Promoting climate-resilient health systems through national surgical plans

The beginning of 2024 evidenced a series of climate-related catastrophes in Latin America. Devastating wildfires in Colombia and Chile, along with floods and heat waves in Brazil, underscore the urgent need for climate action. Moreover, these events have a profound impact on healthcare systems by increasing the burden of trauma and other medical needs. In May, the 77th World Health Assembly (WHA77) accepted a resolution on Climate and Health, calling for concrete actions from governments and highlighting the need to address the healthcare impacts of climate change.¹ This includes building resilient healthcare systems that can withstand the increasing frequency of climate-related events, while reducing their carbon footprint. Ecuador's National Surgical Strengthening Plan (NSSP), recognized internationally as the National Surgical, Obstetric, and Anesthesia Plan (NSOAP), is not only the first in Latin America, but also the first NSOAP to address climate change, which can serve as a building block towards climate resilient health systems regionally and globally.^2,3

The carbon footprint of surgical care is considerably high within health care. While the healthcare sector contributes roughly 5% of all global greenhouse gas emissions, the operating room is up to 6 times as energy-intensive as other clinical areas and produces more than half of all hospital waste.^4,5 Considering the significant footprint of medical and surgical care provision, efforts must focus on monitoring and reducing the environmental impact of healthcare at the national planning level. Conversely, climate change results in an increased burden of surgical disease, including increased traumatic injuries and delays resulting from extreme weather events, adverse pregnancy outcomes due to heat and pollution exposure, and displacement of population, leading to migration of demand.⁶ From 2004 to 2014, an estimated 140 million individuals annually were impacted by climate-related disasters, translating into the need for an additional 7 million surgical interventions annually.⁷ Alarmingly, these numbers are expected to increase year-on-year as we witness the increasing incidence and severity of natural hazards and climate catastrophes.⁸ Given the significant intersection between surgical care and climate change,⁹ surgical system strengthening and emergency preparedness play a key role in responding, recovering, and rebuilding when these events happen. In this context, governments from all countries hold an urgent responsibility.²

Ecuador's NSSP integrates surgical care within the country's broader health agenda, with a focus on climate change and emergency preparedness, especially in light of the approaching El Niño-Southern Oscillation (ENSO) event.¹⁰ The integration of climate objectives within the plan is a strategic move to develop healthcare systems that are resilient to immediate environmental crises and capable of mitigating future risks exacerbated by climate change. The plan identifies critical priorities such as interfacility communication and coordination among national and international actors. The proposed strategic objectives and activities encompass both adaptation and mitigation. This includes risk assessment, emergency preparedness, national response initiatives, and strategies to reduce the surgical footprint. These initiatives were integrated into the six domains of the NSSP (Fig. 1). Although initially not discussed in the stakeholder meeting conducted at the beginning of every NSSP to define national priorities led by local champions, climate change was later included in the process, aligning with Ecuador's preexisting disaster preparedness plan. This preexisting plan, established in anticipation of the next ENSO phenomenon, prepares various institutions to better manage high rainfall, floods, landslides, and coastal erosion.¹⁰ This alignment highlights the importance of strategic health system planning in addressing cross-sectoral national priorities.

Fig. 1.

The six domains of NSOAPs with emphasis on climate change adaptation in Ecuador's NSSP.

However, like many countries in Latin America, Ecuador's healthcare system is fragmented and lacks an integrated electronic medical record or integrated data registry and communication portal, limiting coordination and data sharing.¹¹ The NSSP seeks to address this by fostering collaboration and advocating for a unified electronic health record (EHR) system to enable real-time data sharing. Aligned with the Ministry of Health's Decennial Health Plan, which emphasizes digital transformation, the plan leverages information and communication technologies to enhance efficiency.¹² Rwanda's and Brazil's implementation of a national EHR system illustrate how this approach can improve coordination between healthcare providers, reduce delays, and enhance patient outcomes.^13,14 Moreover, the NSSP has proposed a series of implementation projects, some of which have direct implications towards improving data systems and creating trauma data registries as a small step towards improved patient quality outcomes, including climate resilience.³ Approaching climate change from an interdisciplinary and cross-sectoral perspective offers a model for other nations at risk of its impacts, enabling more effective disaster management and risk reduction.⁸

The urgent need for climate action is evident. Governments must take action to make decisive, collective efforts to tackle the multifaceted challenges of climate change. Focusing on climate-resilient surgical system strengthening will have a significant impact on reducing the healthcare footprint while saving lives. Promoting the development of NSSPs, regionally and globally, and including crucial components such as climate change mitigation and adaptation ensures a step in the right direction.

Contributors

AG, TUL and ABV conceptualized and defined the design of the manuscript. AG administered the manuscript's activities. CF, TW, NK, EJM, TUL, CDM, JGM, RJ, MJF, and ABV made substantial contributions to the acquisition, analysis, and interpretation of the information discussed. AG, CF and TW wrote the original draft. NK, EJM, TUL, CDM, JGM, RJ, MJGF, and ABV reviewed and critically edited the manuscript. TUL and ABV supervised the manuscript. All authors approve of the final version and agree to be accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Declaration of interests

The authors declare no conflicts of interest.