Essays January 2019

Earth is the only planet with healthcare: Health policy evidence to support outer space settlements

J. Ross Graham and Shannon L. Sibbald


Permanent settlements on Mars or Earth’s Moon will represent a new frontier for humanity. In preparation for humans becoming a multi-planet species, various disciplines are considering their role, and reviewing the evidence their field can translate to these new settings. To support these discussions in the field of health policy, we conducted an inter-planetary literature review to provide foundational information on the healthcare systems of planets in our solar system. While evidence was found on Earth-based systems no information was identified about healthcare on other planets. These results suggest either there is a complete dearth of evidence on healthcare on other planets, or these planets have no healthcare at all. Our findings represent critical information for humans relocating off Earth. We recommend that those moving to Mars or the Moon prepare for little-to-no access to healthcare services. 


Establishing permanent human settlements on Mars and the Moon is shifting from science fiction to reality. Government space agencies have identified new settlements as key policy goals, and the United Nations committee on this topic is actively working to ensure such activities are in the best interest of all humanity 1, 2, 3. In tandem, ‘new space’ companies, including SpaceX and Virgin Galactic, are actively developing technologies to improve space travel, while generating customer demand for these services 4. Similarly, international non-profits such as Mars One and the Mars City Design Competition are working on the social planning elements of a non-Earth human settlement 5, 6.

A permanent settlement beyond Earth would represent a new era in human history. The gravity of this realization (pun intended) is causing many disciplines to reflect on their roles in these future communities. Key considerations include what evidence their field can translate to these new settings, and whether they can bill Extraterrestrials at similar rates to Earthlings. While these discussions are a natural shift for some fields, such as Space Medicine (which has existed for as long as there have been astronauts), others disciplines, such as Urban Planning, are beginning to think critically and strategically about their place in this new frontier 7, 8. We suggest similar discussions are needed in health policy circles. We are already behind our health ethics colleagues, who have begun worrying about topics such as “how much risk can an agency expose its astronauts to in pursuit of a socially valuable mission?” 9.

To support evidence-based discussions about health policy’s role in space, foundational information about inter-planetary healthcare systems is required. Our results aim to describe the healthcare systems of planets in our solar system. While comparative health systems research has yielded many benefits, it has remained limited to systems on Earth 10. We hope our results provide useful information to citizens of Earth relocating to the Moon or to Mars, so they understand what services they should expect upon arrival.


A literature review was conducted to gather information on healthcare systems and services across our solar system. PubMED, Scopus, CINAHL and Google Scholar databases were reviewed using the search terms “health,” “care,” “medical,” “system” and “services” in various combinations (no moon rock left unturned). Results on preventative and public health services were excluded, similar to their priority in most health systems on Earth. Results were limited to systems focused on the medical needs of “homo” organisms, the genus that comprises our species, Homo sapiens, which includes modern humans. Only results in Earth-based languages were included.


Results are reported below for each planet in our solar system. Overall, there was a dearth of literature on the healthcare systems and services on all planets, except Earth. This suggests we may be the only planet in our solar system with healthcare services.


No data found.


No data found.


Literature was identified on many healthcare systems on Earth 11. Nearly all nations of Earth had some form of a health system, and many nations reported having multiple systems. The systems differed greatly in their organization, governance, financing, service provision and performance. However, while most results were described as ‘systems,’ detailed analysis revealed they more closely resembled a collection of poorly coordinated services, organized according to history not need, and with limited integration or alignment of incentives between care providers 12. Nations of Earth allocate significant resources to healthcare (e.g., 11.5% of GDP, on average, for high income countries) in attempt to provide high-quality care to patients, based on their needs and preferences 13. However, resource scarcity, political pressures, and the personal preferences of healthcare administrators and health professions often stymie achieving these goals 14. Literature also showed that not all Earthlings have equitable access to care. For example, children born into wealthy families get better care, faster. Conversely, children who decide to be born to poor families or to families in war-torn regions have limited access to healthcare 15. Even in wealthy regions of Earth, such as the Canada, segments of the population do not have equitable access to care 16


No data found.


No data found.


No data found.


No data found.


No data found.

Discussion & Conclusion

In this study, we sought to review and summarize the healthcare systems on planets in our solar system. Unfortunately, there is dearth of literature on this topic for all planets except Earth. This represents a major knowledge gap and the need for large injections of funding into inter-planetary health policy. Our Earth-shattering results (figuratively speaking) suggest that non-Earth planets may have no healthcare at all, meaning Earth systems (however flawed) may be the most advanced in the solar system. While our findings may seem disappointing, they should be a source of pride for Earthlings as they present the opportunity to share our health policy knowledge with citizens of other planets (i.e., inter-planetary knowledge translation). Our results should also cause a more sincere self-reflection on Earth: Given all we have and the incredible feats that humanity has been able to accomplish, it seems prudent to think about why there remains so many inequities between regions of our planet and within regional healthcare systems. Perhaps humanity’s expansion to other planets is a call to focus more effort on Earth on how we can make a better healthcare system. This would allow us to ‘get our house in order’ before we tread out into the great unknown. We do hope this information is useful to those working to ensure humans might successfully migrate to Mars and the Moon, and we recommend that humans considering moving to Mars or the Moon prepare for little-to-no access to healthcare.

Conflicts & Competing Interests

None to declare.




1. International Space Exploration Coordination Group. The Global Exploration Roadmap; 2018 Feb 2 [cited 2018 Dec 10]. 36 p. < >

2. United Nations Committee on the Peaceful Uses of Outer Space. Report of the Committee on the Peaceful Uses of Outer Space. Geneva, CH; 2018 [cited 2018 Dec 10]. <: >

3. Pearlman RZ. NASA Chief Wants to Send Humans to the Moon ‘To Stay’. 2018 Aug 23 [cited 2018 Dec 10]. < >

4. Crane L. SpaceX proves Mars is in reach. New Scientist 2018;237(3165):14.

5. Mars City Design. About. Silicon Beach, California; 2018. [cited 2018 Dec 10]. < >

6. Mars One. About Mars One; 2018. [cited 2018 Dec 10]. < >

7. Drudi L. Space medicine in Canada. McGill J Med, 2009;12(9):9-10.

8. Adams D, Larkham P, Sage DJ. Planners in space? Town & Country Planning. 2018;87 (8):307-315

9. Shuchman M. Striving for Mars: What are acceptable risks? CMAJ. 2014;186(1):E7.

10. Blank RH, Burau V, Kuhlman E. Comparative health policy. 5th ed. Red Globe Press; 2017.

11. European Observatory on Health Systems and Policies. The Health Systems and Policy Monitor. Brussels, BE; 2018 [cited 2018 Dec 10]. < >

12. Plsek PE, Greenhalgh T. Complexity science: The challenge of complexity in health care. BMJ. 2001;323(7313):625-628.

13. Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. JAMA. 2018;319(10):1024-1039.

14. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Global Health. (2018;6(11): e1196-e1252.

15. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-1104.

16. Public Health Agency of Canada. Key Health Inequalities in Canada: A National Portrait. Ottawa, ON; 2005.  

About the Author

J. Ross Graham MSc MPA1*> and Shannon L. Sibbald PhD2-4

  1. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC
  2. School of Health Studies, Faculty of Health Sciences, Western University, London, ON
  3. Department of Family Medicine & Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, ON

*Corresponding author: 99 Regina Street South, Waterloo, ON N2J 4G6; Phone: 519-575-4400 ext. 5402; Email:


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