Background Older adults are considered a vulnerable group to the risks and impacts of climate change. Health inequalities are strongly associated with increased extreme temperatures morbidity and mortality rates among older adults. This study investigates the impact of health inequalities on the susceptibility (i.e. vulnerability), ability to act (i.e. resilience) and capacity to respond (i.e. adaptation) to the challenges extreme temperatures pose to human health.
Methods Primary data was collected at the individual level through the development and implementation of an inter-seasonal study (i.e. summer and winter). It included a survey and two sets of interviews with 52 independently living older adults aged 65 years or more in the city of Lisbon, Portugal. We used a mixed methods approach to assess the levels of vulnerability and resilience taking into account the distribution of the wider determinants of health (e.g. education, housing, built environment). We used thematic analysis and triangulation to compare and contrast the quantitative and qualitative findings. The role of health inequalities in shaping vulnerability, resilience and adaptation to extreme temperatures was assessed. Analyses were conducted in SPSS and NVivo.
Results Overall, we investigated the socioeconomic status, education, housing, physical environment, built environment, health system and social environment of older adults in our sample. Results indicate an unequal distribution of health determinants between older adults’ with clear impacts on their ability to respond to threats such as extreme temperatures. Older adults living with lower pensions (46.1%), in poor quality housing, lack of accessibility to local services and amenities (42.3%) and lower levels of social capital (88.5%) were those with higher levels of vulnerability to extreme heat and cold temperatures (75.0% and 73.9%, respectively). The qualitative data provided a deeper understanding of health inequalities revealing several emergent themes (e.g. need for independence, thrift). These findings were found to influence the ability of older people to access, mobilise and use the resources available to them (i.e. resilience) and engage in protective behaviours or responses in face of extreme temperatures (i.e. adaptation).
Conclusion Unequal distribution of health determinants resulted in different levels of vulnerability and resilience, as well as adaptation to extreme temperatures. Health inequalities play a significant role in increasing vulnerability, reducing resilience and undermining adaptation. This research represents an opportunity for developing public health responses aiming at reducing health inequalities, as a matter of fairness and social justice, for the promotion of older adults’ health from extreme temperatures risks, and benefit a growing ageing population.
- Health inequalities
- Extreme temperatures