1. For a comprehensive overview of how NASA managed the transition post-Apollo, as well as a detailed discussion of stakeholder politics inside and outside of the agency, see Logsdon, John M., After Apollo? Richard Nixon and the American Space Program (New York, 2015)Google Scholar.

2. Paul, Richard and Moss, Steven, We Could Not Fail: The First African Americans in the Space Program (Austin, 2017)Google ScholarPubMed and Maher, Neil, Apollo in the Age of Aquarius (Cambridge, Mass., 2017)CrossRefGoogle Scholar. Some of the most extensive writing about the program has been by Rashid Bashshur, who has not only studied the program but was involved in its assessment for the Indian Health Service. Many of Bashshur’s works are cited in this article’s notes. More recently, the project has received attention from anthropologist Victor Breitberg and historian Jeremy Greene. Both are acknowledged as collaborators and have been helpful in framing some of the arguments presented in this article.

3. For examples, see Glen Asner “Space History from the Bottom Up: Using Social History to Interpret the Societal Impact of Spaceflight,” chap. 20 in Societal Impact of Spaceflight (NASA SP-2007-4801), ed. Steven J. Dick and Roger D. Launius; Laney, Monique, German Rocketeers in the Heart of Dixie: Making Sense of the Nazi Past during the Civil Rights Era (New Haven, 2015)CrossRefGoogle Scholar; Shetterly, Margot Lee, Hidden Figures: The American Dream and the Untold Story of the Black Women Mathematicians Who Helped Win the Space Race (New York, 2016)Google Scholar; and the proceedings of “NASA in the ‘Long’ Civil Rights Movement Conference,” 16–17 March 2017 (see https://www.nasa.gov/centers/marshall/history/nasa-in-the-long-civil-rights-movement-conference.html).

4. A significant body of practitioner-focused literature on NASA and telemedicine already exists, but there is a dearth of literature with an explicitly historical focus. For recent works on aerospace medicine, see Space Physiology and Medicine—from Evidence to Practice, 4th ed., ed. A. Nicogossian, C. L. Huntoon, R. S. Williams, C. R. Doarn, V. Schneider, and J. D. Polk (Springer, NY, 2016); Williams Sims Bainbridge, “Societal Impact of NASA on Medical Technology,” chap. 2; and Whalen, David, “Societal Impacts of Applications Satellites,” chap. 7, in Historical Studies in the Societal Impact of Spaceflight, ed. Dick, Steven (Washington, DC: NASA SP-2015-4803, 2015)Google Scholar. The history of the relationship of the agency to issues of health was also not a primary focus of the old aerospace history. Two of the earliest books on the subject are Link, Mae Mills, Space Medicine In Project Mercury (Washington, DC: NASA SP-4003, 1965)Google Scholar and Pitts, John A., The Human Factor: Biomedicine in the Manned Space Program to 1980 (Washington, DC: NASA SP-4213, 1985)Google Scholar.

5. See, for example, Starr, Paul, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York, 1982), 343Google Scholar.

6. This legislation provided federal funds to build hospitals as part of a larger effort to increase access for all Americans. See Hospital Survey and Construction Act (Hill-Burton Act, Public Law 725, 79th Congress); Perlstadt, H., “The Development of the Hill-Burton Act Legislation: Interests, Issues, and Compromise,” Journal of Health and Social Policy 6, no. 3 (1995): 77–96CrossRefGoogle Scholar; and “The Hospital Survey and Construction Act: An Editorial,” Journal of the American Medical Association 132, no. 2 (1946): 148–49.

7. Lyndon Baines Johnson, “Special Message to Congress: Advancing the Nation’s Health,” 7 January 1965, https://www.presidency.ucsb.edu/documents/special-message-the-congress-advancing-the-nations-health) accessed 1 February 2019).

8. Harry S. Truman, “Special Message to Congress Recommending A Comprehensive Heath Program,” 19 November 1945 available at https://www.trumanlibrary.org/publicpapers/index.php?pid=483&st=&st1= (accessed 11 January 2019). For several book-length studies of the evolution of the American health insurance and health-care system, see Quadagno, Jill, One Nation, Uninsured: Why the U.S. Has No National Health Insurance (New York, 2005)Google Scholar, and Chapin, Christy Ford, Ensuring America’s Health: The Public Creation of the Corporate Health Care System (New York, 2015)CrossRefGoogle Scholar. For an important overview of the government’s role in providing health, see Shonick, William, Government and Health Services: Government’s Role in the Development of U.S. Health Services, 1930–1980 (New York, 1995)Google Scholar. See Bailey, Martha J. and Danzieger, Sheldon, eds., Legacies of the War on Poverty (New York, 2013)Google Scholar, for a comprehensive overview of the ways that Great Society policies intersected with efforts to build the welfare state. Chapters by Barbara Wolfe, “Health Programs for Non-Elderly Adults and Children,” and Katherine Swartz, “Medicare and Medicaid,” provide helpful overview of health programs, along with Jonathan Engel, Unaffordable: American Health Care from Johnson to Trump (Madison, 2018). An important government program to expand health-care options during this same time period was the Regional Medical Programs, which grew out of efforts to combat chronic disease. See, for example, https://profiles.nlm.nih.gov/RM/ (accessed 11 January 2019). For a more general overview of the American welfare state, see Hacker, Jacob, The Divided Welfare State: The Battle over Public and Private Social Benefits in the United States (New York, 2002)CrossRefGoogle Scholar.

9. Thanks to an anonymous peer reviewer for making this salient general point. In 1888, only four Native American hospitals existed, but by 1922, the total was up to seventy-three. See Rife, James P. and Dellapenna, Alan J., Caring and Curing: A History of the Indian Health Service (Landover, MD: PHS Commissioner Officers Foundation for the Advancement of Public Health, 2009), 5Google Scholar.

10. Walch, M. C., “Terminating the Indian Termination Policy,” Stanford Law Review 35 (1983): 1183CrossRefGoogle Scholar.

11. See, for example, http://www.nativepartnership.org/site/PageServer?pagename=airc_hist_terminationpolicy, and S. E. Ruckman, “Nixon’s Role in Self Determination Focus of Talk,” Native Times, 25 May 2012, available from http://nativetimes.com/index.php/life/people/7232-nixons-role-in-self-determination-focus-of-talk?tmpl=component&print=1&page= (both accessed 3 February 2017).

12. Richard Nixon, “Special Message to the Congress on Indian Affairs,” 8 July 1970, available from http://www.presidency.ucsb.edu/ws/print.php?pid=2573 (accessed 6 February 2017).

13. Department of Health, Education, and Welfare, Indian Health Service, “Program Report and Plan for Indian Health: Fiscal Years 1971–1975,” 31 July 1969 (held by National Library of Medicine, Bethesda) 1–3. (Hereafter referred to as the IHS Strategic Plan. Emphasis in the original.)

14. Executive Summary of The First 50 Years of the Indian Health Service: Caring & Curing (IHS “Gold Book”) available from https://www.ihs.gov/newsroom/factsheets/ (accessed 20 December 2018), 9. This publication was produced to mark the 50th anniversary in 2005, but it lacks a formal date or author. The original “Gold Book” was an IHS report to Congress in 1957.

15. IHS Strategic Plan, 3 and 5. See also Rashid Bashshur, Technology Serves the People: The Story of a Co-operative Telemedicine Project by NASA, the Indian Health Service, and the Papago People (Tucson: Indian Health Service Office of Research and Development, 1980, GPO Report No. 017-028-00009-0). For additional background about the challenges the federal government faced in providing Native American health care, see 32–39.

16. Rife and Dellapenna’s Caring and Curing provides an overview of IHS history. David H. DeJong wrote two volumes on IHS history: If You Knew the Conditions: A Chronicle of the Indian Medical Service and American Indian Health Care, 1908–1955 (Lanham and Lexington, 2010), and Plagues, Politics, and Policy: A Chronicle of the Indian Health Service, 1955–2008 (Lanham, 2011).

17. IHS Strategic Plan, 24–26.

18. Wilkinson, Charles, Blood Struggle: The Rise of Modern Indian Nations (New York, 2005), 129–48Google Scholar, provides a summary and analysis of these AIM developments. Thanks to historian David Kleit for suggesting this excellent source. Also see Laura Waterman Wittstock and Elaine J. Salinas, “A Brief History of the American Indian Movement,” https://www.aimovement.org/ggc/history.html (accessed 6 February 2017.

19. “NASA’s Multiple Interagency Interfaces Blend Know-How Toward Complex Programs,” Aerospace Management (General Electric Co.) 5. no. 1 (1970), copy in General Jacob Smart Bio File, file 2111, NASA Historical Reference Collection. (Hereafter NASA HRC, NASA Headquarters, Washington, DC (NASA HRC).

20. Johnson, Stephen B., The Secret of Apollo: Systems Management in American and European Space Programs (Baltimore, 2002)Google Scholar; Launius, Roger D., “Managing the Unmanageable: Apollo, Space Management, and American Social Problems” Space Policy 24 (2008): 158–65CrossRefGoogle Scholar; and Needell, Allan A., “James E. Webb, Technology, and the New Deal Roots of ‘Space Age Management,’” Technology and Culture (July 2017): 790–814CrossRefGoogle Scholar.

21. Space Science Technology Panel of the President’s Science Advisory Committee, “The Next Decade in Space” (Washington, DC, March 1970), 1. See also Logsdon, After Apollo?, esp. chap. 5.

22. J. W. Humphreys, “Memorandum for the Record, RE: Health Services Preview Office of Science and Technology,” 10 May 1971, in Federal Council for Science and Technology, file 12476, NASA HRC, 1.

23. The executive summary of the 1969 Space Task Group report is available at https://history.nasa.gov/taskgrp.html; information about President Nixon’s Shuttle decision is at https://history.nasa.gov/stsnixon.htm; and dates of service for and biographical information about NASA Administrators and Deputy Administrators are available from https://history.nasa.gov/prsnnl.htm (all accessed 11 January 2019).

24. Bashshur, Rashid L. and Shannon, Gary W., History of Telemedicine: Evolution, Context, and Transformation (New Rochelle, NY, 2009), 156–97Google Scholar.

25. Space Science Technology Panel of the President’s Science Advisory Committee, “The Next Decade in Space” (Washington, DC, March 1970), 1. See also Logsdon, After Apollo?, esp. chap. 5.

26. Doarn, C. R., Nicogossian, A. E., and Merrell, R. C., “Application of Telemedicine in the United States Space Program,” Telemedicine Journal 4, no. 1 (1998): 19-30CrossRefGoogle ScholarPubMed.

27. Bashshur and Shannon, History of Telemedicine, 203–4.

28. The Health Education Experiments have received some attention from historians. See Tess Lanzarotta and Jeremy Greene, “Communications Technologies as Community Technologies: Alaska Native Villages and the NASA Satellite Health Trials of the 1970s,” https://www.technologystories.org/communications-technologies-as-community-technologies-alaska-native-villages-and-the-nasa-satellite-health-trials-of-the-1970s/ (accessed 11 January 2019, and Bashshur and Shannon, 204–6).

29. NASA Johnson Space Center Press Release number 74-264 “NASA-JSC Tests Apollo-Soyuz Satellite Communications Relay,” 22 October 1974, in ATS-6 File, NASA HRC. For more on the relationship to the National Library of Medicine, The National Library of Medicine, “Programs and Services Fiscal Year 1974” at National Library of Medicine, Bethesda, 33–34.

30. Congressional Record, 21 March 1975 (Humphrey); 2 May 1974 (Moss); 31 July 1974 (Mondale); 30 May 1974, and 5 June 1974 (Teague), in ATS-6 File, file #5652, NASA HRC. This is not an exhaustive listing in the Congressional Record.

31. See, for example, Lyndon Johnson, “Memorandum on the Need for ‘Creative Federalism’ Through Cooperation with State and Local Officials, 11 November 1966, available from https://www.presidency.ucsb.edu/documents/memorandum-the-need-for-creative-Federalism-through-cooperation-with-state-and-local (accessed 11 January 2019). Johnson’s successor, Richard Nixon, embraced a different vision of federalism known as “new Federalism.” See Richard Nixon, “Address to the Nation on Domestic Programs,” 8 August 1969, available at https://www.presidency.ucsb.edu/documents/address-the-nation-domestic-programs (accessed 11 January 2019). A fuller discussion of Nixon’s understanding of Federalism can be found in Bruce Katz, “Nixon’s New Federalism 45 Years Later,” The Avenue (Washington, DC: Brookings Institution), available from https://www.brookings.edu/blog/the-avenue/2014/08/11/nixons-new-Federalism-45-years-later/.

32. Cowie, Jefferson, Stayin’ Alive: The 1970s and the Last Days of the Working Class (New York, 2012)Google Scholar, and Stein, Judith, Pivotal Decade: How the United States Traded Factories for Finance in the Seventies (New Haven, 2011) as two examples of the growing 1970s literatureGoogle Scholar.

33. Bashshur, Technology Serves the People, 85; Pitts, The Human Factor, 118 and 166; Pool, Samuel L. and Belasco, Norman, “An Integrated Medical System for Long-Duration Space Missions,” Journal of Spacecraft and Rockets 9, no. 8 (1972): 613–14CrossRefGoogle Scholar.

34. For examples of internal NASA correspondence discussing the movement to phases C and D of the IMBLMS project, see Robert Gilruth to James W. Humphreys, 24 August 1967, in Skylab-856-IMBLMS Correspondence 1967; assorted memoranda related to procurement in Skylab-856-IMBLMS Correspondence 196; Request for Procurement Plan Approval IMBLMS, 10 August 1971 Skylab-856-IMBLMS Correspondence 1971, all in Records of Johnson Space Center, University of Houston Clear Lake.

35. Bashshur, Technology Serves the People, 85, and Logsdon, After Apollo, 200–201.

36. NASA, “Integrated Medical and Behavioral Laboratory Measurement System,” Phase C Procurement Plan, 20 August 1971, 3. Skylab-856-IMBLMS Correspondence 1971, Records of Johnson Space Center, University of Houston Clear Lake.

37. Site Selection Data Sheet 1972. This was sent as an appendix in a reply letter sent to the Galveston, Texas Health Department in April of 1972 by Richard Johnston. The previous month, W. W. Kemmerer Jr., director of the Health Department, sent Chris Kraft at the Manned Spaceflight Center a letter asking if it might be possible to locate the project in Galveston. Craft referred the letter to Johnston, who replied with the list of site-selection criteria and a suggestion that Kemmerer contact Norman Belasco for more details about how Galveston might be considered. See W. W. Kemmerer Jr. to Chris Craft, 27 March 1972, and Richard Johnston to W. W. Kemmerer Jr., 21 April 1972. Both letters are in Skylab-856-IMBLMS Correspondence 1972, Records of Johnson Space Center, University of Houston Clear Lake.

38. Memorandum from George Low to Edgar Cortright, “Broadened Role for NASA,” folder 57, George M. Low Papers, Folsom Library, Rensselaer Polytechnic Institute, Troy, cited in After Apollo?, 183.

39. George Low, “Personal Notes No. 50,” 4 July 1971, and “Personal Notes No. 51,” 18 July 1971, George M. Low Papers, Folsom Library, Rensselaer Polytechnic Institute, Troy, cited in After Apollo?, 200.

40. Edgar Cortright to George Low cover memo, “Applying NASA Capabilities to National Goals” report, 8 July 1971; Cover memo from James Fletcher to Donald Rice, 21 July 1971; and undated, handwritten cover note from Donald Rice to John Ehrlichman, cited in After Apollo, 200. The “Applying NASA Capabilities to National Goals,” memo and related documents come from box 26, White House Central Files, Richard Nixon Presidential Library and Museum.

41. Richard Johnston to NASA Headquarters, RE: IMBLMS Site Selection, 6 June 1972, in Skylab-856-IMBLMS Correspondence 1972, Records of Johnson Space Center, University of Houston Clear Lake.

42. NASA Headquarters News Release, “Remote Health Care Test Site to Be Selected,” 5 November 1972, Release No: 72-210 Skylab-856-IMBLMS Correspondence 1972, Records of Johnson Space Center, University of Houston Clear Lake.

43. Johnson Memo, Skylab-856-IMBLMS Correspondence 1972, Records of Johnson Space Center, University of Houston Clear Lake.

44. Bashshur, Technology Serves the People, 23–27.

45. NASA Press Release No. 72-210, “Remote Health Care Test Site to Be Selected,” 5 November in Skylab-856-IMBLMS Correspondence 1972, Records of Johnson Space Center, University of Houston Clear Lake.

46. Boeing Company, Candidate Site Analyses: IMBLMS Phase C, vol. 1, 2 October 1972, in Bioinstrumentation Box LS163, John P. McGovern Historical Center, HAM-TMC Library, Houston. General Site Selection Criteria. A summary of the site-selection process can also be found in Bashshur, Technology Serves the People, chap. 5.

47. By comparison, Delaware compromises approximately 2,500 square miles of land. See STARPAHC Record of Transfer from NASA JSC to HEW/HIS/ORD document, 30 April 1977, 1 and, for example, http://state.1keydata.com/states-by-size.php (accessed 3 March 2017). Re the Papago population, see, for example, Pool and Johnston presentation to Royal Society of Medicine, Leyden, Netherlands, 11 October 1974, 9.

48. Bashshur, Technology Serves the People, 69, notes that only a quarter of Papago families owned motor vehicles.

49. Mutting, Paul A. and Connor, Eileen M., Community Oriented Primary Care: A Practical Assessment, Volume II: Case Studies (Washington, DC: Division of Health Care Service, Institute of Medicine, National Academies Press, April 1984), 138Google Scholar, and Office of Inspector General, “Revitalizing the Community Health Representative Program” (Department of Health and Human Services, April 1993), 1.

50. Rife and Dellapenna, Caring and Curing, 49.

51. Bashshur, Technology Serves the People, 63, 65, 69.

52. Ibid., 66. Quotes on 66 and 67.

53. Richard S. Johnston to Jacob Escalente, 15 May 1975. STARPAHC archive: records from the Space Technology Applied to Rural Papago Advanced Health Care project, 1970–79, 1991 (bulk 1972–78) (AHSL HT 0001). Special Collections, University of Arizona Health Sciences Library, Tucson, Box 11, Folder 3.34.

54. See Bashshur, Technology Serves the People, 70–71, 77, and Lanzarotta and Greene.

55. Bashshur, Technology Serves the People, 70–71, 77, 73.

56. Boeing Site Selection Report Appendix A to 5-2720-Hou-2-161. John P. McGovern Historical Center, HAM-TMC Library, Houston.

57. Boeing Site Selection Report, 5-2720-Hou-2-161. 31 May 1972. John P. McGovern Historical Center, HAM-TMC Library, Houston.

58. Bashshur, Technology Serves the People, 46–47.

59. Chronology of Events Leading to IMBLMS Site Selection, attachment to 4 April 1973 memo from Charles Berry to George Low, box 4 of STARPAHC/Papago Indians, 1971–75, National Library of Medicine, Bethesda. In this same file, there is a 6 April 1973 letter from David Sencer, Assistant Surgeon General, to Stuart Rabeau, Director of IHS ORD, informing him of this decision.

60. Rife and Dellapenna, Caring and Curing, 77.

61. Memo of 4 April from Chuck Berry to George Low in document 3.54 STARPAHC Record of Transfer.

62. Bashshur, Technology Serves the People, 88–90, 98, 3–8, and Rife and Dellapenna, Caring and Curing, 77–78.

63. STARPAHC Record of Transfer, document 3.54 from University of Arizona STARPAHC files, 30 April 1977, 3, 8 and 38 (Appendix C).

64. Bashshur Technology Serves the People, 90–91, 99.

65. Final Report: Integrated Medical and Behavioral Laboratory Measurement System, vol. 2, System Considerations (NASA-CR-115648, 14 December 1970); Allan R. Coming, “The Era of Telemedicine: Interactive Audio/Video Telediagnosis Is Proven Viable in both Government- and Privately-Funded Experiments,” IEEE Spectrum 13, no. 12 (1976): 31–36; and Samuel L. Pool and Norman Belasco, “An Integrated Medical System for Long-Duration Space Missions,” Journal of Spacecraft and Rockets 9, no. 8 (1972): 613–14.

66. Important Dates Listing following chap. 7, draft history of the STARPAHC project by Rashid Bashshur, box 4 of STARPAHC/Papago Indians, 1971–75, National Library of Medicine, Bethesda; and Paul A. Mutting and Eileen M. Connor, Community Oriented Primary Care: A Practical Assessment, Volume II: Case Studies (Washington, DC: Division of Health Care Service, Institute of Medicine, National Academies Press, April 1984), 137–39.The data from this publication are from about a decade after the STARPAHC project.

67. Bashshur, Technology Serves the People, 10.

68. Pool and Johnston presentation to Royal Society of Medicine, Leyden, Netherlands, 11 October 1974, 9.

69. Bashshur, Technology Serves the People, 44.

70. Ibid., 10.

71. Ibid., 12.

72. Higgins, C., Dunn, E., and Conrath, D., “Telemedicine: An Historical Perspective,” Telecommunications Policy 8, no. 4 (1984): 307–13CrossRefGoogle Scholar.

73. Michael Fuchs, “Provider Attitudes Toward Telemedicine: Preliminary Findings” paper presented to the second telemedicine workshop, Tucson, 5 December 1975, 9.

74. Michael Rios to Richard Johnston, 18 April 1975. STARPAHC archive: records from the Space Technology Applied to Rural Papago Advanced Health Care project, 1970–79, 1991 (bulk 1972–78) (AHSL HT 0001), Special Collections, University of Arizona Health Sciences Library, Tucson. Box 11, Folder 3.34

75. Johnston to Escalante, 15 May 1975. STARPAHC archive: records from the Space Technology Applied to Rural Papago Advanced Health Care project, 1970–79, 1991 (bulk 1972–78) (AHSL HT 0001). Special Collections, University of Arizona Health Sciences Library, Tucson, Box 11, Folder 3.34

76. See Dillingham, Brint, “Indian Health Service and the Health lnformation System,” American Indian Journal 3, no. 4 (1977): 16–18Google Scholar; Brown, Virginia B., Mason, William B., and Kaczmarski, Michael, “A Computerized Health Information Service,” Nursing Outlook 19, no. 3 (March 1971): 158–60Google ScholarPubMed; and Indian Health Service Office of Research and Development and A Summary of the Initial System Designs (Health Program Systems Center, Indian Health Service, 1969), all cited in deJong, Plagues, Politics, and Policy, 129–30 and 143.

77. DeJong, Plagues, Politics, and Policy, 134, 144–45. DeJong cites “Cronyism Within IHS Alleged”: Arizona Daily Star (Tucson), 18 October 1976, A-1; “Empire Building Charged in Moving ORD Here,” Arizona Daily Star, 17 October 1976, A-4; and “Critics Assail Indian Health Research Efforts,” Arizona Daily Star, 17 October 1976, A-1.

78. UPI, “STARPAHC Brings Medical Care to Reservation,” Hutchinson Daily News, 25 February 1976, 14.

79. Bashshur, Technology Serves the People, 73–76, quotation on 76.

80. See, for examples, Kay, W. D., Defining NASA: The Historical Debate over the Agency’s Mission (Albany, NY, 2005)Google Scholar, and Glen Asner and Stephen Garber, Origins of Twenty-first Century Space Travel: A History of NASA’s Decadal Planning Team and the Vision for Space Exploration, 1999–2004 (NASA, 2019). NASA and its contractors are currently building the Space Launch System and Orion spacecraft to send astronauts into space from U.S. soil.

81. Rife and Dellapenna, Caring and Curing, 79.

82. For information on the policy window concept, see Kingdon, John W., Agendas, Alternatives, and Public Policies (New York, 1995)Google Scholar, cited in Thor Hogan, Mars Wars: The Rise and Fall of the Space Exploration Initiative (NASA SP-2007-4410), 3. Thanks to Audrey Schaffer for mentioning this useful policy window concept in a different context.

83. See, for examples, Frutkin, Arnold, International Cooperation in Space (Englewood Cliffs, 1965)Google Scholar, and Krige, John, Callahan, Angelina Long, and Maharaj, Ashok, NASA in the World: Fifty Years of International Collaboration in Space (New York, 2013)CrossRefGoogle Scholar. One major section of the latter book addresses NASA cooperation with the former Soviet Union and Russia.

84. Lambright, W. Henry, Powering Apollo: James E. Webb of NASA (Baltimore, 1995), 215Google Scholar.