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Help the Chinese elderly better adapt
to climate change and extreme heat
School of Public Health
China Studies Centre
Dr Ying Zhang
CSC annual conference 2013
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.
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Background - China
› 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
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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
-
…
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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?
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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
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Methods: Quantitative and Qualitative
› In-depth interviews
- Grounded theory
- Participants:
- 20 individual elderly over 60 years old with a diverse socioeconomic 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
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The map of study locations in urban and rural areas in Shandong
Province, China
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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.
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Results and Discussion
“How much of a concern do you think extreme heat is for your health?” *
60.00%
App. 70%
50.00%
40.00%
30.00%
rural
urban
20.00%
10.00%
0.00%
no
little
some moderate major
concern concern concern concern concern
don't
know
*Comparison between rural and urban areas, p>0.05
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Results & Discussion
The elderly’s worries during heatwaves
70.00%
60.00%
Percentage
50.00%
40.00%
30.00%
Urban
Rural
20.00%
10.00%
0.00%
* Comparison between rural and urban areas, p<0.05
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Results & Discussion
The elderly’s adaptive behaviours during heatwaves
100.00%
90.00%
80.00%
70.00%
60.00%
Urban
Rural
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
* Comparison between rural and urban areas with p<0.05
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Results & Discussion
Table 2:
Responses to
questions
about support
and resource
received
regarding
heatwaves
Less support
and less
resource for
the rural
elderly
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Results and Discussion
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.
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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
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Results and Discussion
› 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
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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
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Acknowledgement
Endeavour Australia Cheung Kong
Research Fellowship