NASA Office of Inspector General

Office of Audits

Report No. IG-16-003

NASA’S EFFORTS TO 

MANAGE HEALTH AND 

HUMAN PERFORMANCE 

RISKS FOR SPACE 

EXPLORATION

October 29, 2015

National Aeronautics and Space Administration
Office of Inspector General

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RESULTS IN BRIEF

NASA’s Efforts to Manage Health and Human 

Performance Risks for Space Exploration

October 29, 2015

NASA Office of Inspector General 

Office of Audits IG-16-003 (A-14-011-00)

Space flight is an inherently risky endeavor and NASA has identified 30 human health and performance risks associated 

with space travel, including Behavioral Health and Performance, Inadequate Food and Nutrition, Space Radiation, and 

Vision Impairment and Intracranial Pressure. In addition, NASA’s current plan to send a crewed mission to the Martian 

surface by the 2030s will expose astronauts to new and increased hazards. Although the Agency has developed 

mitigation strategies to reduce the impact of most of the risks associated with travel in low Earth orbit, many of the risks 

associated with long duration space travel are not fully understood. 

To better appreciate the risks to human health and performance associated with space travel, NASA and its partners are 

performing a variety of studies on Earth and the International Space Station. In addition, multiple NASA offices play a 

role in developing procedures, medications, devices, and other strategies (countermeasures) to mitigate these risks, 

including the Human Exploration and Operations Mission Directorate (HEOMD), which provides leadership and 

management of NASA’s human space exploration programs; Human Health and Performance (HHP) Directorate, the 

Agency’s primary resource for human health and performance issues related to space travel; and Human Research 

Program (HRP), which is focused on investigating and mitigating the highest risks to astronaut health and performance. 

In 2014, HRP completed a detailed schedule known as the Path to Risk Reduction setting forth the rate by which the 

Program expects to complete development of countermeasures for various risks through 2028.

In this audit, we examined NASA’s efforts to manage the health and human performance risks posed by space

exploration. To determine how NASA manages risk mitigation, we reviewed the status of HRP’s human health and 

performance risks based on the Program’s schedule and risk matrix. We also reviewed Federal and NASA policies, 

regulations, and plans, and interviewed representatives from the Office of the Chief Health and Medical Officer, 

HEOMD, HHP, and HRP; various subject matter experts; and a selection of astronauts. 

Although NASA continues to improve its process for identifying and managing health and human performance risks 

associated with space flight, we believe that given the current state of knowledge, the Agency’s risk mitigation schedule 

is optimistic and NASA will not develop countermeasures for many deep space risks until the 2030s, at the earliest. One 

of the major factors limiting more timely development of countermeasures is uncertainty about the mass, volume, and 

weight requirements of deep space vehicles and habitats. Moreover, even as NASA gains additional knowledge about its 

vehicles and habitats and the effects of radiation and other space conditions on the human body, the Agency may be 

unable to develop countermeasures that will lower the risk to deep space travelers to a level commensurate with NASA 

standards for low Earth orbit missions. Accordingly, the astronauts chosen to make at least the initial forays into deep 

space may have to accept a higher level of risk than those who fly International Space Station missions. We also found 

that NASA cannot accurately report the true costs of developing countermeasures for the identified risks.

WHY WE PERFORMED THIS AUDIT

WHAT WE FOUND
Furthermore, NASA’s management of crew health risks could benefit from increased efforts to integrate expertise from 

all related disciplines. While many life science specialists attempt to utilize the range of available expertise both inside 

and outside the Agency, NASA lacks a clear path for maximizing expertise and data at both the organizational and

Agency level. For example, NASA has no formalized requirements for integrating human health and research among life 

sciences subject matter experts nor does it maintain a centralized point of coordination to identify key integration points

for human health. Moreover, integrating the experiences of NASA’s engineering and safety efforts would benefit the 

outside life sciences community. The lack of a coordinated, integrated, and strategic approach may result in more time 

consuming and costly efforts to develop countermeasures to the numerous human health and performance risks 

associated with deep space missions.

Long duration missions will likely expose crews to health and human performance risks for which NASA has limited 

effective countermeasures. Accordingly, for these missions NASA will have to determine the level of risk that is 

acceptable and clearly communicate the Agency’s decisions to astronauts, Congress, and the public. Moreover, NASA 

needs to continue to examine whether its current health care model for astronauts is sufficient to meet both the 

long-term health needs of the astronaut community and the research needs of the Agency.

To ensure NASA management has the best possible information available to make decisions related to human health 

and performance risks to Agency missions, we recommended the Manager of HRP ensure (1) HRP costs for research and 

countermeasure development are accurate and (2) the Path to Risk Reduction accurately reflects the status of research 

and realistic timeframes for countermeasure development to better determine what risks will be mitigated for the first 

human mission to Mars. In addition, to ensure appropriate integration of Agency expertise across disciplines, we 

recommended the Associate Administrator for HEOMD (3) establish a primary point of coordination within HEOMD to 

interface with all NASA programs, projects, and functions; (4) ensure that integration of technical authorities is occurring 

and consider inclusion of engineering and safety experts on all HHP and HRP control boards; and (5) clarify the 

organizational technology development responsibilities for human system risk mitigation. Regarding astronaut health 

care, we recommended the NASA Administrator and the Chief Health and Medical Officer (6) determine whether the 

current model satisfies Agency needs and the needs of the astronaut community and, if not, pursue legislative authority 

to implement necessary changes. 

In response to a draft of our report, management concurred or partially concurred with our recommendations and 

described corrective actions they plan to address them. We consider management’s comments responsive; therefore, 

the recommendations are resolved and will be closed upon completion and verification of the proposed corrective 

actions.

WHAT WE RECOMMENDED

For more information on the NASA 

Office of Inspector General and to 

view this and other reports visit 

https://oig.nasa.gov.
NASA Office of Inspector General IG-16-003 i

TABLE OF CONTENTS

Introduction..................................................................................................................................................1

Background ...............................................................................................................................................1

Challenges Delay Research and Impact Development of Mitigation Strategies......................................13

NASA’s Management of Human Health and Performance Risks............................................................13

Progress Made to Mitigate Risks, but Many Gaps Remain.....................................................................14

Challenges Delay Progress in Identifying and Mitigating Risks...............................................................22

NASA Lacks a Coordinated Approach to Managing Astronaut Health for Long Duration 

Space Missions ...........................................................................................................................................25

A Culture of Silos and the Absence of Agency-Level Integration............................................................25

Control Boards for Decision Making Lack Cross-Agency Expertise.........................................................27

Historical Issues with Integration and Stove-piping ...............................................................................28

NASA Must Establish and Maintain an Ethical Framework For Risk Acceptance for Long 

Duration Space Flight.................................................................................................................................30

Transparency of Risk Acceptance ...........................................................................................................30

Astronaut Health Care ............................................................................................................................32

Conclusion ..................................................................................................................................................35

Recommendations, Management’s Response, and Our Evaluation ........................................................36

Appendix A: Scope and Methodology ......................................................................................................38

Appendix B: Acceptance of Human Health and Performance Risks by Selected DRMs.........................40

Appendix C: Management’s Comments...................................................................................................44

Appendix D: Report Distribution ..............................................................................................................48
NASA Office of Inspector General IG-16-003 ii

Acronyms

CHMO Chief Health and Medical Officer

CMO Chief Medical Officer

DRM Design Reference Mission

FY Fiscal Year

HEOMD Human Explorations and Operations Mission Directorate

HERA Human Exploration Research Analog

HMTA Health and Medical Technical Authority

HHP Human Health and Performance 

HRP Human Research Program

HSRB Human System Risk Board

IOM Institute of Medicine

ISS International Space Station

LSAH Longitudinal Study of Astronaut Health

NPR NASA Procedural Requirements

NSBRI National Space Biomedical Research Institute 

PRR Path to Risk Reduction

OCHMO Office of the Chief Health and Medical Officer

VIIP Vision Impairment and Intracranial Pressure
NASA Office of Inspector General IG-16-003 1

INTRODUCTION

Space flight is an inherently risky endeavor. Apart from the tremendous engineering challenges in 

launching and returning astronauts safely to Earth, humans living in space experience a range of 

physiological changes that can affect their ability to perform necessary mission functions and, in the 

long term, increased risk of developing cancer, damaged vision, reduced bone strength, and other 

damage to their health and wellbeing. Moreover, despite efforts over the last 40 years to characterize 

and study the risks posed by space travel, many are not fully understood. Although NASA has developed 

mitigation strategies to reduce the impact of most of the risks associated with travel in low Earth orbit, 

the Agency’s plans to send humans deeper into space for extended periods of time will expose 

astronauts to new and increased risks.

To further understand the risks to human health and performance associated with space travel, NASA 

and its partners are performing a variety of studies on Earth and the International Space Station (ISS). 

For example, in March 2015, NASA launched astronaut Scott Kelly on the first one-year mission to the 

ISS. NASA will compare health data taken from Scott Kelly with that of his twin brother and former 

astronaut, Mark Kelly, in the hope of advancing knowledge about the effects on the human body of long 

duration habitation in space. 

In this audit, we examined NASA’s efforts to manage the health and human performance risks posed by 

space exploration. See Appendix A for details of the audit’s scope and methodology.

Background

The Path to Mars

NASA’s space exploration goal is to conduct a crewed mission to the surface of Mars by the 2030s. 

Given the difficulty of such a journey, NASA has indicated it will take a flexible path to Mars that evolves 

based on lessons learned from prior and current missions. The NASA Authorization Act of 2010 

endorses this approach as an incremental method of progressively traveling, living, and working deeper 

in space and developing capabilities that will allow space system components to be used for multiple 

and varied missions. In this regard, NASA plans to test new systems and technologies in cis-lunar orbit 

before traveling to near-Earth asteroids and beyond.

1

 By 2027, NASA hopes to establish a formal Mars 

Program and begin human flights to the planet by the middle of the following decade. 

Moving the space frontier from low Earth orbit to deep space will be a significant undertaking. For 

perspective, low Earth orbit is the area extending approximately 200 – 1200 miles from the Earth’s 

surface, while the Moon is 237,000 miles away. Astronauts on missions in these areas of space are 

 

1 Cis-lunar is the area between Earth and the Moon or the Moon’s orbit.
NASA Office of Inspector General IG-16-003 2

within a couple of days of return to Earth and, when living on the ISS, receive regular resupply missions. 

In contrast, Mars is almost 34 million miles from Earth, and a round trip to the planet is likely to take up 

to 3 years through harsh conditions, making resupply and quick return to Earth in case of emergency 

impossible. 

NASA’s Health and Medical Technical Authority (HMTA) has developed design reference missions (DRM) 

for each type of mission along the flexible path to Mars: low Earth orbit, deep space sortie, lunar visit or 

habitation, deep space journey or habitation, and planetary.2 The DRMs provide a framework to help

the HMTA identify capabilities, drivers, and assumptions for each mission type. Although the missions

share some of the same human health and performance challenges, each also poses unique challenges. 

Key factors distinguishing the various DRMs include distance traveled from the Earth, abort time

(i.e., the time it takes to return to Earth in the case of emergency), and duration. See Table 1 for more 

information about the various DRMs.

Table 1: Design Reference Missions for Flexible Path

Design Reference 

Mission 

Mission 

Duration

Distance from 

Earth (in miles) Earth Return Gravity Environment

Radiation 

Environment

Low Earth Orbit (ISS) 6 months 237 less than or 

equal to 1 day Microgravity Low Earth Orbit

Low Earth Orbit (ISS) 1 year 237 less than or 

equal to 1 day Microgravity Low Earth Orbit

Deep Space Sortie 1 month greater than 

237,000

less than 5 

days Microgravity Deep Space

Lunar Visit or Habitation 1 year 237,000 5 days 1/6 G Lunar

Deep Space Journey or 

Near-Earth Asteroid 1 year 237,000 –33,900,000

weeks to 

months Microgravity Deep Space

Planetary 3 years 33,900,000a months Fractional Deep Space

Source: NASA.

a Planetary distance is based on the distance of Mars from Earth.

Hazards Associated with Deep Space Exploration

With relation to human travel, the deep space environment differs from low Earth orbit in several 

important respects: (1) it likely poses risks that have not yet been identified (unknown risks); (2) ways to 

mitigate many of the known risks have yet to be developed; and (3) humans will not be able to 

communicate with Earth in-real time or return to Earth quickly in case of emergency. Hazards of deep 

space travel include:

 Limited resources. Storage, power, and weight limitations in the crafts in which humans will 

travel and live in deep space will affect the amount and type of food, medical supplies, exercise

equipment, and other resources available.

 

2 HMTA provides independent oversight of all health, medical, and space crew/personnel performance matters related to 

NASA programs or projects. 
NASA Office of Inspector General IG-16-003 3

 Isolation. Because crews will be millions of miles and many months travel from Earth, they must 

be prepared to deal with a variety of medical situations ranging from minor cuts to catastrophic

injuries. In addition, isolation from Earth may cause psychological and behavioral issues for crew 

members that could affect their wellbeing and performance. Finally, the periodic deliveries of 

supplies available to crews living on the ISS will not be an option in deep space. 

 Hostile/closed environment spacecraft design. Spacecraft will have a closed life-support system 

and cramped working and living quarters. The ISS has 15,000 cubic feet of habitable area –

more than a conventional 3-bedroom house. In contrast, the Orion crew capsule NASA is 

developing and plans to use for at least the initial forays beyond low Earth orbit has 314 cubic 

feet of habitable area. 

 Altered gravity. The prolonged weightlessness experienced in space causes astronauts to endure

a number of physical and physiological changes. For example, astronauts routinely experience 

altered inner ear function as well as loss of bone density and muscle strength and blood and

other bodily fluids move from the legs and lower extremities to the upper parts of the body. 

 Space radiation. Deep space radiation is significantly different from radiation encountered on 

Earth, and it is unknown how the human body will respond to prolonged exposure. Earth, and 

to a lesser extent low Earth orbit, are protected by the Van Allen Belts, regions of trapped 

radiation held in place by the Earth’s magnetic field that shield the planet and its human 

inhabitants from space radiation and solar weather. Missions that travel beyond low Earth orbit 

do not enjoy the protection of the Belts. 

As depicted in Figure 1, NASA has identified 30 human health and performance risks emanating from 

these primary hazards. In addition, the Agency has identified 2 other issues it has not yet accepted as 

risks and therefore labels concerns. For detailed information on each of the risks, see Appendix B.
NASA Office of Inspector General IG-16-003 4

Figure 1: Human Health and Performance Risks by Space Environment Hazard

Source: Human Research Program, 2015.

a Concern. 

b Pharmacokinetics is the study of the movement of drugs in the body. 

c Risk has been retired.

NASA Organizations that Manage Human Health and 

Performance Risks 

Multiple NASA offices play a role in developing procedures, medications, devices, and other strategies 

(countermeasures) to mitigate the adverse health and human performance risks of traveling and living 

in space. Most of these offices are part of the Agency’s Human Explorations and Operations Mission 

Directorate (HEOMD). In addition to HEOMD components, the Office of the Chief Health and Medical 

Officer (OCHMO) defines the level of risk NASA will accept for its astronauts by setting standards for 

such issues as maximum radiation exposure levels and required hours of sleep during a mission. 

Office of the Chief Health and Medical Officer 

The OCHMO establishes NASA’s health and medical policy and related procedural requirements and 

technical standards. The Chief Health and Medical Officer (CHMO) serves as the focal point for policy 

formulation, oversight, coordination, and management of all health and medical matters and as the 

principal advisor to the Administrator and other senior officials on matters pertaining to human health. 

By policy, he or she also serves as NASA’s lead HMTA, providing independent oversight of all health, 

medical, and space crew/personnel performance matters that arise in association with NASA programs 
NASA Office of Inspector General IG-16-003 5

or projects.3 The CHMO has delegated HMTA responsibilities for human space flight to the Johnson 

Space Center (Johnson) Chief Medical Officer (CMO). Any deviations from OCHMO policy, requirements, 

and standards may be made only with concurrence of the HMTA. 

Human Exploration and Operations Mission Directorate

HEOMD provides leadership and management of NASA’s human space exploration programs, and 

several HEOMD divisions share responsibility for issues relating to human health and performance. The 

Space Life and Physical Sciences Research and Applications Division at NASA Headquarters oversees 

basic and mission driven scientific research in support of human space flight and is comprised of three

major components – Space Life Sciences, Physical Sciences, and Human Research Program (HRP). The 

Human Spaceflight Capabilities Division includes Crew Health and Safety. The two divisions work with 

the Office of the Chief Scientist to establish the overall direction, scope, budget, and resource allocation 

for managing activities that support astronaut health and safety for space flight operations, including 

pre- and post-flight performance. HEOMD-sponsored life sciences research is managed primarily at 

Johnson, Ames Research Center, Glenn Research Center, and Langley Research Center, with supporting 

infrastructure and plant research performed at the Kennedy Space Center. 

Human Health and Performance Directorate

Based at Johnson and reporting to the Johnson Center Director and the HEOMD Associate 

Administrator, the Human Health and Performance (HHP) Directorate serves as the Agency’s primary 

resource for human health and performance issues. HHP’s strategic goals are aimed at leading human 

exploration and ISS utilization, leading human health and performance internationally, excelling in 

management and advancement of innovations in health and human system integration, and expanding 

relevance to life on Earth and creating enduring support and enthusiasm for space exploration. HHP 

was reorganized in 2012 to integrate research and development with space flight operations to better 

support human space flight and utilization of the ISS for related research. 

Human Research Program

NASA established HRP at Johnson in October 2005 to focus Agency research investment on investigating 

and mitigating the highest risks to astronaut health and performance. HEOMD and OCHMO are HRP’s 

two primary customers. While HRP resides within and relies on the infrastructure and staff of HHP, it is 

considered a separate program and reports directly to HEOMD (see Figure 2 for a description of the 

organizational relationship). 

 

3 NASA established technical authorities in a variety of areas to provide independent oversight of programs and projects to

support safety and mission success in response to recommendations made in 2003 by the Columbia Accident Investigation 

Board. 
NASA Office of Inspector General IG-16-003 6

Figure 2: Human Explorations and Operations, Human Research Program, and Human 

Health and Performance Directorate Organizational Structure

Source: Johnson HMTA.

Note: Programmatic authority consists of the mission directorates and their respective programs and projects. Institutional 

authority includes the Headquarters and Center mission support organizations, technical authorities (in this case HMTA), and 

Center Directors. Further, HSRB refers to the Human System Risk Board and TtO refers to Transition to Operations. 

HRP conducts basic, applied, and operational research with the goal of increasing understanding of and 

developing countermeasures for 23 of the human health and performance risks and the 2 concerns 

NASA has identified.4 HRP organizes its research into five “Risk Elements” that encompass the risks and 

concerns:

1. Behavioral Health and Performance

2. Exploration Medical Capability

3. Human Health Countermeasures

 

4 Generally, HRP accomplishes its research through either directed or solicited research tasks. Directed research is carried out 

by the Agency and external researchers who have been selected through noncompetitive mechanisms such as contracts and 

grants. Research may be directed instead of solicited due to time limitations, highly focused or constrained research topics, 

or because in-house experts are better suited to conduct it. Conversely, solicited research tasks are awarded through 

competitive means such as NASA Research Announcements or Requests for Proposals. HRP reports that approximately 

80 percent of the research it sponsored in fiscal year (FY) 2014 was solicited. 
NASA Office of Inspector General IG-16-003 7

4. Space Human Factors and Habitability

5. Space Radiation5

HHP and HRP staff tasked with managing specific risks are called “risk owners.” The process for 

identifying and mitigating risks begins with risk owners collecting evidence and developing an Evidence 

Report for each risk. As part of that process, they identify the knowledge gaps relating to a particular 

risk and the tasks necessary to close those gaps and document this information in an Element Research 

Plan. These Plans detail when, where (e.g., the ISS or a ground analog), and who will accomplish the 

tasks and the products they will produce. Using Element Research Plans, risk owners direct internal 

principal investigators or solicit external experts to complete tasks by developing an Integrated Research 

Plan. Upon receipt of the research results, risk owners revise Evidence Reports to reflect the new 

information and continue working the issue until the risk is deemed fully mitigated. Throughout the 

process, HMTA and the Human System Risk Board (HSRB) help risk owners prioritize research tasks and 

monitor progress toward mitigation. 

HRP tracks the likelihood of occurrence, severity of consequences, and the extent a risk can be 

controlled or mitigated both in-flight and post flight for the various DRMs. This tracking serves as one of 

several inputs that determines the priority of each risk and the resulting allocation of resources. The 

extent to which a particular risk can be mitigated is determined by considering the current state of 

knowledge about the risk; existing standards, if any; and the degree to which proven or potential 

countermeasures will enable NASA to meet those standards. NASA labels risks based on whether they 

can be mitigated to meet existing standards. Risks that can be mitigated beyond what the standards 

require are referred to as “optimized.” Risks that can be mitigated to meet the standards are

considered “controlled” and therefore “acceptable.” Risks for which some validated countermeasures 

exist but additional mitigation is required to meet standards are “partially controlled” and therefore

“unacceptable.” Finally, risks that lack any validated countermeasures are “uncontrolled” and therefore

“unacceptable.” 

In 2014, HRP completed a detailed schedule setting forth the rate by which HRP expects to complete 

development of countermeasures for the risks and concerns assigned to it over a 15-year period 

(i.e., through 2028) known as the Path to Risk Reduction (PRR). The PRR summarizes the Agency’s ability 

to control the risks and concerns based on current understanding and identification and validation of 

potential countermeasures. NASA updated the PRR in June 2015. According to the 2015 version of the 

document, the Agency will lack validated countermeasures for 11 of the 23 identified risks and both of 

the 2 concerns in time for a Mars mission in the 2030s (see Figure 3).

 

5 The following risks do not fall under HRP’s purview: (1) Space Adaptation Back Pain, (2) Urinary Retention, (3) Toxic Exposure, 

(4) Hearing Loss Related to Spaceflight, (5) Acute and Chronic Carbon Dioxide Exposure, (6) Injury from Sunlight Exposure, 

and (7) Electrical Shock.
NASA Office of Inspector General IG-16-003 8

Figure 3: HRP Path to Risk Reduction for a Planetary Mission

Source: HSRB, June 2015, PRR Revision C.
NASA Office of Inspector General IG-16-003 9

National Space Biomedical Research Institute

The National Space Biomedical Research Institute (NSBRI) assists NASA in identifying, selecting, and 

conducting research associated with space exploration mission risks. Formed in 1997 and operating 

under a cooperative agreement with the Agency, NSBRI is a nonprofit research partner of HRP that 

connects the research, technical, and clinical expertise of the biomedical community with the scientific, 

engineering, and operational expertise of NASA. NASA and NSBRI jointly plan annual solicitations 

targeted at research and technology development to reduce human-related exploration risks. 

Human System Risk Board

HSRB is another key player in managing space-related human health and performance risks. Established 

in 2012 and chaired by the Johnson CMO, HSRB provides a venue for the discussion and exchange of 

data and information among stakeholders and has overall responsibility for implementing a consistent, 

integrated process for managing human system risks. In addition, HSRB acts as the HMTA Control Board

or decision-making body, identifying risks and concerns, evaluating and approving evidence-based risk 

assessments, endorsing cross-program and multidisciplinary plans, determining whether 

countermeasures satisfy standards, and documenting and tracking management activities. HSRB is also 

charged with establishing official HMTA positions on risk posture and deciding the work that will be 

performed to address risk mitigation and improve risk posture. One of the tools HSRB uses is the PRR. 

NASA Health Standards

NASA’s health standards are based on the best available scientific and clinical evidence and expert 

recommendations, including medical practice, lessons learned, comparable environments and 

populations (analogs), research findings, and risk management data. The standards are documented in 

two volumes: NASA-STD-3001, Volume 1 and 2. The first volume sets requirements for fitness for duty, 

permissible exposure limits, permissible outcome limits, levels of medical care, medical diagnosis, 

intervention and treatment, and care. For example, one fitness for duty standard is that crewmembers 

maintain 80 percent of their baseline muscle strength during a mission. The second volume defines 

standards for spacecraft, including habitats, suits, related equipment, and software systems and informs 

requirements for the ISS, the commercial vehicles NASA hopes will ferry crew to the ISS starting in 2017, 

Orion, and any vehicles developed in the future. Figure 4 illustrates NASA’s process for identifying risks 

and developing standards, mitigation, and program requirements.
NASA Office of Inspector General IG-16-003 10

Figure 4: Overview of Process for Identifying Risk and Developing Standards, Mitigation 

and Program Requirements

Source: Human Research Program.

The Role of the Institute of Medicine

Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine 

(IOM) provides independent, objective, evidence-based advice to policymakers, health professionals, 

the private sector, and the public. In its review of NASA health-related issues, the IOM has found that 

HRP is taking the right approach in developing mitigation strategies for the various space travel-related 

risks. For example, in 2008, the IOM reported that Evidence Reports are valuable resources and 

important components in the overall risk mitigation process. Since 2008, the IOM has reviewed each 

risk once and will continue to review a few selected risks each year until all 23 risks under HRP purview 

have undergone a second review. 

Although NASA has sponsored numerous IOM reviews, three bear particular significance to the subject 

of this report: “Safe Passage: Astronaut Care for Exploration Missions;” “Review of NASA’s Longitudinal 

Study of Astronaut Health;” and “Health Standards for Long Duration and Exploration Spaceflight: Ethics 

Principles, Responsibilities, and Decision Framework.”
NASA Office of Inspector General IG-16-003 11

Safe Passage: Astronaut Care for Exploration Missions 

In response to a request from NASA, the IOM convened the Committee on Creating a Vision for Space 

Medicine During Travel Beyond Earth Orbit to address astronaut health. This Committee was charged 

with making recommendations regarding the infrastructure for a health system in space, defining the 

principles that should guide such a system to provide an appropriate standard of care for astronauts, 

and identifying the nature of clinical and health services research that will be required before and during 

long duration missions. The resulting 2001 report, “Safe Passage: Astronaut Care for Exploration 

Missions,” made seven recommendations to improve NASA’s medical care system and develop the 

infrastructure needed to support long duration missions:

1. Give increased priority to understanding, mitigating, and communicating to the public the health 

risks of long duration missions beyond Earth orbit.

2. Develop a comprehensive health care system for astronauts for the purpose of collecting and 

analyzing data while providing the full continuum of health care to ensure astronaut health.

3. Develop a strategic health care research plan designed to increase the knowledge base about 

the risks to astronaut health.

4. Give priority to increasing the knowledge base of the effects of living conditions and behavioral 

interactions on the health and performance of astronauts on long duration space missions.

5. Develop and use an occupational health model for the collection and analysis of astronaut 

health related data, giving priority to the creation and maintenance of a safe work environment.

6. Accelerate integration of Agency engineering and health sciences cultures.

7. Establish an organizational component headed by an official who has authority over and 

accountability for all aspects of astronaut health, including appropriate policy-making, 

operational, and budgetary authority.

Review of NASA’s Longitudinal Study of Astronaut Health 

In 1992, NASA designed a protocol known as the Longitudinal Study of Astronaut Health to examine the 

long-term effects of space flight and the overall health-related risks associated with working as an 

astronaut. The Study investigates the incidence of acute and chronic illness and astronaut deaths to 

determine whether the unique occupational exposures of space flight are associated with increased risk. 

NASA requested assistance from the IOM in assessing the progress of the study and making any 

necessary midcourse corrections. In January 2004, the IOM issued “Review of NASA’s Longitudinal Study 

of Astronaut Health” and made recommendations for improving the Study and recommended that 

NASA “assume responsibility for the lifelong healthcare of active and former astronauts.” Currently,

NASA provides comprehensive health exams to active astronauts to ensure they are “flight ready” and,

once an astronaut retires, offers occupational surveillance screenings like blood chemistry panels and 

ocular assessments. However, beyond these services, retired astronauts are entitled only to the 

standard benefits provided to all Federal civil servants and military personnel – benefits that are tied to 

length of service and retirement age. Moreover, once astronauts retire and receive health care 

elsewhere, NASA may lose access to important medical data that can further knowledge about the 

long-term human health risks of space travel.
NASA Office of Inspector General IG-16-003 12

Health Standards for Long Duration and Exploration Spaceflight: Ethics 

Principles, Responsibilities, and Decision Framework 

In 2014, the IOM issued “Health Standards for Long Duration and Exploration Spaceflight: Ethics 

Principles, Responsibilities, and Decision Framework,” which sets forth a framework of ethical and policy 

principles to help guide NASA’s decision making surrounding the implementation of crew health 

standards for long duration missions. Among other issues, the study addressed the appropriate course 

of action when existing NASA standards for radiation exposure or other health and safety issues cannot 

be fully met or the level of knowledge concerning a particular condition is sufficiently limited that an 

adequate standard cannot be developed.6 

 

6

 In response, NASA drafted an implementation plan to address the ethical framework concerns highlighted in the report. The 

implementation plan remains in draft and has not been approved by the Administrator as of September 1, 2015.
NASA Office of Inspector General IG-16-003 13

CHALLENGES DELAY RESEARCH AND IMPACT 

DEVELOPMENT OF MITIGATION STRATEGIES

Although NASA continues to improve its process for identifying and managing health and human 

performance risks associated with space flight, we believe that given the current state of knowledge,

HRP’s schedule for mitigating its top risks is optimistic and the Agency will not develop countermeasures 

for many deep space risks until the 2030s, at the earliest. One of the major factors limiting more timely 

development of countermeasures is uncertainty about the mass, volume, and weight requirements of 

deep space vehicles and habitats – in essence, NASA is trying to develop countermeasures for an 

environment it does not yet fully understand. Moreover, even as NASA gains additional knowledge 

about those vehicles and habitats and the effects of radiation and other space conditions on the human 

body, the Agency may be unable to develop countermeasures that will lower the risk to deep space 

travelers to a level commensurate with Agency standards for low Earth orbit missions. Accordingly, the 

astronauts chosen to make at least the initial forays into deep space may have to accept a higher level of 

risk than those who fly ISS missions. We also found that NASA could not accurately report the true costs 

of developing countermeasures for the identified risks. 

NASA’s Management of Human Health and 

Performance Risks

HRP management creates a budget for each of the five risk elements (Behavioral Health and 

Performance, Exploration Medical Capability, Human Health Countermeasures, Space Human Factors 

and Habitability, and Space Radiation) that element risk managers must allocate among their various 

research tasks. In fiscal year (FY) 2014, HRP spent a total of $152.2 million on the 5 research elements: 

$86.9 million on 120 active research tasks and $65.3 million on programmatic costs, such as 

infrastructure and travel. Figure 5 shows HRP’s FY 2014 costs by risk category.
NASA Office of Inspector General IG-16-003 14

Figure 5: Human Research Program FY 2014 Spending 

Source: NASA.

a Other funding includes ISS Medical Projects and HRP infrastructure and management costs.

Despite these reported budget figures, the true cost of mitigating the various risks is unclear because 

some research tasks are connected to multiple risks and rely on programs outside of HRP, and therefore 

are funded from multiple sources. For example, research tasks associated with the Inadequate Food 

and Nutrition risk receive funds from both the Human Health Countermeasures and Space Human 

Factors and Habitability elements, and the Space Radiation Program relies on HRP funding, as well as,

the ISS Program Office and the Advanced Exploration Systems Program. Specifically, the 5-year space 

radiation budget for FYs 2014 through 2019 was approximately $238 million, only $198.5 million of 

which came from HRP with the rest provided by the ISS Program, Advanced Exploration Systems, Space 

Technology Mission Directorate, and Crew Health and Safety Office. 

HHP is starting to clarify the cost associated with mitigating the various risks by implementing a 

budget-reporting requirement for the HSRB reviews. However, we found that the February 2015 HSRB 

review did not include budget information for the Behavioral Health and Performance, Inadequate Food 

and Nutrition, and Human-System Interaction Design risks. More complete information about the true 

cost of mitigation efforts would improve HRP’s ability to plan and conduct research and help avoid 

delays caused by unexpected funding shortages. 

Progress Made to Mitigate Risks, but Many Gaps Remain

HSRB measures progress on risk reduction by determining whether in-flight and post-mission health and 

performance effects can be mitigated to an acceptable level as defined by NASA health and 

performance standards. In February 2015, HRP reported that of the health and human performance

risks they research, the majority of risks for ISS missions up to a year in duration could be mitigated to 

an acceptable level. However, more than half of the risks for a 3-year planetary mission, such as a trip 

to Mars, remain unmitigated. Table 2 shows the 30 HHP risks as of February 2015 NASA can mitigate to 
NASA Office of Inspector General IG-16-003 15

an acceptable level (Accepted) and those that still require countermeasures to be developed or

validated to meet existing health standards (Requires Mitigation). While some risks can be mitigated for 

the duration of a mission, they may still require mitigation for post-mission effects.

Table 2: Risks Mitigated to an Acceptable Level for Selected Design Reference Missions

Design Reference Mission Accepted for 

In-Flight

Requires 

Mitigation 

for In-Flight

Accepted for 

Post-Mission

Requires 

Mitigation for 

Post-Mission

Low Earth Orbit (6 months)a 28 1 26 2

Low Earth Orbit (1 year)a 27 2 26 2

Lunar Visit Habitation (1 year) 23 7 22 7

Planetary (3 years)b 9 20 11 17

Source: Human System Risks Summary Charts, HMTA, February 2015.

Note: The table reflects 30 HHP risks, only 23 of which are assigned to HRP. There is insufficient information about the Space 

Adaptation Back Pain to determine the mitigation status for post-flight risks. 

a The Celestial Dust Exposure risk is not applicable to the ISS because crew is not exposed to such dust.

b The acceptance of the Celestial Dust Exposure risk is to be determined for a planetary mission; therefore, a decision on 

acceptance level has yet to be determined.

Over the next 13 years, HRP expects to develop countermeasures for and bring to an acceptable level 

most of the risks associated with a human mission to Mars. However, several HRP researchers we spoke 

with characterized the PRR as overly optimistic and believe it will take longer than NASA anticipates to 

reach the acceptable level for several risks. Moreover, according to the CHMO, although NASA will not

waive the existing standards applicable to low Earth orbit missions for a Mars mission, it will likely seek

exceptions to the standards for some risks. 

We selected six specific risks in various stages of maturity and countermeasure development from four 

risk areas: (1) Behavioral Health and Performance, (2) Inadequate Food and Nutrition, (3) Space 

Radiation, and (4) Vision Impairment and Intracranial Pressure (VIIP). To gain an understanding of how 

NASA addresses these risks, we analyzed the Agency’s current and planned research. Based on 

information the HMTA presented at a February 2015 HSRB meeting, NASA has countermeasures to 

mitigate to an acceptable level all short-term effects for the six risks associated with an ISS mission of 

6 months or less. In contrast, for a planetary mission, NASA had accepted only the space radiation risks 

during flight. We found that progress in mitigating risks varied based on the current level of 

knowledge, available countermeasures, and the extent to which the deep space environment differs 

from low Earth orbit. 

Behavioral Health and Performance 

We examined NASA’s efforts to address three specific Behavioral Health and Performance risks: 

(1) adverse cognitive and behavioral conditions, (2) sleep loss, and (3) poor team cohesion and 

performance. Lack of privacy; isolation from family, friends, and the familiarity of Earth; and shorter, 

less restful and more interrupted sleep can negatively affect astronauts’ physical and mental health both 

during and after a mission. For example, during a mission crew cohesion may be affected, long-term 
NASA Office of Inspector General IG-16-003 16

sleep loss can lead to hypertension, diabetes, obesity, heart attack, stroke, and psychiatric disorders 

such as depression or severe anxiety may occur. Although conflict among crew members has been 

relatively infrequent during ISS missions, these issues may take on more significance with longer 

duration missions and in more closely confined spaces. 

NASA has used environmental factors, crew selection 

requirements, training, workload scheduling, 

medicine, and communication with support networks 

to counter these risks. For example, the ISS has 

private crew quarters and Earth-viewing windows to 

help astronauts cope with lack of privacy and isolation 

from Earth. In addition, NASA has established 

standards for a normal, uninterrupted sleep period 

and limited the amount of work astronauts can 

perform in a day and week to an average of 6.5 and

48 hours, respectively.

7

 NASA also works to identify 

crew members who are well suited to working in 

teams. Finally, astronauts are given medications to 

prevent and treat motion sickness, sleep problems, 

illnesses, and injuries. 

Anecdotal and empirical evidence from NASA and external studies indicate that the likelihood a 

behavioral concern or psychiatric disorder will occur during a mission increases with mission length. 

Several of the countermeasures NASA uses to combat these risks on ISS missions – such as real-time 

communication with Mission Control and care packages from family members – will not be available 

during a Mars mission. Unlike for the ISS, there will be no regular resupply missions on a Mars trip and 

communications between Earth and Mars could take up to 44 minutes roundtrip. Moreover, sleep and 

non-sleep medications may be required in-flight, and the potential interactions between these and 

other medications needed to mitigate other deep space risks have yet to be determined. Table 3 shows 

by DRM the extent to which behavioral risks have been accepted and the associated consequence (from 

very low to high) should the risk occur.

 

7 According to NASA-STD-3001 Vol.1, an overloaded workload is defined as a 10-hour workday for more than 3 days a week or 

more than 60 hours for a workweek. 
NASA Office of Inspector General IG-16-003 17

Table 3: Behavioral Health and Performance In-Mission and Post-Mission Risks

Low Earth 

Orbit 

(6 months)

Low Earth 

Orbit 

(1 year)

Lunar Visit 

(1 year)

Asteroid (1 

year)

Planetary 

(3 years)

Cognitive or 

Behavioral 

Conditions

In-Mission Risk Accepted Requires 

Mitigation 

Requires 

Mitigation

Requires 

Mitigation 

Requires 

Mitigation 

Post-Mission Risk Accepted Accepted Accepted Accepted Requires 

Mitigation 

Sleep Loss

In-Mission Risk Accepted Accepted Accepted Requires 

Mitigation 

Requires 

Mitigation 

Post-Mission Risk Accepted Accepted Accepted Requires 

Mitigation 

Requires 

Mitigation 

Team 

Performance

In-Mission Risk Accepted Accepted Accepted Accepted Requires 

Mitigation 

Post-Mission Risk Accepted Accepted Accepted Accepted Accepted 

Source: Human System Risks Summary Charts, HMTA, January 2015.

Legend: High consequences Low to medium consequences Very low to low consequences

In FY 2014, HRP funded 32 research tasks aimed at helping to close knowledge gaps associated with 

these behavioral risks, including ways in which astronauts can most effectively and safely use 

medications to promote sleep and alertness; acceptable thresholds of team function for autonomous, 

long duration or distance missions; how personal relations with family, friends, and colleagues affect 

behavioral health and performance during long duration missions; and identifying biomarkers that 

indicate the presence of a medical condition or disease.8In addition, NASA constructed the Human 

Exploration Research Analog (HERA), a facility at Johnson that allows research subjects to be placed in 

isolated and confined environments for up to a month. Using the HERA facility, NASA has run several 

scenarios and is planning an uninterrupted stay of one month. Furthermore, in August 2015, a 

six-person team began a year stay locked in an isolation dome as part of the Hawaii Space Exploration 

Analog and Simulation. As of August 2015, NASA does not have a validated mitigation strategy for any 

of the behavioral risks for a Mars mission. According to the June 2015 PRR, HRP plans to validate 

countermeasures for sleep loss in FY 2021 and for team performance by FY 2023, in time for NASA to 

designate both risk as accepted for an early 2030s Mars mission. However, the behavioral condition risk 

will only be partially controlled by FY 2027, and it is unclear whether it will be accepted by the early 2030s. 

Nutrition and Food System 

Ensuring adequate nutrition for humans living and traveling in space is critical. Despite 35 years of 

experience with space flight and research in this area, NASA food scientists continue to face challenges 

from crew member weight loss, dehydration, and reduced appetite that can result in nutrient 

deficiencies both during and post mission. Although these issues are a concern for all missions, it is 

 

8 A biomarker is a biologic feature that can be used to measure the presence or progress of disease or the effects of 

treatment. For example, prostate specific antigen is a biomarker for prostate cancer.
NASA Office of Inspector General IG-16-003 18

relatively easy for astronauts who return to Earth after a year or less in space to regain their nutritional 

baselines with little impact on their long-term health. However, NASA does not know whether this will 

be the case for a Mars mission.

NASA has not yet developed a validated strategy for overcoming nutritional risks for a planetary mission 

lasting up to 3 years. For the ISS, NASA sustains crews with prepackaged food supplemented with 

limited fresh food delivered during periodic resupply missions. As mission length and distance from the 

Earth increases, such a system will not be sufficient to meet astronaut nutritional needs. First, the 

current shelf life for prepackaged foods is only 1.5 years, and several key nutrients in many foods start 

to degrade even earlier. Second, because any vehicle traveling to Mars will likely be significantly smaller 

than the ISS, mass, volume, waste, and disposal issues associated with current food packaging must be 

addressed. Third, periodic resupply missions bringing fresh supplies will not be feasible. Finally, 

scientists do not know how deep space radiation will affect the quality and nutritional value of food. 

NASA is investigating countermeasures for these risks, including growing food in the vehicle during the 

mission and alternative storage solutions such as processing foods at lower temperatures to better 

preserve nutrients and increase shelf life. Table 4 shows by DRM the extent to which food and nutrition 

risks have been accepted and the associated consequences.

Table 4: Inadequate Food and Nutrition In-Mission and Post-Mission Risk

Low Earth 

Orbit 

(6 months)

Low Earth 

Orbit 

(1 year)

Lunar Visit 

(1 year)

Asteroid 

(1 year)

Planetary 

(3 years)

Inadequate 

Food and 

Nutrition

In-Mission Risk Accepted Accepted Accepted Accepted Requires 

Mitigation 

Post-Mission Risk Accepted Accepted Accepted Accepted Requires 

Mitigation 

Source: Human System Risks Summary Charts, HMTA, January 2015.

Legend: High consequences Low to medium consequences Very low to low consequences

In FY 2014, HRP funded 16 research tasks associated with food and nutrition to help answer 18 research 

gaps, including identifying the most important nutritional factors for cardiovascular health; how mission 

architecture and available countermeasures impact the nutritional status of crew; and methods, 

technologies, and requirements to deliver a food system that provides adequate safety, nutrition, and 

acceptability for long duration missions. For example, 

in 2014, NASA began investigating whether food can

be grown onboard by testing a plant growth system 

on the ISS. In August 2015, ISS crew members 

sampled red romaine lettuce grown in the system. 

Researchers are evaluating several varieties of leafy 

vegetables with the goal of selecting those with the 

best growth, nutrition, and taste acceptability for an 

ISS mission; however, it is unknown whether growing 

food in deep space will differ from doing so in low

Earth orbit. 
NASA Office of Inspector General IG-16-003 19

HRP funding for nutrition research and countermeasure development is expected to end in 2020, at 

which time HRP plans to redirect those funds to developing a system to extend the shelf life of 

prepackaged foods to make them more suitable for long duration missions. NASA anticipates it will 

have validated countermeasures for all nutritional risks by FY 2027, which will allow it to accept the risks 

in time for a Mars mission in the early 2030s. 

Space Radiation Exposure 

Radiation in space comes from a variety of sources, including solar particle events and galactic cosmic 

rays, and is significantly different from the types of radiation encountered on Earth (e.g., gamma-rays 

and x-rays) that have lower energy and inflict less harm on the human body. Consequently, many 

uncertainties exist regarding how the human body will respond to exposure to space radiation. In 

addition to radiation sickness and cancer, other possible effects include central nervous system damage, 

cataracts, cardiovascular damage, inheritable effects, impaired wound healing, and infertility. HRP’s 

Space Radiation Element covers four specific risks: (1) cancer, (2) changes in the central nervous system, 

(3) degenerative tissue diseases, and (4) acute radiation syndrome (e.g., nausea, vomiting, and fatigue). 

Some of these are immediate term risks that can affect crew performance and the success of a mission, 

while others are long-term issues that affect the length and quality of crew members’ lives. 

NASA’s current radiation standard limits astronauts to a lifetime 3 percent risk of exposure-induced 

death for cancer mortality.

9

 This means that were 100 astronauts exposed to the upper bounds of the 

radiation limits, 3 would die of cancer attributable to that exposure. NASA research estimates that life 

expectancy for astronauts with radiation-induced cancer would be reduced by an average of 12 to 

16 years. As part of its mitigation strategy, NASA currently sets short-term exposure limits to minimize 

acute affects that could impair a crew’s ability to complete a mission. 

Radiation countermeasures for ISS missions are preventative in nature and include shielding, limiting 

mission length, and predictive modeling that estimates spikes in radiation levels. Although similar 

countermeasures could be used for planetary missions, they may not be as effective in the deep space 

radiation environment. For example, experts generally agree shielding alone will not be sufficient to 

minimize exposure to galactic cosmic rays and biological and pharmacological countermeasures need to 

be explored. 

Based on current knowledge, astronauts on a mission to Mars would exceed NASA’s career radiation 

dosage limits. Although the Agency plans to continue efforts to develop countermeasures to address 

the radiation risk, NASA is likely to seek an exception from the current standards for those that cannot 

be fully mitigated.10 Table 5 shows by DRM the extent to which NASA has accepted space radiation risks 

and the associated consequences.

 

9 At the upper 95 percent confidence interval of the risk estimate.

10 NASA Advisory Council meeting, January 2015.
NASA Office of Inspector General IG-16-003 20

Table 5: Space Radiation Exposure In-Mission and Post-Mission Risk

Low Earth 

Orbit 

(6 months)

Low Earth 

Orbit

(1 year)

Lunar Visit 

(1 year)

Asteroid 

(1 year)

Planetary 

(3 years)

Space 

Radiation 

Exposure

In-Mission Risk Accepted Accepted Accepted Accepted Accepted 

Post-Mission Risk Accepted Accepted Requires 

Mitigation

Requires 

Mitigation

Requires 

Mitigation 

Source: Human System Risks Summary Charts, HMTA, January 2015.

Legend: High consequences Low to medium consequences Very low to low consequences

In FY 2014, HRP funded 55 research tasks to help close 38 knowledge gaps associated with space 

radiation exposure. Although HRP research has focused primarily on understanding cancer risk, the 

group plans to increase its focus on degenerative tissue diseases, an area with which NASA is less 

familiar. The Space Radiation Element recently received funds to upgrade a facility known as the 

Galactic Cosmic Ray Simulator to simulate the intense radiation that exists in space. In addition, risk 

owners have recently proposed developing a cardiovascular model as part of the FY 2016 testing plan 

that would estimate the effects of radiation on the human cardiovascular system without exposing 

human test subjects to radiation. 

According to the June 2015 PRR, the space radiation risk remains uncontrolled for a planetary mission

past FY 2027 due to limited knowledge about degenerative effects and the need to develop and validate 

countermeasures for post-mission risks; however, NASA has countermeasures in place for all in-flight 

radiation risks related to low Earth orbit missions. 

Vision Impairment and Intracranial Pressure 

Changes in vision during space flight have been documented through medical testing, research, and 

anecdotal reports by astronauts over the last 40 years. Based on data from 300 post-flight 

questionnaires, approximately 29 percent of short duration and 60 percent of long duration mission 

astronauts reported a degradation in vision and research has shown vision changes can occur after as 

little as 2 weeks aboard the ISS. In 2010, NASA formally identified VIIP as a space-related health risk. 

NASA believes that the microgravity environment of space leads to a shift in bodily fluids that creates 

intracranial pressure and that other factors such as resistive exercise, diet, medicines, and radiation may 

contribute to VIIP. The shift in fluids is also thought to lead to changes in vision and eye anatomy. 

Figure 6 shows the changes to vision and eye anatomy reported to date. 
NASA Office of Inspector General IG-16-003 21

Figure 6: Reported Changes to Vision and Eye Anatomy Due to Space Flight

Source: NASA.

NASA requires a set of pre-, in-, and post-flight testing to determine the presence and degree of vision 

changes in astronauts and are utilizing new devices to image the back of and measure pressure in the 

eye. For treatment on orbit, corrective lenses are available. Additional potential countermeasures 

include pharmaceuticals, modified aerobic exercise, new mechanical devices to restrict blood flow to the 

head, reduced salt intake, and crew selection. Table 6 shows by DRM the extent to which the VIIP risk 

has been accepted and the associated consequence.

Table 6: Vision Impairment and Intracranial Pressure Risk

Low Earth 

Orbit 

(6 months)

Low Earth 

Orbit 

(1 year)

Lunar Visit 

(1 year)

Asteroid 

(1 year)

Planetary 

(3 years)

Vision Impairment 

and Intracranial 

Pressure 

In-Mission Risk Accepted Accepted Accepted Requires 

Mitigation

Requires 

Mitigation 

Post-Mission Risk Accepted Accepted Accepted Requires 

Mitigation

Requires 

Mitigation 

Source: Human System Risk Summary Charts, HMTA, January 2015. 

Legend: High consequences Low to medium consequences Very low to low consequences

In FY 2014, HRP funded 19 research tasks to address 4 VIIP research gaps. In addition to the use of 

diagnostic tools to measure changes in the eye, ongoing studies include use of animal analogs, bed rest 

and other human microgravity analogs, computer modeling, technology development and flight 

certification, and in-flight studies involving crew members. According to the June 2015 PRR, NASA 

expects to have countermeasures to address VIIP risks in place by FY 2024. 
NASA Office of Inspector General IG-16-003 22

Challenges Delay Progress in Identifying and

Mitigating Risks

HRP faces inherent and programmatic challenges that may affect the pace at which knowledge gaps can 

be closed and risks mitigated before NASA attempts a Mars mission. Inherent challenges include 

unknowns associated with exploring a new space frontier, difficulty replicating the deep space 

environment on Earth, and knowledge gaps concerning how the various known human health and 

performance risks impact one another. Programmatic challenges include barriers to data sharing, 

limited time on the ISS to collect data, undefined health standards and vehicle requirements for a 

planetary mission, and funding constraints. As a result, NASA is not likely to develop countermeasures 

to mitigate all human health and behavioral risks to acceptable levels for a Mars mission by 2030 and 

Mars crews are likely to accept more risks than astronauts have in the past. 

Although the PRR has only been in place since 2013, HRP has already revised the schedule twice and 

pushed out the mitigation schedules for some risks. For example, the original July 2013 PRR projected 

countermeasures to address the VIIP risk would be validated in FY 2022, while the June 2015 version 

shows a 2-year slip with validation occurring in FY 2024. Similarly, countermeasure validation for 

cancer, the central nervous system, and degenerative disease risks from space radiation exposure all 

moved from FY 2027 to FY 2029. Risk managers told us that some of the optimism in the initial PRR was

attributable to the assumption that research aimed at closing knowledge gaps would yield the expected 

results, which is not always the case. We found that in developing the PRR, HRP did not consistently 

solicit input from engineers, flight operations, and other stakeholders involved in countermeasure 

development, which may also have contributed to schedule optimism. 

Inherent Challenges

Predicting when knowledge gaps will be closed and countermeasures validated for the many risks 

associated with space travel is inherently complex. First, despite a nearly 50-year history of human 

travel in space, scientists do not fully understand many issues and there are many unknowns, 

particularly about extended human travel in deep space. Second, it is difficult to predict the pace of 

research breakthroughs and setbacks. Third, as was the case with VIIP, scientists may identify previously 

unknown risks, adding to the research agenda. Finally, as scientists learn more about the various risks, 

some risks grow in significance. For example, cancer was believed to be the most significant risk 

associated with radiation exposure, but research has shown that late central nervous system effects 

such as impaired motor skills and seizures may also be a major concern. Based on this research, the 

Space Radiation risk owner stated that the effects will take longer to understand – an additional 6 years 

– and as a result, the countermeasure validation date has been extended from FY 2027 to FY 2033. 

Risks do not exist independently of one another, which makes research more challenging and less 

predictable. In its FY 2014 annual report, HRP noted that risks are generally studied in a segregated 

fashion, one system at a time, ignoring the strong connections between them. Although the IOM and

standing review panels have noted relationships between risks, HRP has not developed a systematic 

approach to identify and investigate these relationships. HRP reported that it is in the early stages of 

addressing this problem, noting in its 2014 report that an integrated approach would help produce more 

efficient countermeasures to address multiple risks.
NASA Office of Inspector General IG-16-003 23

Risk owners stated that to date coordination among researchers has occurred as a result of informal 

contacts initiated by the researchers themselves. For example, researchers studying the Space 

Radiation and the Behavioral Health and Performance risks are coordinating to assess changes in sleep 

following radiation exposure. Similarly, Behavioral Health and Performance researchers are working 

with Inadequate Food and Nutrition researchers to assess how smell, variety, and choice of food affect 

mood and stress on long duration missions. Moreover, countermeasures developed for one risk may 

impact other risks, and researchers are starting to explore these types of connections. For example, 

sodium is often used as a food preservative. At the same time, HRP researchers are exploring whether 

reducing astronauts’ sodium intake will decrease the intracranial pressure thought to contribute to VIIP. 

Programmatic Challenges

NASA missions involve a relatively small group of astronauts and therefore provide a limited group for 

scientific study, in some instances no more than two individuals. For example, in March 2015, Scott Kelly 

began the first mission in which a U.S. astronaut will spend a full year living and working on the ISS. NASA 

will be collecting health data on him and his twin brother back on Earth in the hopes of learning more 

about the effects of long duration missions on the human body. However, the Kelly brothers and other 

small groups of astronauts may not reflect individual differences in the total population of the astronaut 

corps and therefore relying on information obtained from these studies could lead to inaccurate 

conclusions about how that larger population will react to risks and proposed countermeasures. 

Other obstacles to collecting useful data include limited time and space for research on the ISS and 

concerns about privacy and how astronaut medical data will be used. Astronauts may be hesitant to share 

medical information if they perceive the information could jeopardize their chances of flying. Moreover, 

because of the relatively small size of the astronaut corps, it can be difficult to mask the identity of 

individual test subjects to ensure privacy and comply with applicable laws. Risk owners also told us that 

unless data collection is an operational requirement, it is considered voluntary and may be rescheduled for 

a later date due to a demanding workload. Finally, there are limitations on the number of experiments 

that can be conducted simultaneously because of crew time and space on the ISS. Therefore, studies 

addressing one risk may compete for flight resources with studies addressing another risk. For example, 

research projects for both the VIIP and Behavioral Health and Performance risks have been delayed for this 

reason, which in turn has caused slippage in the PRR schedule.

In January 2014, the President proposed extending the ISS through 2024 – a plan, which the Senate 

endorsed in a bill this year.

11 HRP management anticipates that extending ISS operations to 2024 will help 

NASA develop countermeasures to mitigate risks related to Team Performance, VIIP, and Unpredicted 

Effects of Medicine. Further, with the plan for a flexible path approach that involves cis-lunar habitation, 

the Agency has an opportunity to verify risk reduction strategies in space even after ISS operations end.

In addition, NASA needs to work through issues regarding researcher access to medical data already in the 

Agency’s possession. NASA houses information from space flight experiments in its Life Sciences Data 

Archive, which includes data from 1961 (Mercury Project) through current flights, as well as analog studies 

involving human, plant, and animal subjects. In 2014, HRP surveyed its principal investigators and 

determined that 90 percent of those who sought archived data were able to access it.12 However, only 

 

11 The Senate passed, S. 1297, “U.S. Commercial Space Launch Competitiveness Act,” in August 2015, which states that NASA 

shall ensure that the ISS remains a viable and productive facility capable of potential U.S. utilization through at least FY 2024.

12 562 respondents completed the survey in 2014.
NASA Office of Inspector General IG-16-003 24

60 percent of respondents reported seeking such data. The top three reasons respondents gave for not 

seeking this data were (1) not needing the data, (2) not knowing how to request the data, and (3) not 

knowing what data was available. In addition, some investigators noted long lag times between their 

requests and receipt of data. According to HRP managers, a 2012 policy clarifying the process for 

requesting data has led to improvements, but they recognize data access remains a challenge for some 

researchers.13 

Adequate research and testing facilities are also essential to timely development of countermeasures to 

address space travel risks. However, replicating the deep space environment in facilities on Earth or on the 

ISS is complicated. Although valuable insights can be gained from experiments carried out aboard the ISS, 

deep space presents a very different environment in terms of radiation, habitat size, and isolation from 

Earth. These differences make it difficult to correlate data collected on the ISS to the conditions of a deep 

space mission. For example, HRP examined the effects of radiation levels on the ISS on the nutrition and 

quality of food, and though they found no adverse effect, this may not hold true in the more intense 

radiation environment of deep space. 

While ISS missions have defined vehicle and mission requirements, NASA has not established similar 

parameters for planetary missions. As the standing review panels have noted, planning an approach 

without defined mission requirements is difficult. For example, the current Mars DRM is based on a DRM 

from 2009, which NASA officials have stated will be updated in the future. 

In addition, many key technologies required for human space flight to travel Mars have not yet been 

developed. For example, in 2012, the National Academies of Science noted the need for new propulsion 

technology and a habitat design. Similarly, NASA has noted that one way to mitigate risks associated with 

radiation, reduced gravity, and other conditions astronauts will experience during long duration, deep 

space travel is to develop propulsion systems that would reduce transit times. NASA technology 

development and design personnel stated that the Orion capsule currently under development is not 

suitable by itself for long duration missions and that a crew habitat of some type would be required. 

Several researchers we interviewed noted the difficulty in conducting research to mitigate risks associated 

with a mission for which there is no set spacecraft design or mission profile. Although NASA expects a 

spacecraft capable of transit to Mars will have less mass and volume than current vehicles, the vehicle’s 

overall parameters remain unknown. Accordingly, it is unclear how much mass, volume, or weight will be 

available to accommodate potential countermeasures such as developing methods to supply food to a 

crew for up to 5 years without resupply. Options under consideration include shipping food ahead of time 

to a preexisting habitat and growing food in space; however, not knowing how much storage will be 

available in such a habitat or in a Mars-bound crew spacecraft complicates this challenge. 

Finally, funding constraints have resulted in milestone delays so that HRP can prioritize research tasks. 

HRP management told us funding shortages and associated delays in research are not unusual, and that 

the program’s approach is to rebalance funds in the middle of the fiscal year when they select research 

tasks to fund with grants. According to HRP management, HRP keeps about $5 million in reserve to assist 

with budget needs that arise throughout the year. HEOMD has also contributed additional funds to HRP 

projects as needed. However, for FY 2015, these steps were not enough to offset a $16 million shortage –

about 10 percent less than the amount requested from Congress. As a result, HRP has had to delay start 

dates for multiple grants, including six to fund space radiation research. 

 

13 Data Sharing Policy for Release of NASA Protected Health and Research Information, Space Life Sciences Directorate, 

March 2012.
NASA Office of Inspector General IG-16-003 25

NASA LACKS A COORDINATED APPROACH TO 

MANAGING ASTRONAUT HEALTH FOR LONG

DURATION SPACE MISSIONS

NASA’s management of crew health risks could benefit from increased efforts to integrate expertise 

from all related disciplines. While many life science specialists attempt to utilize the range of available 

expertise both inside and outside the Agency, NASA lacks a clear path for maximizing expertise and data 

at both the organizational and Agency level. For example, NASA has no formalized requirements for 

integrating human health and research among life sciences subject matter experts nor does it maintain a 

centralized point of coordination to identify key integration points for human health. Moreover, 

integrating the experiences of NASA’s engineering and safety efforts would benefit the outside life 

sciences community. The lack of a coordinated, integrated, and strategic approach may result in more 

time consuming and costly efforts to develop countermeasures to the numerous human health and 

performance risks associated with deep space missions. 

A Culture of Silos and the Absence of Agency-Level 

Integration

NASA has a long history of working in silos with technical teams collaborating primarily with specialists 

within their own fields. We found multiple examples of work taking place on health and human 

performance risks that suffered from such communication silos. 

Presently at NASA, a board of experts comprised primarily of Agency life sciences managers and subject 

matter experts designates the various groups that approve and may oversee various projects. These 

boards meet on a routine basis to review risks, activities, documents, and other issues requiring 

management decisions. A level above that authority is the NASA Mission Directorate or Program 

officials, which are responsible for orchestrating the projects.

14 At the project level, HHP life sciences 

subject matter experts typically collaborate with Agency experts from the safety and engineering 

technical authorities only during the development of operational hardware. At the board review level, 

engineering and safety technical authorities do not have permanent membership on life sciences boards 

and therefore HHP makes the initial identification of engineering and safety issues. At the Agency level, 

the life science community lacks a designated advocate to interface with the engineering, safety, and 

mission planning communities to ensure health and human performance issues are elevated and receive 

the appropriate attention across Agency disciplines.

 

14 Section 2.1.B Project Categorization and Section 2.4 Program and Project Oversight and Approval in NASA Procedural 

Requirements (NPR) 7120.5E, NASA Space Flight Program and Project Management Handbook. These sections define typical 

project categories and program and project oversight and approval. 
NASA Office of Inspector General IG-16-003 26

The most prominent drivers of space vehicle architecture are the gravity environment, mission 

objectives and duration, size and number of crew, and limitations on mass and volume. According to 

NASA’s Spaceflight Human System Standards, the human system should be viewed as an integral part of 

overall vehicle design. In other words, the standards of the human system should be centrally

incorporated into vehicle design, mission architecture, countermeasures, and research. Several senior 

NASA officials we met with noted that although NASA has traditionally and successfully operated with a 

vehicle-centered design focus, a shift to a more human-centered design is necessary for Mars and other 

exploration class missions. While Agency officials agreed that a shift in the Agency’s focus is required, 

they offered little insight into how NASA would effectively utilize human-centered design for long-term 

decision making in mission planning and vehicle design. However, many Agency officials pointed to 

astronaut input in the configuration of the Orion capsule in areas such as seating placement and lighting 

options.

NASA has been struggling to provide appropriate consideration of the human component in vehicle 

design for more than a decade. For example, as early as 2001, the IOM expressed the view that the 

Agency did not give the human component the attention it deserved: 

NASA, because of its mission and history, has tended to be an insular organization 

dominated by traditional engineering, because of the engineering problems associated 

with early space endeavors, the historical approach to solving problems has been that of

engineering. Long duration space travel will require a different approach, one requiring 

wider participation of those with expertise in divergent, emerging, and evolving fields.

NASA recognizes that the life sciences community may not be well integrated or using its resources as 

effectively as possible. For example, in July 2014, the Agency’s Technical Capability Assessment Team 

recommended establishment of a life sciences technical capability position.15 According to the Team’s

report, such a capability would improve engagement among life sciences researchers by fostering

collaborative dialog and knowledge exchange, enhancing communication among researchers, and 

providing advice to program and project managers. The recommended position has been established in 

the Office of the Chief Scientist at NASA Headquarters. However, the Team did not include medical 

operations and the human system integration work sponsored by HEOMD in this recommendation.

Both HHP and HRP are located at Johnson, the home Center for the astronaut crew office and all active 

astronauts, which facilitates the programs’ operational and research tasks. Moreover, although HHP 

and HRP have distinct and separate functions, with HHP focusing primarily on current, human space

flight mission operations and HRP on research for future deep space missions, HRP is largely dependent 

upon HHP for the majority of its research scientists, research facilities, and physical office space. 

Further, the majority of HRP staff are HHP employees who report to HHP management but are funded 

by programs other than HRP. Although the co-location and interdependencies between HHP and HRP

should facilitate integration between the two groups, some stakeholders we spoke with expressed 

dismay at the lack of integration, collaboration, and productive communication between the two 

groups. For example, as discussed previously, NASA only recently identified vision impairment and

changes in intracranial pressure as a serious risk to crew health. While changes in vision in some 

 

15

 NASA formed the Technical Capabilities Assessment to develop a more efficient operating model that maintains critical 

capabilities to meet current and future Agency mission needs.
NASA Office of Inspector General IG-16-003 27

crew members were noted for years through medical monitoring and believed to be temporary, it was 

only when permanent changes were noted in a few ISS astronauts that HRP experts and investigators 

identified a more substantial pattern in the historical data.

We also noted the lack of a formal process to facilitate integration between the life sciences research 

and operations communities. Instead, collaborative work occurs as a result of personal relationships. 

Moreover, for both HHP and HRP, the reporting of crew health risks for integration into other NASA 

programs at the Headquarters level is inadequate. During our discussions with key life sciences leaders, 

we anticipated that one official would claim responsibility for integrating ongoing life sciences work;

however, this was not the case. Instead, many of the life sciences officials identified a need for a 

high-level focal point within HEOMD for all Agency issues related to astronaut health and the human 

system. 

We found the lack of integration has led to confusion regarding the proper role of life sciences experts in 

developing technology for countermeasures. One of HRP’s goals is to “develop and validate 

technologies that serve to characterize and reduce medical risks associated with human spaceflight” and

the life sciences operational and research community at Johnson expects to develop much of the 

hardware to mitigate human health issues for current and future operations. However, HRP also

conducts research “necessary to understand and reduce spaceflight human health and performance 

risks in support of exploration and enable development of human spaceflight medical and human 

performance standards.” Tasking the same entity to both develop and validate technology rather than 

separating those roles across the Agency places the life sciences technology developer and the validator 

in potentially conflicting positions. Indeed, the appearance of a conflict of interest stemming from this 

dual role has been previously noted in dissenting opinions by Agency experts. When a life sciences

researcher or hardware developer is also charged with validating or recommending the best available 

technology to the Agency, the appearance of favoring one’s own technology is likely, regardless of 

whether or not undue favoritism exists. Moreover, representatives within NASA’s engineering 

technology development areas expressed the view that HHP and HRP should be limited to developing 

enabling technology, such as an instrument developed to conduct research. Similarly, engineering 

hardware experts have expressed concern that these roles were not adequately separated within the 

life sciences communities. Nevertheless, the life sciences operational and research community at 

Johnson expects to develop much of their own hardware to mitigate human health issues, both for 

current and future operations. We are concerned by a lack of organizational clarity regarding 

technology development responsibilities for human system risk mitigation, particularly the lack of 

engagement of key NASA experts from outside the life sciences community.

Control Boards for Decision Making Lack Cross-Agency

Expertise

NASA’s HHP and HRP boards are not fully leveraging cross-Agency technical expertise and support from 

the safety and engineering communities. We found the boards did not consistently involve subject 

matter experts from across the NASA directorates when addressing human health and performance 

risks. Including engineering and safety and mission assurance experts on these boards could lead to 

improved mitigation responses and earlier incorporation and “buy-in” for mission and vehicle and 

habitat design planning. 
NASA Office of Inspector General IG-16-003 28

HHP and HRP have a multi-level structure of control boards with key decision-making authority. The 

working level boards at Johnson have distinct yet complimentary roles meant to ensure necessary 

expertise and coverage within the HHP community. However, NASA experts from outside the life 

sciences discipline are not consistently included in the boards’ work. For example, while HHP’s Flight 

Activities Control Board has a permanent member from the engineering community, it has no 

representative from the safety and mission assurance community. Furthermore, most HHP control 

boards include experts from engineering and safety and mission assurance only as ad-hoc members to 

be called upon as determined by the life science experts. 

In our judgment, it is important to include experts from both the engineering and safety community on 

these boards. Issues such as monitoring, countermeasure development, hardware selection, 

habitability, and performance needs all have inherent engineering and safety components. Without 

consistent participation by the safety and engineering technical authorities, HHP life sciences experts

must identify safety and engineering issues themselves and decide when to call in experts from those 

areas. This can lead to delays in or failure to identify these issues. Inclusion of these technical 

communities on all HHP decision-making control boards would not only ensure participation of 

appropriate expertise from a cross section of the Agency’s technical communities, but may help to 

identify crew health issues at an earlier juncture and avoid mistakes when planning countermeasures 

and developing technologies targeted at specific crew health risks. 

We noted that at an August 2014 meeting, the HSRB discussed that owners of change requests need to 

do a better job ensuring that the correct evaluators, especially mandatory evaluators, are included in 

decisions relating to hardware changes and are given adequate time to respond to reviews. At the 

meeting, the HSRB Chair pointed out that HHP experts did not perform an engineering design review for 

microbiology hardware, which led the Chair to contact the experts during the meeting via telephone to 

get a real-time concurrence. In another instance, the development of hardware for an air quality

replacement monitor did not receive timely input from engineering, which caused multiple approval 

delays and increased costs.

Historical Issues with Integration and Stove-piping

In 2002, both the engineering and human health and research communities recognized the need to build 

better working relationships and identify opportunities for integration. As a result, the directors of the 

Johnson Engineering Directorate and HHP signed a memorandum committing themselves to a 

“partnership whose purpose is to better position the organizations to achieve NASA’s goals for human 

spaceflight and space research.” The memorandum established agreements between the two 

organizations to provide space- and ground-based hardware and software that will better enable NASA 

to carry out its mission and required the formation of an Engineering and Science Review Board that 

would “authorize new joint products and processes to resolve significant issues and to approve joint 

positions and/or decisions for forwarding to NASA Headquarters or other external organizations.” The 

memorandum appeared to be a blueprint to ensure long-term integration and allow both specialties to 

work together early in the project phase. Although the memorandum is still in effect, the Engineering 

and Science Review Board was never formed and to date working partnerships are not consistent within 

the Engineering Directorate and HHP. As a result, while integration issues were identified over a decade 

ago and initial corrective steps taken, the groups did not follow through to establish a formalized

agreement of work. 
NASA Office of Inspector General IG-16-003 29

The range of life sciences issues relevant to NASA missions are quite diverse and require a broad range 

of technical expertise. Accordingly, NASA has incorporated an extensive array of experts into its life 

sciences community to ensure full coverage across operational and research projects. However, we 

found that many of these experts, some of whom may also act as principal investigators for NASA 

research projects, operate in silos without a requirement to ensure diversified scientific teams that 

contain the appropriate portfolio of experts. This could lead to missed opportunities for collaborative 

efforts and a failure to recognize critical health issues in a timely manner. For example, one researcher 

we spoke with expressed the view that NASA may have identified the VIIP risk sooner had crew data 

been more effectively shared among life sciences experts.
NASA Office of Inspector General IG-16-003 30

NASA MUST ESTABLISH AND MAINTAIN AN 

ETHICAL FRAMEWORK FOR RISK ACCEPTANCE 

FOR LONG DURATION SPACE FLIGHT

Long duration missions will likely expose crews to health and human performance risks for which NASA 

has limited effective countermeasures. Accordingly, for these missions NASA will have to determine the 

level of risk that is acceptable and clearly communicate the Agency’s decisions to astronauts, Congress, 

and the public. Moreover, NASA needs to continue to explore whether its current health care model for 

astronauts is sufficient to meet both the long-term health needs of the astronaut community and the 

research needs of the Agency. 

Transparency of Risk Acceptance

For more than two decades, NASA has sought to understand the effects of space flight through the 

Longitudinal Study of Astronaut Health (LSAH), investigating a variety of issues relating to astronaut 

health both during and post mission. In addition, at NASA’s request, the IOM has studied and issued 

reports on a variety of astronaut health issues and, in 2001, offered seven recommendations to improve 

NASA’s medical care system and develop the infrastructure needed to support long duration missions. 

In 2004, the IOM recommended NASA improve the validity of the LSAH database and assume 

responsibility for the lifelong health care of its active and former astronauts. Finally, in 2014, the IOM 

issued a report that discussed expanding Agency policy for initiating and revising health standards, as 

well as, the related ethical principles and responsibilities OCHMO should incorporate into NASA’s health

and medical standards processes and decision-making. The report offered the following principles: 

 Avoid harm. This principle includes the duty to prevent harm, exercise caution, and remove or 

mitigate harms that occur. Thus, NASA should exhaust all feasible measures to minimize the 

risks to astronauts from long duration and exploration space flights, including addressing 

uncertainties through approaches to risk prevention and mitigation that incorporate safety 

margins and include mechanisms for continuous learning that allow for incremental approaches 

to risk acceptance.

 Beneficence. This principle provides benefit to others. NASA should consider in its decision 

making the potential benefits of a specific mission, including its scientific and technological 

importance, as well as its potential beneficiaries such as current and future astronauts and 

members of society at large.

 Favorable balance of risk and benefit. This principle seeks both a favorable and acceptable 

balance between the risk of harm and potential for benefit. In authorizing long duration and 

exploration activities and in approving particular missions, NASA should systematically assess 

risks and benefits and the uncertainties attached to each, drawing on the totality of available 

scientific evidence, and ensuring that benefits sufficiently outweigh risks.
NASA Office of Inspector General IG-16-003 31

 Respect for autonomy. This principle ensures that individuals have both the right to 

self-determination and processes in place to exercise that right. NASA should ensure that 

astronauts are able to exercise voluntariness to the extent possible in personal decision making 

regarding participation in proposed missions, have all available information regarding the risks 

and benefits of the proposed mission, and continue to be apprised of any updates to risk and 

benefit information throughout the mission

 Fairness. This principle requires that equals be treated equally, burdens and benefits be 

distributed fairly, and fair processes be created and followed. NASA’s decision making 

surrounding missions should explicitly address fairness, including the distribution of the risks 

and benefits of the mission, crew selection, and protections for astronauts after missions.

 Fidelity. This principle recognizes that individual sacrifices made for the benefit of society may 

give rise to societal duties in return. Given the risks that astronauts accept in participating in 

hazardous missions, NASA should respect the mutuality of obligations and ensure health care 

and protection for astronauts not only during the mission but after return, including provision of 

lifetime health care for astronauts. 

The IOM’s 2014 report also identified the following ethical “responsibilities” relating to and flowing from 

the ethical principles:

 Fully inform astronauts about the risks of long duration and exploration missions and make 

certain that the informed decision-making process is adequate and appropriate. 

 Adhere to a continuous learning strategy, including health surveillance and data collection, to 

ensure that health standards evolve and improve over time and are informed by data gained 

before, during, and after long duration and exploration missions, as well as from other relevant 

sources. 

 Solicit independent advice about any decision to allow any specific mission that fails to meet 

NASA health standards or any decision to modify health standards. 

 Communicate with all relevant stakeholders such as astronauts and the public at large the 

rationale for, and possible impacts, including harm type, severity, and probability estimates,

related to any decision about health standards in a procedurally transparent, fair and timely 

manner, and providing adequate opportunity for public engagement. 

 Provide equal opportunity for participation in long duration and exploration missions to the 

fullest extent possible. For example, fairness in crew selection means that NASA should accept 

some group differences in population risk in order to create an equal opportunity to participate 

in missions, and accommodate individual variance from population-based risk estimates to the 

extent that individual differences do not jeopardize mission operations. 

 Provide preventive long-term health screening and surveillance of astronauts and lifetime health 

care to protect their health, support ongoing evaluation of health standards, improve mission 

safety, and reduce risks for current and future astronauts.

 Develop and apply policies that appropriately and sufficiently protect the privacy and 

confidentiality of astronaut health data. 

The IOM stated that if a human space flight mission cannot meet existing health standards or 

inadequate information exists to revise an existing standard, NASA’s options are to: (1) expand current 

standards; (2) establish new, more permissive long duration and exploration health standards; or (3) 

grant an exception to the standard. The IOM found the first two options unacceptable when evaluated 
NASA Office of Inspector General IG-16-003 32

against the ethical guidelines. Consequently, the IOM concluded that the only ethically acceptable 

option would be to make an exception to existing health standards. Additionally, the IOM 

recommended NASA consider exceptions only on a mission-by-mission basis and follow a strict 

ethics-based decision framework for determining whether waivers are appropriate for a particular 

mission. The IOM presented the following three-step decision-making process for NASA’s consideration:

 Level 1. Whether and under what conditions are any missions that are unlikely to meet current 

health standards ethically acceptable.

 Level 2. Whether a specific, contemplated mission unlikely to meet current health standards is 

ethically acceptable.

 Level 3. Once a specific mission is deemed ethically acceptable, the crew is chosen based on the 

requisite skills and expertise needed and individual astronauts’ health susceptibilities and 

personal risk factors, and their informed decision to participate.

An important component of risk acceptance the IOM identified is that NASA fully inform astronauts 

about mission risks and set up a process that ensures the astronauts have a full understanding of those 

risks before agreeing to participate. In addition, the IOM expressed the view that not all risks can be 

morally adjudicated by leaving the decision whether to accept them entirely to the astronauts. Rather, 

NASA has an independent responsibility to protect its employees and minimize risks to the extent 

possible. NASA has recognized this responsibility by requiring not only consent from participating 

astronauts but also that the responsible program, project, or operations manager formally accept 

increased levels of risks to human safety and formal concurrence from the responsible technical 

authorities.

Furthermore, the IOM stated that NASA communicate the true level of risk to Congress and the public. 

As the IOM pointed out in 2001: 

The successes of the space program may have fostered the impression that space travel 

has few associated risks. Making potential problems and overall risks clear and openly 

disclosing them will allow NASA to gain continuing public understanding, trust, and 

support for exploration-class space missions. At the extreme, the public must be 

prepared for the possibility that all countermeasures may tragically fail, that a crew may 

not return from a prolonged mission, or that individuals may not be able to function 

physically or mentally upon their return.

NASA agreed with the IOM that making exceptions to health standards or going forward with a mission 

when health standards do not exist because of limited knowledge should occur only “under very limited 

circumstances” and stated that the Administrator would waive health standards only after careful 

assessment of the risk and benefits with the ethical principles. Currently, NASA is working to develop a 

detailed implementation plan that addresses each of the recommendations in the IOM’s 2014 report.

Astronaut Health Care

NASA does not provide lifetime healthcare for spaceflight induced injuries or diseases that may develop 

once the astronauts leave the Agency. Currently, NASA provides comprehensive health exams to active 

astronauts to ensure they are “flight ready” and, once an astronaut retires, offers occupational 

surveillance screenings like blood chemistry panels and ocular assessments. However, beyond these 

services, retired astronauts are entitled only to the standard benefits provided to all Federal civil
NASA Office of Inspector General IG-16-003 33

servants and military personnel – benefits which themselves are tied to length of service and retirement 

age. Moreover, once astronauts retire NASA may lose access to their ongoing medical data that could 

help inform research regarding the effects of long-term space travel on human health.

In a series of reports over the past decade, the IOM has stressed NASA’s moral obligation to provide 

medical surveillance of and care to astronauts due to their occupational exposures. The IOM’s position 

is that NASA should develop a policy addressing the practical consequences that a career as an 

astronaut or the experience of space travel leaves individuals at increased risk for an adverse health 

effects. The IOM was particularly concerned in cases where the effects of space travel do not become 

obvious during or immediately after a space flight but develop only after the astronaut leaves active 

duty and is no longer receiving medical care from NASA. In the 2001 Safe Passages report, the IOM 

stated that it is essential that NASA create a comprehensive healthcare system for the dual purpose of 

maintaining astronaut health and collecting and analyzing data to inform future space travel. The IOM 

advocated for a system that would include care for all astronauts and their families.

According to NASA, approximately 70 percent of retired astronauts participate in NASA’s annual 

preventive screenings program. NASA officials told us that a comprehensive health care program would 

encourage more participation and provide the Agency with access to more comprehensive medical data 

that could help identify common issues sooner, which in turn could inform research and 

countermeasure development. 

Providing health care to workers exposed to hazardous conditions is not unprecedented. For example, 

the Departments of Energy, Defense, and Veterans Affairs have programs for individuals exposed to 

beryllium, nuclear weapons tests, and Agent Orange.16 In each case, Congress passed legislation to 

ensure the Federal Government provides monitoring and medical care to affected civil servants and 

service members. 

The 2005 NASA Authorization Act instructed the Administrator to “develop a plan to better understand 

the longitudinal health effects of space flight on humans” considering “the need for the establishment of 

a lifetime health care program for NASA astronauts and their families or other methods to obtain 

needed health data from astronauts and retired astronauts.” As part of this effort, NASA utilized a 

feasibility study conducted by the University of Nebraska Medical Center that estimated the cost of 

providing such care and identified three options using existing coverage platforms: (1) the existing 

Department of Defense program for military retirees and their dependents (Tricare), (2) private 

insurance, and (3) the Federal Employees Health Benefits Program. The cost of these options ranged 

from $2.4 million to $6.5 million per year for a population of 367 current and retired astronauts and 

their families. However, NASA determined it could not enact such a program without specific legislative 

authority. In 2010, NASA proposed legislation that would modify the Space Act to provide health 

insurance to all current and retired astronauts and their families, but the proposal gained little traction 

in Congress and was not enacted into law.

 

16 Beryllium is a hard, gray metal that occurs as a chemical component of certain rocks (bertrandite and beryl), coal and oil, soil, 

and volcanic dust. More than 90 percent of all beryllium was processed to produce nuclear weapons and workers exposed to 

beryllium dust are at risk of developing serious debilitating diseases. From 1962 to 1971, U.S. military forces sprayed more 

than 19 million gallons of herbicides over Vietnam to strip the thick jungle canopy that helped conceal opposition forces, 

destroy crops on which enemy forces might depend, and clear tall grass and bushes from around the perimeters of U.S. base 

camps. After a scientific report concluded that a contaminant in one of the primary chemicals used in the herbicide called 

Agent Orange could cause birth defects in laboratory animals, U.S. forces suspended its use.
NASA Office of Inspector General IG-16-003 34

Since 2010, the Agency has modified its proposed legislation to eliminate coverage for astronaut 

families, focusing instead on an occupational health care model for retired astronauts that mirrors other 

agencies’ workers’ compensation programs. The Agency’s current proposal would utilize the existing 

infrastructure of the Lifetime Surveillance of Astronaut Health initiative and NASA processes for active 

astronaut occupational health care, focusing on early detection of health conditions using the 

Department of Labor Worker’s Compensation program as the first approach to pay for treatment. 

In the proposed NASA Authorization Act of 2015, Congress again instructed the Administration to 

prepare a response to the IOM’s recommendations regarding lifetime health care for astronauts. The 

legislation requires NASA to report the estimated budgetary resources required for implementation of 

those recommendations and options that might be considered. 
NASA Office of Inspector General IG-16-003 35

CONCLUSION

NASA has taken positive steps to address the human health and performance risks inherent in space 

travel. However, the Agency still faces significant challenges to ensuring the safety of crew members on 

a human mission to Mars or deep space. To that end, NASA must continue to develop countermeasures 

to minimize health and human performance risks and improve Agency insight into how much it will cost 

to do so and on what timetable. Moreover, effective mitigation of the risks to human health posed by 

long duration missions is a significant undertaking that can only be achieved with effective management 

and collaboration among the various NASA life sciences offices and technical experts from the 

engineering and safety disciplines. Accordingly, NASA must increase efforts to break down a culture of 

silos that impedes such collaboration. 

NASA recognizes that the astronauts it sends on deep space missions will be exposed to a greater level 

of risk than the Agency accepts for current missions to low Earth orbit. Therefore, it is crucial NASA 

develop an ethical framework to guide the informed consent and waiver process for astronauts. In 

addition, NASA must be transparent with Congress and the public about the level of the risk involved in 

deep space missions. Finally, NASA should continue to consider whether its current model for astronaut 

health care meets its research needs and the health care needs of the astronaut community.
NASA Office of Inspector General IG-16-003 36

RECOMMENDATIONS, MANAGEMENT’S RESPONSE,

AND OUR EVALUATION

In order to ensure NASA management has the best possible information available to make decisions 

related to human health and performance risks to Agency missions, we recommended the Manager of 

HRP in coordination with HSRB

1. ensure HRP costs for research and countermeasure development are accurate so the program 

can be better informed on how funding challenges will impact the rate of progress for 

countermeasure development and

2. ensure the PRR accurately reflects the status of research and realistic timeframes for 

countermeasure development to better determine what risks will be mitigated for the first 

human mission to Mars.

In order to ensure appropriate integration of Agency expertise across disciplines, we recommended the 

Associate Administrator for HEOMD

3. establish a primary point of coordination within HEOMD to interface with all NASA programs, 

projects, and functions to ensure human health and performance issues have appropriate 

visibility;

4. ensure that integration of technical authorities is occurring and consider inclusion of 

engineering and safety experts on all HHP and HRP control boards; and

5. clarify the organizational technology development responsibilities for human system risk 

mitigation.

Regarding astronaut health care, we recommended the NASA Administrator and the Chief Health and 

Medical Officer

6. determine whether the current model satisfies Agency needs and the needs of the astronaut 

community and, if not, pursue any necessary legislative authority to implement necessary 

changes.

We provided a draft of this report to NASA management, who concurred or partially concurred with our 

recommendations and described planned corrective actions. Because we consider management’s 

comments responsive to our recommendations, the recommendations are resolved. We will close the 

recommendations upon completion and verification of the proposed corrective actions. Management’s 

full response to our report is reproduced in Appendix C. Technical comments provided by management 

have also been incorporated, as appropriate.
NASA Office of Inspector General IG-16-003 37

Major contributors to this report include, Laura Nicolosi, Mission Support Director; Julia Eggert, Project 

Manager; Scott Riggenbach, Team Lead; Noreen Khan-Mayberry, Ph.D., Technical Evaluator; Rebecca 

Wilson, Management Analyst; and Jason Hensley, Auditor.

If you have questions about this report or wish to comment on the quality or usefulness of this report, 

contact Laurence Hawkins, Audit Operations and Quality Assurance Director, at 202-358-1543 or

laurence.b.hawkins@nasa.gov. 

Paul K. Martin

Inspector General 
Appendix A

NASA Office of Inspector General IG-16-003 38

APPENDIX A: SCOPE AND METHODOLOGY

We performed this audit from April 2014 through September 2015 in accordance with generally 

accepted government auditing standards. Those standards require that we plan and perform the audit 

to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions 

based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for 

our findings and conclusions based on our audit objectives.

This review assessed NASA’s efforts to manage human health and performance risks for space 

exploration. We reviewed Federal and NASA policies, regulations, and plans to determine the 

requirements and criteria for managing human health and performance risks. The documents we 

reviewed included:

 NASA-STD-3001, Vol. 1, “NASA Spaceflight Human System Standard Volume 1: Crew Health,” 

March 2007

 NASA-STD-3001, Vol. 2, “NASA Spaceflight Human System Standard Volume 2: Human Factors, 

Habitability, and Environmental Health,” January 2011

 NASA Policy Directive 8900.5B, “NASA Health and Medical Policy for Space Exploration,” 

December 2011

 NPR 7120.5E, “NASA Space Flight Program and Project Management Handbook,” August 2012.

 NPR 7120.8, “NASA Research and Technology Program and Project Management 

Requirements,” April 2013

 NPR 7120.11, “NASA Health and Medical Technical Authority (HMTA) Implementation,” 

November 2011

 NPR 8000.4A, “Agency Risk Management Procedural Requirements,” January 2014

 NPR 8900.1A, “NASA Health and Medical Requirements for Human Space Exploration,” July 

2012

 14 Code of Federal Regulation 1230, “Protection of Human Subjects,” January 2012

 45 Code of Federal Regulation 46, “Protection of Human Research Subjects,” October 2013

To determine how NASA manages risk mitigation, we reviewed the status of NASA’s 30 human health 

and performance risks, of which 23 and 2 concerns are assigned to HRP, based on the program’s 

schedule and risk matrix. We then selected four risk areas to better understand management and 

identify challenges. The four risk areas were (1) Behavioral Health and Performance, (2) Inadequate 

Food and Nutrition, (3) Space Radiation, and (4) VIIP. We reviewed Evidence Reports, integrated 

research plans, budgets, schedules, HRP’s annual reports, external reviews, and information on DRMs. 

Additionally, we interviewed numerous individuals to gain an understanding of how health and human 

performance risks are currently managed and integrated across the Agency, including representatives 

from the HEOMD, HHP, HRP, OCHMO , various subject matter experts, and a selection of astronauts. 
Appendix A

NASA Office of Inspector General IG-16-003 39

Use of Computer-Processed Data

We did not use computer-processed data to perform this audit. 

Review of Internal Controls

We evaluated internal controls, including NASA policies and procedures associated with the audit 

objectives, and concluded that the internal controls were generally adequate, except in specific 

circumstances, as discussed in the body of this report. Our recommendations, if implemented, should 

correct the weakness identified.

Prior Coverage

During the last 5 years, the NASA Office of Inspector General and IOM have issued four and three

reports, respectively, of significant relevance to the subject of this report. Unrestricted OIG reports can 

be accessed at http://oig.nasa.gov/audits/reports/FY16.

NASA Office of Inspector General

NASA’s Efforts to Maximize Research on the International Space Station (IG-13-019, July 8, 2013)

A Review of NASA’s Replacement of Radiation Monitoring Equipment on the International Space Station

(IG-11-027, September 29, 2011)

NASA’s Astronaut Corps: Status of Corrective Actions Related to Health Care Activities (IG-10-016, 

July 6, 2010)

NASA’s Constellation Standing Review Boards Established without Due Regard for Member Independence 

Requirements (IG-09-011, February 25, 2009)

Institute of Medicine 

Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and 

Decision Framework (2014)

Review of NASA's Longitudinal Study of Astronaut Health (2004)

Safe Passage: Astronaut Care for Exploration Missions (2001)
Appendix B

NASA Office of Inspector General IG-16-003 40

APPENDIX B: ACCEPTANCE OF HUMAN HEALTH

AND PERFORMANCE RISKS BY SELECTED DRMS
Appendix B

NASA Office of Inspector General IG-16-003 41
Appendix B

NASA Office of Inspector General IG-16-003 42
Appendix B

NASA Office of Inspector General IG-16-003 43
Appendix C

NASA Office of Inspector General IG-16-003 44

APPENDIX C: MANAGEMENT’S COMMENTS
Appendix C

NASA Office of Inspector General IG-16-003 45
Appendix C

NASA Office of Inspector General IG-16-003 46
Appendix C

NASA Office of Inspector General IG-16-003 47
Appendix D

NASA Office of Inspector General IG-16-003 48

APPENDIX D: REPORT DISTRIBUTION

National Aeronautics and Space Administration

Administrator

Deputy Administrator

Associate Administrator

Deputy Associate Administrator

Chief of Staff

Executive Officer

Associate Administrator for Human Exploration and Operations

Chief Health and Medical Officer

Director, Human Health and Performance 

Manager, Human Research Program

Director, Johnson Space Center

Non-NASA Organizations and Individuals

Office of Management and Budget

Deputy Associate Director, Energy and Space Programs Division

Government Accountability Office

Director, Office of Acquisition and Sourcing Management

Congressional Committees and Subcommittees, Chairman and 

Ranking Member

Senate Committee on Appropriations

Subcommittee on Commerce, Justice, Science, and Related Agencies

Senate Committee on Commerce, Science, and Transportation

Subcommittee on Space, Science, and Competitiveness 

Senate Committee on Homeland Security and Governmental Affairs

House Committee on Appropriations

Subcommittee on Commerce, Justice, Science, and Related Agencies

House Committee on Oversight and Government Reform

Subcommittee on Government Operations

House Committee on Science, Space, and Technology

Subcommittee on Oversight

Subcommittee on Space

(Assignment No. A-14-011-00)