www.thelancet.com/planetary-health Vol 4 November 2020 e538 Personal View Lancet Planet Health 2020; 4: e538–43 *Joint first authors Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School (L Roa MD, L Velin, C D McClain MD, Prof J G Meara MD) and Center for Climate, Health and the Global Environment, Harvard T H Chan School of Public Health (A Bernstein MD), Harvard University, Boston, MA, USA; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada (L Roa); Surgery and Public Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden (L Velin); Ministry of Health and Medical Services, Suva, Fiji (J Tudravu MD); Department of Anesthesiology, Critical Care and Pain Medicine (C D McClain), Department of Pediatrics (A Bernstein), and Department of Plastic and Oral Surgery (Prof J G Meara), Boston Children’s Hospital, Boston, MA, USA; and Climate and Health Initiative, Harvard Global Health Institute, Harvard University, Cambridge, MA, USA (A Bernstein) Correspondence to: Dr Lina Roa, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA 02115, USA lroa123@gmail.com Climate change: challenges and opportunities to scale up surgical, obstetric, and anaesthesia care globally Lina Roa*, Lotta Velin*, Jemesa Tudravu, Craig D McClain, Aaron Bernstein, John G Meara Climate change afects human health in a myriad of ways, requiring reassessment of the nature of scaling up care delivery and the efect that care delivery has on the environment. 5 billion people do not have access to safe and timely surgical care, and the quantity and severity of conditions that require surgical, obstetric, and anaesthesia care will increase substantially as a result of climate change. However, surgery is resource intensive and contributes substantially to greenhouse-gas emissions. In response to climate change, the surgical, obstetric, and anaesthesia community has a key role to play to ensure that a scale-up of service delivery incorporates mitigation and adaptation strategies. As countries scale up surgical care, understanding the implications of surgery on climate change and the implications of climate change on surgical care will be crucial in the development of health policies. Introduction Climate change is one of the biggest threats to human health. It will afect everyone; however, climate change will have the most devastating efects on people who are poor and marginalised. Climate change results from the accumulation of greenhouse gases that trap heat in the atmosphere, resulting in rising temperatures. The most common greenhouse gas from human activity is carbon dioxide (CO 2 ), followed by methane, nitrous oxide, and fuorinated gas. 1 The main sources of CO 2 emis- sions are electricity, transportation, industry, commercial and residential use, and agriculture. 1 As a result of the increased global burning of coal and fossil fuels, concentrations of CO 2 are rising at unprecedented rates. Climate change afects health and is changing the burden of disease. 2 Air pollution is worsening, par- ticularly in rapidly growing economies, such as China and India, leading to an increase in pulmonary diseases. 3,4 Rising temperatures have resulted in approximately 125 million more people who have health issues related to heat, such as dehydration, heatstroke, and cardio- vascular disease, in 2016 compared with in 2000. 5 Extremes of precipitation and fooding are increasing in severity and continue to have a health and economic efect. 6 For example, in 2017, the Atlantic storms that devastated Puerto Rico, Texas state (USA), and Florida state (USA) resulted in more than US$300 billion in economic damage. 7 Increased severity and frequency of natural disasters increase the need for trauma care and resilient health systems. 1 Furthermore, in addition to the direct efect that climate change has on health, it also afects the social determinants of health, including housing, poverty, food and water availability, and air quality. Despite working to improve patient and population health, the health-care sector is contributing to climate change. For example, 4% of global carbon emissions come from health-care systems in two member countries of the Organisation for Economic Co-operation and Development: India and China. 8 Promoting population health and addressing climate change are not mutually exclusive goals; it is possible to modify the methods by which we deliver care such that we improve human and planetary health and economic wellbeing at the same time. In particular, when accounting for health co- benefts (ie, positive benefts related to the reduction of greenhouse gases) of decreased air pollution, renewable energy programmes are cost-saving, and carbon pricing has been estimated to deliver $211 in health co-benefts per ton of CO 2 reduced by 2030. 9 There is also a cost that comes with an absence of preparation for extreme events because operations and utilities are disrupted, resulting in increased capital, operating, and supply chain costs. 10 Climate change will afect human health in a myriad of ways, which requires reassessment of the efect that care delivery has on the environment and the importance of scaling up care delivery. Climate change and surgery, obstetric, and anaesthesia care Growing evidence exists that climate change afects human health, but the intersection of surgical care and climate change has received little attention. Anthropogenic greenhouse gases have resulted in increasing tempera- tures, rising sea levels, air pollution, and increasing natural disasters, all of which afect surgical, obstetric, and anaesthesia (SOA) care (fgure 1). Rising tempera- tures are changing the obstetric and neonatal burden of Key messages • Climate change is a threat to global public health, which will change the burden of surgical disease and exacerbate existing health disparities. • Surgical, obstetric, and anaesthesia care is one of the major contributors to climate change within the health sector. The global need to scale up surgical, obstetric, and anaesthesia care could lead to further acceleration of climate change if measures of adaptation and mitigation are not taken. • To face climate change, resilient health systems that include sustainable solutions to scale up surgical, obstetric, and anaesthesia care are needed.