Diversity regained: Precautionary approaches to COVID-19 as a phenomenon of the total environment

As COVID-19 emerged as a phenomenon of the total environment, and despite the intertwined and complex relationships that make humanity an organic part of the Bio- and Geospheres, the majority of our responses to it have been corrective in character, with few or no consideration for unintended consequences which bring about further vulnerability to unanticipated global events. Tackling COVID-19 entails a systemic and precautionary approach to human-nature relations, which we frame as regaining diversity in the Geo-, Bio-, and Anthropospheres. Its implementation requires nothing short of an overhaul in the way we interact with and build knowledge from natural and social environments. Hence, we discuss the urgency of shifting from current to precautionary approaches to COVID-19 and look, through the lens of diversity, at the anticipated benefits in four systems crucially affecting and affected by the pandemic: health, land, knowledge and innovation. Our reflections offer a glimpse of the sort of changes needed, from pursuing planetary health and creating more harmonious forms of land use to providing a multi-level platform for other ways of knowing/understanding and turning innovation into a source of global public goods. These exemplary initiatives introduce and solidify systemic thinking in policymaking and move priorities from reaction-based strategies to precautionary framework

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The Factual Nature of Resource Flow Accounting in the Calculation in Kind of the “Other Austrian Economics”

In the 1910s and 1920s, Austrian thinkers Josef Popper-Lynkeus (1838–1921) and Otto Neurath (1882–1945) ascended as the main advocates of a heterodox, biophysical approach to economic science dubbed the “Other Austrian Economics”. Their ideas included an emphasis on economic planning based on calculation in kind as means to regulate production and distribution processes toward improved living standards for all. Natural resource flow accounting posed as the main method through which they collected empirical evidence in order to develop new policy-relevant economic theories. This paper analyzes in detail what the ontological and epistemological assumptions underlying their resource flow accounting were, as well as how facts and values interplayed in their argumentation for calculation in kind as a key tool for economic science. Based on seminal works of Neurath and Popper-Lynkeus concerning the subject of the factual nature of such socioecological flows and stocks of matter and energy, the empirical character of their assessments can hardly be denied, while a genuine concern for the role played by value-based judgements in decisions about production and consumption is recurrent. They faced head-on the challenges posed by incommensurable values, and believed value-based judgements are political decisions. The more information there is about alternative economic plans, the better these decisions would be, especially in terms of a materially and energetically rational relationship between nature and society.Dans les années 1910 et 1920, les penseurs autrichiens Josef Popper-Lynkeus (1838-1921) et Otto Neurath (1882-1945) sont devenus les principaux défenseurs d'une approche hétérodoxe et biophysique de la science économique, appelée "l'autre économie autrichienne". Leurs idées mettaient l'accent sur une planification économique fondée sur le calcul en nature comme moyen de réguler les processus de production et de distribution, en vue d'améliorer le niveau de vie de tous. La comptabilité des flux de ressources naturelles a été la principale méthode utilisée pour recueillir des preuves empiriques afin de développer de nouvelles théories économiques utiles pour les politiques publiques. Cet article analyse en détail les hypothèses ontologiques et épistémologiques qui sous-tendent la comptabilité des flux de ressources, ainsi que la manière dont les faits et les valeurs interagissent dans leur argumentation pour le calcul en nature en tant qu'outil clé de la science économique. S'appuyant sur les travaux fondateurs de Neurath et Popper-Lynkeus concernant la nature factuelle de ces flux et stocks socio-écologiques de matière et d'énergie, le caractère empirique de leurs évaluations peut difficilement être nié, alors qu'une véritable préoccupation pour le rôle joué par les jugements de valeur dans les décisions de production et de consommation est récurrente. Ils ont fait face aux défis posés par des valeurs incommensurables, et ont estimé que les jugements de valeur sont des décisions politiques. Plus il y a d'informations sur les plans économiques alternatifs, plus ces décisions peuvent être dites bonnes, notamment en ce qui concerne une relation matériellement et énergétiquement rationnelle entre la nature et la société

Escrevendo a história do pensamento econômico-ecológico

A história do pensamento econômico-ecológico (PEE) tem sido construída de diversas formas e de acordo com diferentes fundamentos, dado o caráter evolutivo de conceitos relacionados a processos naturais e econômicos. Este artigo propõe um arcabouço teórico para se entender o PEE como um conjunto de ideias interligando as esferas social e natural por meio de ontologias e epistemologias compartilhadas. Essas ideias se opõem a dicotomias entre o humano e o natural que caracterizam o pensamento ocidental moderno, contribuindo para a elucidação de desafios contemporâneos no contexto da sustentabilidade e oferecendo uma história intelectual estruturada das raízes da economia ecológica. O artigo defende que escrever a história do PEE requer o escrutínio dos desafioshistoriográficos, em particular dos riscos associados ao presentismo e ao anacronismo; além disso, ele traz uma revisão da literatura sobre PEE e, finalmente, identifica novas linhas de pesquisa com destaque para narrativas globais.The history of ecological economic thought (EET) has been addressed in different ways and according to multifarious foundations, given the evolving character of conceptions of natural processes and economic phenomena. This article proposes a theoretical framework for understanding EET as the set of ideas bridging the social and the natural worlds by means of shared ontologies and epistemologies. These ideas stand against the human-nature divide which characterizes modern Western thought, contribute to thinking about contemporary sustainability challenges, and offer a more structured intellectual history of the roots of ecological economics. The article argues that writing the history of EET calls for an appraisal of historiographical challenges, in particular the risks posed by presentism and anachronism. It also reviews the literature engaging with the history of EET and, finally, identifies new lines of research, especially in terms of global narratives.La historia del pensamiento económico-ecológico (EEP) se ha construido de diferentes formas y según diferentes fundamentos, dado el carácter evolutivo de los conceptos relacionados con los procesos naturales y económicos. Este artículo propone un marco teórico para entender el PEE como un conjunto de ideas que vinculan las esferas social y natural a través de ontologías y epistemologías compartidas. Estas ideas se oponen a las dicotomías entre lo humano y lo natural que caracterizan el pensamiento occidental moderno, contribuyendo a dilucidar los desafíos contemporáneos en el contexto de la sustentabilidad y ofreciendo una historia intelectual estructurada de las raíces de la economía ecológica. El artículo argumenta que escribir la historia del PEE requiere el escrutinio de los desafíos historiográficos, en particular los riesgos asociados con el presentismo y el anacronismo; además, trae una revisión de la literatura sobre PEE y, finalmente, identifica nuevas líneas de investigación con énfasis en las narrativas globales

A History of Ecological Economic Thought

International audienceContributing to a better understanding of contemporary issues of environmental sustainability from a historical perspective, this book provides a cohesive and cogent account of the history of ecological economic thought (EET). The work unearths a diverse set of ideas within a Western and Slavic context, from the Renaissance and the Enlightenment to the late 1940s, to reveal insights firmly grounded in historiographical research and of import for addressing current sustainability challenges, not least by means of improving our grasp on how humans and nature can generously coexist in the long term.The history of EET offered in this volume is rich and diverse, encompassing views that are bound by the observance of the tenets of the natural sciences, but which differ significantly in terms of the role of energy and materials to cultural development and the normative aspects involving resource distribution, social ideals and policy-making. Combining the approaches of independent scholarly figures and scientific communities from different historical periods and nationalities, the book brings elements that are still missing in the scarce literature on the history of ecological economic thought and highlights the underlying threads which unite such initiatives.The book brings a fresh look into the historical development of ecological economic ideas and will therefore be of great interest to scholars and students of ecological economics, environmental economics, sustainability science, interdisciplinary studies and history of economic thought

Escrevendo a história do pensamento econômico-ecológico: desafios e perspectivas

International audienceThe history of ecological economic thought (EET) has been addressed in different ways and according to multifarious foundations, given the evolving character of conceptions of natural processes and economic phenomena. This article proposes a theoretical framework for understanding EET as the set of ideas bridging the social and the natural worlds by means of shared ontologies and epistemologies. These ideas stand against the human-nature divide which characterizes modern Western thought, contribute to thinking about contemporary sustainability challenges, and offer a more structured intellectual history of the roots of ecological economics. The article argues that writing the history of EET calls for an appraisal of historiographical challenges, in particular the risks posed by presentism and anachronism. It also reviews the literature engaging with the history of EET and, finally, identifies new lines of research, especially in terms of global narratives.A história do pensamento econômico-ecológico (PEE) tem sido construída de diversas formas e de acordo com diferentes fundamentos, dado o caráter evolutivo de conceitos relacionados a processos naturais e econômicos. Este artigo propõe um arcabouço teórico para se entender o PEE como um conjunto de ideias interligando as esferas social e natural por meio de ontologias e epistemologias compartilhadas. Essas ideias se opõem a dicotomias entre o humano e o natural que caracterizam o pensamento ocidental moderno, contribuindo para a elucidação de desafios contemporâneos no contexto da sustentabilidade e oferecendo uma história intelectual estruturada das raízes da economia ecológica. O artigo defende que escrever a história do PEE requer o escrutínio dos desafios historiográficos, em particular dos riscos associados ao presentismo e ao anacronismo; além disso, ele traz uma revisão da literatura sobre PEE e, finalmente, identifica novas linhas de pesquisa com destaque para narrativas globais

A History of Ecological Economic Thought

International audienceContributing to a better understanding of contemporary issues of environmental sustainability from a historical perspective, this book provides a cohesive and cogent account of the history of ecological economic thought (EET). The work unearths a diverse set of ideas within a Western and Slavic context, from the Renaissance and the Enlightenment to the late 1940s, to reveal insights firmly grounded in historiographical research and of import for addressing current sustainability challenges, not least by means of improving our grasp on how humans and nature can generously coexist in the long term.The history of EET offered in this volume is rich and diverse, encompassing views that are bound by the observance of the tenets of the natural sciences, but which differ significantly in terms of the role of energy and materials to cultural development and the normative aspects involving resource distribution, social ideals and policy-making. Combining the approaches of independent scholarly figures and scientific communities from different historical periods and nationalities, the book brings elements that are still missing in the scarce literature on the history of ecological economic thought and highlights the underlying threads which unite such initiatives.The book brings a fresh look into the historical development of ecological economic ideas and will therefore be of great interest to scholars and students of ecological economics, environmental economics, sustainability science, interdisciplinary studies and history of economic thought

Escrevendo a história do pensamento econômico-ecológico: desafios e perspectivas

International audienceThe history of ecological economic thought (EET) has been addressed in different ways and according to multifarious foundations, given the evolving character of conceptions of natural processes and economic phenomena. This article proposes a theoretical framework for understanding EET as the set of ideas bridging the social and the natural worlds by means of shared ontologies and epistemologies. These ideas stand against the human-nature divide which characterizes modern Western thought, contribute to thinking about contemporary sustainability challenges, and offer a more structured intellectual history of the roots of ecological economics. The article argues that writing the history of EET calls for an appraisal of historiographical challenges, in particular the risks posed by presentism and anachronism. It also reviews the literature engaging with the history of EET and, finally, identifies new lines of research, especially in terms of global narratives.A história do pensamento econômico-ecológico (PEE) tem sido construída de diversas formas e de acordo com diferentes fundamentos, dado o caráter evolutivo de conceitos relacionados a processos naturais e econômicos. Este artigo propõe um arcabouço teórico para se entender o PEE como um conjunto de ideias interligando as esferas social e natural por meio de ontologias e epistemologias compartilhadas. Essas ideias se opõem a dicotomias entre o humano e o natural que caracterizam o pensamento ocidental moderno, contribuindo para a elucidação de desafios contemporâneos no contexto da sustentabilidade e oferecendo uma história intelectual estruturada das raízes da economia ecológica. O artigo defende que escrever a história do PEE requer o escrutínio dos desafios historiográficos, em particular dos riscos associados ao presentismo e ao anacronismo; além disso, ele traz uma revisão da literatura sobre PEE e, finalmente, identifica novas linhas de pesquisa com destaque para narrativas globais