In the last few months, the battle between Jeremy Hunt and the entire medical profession regarding the unworkable contracts he is set to impose unilaterally on NHS junior doctors has continued to rage. Many see the contract as a deliberate plan to cripple the NHS, funnelling ever more services towards the private healthcare providers which the Health Secretary has links to. Meanwhile, across the pond, Senator Bernie Sanders is pushing his single-payer health plan as a replacement for Obamacare, and a major plank in his presidential bid.

With that in mind, it seems a good time to talk about medical care.

The first thing to consider here is what, exactly, the kinds of medical issues your fictional world needs to worry about. Your historical world might suffer from bubonic plagues, typhus, cholera and dysentery. Your culture surviving on scraps of food may have issues with scurvy and rickets. Your space-faring civilisation might encounter diseases unknown to medical science.

Additionally, your diseases might affect one species but not others, else have different effects from one species to another. The most famous example here is the common cold proving fatal to Wells’ Martian invaders, and the range of magical diseases in the Harry Potter universe also offer a variant of this idea.

Example: The Gellerian Mastery is home to two races; humans and the lemur-like Ijjia. While the two races coexist in harmony, the Ijjia are particularly affected by a new disease brought back by trader; while humans get nothing but a mild headache, Ijjian immune systems are completely unable to recover, and it usually results in their death.

How might this uneven effect of a disease play out for the Gellerian Mastery? Might it cause deep rifts between the humans and the Ijjia, as the Ijjia fear for their lives? Might it lead to segregation and quarantine?

Another side to this is access to healthcare. Is healthcare provided for free for every citizen, as is currently the case in the UK, or is it a complex network of private providers and expensive insurance as is currently the case in the US? How might this affect how your society operates? Might people be forced to do things they would rather not in order to pay for their healthcare (as seen in Breaking Bad and about 50% of Simpsons episodes), or might they take healthcare for granted and perhaps take more risks than they otherwise would?

Let us return to our Gellerian Mastery example, but change the parameters slightly;

Example: The Gellerian Mastery is home to two races; humans and the lemur-like Ijjia. When a new disease is brought back by traders and begins to spread like wildfire, a cure is quickly found. For the humans only. Due to decades of extra funding for research for the majority human population, medical understanding of human biology is much better than that of the Ijjia, and the same cure simply isn’t compatible with Ijjian bodies.

Here we can see a society with an apparently insurmountable issue with medical care. While officially both races are equal, with equal access to medical cover, one of the races is likely to always have better medical care than the other.

How might this change affect the civilisation? Might the Ijjia come to resent the humans, seeing them as not treating them with the equal concern they deserve? Might the Ijjia have a lower social status due to regular illness disrupting education and work? Whatever the result, how your society’s medical system is set up will have a huge impact on how this story might play out.