Chen Sophia, Zolo Yvan, Ngulube Lumbani, Isiagi Moses, Maswime Salome
Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
BMC Surg. 2025 Jan 11;25(1):21. doi: 10.1186/s12893-024-02712-9.
Climate change is an emerging global health crisis, disproportionately affecting low- and middle-income countries (LMICs) where health outcomes are increasingly compromised by environmental stressors such as pollution, natural disasters, and human migration. With a focus on promoting health equity, Global Surgery advocates for expanding access to surgical care and enhancing health outcomes, particularly in resource-limited and disaster-affected areas like LMICs. The healthcare industry-and more specifically, surgical care-significantly contributes to the global carbon footprint, primarily through resource-intensive settings, i.e. operating rooms that generate greenhouse gases and substantial medical waste. Therefore, Global Surgery efforts aimed at improving surgical access through an increase in surgical volumes may inadvertently exacerbate health challenges for vulnerable populations by further contributing to environmental degradation. This predicament is particularly pronounced in LMICs, who already suffer from a disproportionate share of the global burden of disease, and where the demand for surgery is rising without corresponding resilient infrastructure. LMICs face a double jeopardy of health inequity coupled with climate vulnerability. As a movement positioned to improve health around the world, Global Surgery has an increasingly significant role in envisioning and ensuring a sustainable future. Global Surgery initiatives must prioritise sustainable infrastructure in both high-income countries (HICs) and LMICs, all while accounting for the unequal polluting contributions between HICs and LMICs and, consequently, moral responsibilities moving forward. Moreover, through targeting upstream causes of poor health at urban and perioperative levels, Global Surgery's interventions may help to reduce the global burden of disease-avoiding preventable surgeries and their carbon footprints from the outset. Altogether, Global Surgery and climate change are two matters of social justice whose solutions must synergistically centralise the health of both the planet and its most vulnerable people.
气候变化是一场新出现的全球健康危机，对低收入和中等收入国家（LMICs）影响尤甚，在这些国家，健康成果日益受到污染、自然灾害和人口迁移等环境压力因素的损害。全球外科手术致力于促进健康公平，主张扩大手术治疗的可及性并改善健康成果，特别是在像低收入和中等收入国家这样资源有限和受灾害影响的地区。医疗行业——更具体地说是外科手术治疗——对全球碳足迹有重大影响，主要是通过资源密集型环境，即产生温室气体和大量医疗废物的手术室。因此，全球外科手术旨在通过增加手术量来改善手术可及性的努力，可能会因进一步加剧环境退化而无意中加剧弱势群体面临的健康挑战。这种困境在低收入和中等收入国家尤为明显，这些国家已经承担了全球疾病负担中不成比例的份额，而且手术需求在上升，却没有相应的有韧性的基础设施。低收入和中等收入国家面临着健康不平等与气候脆弱性的双重困境。作为一项旨在改善全球健康的行动，全球外科手术在构想和确保可持续未来方面发挥着越来越重要的作用。全球外科手术倡议必须在高收入国家（HICs）和低收入和中等收入国家优先考虑可持续基础设施，同时要考虑到高收入国家和低收入和中等收入国家之间不平等的污染贡献以及由此产生的未来道德责任。此外，通过在城市和围手术期层面针对健康不佳的上游原因，全球外科手术的干预措施可能有助于减少全球疾病负担——从一开始就避免可预防的手术及其碳足迹。总之，全球外科手术和气候变化是两个社会正义问题，其解决方案必须协同将地球及其最脆弱人群的健康置于核心位置。
