthcare providers (doctors, nurses or allied health professionals) are required to meet all holistic care needs of the patient, despite being trained to specialise in one area of medicine or health. Telemedicine may offer remote consultation with specialist members of a multidisciplinary healthcare team, but this is a vulnerable dependency on internet or satellite connection, which is often unreliable due to the topography or distance from connected locations (such as Mars). There is limited literature on interdisciplinary healthcare practice, therefore, patients and practitioners are exposed to heuristically developing remote or space health practice and human error. This is a social vulnerability that increases the risk of disaster (physical or psychological deterioration of patient’s health) in environments where resources and accessibility are already limited [6].

UCL Institute for Risk and Disaster (IRDR), Space Health Risks Research Group, is a multidisciplinary community of researchers and practitioners who are investigating how the mitigation of risks to health in space can contribute to promoting good health and well-being in remote environments on Earth. On 01^st September 2021, IRDR Space Health Risks Research Group will be hosting a symposium on ‘space health and disaster risk reduction’, in collaboration with industry partners and Universities of Manchester, Bristol and King’s College London. The symposium is funded by UCL Grand Challenges and booking details will be released here: https://tinyurl.com/spacehealthrisks.

The symposium will be a theoretical exploration of how interdisciplinary healthcare practice during deep space missions to explore other planetary bodies (Figure 2) can inform disaster risk reduction and remote health system on Earth, including how to promote good health and well-being. The aim is to establish a multidisciplinary consensus on the provision of prolonged, holistic healthcare (PFC) for an interdisciplinary healthcare practitioner. An underlying objective of the symposium is to identify where consensus is not achieved, thus highlighting research gaps for future systematic enquiry. The symposium is open to all healthcare providers, including those on a professional register and qualified first aiders.

During the symposium, attendees will participate in breakout rooms with the following themes:

• Space medicine
• Global health (and public health)
• Medicine, nursing and allied health (military and civilian)
• Anthropology (biosocial, medical and data science)
• Disaster sciences

Informal discussions will take place in the breakout rooms about how each discipline (the breakout room theme) can contribute to interdisciplinary healthcare practice during the exploration of another planetary body and when in a remote environment on Earth. Each breakout room will be facilitated by affiliate or associate members of IRDR Space Health Risks Research Group, and attendees will be invited to (anonymously) share their thoughts via an online Microsoft Form for each breakout room they participate in. The symposium will take place in-person at UCL Institute for Advanced Studies (lite refreshments provided) and online to enable world-wise participation.

Cultural engagement and perception of health differs hugely around the world, hence understanding how the perception of good health and well-being may change in space has relevance for remote health on Earth. Thus, the notions of future healthcare during deep space missions and on other planetary bodies brings into question the meaning of health, relative to remote environments. Therefore, exploring future healthcare practices and cultural engagement of health in space, through the lenses of healthcare, anthropology and disaster science, is a significant area of interest that has benefit to society. The findings of this symposium will contribute to the knowledge of interdisciplinary healthcare practice in space, and to reducing health inequalities for people in remote environments on Earth by informing remote health systems, policy and training.

12^th April is the UN International Day of Human Space Flight, which celebrates the first human flight in space by Cosmonaut Yuri Gagarin and 2021 is the 60^th anniversary of the famous space flight [7]. In the UN General Assembly 2011 resolution about the International Day of Human Space Flight, “the important contribution of space science and technology in achieving sustainable development goals and increasing the well-being of States and peoples,” is reaffirmed [8]. In this spirit, IRDR Space Health Risks Research Group are developing the first UK pilot analogue space mission (a simulated space mission), which will take place in Spring 2022.

Analogue space missions are an opportunity to conduct research in simulated outer space conditions [9]. There are many types of analogue missions and it is important to clearly define what aspect of space is being simulated for research impact. For the pilot analogue mission, the Lunar and Martian topography is being represented by the Cairngorm National Park mountains in Scotland, whereas the limited resources and accessibility during an extra-vehicular activity (EVA – spacewalk; Figure 2) are being simulated. Analogue astronauts will be evaluating the findings of the space health and disaster risk reduction symposium, critically appraising how their interdisciplinary clinical decision making was informed during three healthcare scenarios of the pilot analogue mission. The findings of the pilot analogue space mission will similarly inform remote health practice, policy and training on Earth; but, furthermore, it will lay the foundation for future high-fidelity analogue space mission research in the UK.

While space is a remote environment that begins 100km above our heads, remoteness is much closer than most people recognise. The recent COVID19 pandemic has created a temporary remote environment for many people, caused by self-isolation, physical distancing and transmission control precautions (Figure 3). However, the higher COVID19 transmission rates in areas with limited resources and accessibility to healthcare services exemplify the disproportionate health inequalities of people permanently living in remote environments [10]. Furthermore, perceptions of good health and well-being have changed, which echoes the concept of space health. IRDR Space Health Risks Research Group’s investigation of the interrelation between space health and disaster risk reduction aims to bridge these research gaps and contribute to remote health on Earth.

References

[1] Henning-Smith, C. (2020) The unique impact of COVID-19 on older adults in rural areas, Journal of Aging and Social Policy, 32, pp. 396-402.

[2] United Nations Department of Economic and Social Affairs. (2018) World Urbanization prospects. [online]. New York: United Nations. Available at: https://population.un.org/wup/Publications/ [Accessed 01 March 2021].

[3] DeSoucy, E., Shackelford, S., Dubose, J., Zweben, S., Rush, S., Kotwalk, R., Montgomery, H. and Keenan, S. (2017) Review of 54 cases of prolonged field care, Journal of Special Operations Medicine, 17 (1), pp. 121-129.

[4] Keenan, S. (2015) Deconstructing the definition of prolonged field care, Journal of Special Operations Medicine, 15 (4), p. 125.

[5] Keenan, S. and Riesberg, J. (2017) Prolonged field care: beyond the “golden hour”, Wilderness and Environmental Medicine, 28 (2), pp. 135-139.

[6] Ellis, P. (2019) What is evidence-based nursing?, in: Ellis, P. and Standing, M. (eds.) Evidence-based practice in nursing. 4th ed. London: SAGE Publishing Ltd.

[7] United Nations. (2021) International day of human space flight 12 April. [online]. New York: United Nations. Available at: https://www.un.org/en/observances/human-spaceflight-day [Accessed 01 March 2021].

[8] United Nations. (2021) Resolution adopted by the General Assembly on 7 April 2011. [online]. New York: United Nations. Available at: https://documents-dds-ny.un.org/doc/UNDOC/GEN/N10/528/80/PDF/N1052880.pdf?OpenElement [Accessed 01 March 2021].

[9] Groemer, G., Gruber, S., Uebermasser, S., Soucek, A., Lalla, E., Lousada, J., Sams, S., Seilora, N., Garnitschnig, S., Sattler, B. and Such, P. (2020) The AMADEE-18 Mars analog expedition in the Dhofar region of Oman, Astrobiology, 20, pp. 1276-1286.

[10] Behar, J., Liu, C., Kotzen, K., Tsutsui, K., Corino, V., Singh, J., Pimentel, M., Warrick, P., Zaunseder, S., Andreotti, F., Sebag, S., Kopanitsa, G., McSharry, P., Karlen, W., Karmaker, C. and Clifford, D. (2020) Remote health diagnosis and monitoring in the time of COVID-19,  Physiological Measurement, 41, article number 10TR01.