Research Results of "Climate Change and Health in Hong Kong: Response to Natural Disasters and Epidemics"

When facing climate change which leads to more severe typhoons and mosquito-borne illnesses, The Chinese University of Hong Kong’s Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC) conducted a series of territory-wide large scale telephone surveys in 2018. They included:

2018 Climate Change and Health and Environmental Co-Benefits Survey (26 February-19 March; sample size: 1,011)
2018 Typhoon Mangkhut Survey (17 September–2 October; sample size: 540)
2018 Dengue Fever and Mosquito Hazards Survey (6 September–15 September; sample size: 610)

The study series had the following findings:

Climate change

Hong Kong residents have an understanding about climate change. Almost all the respondents (99.0%) had heard of climate change or global warming. Around 90% of the respondents have the following knowledge about climate change (see table below.). However, only 61.3% respondents knew that livestock is a contributing factor to climate change.

	Yes	No	Don’t know
Climate change could cause
Global average temperature rise	97.9%	1.9%	0.2%
Increasing chance for natural disasters	97.0%	2.8%	0.2%
Sea level rise	95.0%	2.9%	2.2%
Changes in rainfall in particular regions	92.8%	5.6%	1.6%
More frequent typhoons	89.7%	8.9%	1.4%
Affecting human health	93.5%	6.1%	0.4%
Increasing health problems caused by hot weather	92.8%	6.6%	0.6%
Changes in communicable diseases’ mode of transmission, increasing the risk of pandemics (e.g. Influenza)	89.1%	9.9%	1.0%
What will cause climate change:
Large scale of deforestation	96.6%	3.2%	0.2%
Burning fossil fuels	95.5%	3.5%	1.1%
Large-scale use of chemical fertilizers	77.8%	19.1%	3.1%
Livestock farming e.g. cattle and sheep	61.3%	36.1%	2.6%

(Number of respondents =1,011)

Mitigating climate change is a pressing matter, yet only half of the respondents thought climate change is currently affecting Hong Kong people and a substantial number of respondents believed climate change will only happen in the future.

（ number of respondents = 1,011）

Hong Kong residents are more concerned about climate change’s effects on future generations than on themselves. Only 12.3% of the respondents were "extremely worried" or "very worried" about climate change affecting themselves. In contrast, 42.3% of the respondents were "extremely worried" or "very worried" that climate change will affect future generations.

How worried are you regarding climate change’s effect on yourself or the future generations?

	Extremely worried	Very worried	Worried	A little worried	Not too worried	Don’t know	Not worried at all
Self	3.5%	8.8%	37.1%	38.8%	11.7%	0.2%	-
Future generations	15.1%	27.2%	31.8%	18.2%	7.3%	0.2%	0.1%

Health and environmental co-benefit behaviours

To mitigate climate change, one of the ways is to push for environmentally-friendly activities to reduce carbon emissions. Many of the carbon reducing activities are also concurrently beneficial for human health. About 84.9% of the respondents believed promoting environmentally friendly education is "extremely important" or "very important". In addition, around 65% to 85% believed the environmentally-friendly activities listed in the table below were "extremely important" or "very important". However, only 36.9% of respondents saw eating less red meat "extremely important" or "very important". This may be related to the finding mentioned above that only 60% of the respondents knew the association between farming livestock and climate changes. Government and related organizations could consider strengthening those types of education.

Health and environmental co-benefit behaviours	Thinking the specific behavior is "important" or "very important"
Reducing waste (e.g. use less plastic bags)	76.6%
Proper waste management (e.g. waste separation)	77.2%
Using or developing renewable energy	75.6%
Using less electricity	69.6%
Growing plants	65.4%
Eating less red meat	36.9%

（number of respondents = 1,011）

Understand of disaster and prevention

Viewing as Hong Kong as a ‘blessed land’ is still quite common as 92.2% of the respondents believed Hong Kong is not a disaster prone area. In addition, only 9.3% of the respondents believed their home is a high risk location during typhoons (of which 40.0% of respondents believed their residential location is exposed to strong winds).
Only 10% to 55% of the respondents adopted the first four disaster prevention actions. In particular, having food reserves were practiced by most of the respondents and those with chronic diseases had more long-term medication supplies.

Types of typhoon preparedness activities	Yes	No	Don’t know or not applicable	Number of respondents
Reserving fire extinguishing equipment	11.7%	88.3%	0.0%	540
Reserved emergency supplies before typhoon	43.7%	56.0%	0.3%	1,011
Reserved water supplies	49.3%	50.7%	0.0%	540
Had first-aid kit	55.0%	44.6%	0.4%	540
Reserved food supplies	83.3%	16.7%	0.0%	540

Typhoon "Mangkhut"

Typhoon Manghkhut landed in Hong Kong where the typhoon signal number 8 to 10 were hoisted from 16 September to the early mornings of 17 September. In order to acquire first-hand data while the memory was still fresh in Hong Kong people’s mind, CCOUC started a survey related to Typhoon Mangkhut on September 17. It lasted for half a month.
During Typhoon Mangkhut, 33.1% of the household respondents were injured or affected in some manner (including financial loss), of which the summary is shown in the table below.

Affected by	%
Due to road blocks or traffic issues were not able to go to work or school (excluding the Monday/Tuesday where the Education Bureau announced school close (September 17/18)	69.8%
Loss of energy source (e.g. water or electricity)	14.5%
Home damage (e.g. broken windows)	13.4%
Affect living means e.g. shop was damaged	5.6%
Item loss (e.g. cars or pets)	3.9%
Injury	2.2%
Others	17.9%

（number of households = 179）

When Typhoon Mangkhut has a typhoon signal hoisted at T8 or above, there were still 15.9% of respondents (86 out of 540 people) who left their homes. Of which, 75.6% was for non-emergencies (not related to work, injury or illness), and 83.6% did not take any safety precautions when outside (e.g. helmets).

Reasons for going out	%
Non-emergencies	75.6%
For work	18.6%
Emergencies (e.g. injury or illness)	5.8%

（number of respondents = 86）

Hong Kong residents felt the government’s performance during Typhoon Mangkhut had room for improvement

Hong Kong Government	Enough	Not enough	Don’t Know/refuse to answer
Was well prepared for this typhoon	68.0%	29.4%	2.6%
Provided enough information for Hong Kong residents to prepare/deal with this typhoon	88.0%	11.5%	0.6%

After Typhoon Mangkhut, still, only 52.0% of the respondents planned to prepare themselves for typhoons in future, which the preparation include:

Disaster preparedness measures	Yes	No	Don’t know/ not applicable
Find the means and methods of getting related information early on	85.1%	14.9%	0.0%
Prepare food reserves early on	77.6%	22.4%	0.0%
Prepare basic medication early on (e.g. fever relievers)	76.9%	22.8%	0.4%
Prepare water reserves early on	69.0%	31.0%	0.0%
Prepare long term medication early on (at least 2 weeks supply)	55.9%	43.8%	0.4%
Learn about disaster preparedness/response early on	51.6%	47.7%	0.7%
Pack a disaster bag early on	45.2%	54.1%	0.7%

（number of respondents = 281）

Dengue fever

Among the respondents who had left Hong Kong for more than 1 day in the previous year, 60.5% of them had traveled to dengue fever endemic regions (Malaysia, Thailand, Singapore, Maldives, Cambodia, Brazil, Indonesia, India, Nepal, Guangdong, Taiwan).

Hong Kong residents did not take sufficient mosquito preventive measures during travel. Only 30% of those who claimed traveling abroad for more than 1 day in the past one year had done certain mosquito preventive measures, which are described in the table below:

Mosquito preventive measures	Yes	No
Using mosquito repellent	25.5%	74.5%
Using mosquito sticker	6.7%	93.3%
Wearing light colored and long clothes during outdoor activities	3.6%	96.4%
Using mosquito net while sleeping	0.2%	99.8%

（Number of respondents = 420）

Hong Kong residents were knowledgeable about dengue fever, but were rather low in perceiving their risk: 71.8% of the respondents believed the risk of getting dengue fever in Hong Kong was "low" and "very low", while 48.2% thought the risk of getting it abroad was “low” and “very low”. Half of the respondents reported they completely avoid going to areas with confirmed cases like Wong Tai Sin, Lion Rock Park, Cheung Chau to avoid getting infected by dengue fever.

HK people’s understanding of dengue fever	Yes	No	Don’t know/not applicable
Aware the news of local dengue fever cases in August announced by government	95.4%	3.8%	0.8%
Dengue fever is transmitted by mosquito	91.8%	1.3%	6.9%
Dengue fever is transmitted by Aedes	79.5%	0%	20.5%

（number of respondents = 610）

During August 2018, 41.0% of respondents were bitten by mosquitoes, mainly in the places listed in the table below. This study also found that people living in the New Territories were most seriously affected by mosquito bites at places waiting for transport. On the one hand, the government should strengthen anti-mosquito actions in relevant places, especially in the wooded areas and places waiting for transport. Also, households are also a high-risk location, and individuals need to pay attention to anti-mosquito and mosquito eliminating measures.

Location of frequent mosquito bites in August

Location	Percentage
Near bushy and grassy area	62.4%
At home	42.0%
Location while waiting transportation	39.6%（NT：48.1%；HK：36.4%；KLN：29.3%）
At workplace	26.4%
Location near water source	18.0%
In public transportation	12.4%
Location near construction area	12.0%

（number of respondents = 250）

Before and after the government announcement that there were local cases of dengue fever in Hong Kong, there was no significant difference in the practice of anti-mosquito measures by the public (see figure below). The main reason for those who not taking any anti-mosquito measures (18%, 113 respondents), is that they do not think it is not necessary (61.1%, 69 out of 113 respondents). There is a need for the government to promote the importance of various anti-mosquito measures.

Anti-mosquito measures	before government announcement	after government announcement
Remove stagnant water	50.7%	55.7%
Mosquito repellent	40.7%	39.0%
Wearing light-coloured long-sleeved clothes and long trousers	28.7%	29.7%
Electronic mosquito repellent	20.3%	15.6%
Insecticide	19.3%	18.4%
Mosquito sticker	18.9%	17.7%
Mosquito net at the surface of door or window	13.6%	13.3%
Mosquito incense	9.3%	8.5%
Mosquito bracelet	6.7%	4.6%
Mosquito repellent plant	3.0%	2.5%
Mosquito net when sleeping	2.8%	2.8%
Detergent	2.3%	2.5%

（number of respondents = 610）

The awareness and practice related to climate change have room for improvement

The Intergovernmental Panel on Climate Change (IPCC) published the Special Report on Global Warming of 1.5°C on October 8, 2018, urgently appealing to policymakers to rapidly promote major changes at all levels of society to limit global temperature rise to 1.5°C, because warming of 1.5°C or higher may result in a permanent and irreversible environmental change. Human activities have caused global temperatures to rise by 1°C from pre-industrial levels, and the consequences have been shown through more extreme weather events and the associated disasters and epidemics. Even if the emission reduction targets promised by the countries signing the current Paris Agreement are followed, the global temperature is likely to rise by 3°C by the end of the century. Our surveys show that in the face of this grim situation, there is room for improvement in the awareness and practice related to climate change, disasters and epidemics. For the sake of our future generations, we have a responsibility to promote and implement health and environmental co-benefits behaviours now. Via this series of surveys, we hope that the various government departments can have more data to improve policies and measures related to climate change, disaster preparedness and epidemic prevention.

In face of the more severe threat of climate change, the public must abandon the old idea of Hong Kong as a blessed land, and actively prepare for disasters, including preparing fire-fighting equipment, first-aid kits, medications and emergency supplies at home, learning disaster preparedness and relief knowledge and taking first-aid courses, and preparing for disaster bags, etc. To cope with mosquito hazards and the related epidemics worsened by climate change, the public cannot take these issues lightly. In addition to relying on the government's measures on preventing mosquito bites and mosquito breeding, they should also strengthen their awareness of mosquito hazards and step up relevant preventive measures.