Healthy Aging in Rural Guangdong Province, China

December 14, 2021

Information

Robert Johnston, PA-SIII

Advisor: Kaveh Khoshnood, PhD, MPH

ID7291

To CiteDCA Citation Guide

00:00Good afternoon everybody again.
00:02I'm Robert to our audience online and
00:06I'd like to first thank Dr Kush nude
00:08and Doctor Leon who really helped
00:10make this project possible both here
00:12and planning it and then executing
00:14it while we were in or in China.
00:16The team that was there.
00:19The focus today is on the idea
00:21of healthy aging in early China,
00:22and I'm just going to walk you
00:24through kind of the big picture
00:25of what that means, what we did,
00:27and kind of why that matters and
00:30why it would matter to us here.
00:32So by the year 2050,
00:34at least 20% of the world's going
00:35to be over the age of 60.
00:37So everyone in this room will be over 60.
00:40By that point,
00:41it challenges us because there's
00:43logistical questions and social
00:44questions about what are we going
00:46to do when more people need support
00:48in different ways than in the past.
00:50And we talked about this idea of
00:52healthy aging and and what that means.
00:54And when you look at the literature,
00:56it doesn't really tell you
00:57a strict definition.
00:58There's a lot of conflicting views,
01:00whether that's physical.
01:02Health, social health, psychological health.
01:04Some combination of that so
01:07we don't have something that
01:08strictly says this is what it is.
01:10And at the same time,
01:12a study that was conducted at through
01:13Yale last year looked through the
01:15literature and said there's this kind
01:17of pervasive ages in both in the
01:19literature and across continents that's
01:20affecting the health care of older adults.
01:22And what does that mean as
01:24clinicians if we know that's true,
01:26what can we do about it?
01:27How can we make things better?
01:29But you might ask,
01:30why did we decide to focus in China?
01:32And there were a couple of reasons.
01:34One,
01:34China still has the largest
01:36population in the world,
01:37so this problem is more present to
01:39them in thinking how do we support
01:41our population as they grow older?
01:42And second,
01:43there's been this distinct
01:45environment of younger people moving
01:47from rural areas to urban areas.
01:49That shows us that they don't
01:51have the support or family
01:53networks that they once had,
01:54so they've had to create different forms of
01:57establishing their selves or sustaining.
01:59Themselves despite those changes.
02:02There have been different
02:03efforts by groups there.
02:04Things like insurance programs,
02:06but there have been mixed results by
02:08that so historically in China there
02:10are these things called kind of red
02:12envelopes or backdoor payments to
02:14physicians to help get better care.
02:16Well,
02:16they subsidized the healthcare and
02:17said you don't have to do that anymore.
02:19Well,
02:20it actually increased the number
02:21of red envelopes that went out,
02:23and there was a large discussion
02:24about why that would happen if we're
02:26actually helping people by saying
02:27that you no longer have to pay.
02:29So there have been different
02:30challenges to even the things
02:31that we've tried to do to help.
02:32This situation,
02:33in terms of what we might think of
02:35as physical health.
02:36And the last piece I think that's
02:38important to consider here is that
02:40across the board there's this idea of
02:42when you study China that everything
02:44is applicable to everyone in China.
02:47As I said, China has 1.3 billion
02:49people and you would think that there
02:51would be some diversity and experience
02:53there simply because of geography
02:55or your own experience as to what
02:57healthy age you might mean to you.
02:59So we tried to make this study very
03:01broad and what we tried to ask.
03:03So we try to answer two basic questions here.
03:06Among this population that we went
03:07and visited that I'll introduce
03:09you to in just a second.
03:10One is what do older men and women
03:12in rural Guangdong province?
03:15This is southern China.
03:16Think healthy aging means let them
03:18define it for themselves and tell us.
03:20And the second is what are the
03:22obstacles to achieving that and how
03:24does that intersect or how is that
03:26different from what individuals
03:28that are involved with healthcare?
03:30Think there so.
03:31How do you investigate these
03:33questions though?
03:34If we just go and say we're just
03:35going to ask these questions,
03:37we probably won't quite get the
03:39results we were hoping for.
03:40So our design was essentially exploratory,
03:43where we let every we allow our
03:46participants to direct us in a sense.
03:48We had an outline where we did interviews,
03:51but we also had our research
03:54team essentially participate.
03:55I had two research assistants who
03:58we trained before they started.
03:59We did about 10 training sessions
04:01where they did interviews where
04:03we sent them out into their
04:04communities before they went there
04:06and they practiced interviewing.
04:07They practiced drawing maps,
04:08they took photographs and did all
04:10these things and then they went
04:12and they lived in this village
04:13for about two months and it was
04:15very challenging for anyone.
04:17I think if I had been there I was.
04:18Anticipating culture shock,
04:19but I think my students who are used
04:22to living in a 15 million person
04:24city moving to a town that has
04:26about 3000 people was a surprise
04:27'cause I saw on social media.
04:29They would say everything is going
04:31great but then we would go on social
04:33media and I would see what was
04:34actually going on and I would say
04:36well what's happening and they would
04:37say there's nothing to do here at night.
04:39There's and then I would say and
04:41there's this other problem that
04:42you have to use a special device
04:44to warm up the water here to take
04:46a bath in the evening and things.
04:48That they weren't anticipating,
04:50but are important to understanding
04:51to experience what people are
04:53going through in their life,
04:54rather than just asking the
04:56question of what the problem is.
04:58And I think that last part of
05:00participant observation is also very
05:01important because what people say and
05:03what people do or sometimes different.
05:05And sometimes it's your ideal.
05:06What you tell someone,
05:08what they actually do
05:09could be different from that and
05:11understanding that and recognizing that
05:12is an important part of what we did.
05:14So you can see the breakdown of
05:16who we interviewed there or who
05:17we met with my students again.
05:19Were instrumental to making that happen.
05:21The research assistance and then as a group.
05:24The team we analyzed our interviews
05:25going by through them line by line.
05:27We debated, we.
05:28I was told I was incorrect about something.
05:31They I told them they were incorrect
05:32and then we finally would come to
05:34some consensus about what the big
05:36picture was in terms of what we
05:37we got out of these interviews.
05:39So where there were three key
05:41themes that we got out of this?
05:43Oh, and one more map for you.
05:45Just so if you aren't oriented to China,
05:47we were in southern China.
05:48This province is called Guangdong
05:50and the students were from that red
05:52area in the middle of 15 million
05:53people and we went to that village.
05:55That's kind of circled up there.
05:57That general vicinity was this
05:59small village of about 3000 people
06:01and I say a Hakka village.
06:02This is kind of a sub category
06:04of the main ethnicity that most
06:06people identify with in China,
06:08so we wanted to try to find some
06:10diversity in perspective there.
06:11So with regard to what we learn,
06:13some of these things will
06:14seem familiar to you.
06:16Chronic disease in discussing healthy aging
06:18came up again and again in some form.
06:21It was about mobility,
06:23psychological health in some form,
06:25and high blood pressure,
06:26but it was also about participating,
06:28which I'll explain to you
06:29in just a moment here.
06:30But you can see pictures from our
06:32site where on special activities
06:33the social workers tried to address
06:35this by saying we can do screenings.
06:38They had a canteen where we
06:40called it the elder rank canteen.
06:42Where older adults often met and they
06:44had activities that went together,
06:45so being able to participate
06:47despite your chronic disease was
06:49very important to people.
06:51The second is relationships and
06:53I think this was unexpected,
06:55but in some ways for others,
06:56not as not too surprising where
06:58people didn't want to burden others,
07:01no matter how bad their situation was.
07:03People often would not ask for help
07:05or they didn't want to even have a
07:07family member because they felt that
07:08it was wrong to put this pressure on
07:10family members or community members.
07:12So again,
07:13there were these social avenues that
07:15they tried to address this through.
07:16The government had subsidized housing
07:18that they tried to say this is
07:20available to you without burdening.
07:21Another person,
07:22social workers who are delivering meals
07:24that was built into the community efforts.
07:30And the final piece here.
07:31The third kind of result we had was
07:33or theme we found with this complex
07:35site set of ideas about where to seek
07:38your health care and what it means.
07:40I put this garden here of someone's home
07:43because a lot of participants use folk
07:45medicine in order to manage their health
07:47beyond the things that we had available.
07:49Like blood pressure medications,
07:52diabetes medications, and so forth,
07:54this was important to them,
07:55but no one was really discussing
07:57it outside of the participants.
07:58The healthcare workers, for instance.
08:00And the other was this was the local clinic.
08:03There were two clinicians total in the town.
08:06And essentially what their role was in
08:09that conversation that we were having.
08:11So before I transitioned to kind
08:14of why any why this matters?
08:16I'd just like to point out with all of
08:18that what I think of the strengths and
08:20limitations here are really connected
08:22to this online collaboration we had.
08:24I couldn't have done this without those
08:25students who were there on the ground,
08:27and the commitment to everyone on the team,
08:29and it was really unexplored
08:31territory in a sense,
08:32because we weren't planning for this.
08:34Everything we got to do the same thing,
08:36but we needed to build the team very strongly
08:38before we could go out into the field.
08:40So how do you foster relationships?
08:42You need more time than you perhaps
08:44would if you were there with the team.
08:47The second part is we made sure that
08:49we had a shared understanding of how we
08:51do this and what the literature says,
08:53so at least came in with the same
08:55framework in terms of what this means.
08:57When we move forward into the field.
09:00And I think the last piece here
09:02is the geographical boundaries.
09:04So we're saying we were in a
09:05village of 3000 people,
09:07which is helpful in the
09:08sense of it closes this off.
09:10It says these results are probably true
09:12for this village for what we had in terms
09:15of reaching saturation for interviews.
09:17However,
09:18can that apply to another part of China
09:20or even another part of the world?
09:23And we'll kind of answer that in terms of
09:26the clinical significance or our conclusions.
09:29Here one is,
09:31there's a dynamic relationship between
09:33the biomedical model of medicine
09:35that we understand and those social
09:38expectations that were defined by
09:40people in the community there.
09:41And those three results are built
09:43into what I've said here.
09:45Community engagement was directly
09:47tide to chronic disease.
09:49You don't necessarily have to
09:51fix every chronic disease.
09:53But being able to participate in
09:54the community was very important to
09:56someone saying this is healthy aging.
09:58So how do you reach that point?
10:00And I think that really relates
10:03to problem number 2.
10:04The medicine was available,
10:06not everyone used it,
10:07and expectations of it were very different.
10:10There were many participants who
10:12talked about having had a stroke,
10:14having diabetes, high blood pressure,
10:16and not using the medications
10:18because they said they weren't
10:19cured by the medicine setting.
10:21Those expectations perhaps wasn't
10:22there and what's going to happen
10:25later on five years after a stroke,
10:27they haven't had another stroke,
10:28so they said I don't need to take
10:30any of these medicines anymore.
10:32And the third part is there were
10:33a lot of people trying to help
10:35this community in different ways.
10:36The social workers,
10:37government officials,
10:39the health care workers.
10:40But they were kind of working in parallel.
10:42There weren't.
10:42There wasn't a lot of communication
10:44between them and I think that there
10:46is an opportunity for a little
10:48more interaction to say who can
10:49deliver this kind of information.
10:51You're you're getting these resources.
10:53You have what you need,
10:54but making sure that we're meeting
10:56what participants want in that
10:58community as well as we're doing
11:00the best in terms of delivery
11:02in the news that we need to.
11:04And I think that question of is this
11:06relevant to anyone else besides
11:09this small community in China?
11:11Our argument is that.
11:13The individual results of.
11:16Not wanting to burden the community
11:18may not be relevant to someone here.
11:20However,
11:20if you are a clinician in any form of
11:22clinic where you work with the Community,
11:25you can repeat this study very
11:26easily with just a few people
11:28to see what people want.
11:30And while you do that,
11:31perhaps in your individual meetings,
11:33when you meet with your patient,
11:34it's the idea that we can take one
11:37step further and say what do we
11:39think the broader community here is.
11:40What do we think we want to achieve
11:43and how can we kind of direct
11:45our resources in that sense?
11:46I think we do a lot of that here,
11:48but I think in terms of some of
11:50those highlights that we have there,
11:51it's surprising if we never asked
11:53the question of our Community,
11:54what do they want?
11:56We'll never get the answer.
11:58Alright,
11:58thank you everyone,
11:59I appreciate it and it was a great
12:01joy taking part in this project
12:03in getting to share a little
12:04bit of it with you today.