**13.3 Behavioral health**

*Mars Exploration - A Step Forward*

**13.2 Medical astrosociology**

with those in space medicine.

Before that point, the trip to Mars will likely involve a considerable time spent in near zero gravity (although artificial gravity is only a slight possibility because this option adds additional cost and difficulties in the solving engineering issues for the spacecraft). This means that the same problems faced by astronauts within the cislunar environment will be experienced by the settlers during the voyage although it may well be worse due to going from microgravity to zero gravity unless preventive actions are taken. It will be vital to keep each individual as physically fit and healthy as possible in order to reduce the physiological problems that could exist upon landing. Some of the well-documented health issues that affect humans during space travel include radiation poisoning, DNA damage, cardiovascular stress, bone density loss, swelling of the optic nerve head, dehydration, cognitive decline, increased risk of mutations and cancer, and various molecular, behavioral, and physiological changes compared to those who continue to live on Earth. These types of detrimental effects were confirmed as a result of the NASA twin study involving Scott Kelly who stayed aboard the International Space Station (ISS) and Mark Kelly, also an astronaut, who remained on Earth [65] (see **Figure 5**). Living and working on the ISS for up to 6 months presents measurable health risks and problems, but this is

mild compared to what can happen during a voyage to the fourth planet.

By contrast, though also complementary, to space medicine, **medical astro-**

Medical astrosociology has become part of the trend that has been moving beyond a concentration on only biomedical concerns so as to include social-scientific dimensions of health. NASA's human research program, for example, "includes many facets

**sociology** is the study of the social, cultural, and behavioral patterns (i.e., astrosocial phenomena) that affect medical issues in space ecosystems such as settlements on Mars [66]. The reason this author created this subfield of astrosociology is an attempt to attract social scientists, especially those who have studied Earth-based medical sociology and medical anthropology in addition to students who may be interested in studying medical astrosociology. The major focus is on the sociocultural and psychological forces that affect space travelers and settlers. The effort is to bring in more social science professionals and students to work

**160**

**Figure 5.**

*Astronauts Scott and Mark Kelly/photo credit: NASA.*

Behavioral health is an important aspect of assessing the well-being of a person in an isolated and confined physical environment, which involves both space medicine and medical astrosociology. It can be defined as "a lack of neuropsychic dysfunction, and the presence of high levels of personal adjustment, cordial interpersonal relations, and positive interactions with the physical and social environments [51], p. 890." When considering behavioral health, countermeasures need to be identified arising from human, environmental, and external factors [68]. The overall wellbeing of individuals must be evaluated as a combination of several medical and psychological problems along with social and cultural forces that impinge on the individual and the ability to interact productively with others. For Mars, these types of forces remain unknown until humans actually set foot on Mars. It is a holistic approach.

### **13.4 Space medicine and medical astrosociology**

Space medicine and medical astrosociology are, in fact, complementary approaches, then, that focus on the health and safety of spacefarers and space settlers, and thus even greater convergence is needed. Together, they provide a comprehensive assessment of the condition of the patient in terms of biomedical impairment on the one hand and sociocultural, ethical, and psychological condition on the other hand. Both approaches focus on the individual and the population. Spread of disease is of importance for both, as medical epidemiology and social epidemiology possess medical and behavioral elements that provide a balance and can result in greater insights when combined together.

Living on Mars will present unique challenges, as the physical environment is inhospitable to human biology and that makes the social environment, the ecosystem inside, challenging as well. The unique Martian living conditions will present physicians and medical astrosociologists with unique issues with which they must seek to understand and then produce life-saving and/or sociocultural and psychological responses. The concept of behavioral health provides a useful approach that involves both branches of science.

## **13.5 Mitigating deleterious effects on Mars**

Several proposals have arisen as possible solutions to mitigate the deleterious effects produced by living on Mars. For example, terraforming the Martian environment is one option to reduce health risks. However, it is tremendously difficult, time consuming, requires tremendous resources, and thus not everyone agrees that it is the best strategy to follow. **Figure 6** depicts what three stages of a terraformed Mars may look like. This is not necessarily a likely solution to living on Mars for the foreseeable future and must overcome ethical objections to even starting such a planetwide procedure. The process would wipe out any existing Martian life, even fossils that may exist, and it could add new detrimental health problems for humans. There are arguments on both sides of this issue.

Terraforming Mars would involve releasing greenhouse gases, what on Earth are regarded as pollutants, into the Martian atmosphere from a number of different

**Figure 6.** *Terraforming Mars/image credit: NASA.*

locations on the planet in order to thicken the atmosphere and make it breathable. Such a herculean effort would take hundreds if not thousands of years. The resource expenditures and length of the process have led proponents of Martian settlement to seek other options.
