Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

How could climate services support disaster risk reduction in the 21st century

In January 2018, three leading European initiatives on climate services (CS) and disaster risk reduction (DRR) initiated a discussion on how the DRR community could be best served by new and emerging CS. The aim was to identify challenges and opportunities for delivery of effective operational disaster risk management and communication informed by an understanding of future climate risks. The resulting discussion engaged experts from civil protection, health, insurance, engineering and the climate service community. Discussions and subsequent reflections recognised that CS can strengthen all phases of the DRR cycle and that there are lessons to learn from experience that could enhance and demonstrate the value of CS supporting the DRR community. For this to happen, however, the supporting information should be relevant, accessible, legitimate and credible and engage both service supply and demand sides. It was also agreed that there was need for identifiable and credible champions recognised as providing leadership and focal points for the development, delivery and evaluation of CS supporting DRR. This paper summarises the identified key challenges (e.g. disconnection between CS and DRR; accessibility of relevant and quality-controlled information; understanding of information needs; and understanding the role of CS and its link to the DRR planning cycle). It also suggests taking advantage of the unique opportunities as a result of the increased coherence and mutual reinforcement across the post-2015 international agendas and the increasing recognition that links between public health and DRR can provide impetus and a focus for developing CS that support DRR.</p

Background on uncertainty assessment supporting climate adaptation decision-making

Although trends in climate change are expected to continue, there is considerable uncertainty about the precise rate of change and its concrete impact. A key element in decision-making on climate adaptation is how to deal with this uncertainty. This chapter provides the background information on dealing with uncertainties: descriptions of uncertainty typology, methods of assessment, as well as a framework for dealing with uncertainty in climate adaptation decision-making. The chapter highlights that the classical elements used in uncertainty assessment (statistics, scenarios and recognised ignorance) can be expanded toward five principal uncertainty dimensions that are crucial for informing/supporting adaptation decision-making: location, level, nature, qualification of knowledge base, and value-ladenness. In practice, to deal with uncertainties, but also because of time and budget constraints, uncertainty assessments may follow a three step approach: (1) identify and characterise sources of uncertainty; (2) weigh, appraise, and prioritise uncertainties; and (3) select and apply methods for dealing with uncertainties in policy. Based on political and societal preferences, adaptation strategies could either use top-down or bottom-up approaches considering adaptation action based on the best prediction, robustness, or resilience. Adaptation policies that focus on enhancing the system’s and society’s capability of dealing with possible future changes, uncertainties and surprises (e.g. through resilience, flexibility, and adaptive capacity) seem most appropriate. For potential climate-related effects for which rough risk estimates are available, ‘robust’ measures are recommended. For potential climate effects with limited societal and/or political relevance, ‘no-regret’ measures are recommended. For highly relevant potential climate-related effects, precautionary measures can be considered. The chapter provides also links to the uncertainty approaches in the case studies described in Chap. 4

Background on uncertainty assessment supporting climate adaptation decision-making

Although trends in climate change are expected to continue, there is considerable uncertainty about the precise rate of change and its concrete impact. A key element in decision-making on climate adaptation is how to deal with this uncertainty. This chapter provides the background information on dealing with uncertainties: descriptions of uncertainty typology, methods of assessment, as well as a framework for dealing with uncertainty in climate adaptation decision-making. The chapter highlights that the classical elements used in uncertainty assessment (statistics, scenarios and recognised ignorance) can be expanded toward five principal uncertainty dimensions that are crucial for informing/supporting adaptation decision-making: location, level, nature, qualification of knowledge base, and value-ladenness. In practice, to deal with uncertainties, but also because of time and budget constraints, uncertainty assessments may follow a three step approach: (1) identify and characterise sources of uncertainty; (2) weigh, appraise, and prioritise uncertainties; and (3) select and apply methods for dealing with uncertainties in policy. Based on political and societal preferences, adaptation strategies could either use top-down or bottom-up approaches considering adaptation action based on the best prediction, robustness, or resilience. Adaptation policies that focus on enhancing the system’s and society’s capability of dealing with possible future changes, uncertainties and surprises (e.g. through resilience, flexibility, and adaptive capacity) seem most appropriate. For potential climate-related effects for which rough risk estimates are available, ‘robust’ measures are recommended. For potential climate effects with limited societal and/or political relevance, ‘no-regret’ measures are recommended. For highly relevant potential climate-related effects, precautionary measures can be considered. The chapter provides also links to the uncertainty approaches in the case studies described in Chap. 4