社会性别视角下广东省基层医疗卫生人员对气候变化健康风险和适应策略的认知差异
Gender differences on perceptions of health risks and adaptation of climate change among primary healthcare workers in Guangdong Province
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摘要:
背景 全球气候变化已经并将持续对人类社会造成健康威胁。不同性别的基层医疗卫生人员是否都认识到气候变化所带来的健康威胁并采取积极应对措施，是基层医疗中开展有效健康适应的关键。
目的 探讨我国基层医疗卫生人员对气候变化健康影响的认知及适应策略的态度是否存在社会性别差异，并提供相应建议。
方法 采用多阶段整群抽样，在广东省21家城区和10家乡镇基层医疗卫生机构中使用调查问卷收集数据资料，通过卡方检验、秩和检验和logistic回归模型探究医疗卫生人员气候变化健康风险认知、知识获取渠道、对开展适应策略的态度以及主要障碍和所需资源观点上的性别差异。
结果 733名调查对象中男性占38.47%（282人），女性占61.53%（451人），男性医疗卫生人员对气候变化正在发生的认同度及发生原因（70.21%和60.99%）认知上均高于女性（59.87%和49.00%）（均P＜0.05），但在高温热浪健康风险、传染病风险认知和敏感人群识别上没有显示出性别差异（均P＞0.05）。92.50%的医疗卫生人员通过电视、广播、报纸等大众传媒获取相关信息，男性对新媒体渠道的选择明显低于女性（OR=0.62，95%CI∶0.41~0.94），只有30.56%的人员（男性33.69%，女性28.60%）参加过相关的培训、讲座等。90.96%的医疗卫生人员都认同采取主动措施应对气候变化健康威胁，各措施认同度上没有发现性别差异（均P＞0.05）。女性（72.28%）最认同的障碍是气候变化的健康应对难以纳入机构主要工作，而男性（77.66%）认为是资金不足；男性（86.88%）和女性（89.14%）都认为需要增加用于基层医疗卫生保健的资金。控制其他社会因素的影响后，男性在资金不足观点上的认同度高于女性（OR=1.57，95%CI∶1.10~2.24）。
结论 基层医疗卫生人员对气候变化与健康适应措施的认知存在些许性别差异，男性医疗人员更倾向于认同气候变化、认为应对资金缺乏是主要障碍，女性更倾向于选择新媒体渠道获取信息。建议政府和相关机构针对基层医疗卫生人员对气候变化健康风险和适应的社会性别差别，重视气候变化与健康相关的知识学习和培训，拓展多样化信息获取渠道，加强气候变化与健康应对的基层能力建设。
Abstract:Background Climate change has resulted in long-term impacts on human health. Implementing efficient adaptation strategies among primary healthcare facilities is well determined by whether staff of different genders recognize the health risks related to climate change and are willing to take active measures.
Objective To investigate gender differences on perceptions of health risks and attitude towards adaptation strategies among primary healthcare workers in China, and provide relevant suggestions.
Methods By adopting a multi-stage cluster sampling method, we selected 21 urban and 10 rural healthcare facilities in Guangdong Province to collect information with a questionnaire. Then chi-square test, Wilcoxon rank sum test, and logistic regression analysis were used to explore the gender differences in climate change-related health risk cognition, knowledge acquisition channels, attitudes towards adaptation strategies, main obstacles, and resource requirements among the healthcare workers.
Results Of 733 participants, 38.47% (282 participants) were male and 61.53% (451 participants) were female. The percentages of male healthcare workers who agreed that climate change is happening and recognized the causes of climate change (70.21%, 60.99%) were higher than the percentages of female counterparts (59.87%, 49.00%) (both Ps＜0.05), but no obvious gender differences existed in recognizing health risks of heatwaves and infectious diseases as well as sensitive population identification (all Ps＞0.05). Most of the participants (92.50%) received climate change and health-related information from mass media like TV, radio, and newspapers. Meanwhile less men chose new media channels than women (OR=0.62, 95%CI∶ 0.41-0.94). Only 30.56% of the participants (33.69% of men and 28.60% of women) reported involvement of relevant training and lectures. Most of them (90.96%) agreed to take active measures to deal with the health threats associated with climate change without gender differences for various measures (all Ps＞0.05). The leading obstacles were hard to integrate health adaptation to climate change into main work of institutions (most female agreed, 72.28%) and the lack of funds (most male agreed, 77.66%). Increasing funding for primary health care was regarded as the most needed resource by male (86.88%) and female (89.14%). After controlling the influence of other social factors, more men agreed with the lack of funds than women (OR=1.57, 95%CI∶ 1.10-2.24).
Conclusion There are some gender differences in the perceptions of health risks and adaptation strategies of climate change among primary healthcare workers: Male staff are more likely to agree with climate change and regard the lack of funds as the main obstacle, while women prefer to choose new media channels to obtain information. It’s suggested that the government and relevant institutions focus on the learning and training of climate change and health-related knowledge and expand diversified information access, and promote capacity building to cope with health threats at grass-root level, in the light of recognized gender differences among primary healthcare workers.
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