Help the Chinese elderly better adapt to climate change and extreme heat CSC annual conference 2013 Dr Ying Zhang School of Public Health China 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.

›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 3 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?

Methods: Quantitative and Qualitative ›A cross-sectional survey -Conducted in late summer 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 6

›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 7 Methods: Quantitative and Qualitative

The map of study locations in urban and rural areas in Shandong Province, China 8

Results & Discussion Table 1 Characteristics of the study populations in urban and rural areaa 9 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.

Results and Discussion 10 “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 Results & Discussion * Comparison between rural and urban areas, p<0.05 The elderly’s worries during heatwaves

Results & Discussion 12 * Comparison between rural and urban areas with p<0.05

Results & Discussion Table 2: Responses to questions about support and resource received regarding heatwaves 13 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

›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 15

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