Help the Chinese elderly better adapt to climate change and extreme heat

CSC annual conference 2013

Dr Ying ZhangSchool of Public HealthChina Studies Centre

2

Background- Global Climate change and population ageing are two emerging public

health threats in both developed and developing countries in the 21th Century.

“Warming in the climate system is unequivocal”- (IPCC2013 AR5).

Evidence suggests that older people are at a particular risk to extreme heat.

3

› More heatwaves observed in recent years› The only country with more than 100 million older people, and the

world’s fastest ageing country› Little attention paid to the exploration of relevant adaptive strategies

specifically for the elderly

Background - China

4

Background- Ageing health during heat

• It is the elderly who are the most affected during heatwaves.

• The highest proportion of deaths during heatwaves always occurs amongst those who are older.

• Contributing factors to heat intolerance:

- Age-related decline in general health

- Capacity to cope

- Socio-economic status

- Available support

- …

5

Aims

• Research is insufficient in this field, particularly in developing countries

• Research aims

i. What are the Chinese older people’s perceptions, knowledge and behaviours regarding extreme heat and health?

ii. What are the barriers for a better adaptation?

6

Methods: Quantitative and Qualitative

› A cross-sectional survey- Conducted in late summer 2012

- In a temperate region in northern China

- Including urban and rural areas

- Face-to-face questionnaire-based interviews

- Two-stage cluster sampling for residents

aged 60 and over

- Questions covered perceptions, behaviours and

contributing factors

- Descriptive, comparison and regression analyses

1208 questionnaires were collected, 600 from the rural areas

7

› In-depth interviews- Grounded theory- Participants:

- 20 individual elderly over 60 years old with a diverse socio-economic status;

- 5 stakeholders from private and public nursing homes, local Ageing Council and local Centres for Disease Prevention and Control.

- Text-based thematic qualitative analyses, aided by Nvivo

Methods: Quantitative and Qualitative

8

The map of study locations in urban and rural areas in Shandong Province, China

9

Results & Discussion

Table 1 Characteristics of the study populations in urban and rural areaa

The rural elderly were older, more males, having a lower income, a lower education level, more living alone, less air-con at home, less medication, less social contacts.

10

no conce

rn

little

conce

rn

some c

oncern

moderate

conce

rn

major c

oncern

don't know

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

ruralurban

Results and Discussion

“How much of a concern do you think extreme heat is for your health?” *

*Comparison between rural and urban areas, p>0.05

App. 70%

11

own fe

elings*

own hea

lth

how to

cope

*

how ot

hers

cope

healt

h of fa

mily m

ember

s

pets/

animals*

gard

en/plants

*co

st*

sche

dule

of goin

g out

inconv

enien

ce*

water use

restr

iction

*fire

dura

tion o

f hea

t*

hous

e tempe

ratur

e

not a

t all w

orrie

d

don't

know

refus

ed0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Urban

Rural

Perc

enta

ge

Results & Discussion

* Comparison between rural and urban areas, p<0.05

The elderly’s worries during heatwaves

12

Results & Discussion

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

The elderly’s adaptive behaviours during heatwaves

Urban

Rural

* Comparison between rural and urban areas with p<0.05

13

Results & Discussion

Table 2: Responses to questions about support and resource received regarding heatwaves

Less support and less resource for the rural elderly

14

Table 3 Multiple logistic regression results showing odds ratios (OR), 95% confidence intervals (CI) and p-values for significant risk factors of reporting any of the following symptoms (anxiety, loss of balance/dizziness, a fall, headache, shortness of breath, heat stress, heart condition, renal condition, something else) during heatwaves.

Results and Discussion

15

Results and Discussion

› Results from Qualitative interviews- From the participated elderly:- All of the participated elderly believed the climate is getting warmer based on their own

experience.- “The climate has definitely changed as I don’t need to wear very thick cotton-padded coat (Mian’ao) like in

the old days.” - F, 75, Rural

- None of them could explain clearly what a ‘heatwave’ is and its possible impacts on human health. - “I have never heard about ‘heatwave’…Is it a wave from the sea? I know nothing about its impact.” - F, 69,

Urban; and many other participants

- Some of them did mention behaviour changes on very hot days but some did not perceive any potential risk upon themselves. - “I will go to the market in early mornings if it is going to be very hot.” -F, 65, Urban

- “I am not worried about myself in hot days and don’t need any help.” - M, 73, Rural

- Lack of support and lack of trust- “I have not received any information about health and climate change at all.”- F, 65, Rural

- “I doubt the government will do anything serious about climate change as it will affect our economic development…look at the bad air quality we still have regardless what the government says” – M, 73, Urban

16

› Results from Qualitative interviews- From the participated stakeholders:- A lack of concern/knowledge for climate change as a health risk;

- “It is true that some diseases peak at some time of the year, which may be related to short changes of seasons. As for a long-term climate change, there won’t be any impact on the older people.”- a doctor in a public nursing home

- Not enough government commitment, resource and collaboration at a local level; - “We have a lot of work to do and really no extra funding and time to think about how to response to

climate change at present.” “Who shall we work with?” ““Climate change is a topic that developed country used to hinder the development in developing countries.” – Committee of Ageing

- No existing relevant adaptation strategies, policies or action plans; - “We are at the stage of “complaining”, we haven’t started doing anything for climate change, which

may be a neglect of our duty.” – CDC

- A lack of preparation to respond to extreme weather events related to climate change.- “We don’t have any particular preparation for summers as we are living in the mountain area and

summer is usually not bad for older people here.” – owner of a private nursing home

Results and Discussion

17

Take-home messages

• Majority of the Chinese elderly are not concerned about their own health during heatwaves but many would take behavior change to adapt.

• The elderly living in the rural areas have more worries but less resource/support to cope with heatwaves.

• How can we help the elderly better adapt to climate change and extreme heat?

• To increase awareness• To build capacity and develop strategies • To generate local government leadership with a multi-sectoral

collaboration scheme• To focus on vulnerable population at a higher risk and in rural areas

Acknowledgement

Endeavour Australia Cheung Kong Research Fellowship

Thank you!