Table 2 Vulnerability factors identified from Adelaide data

1

Not culturally acceptable for some people to pick up information pamphlets which need to be given.

Messages should specify that people need to drink water. Incontinence issues can be a problem in older people.

Many in new & emerging communities have high blood pressure, mental health problems including grief and loss issues, kidney problems, and nutritional deficiencies. Health issues with older people.

Climate is different (very dry) here. Cannot assume people from hot areas will be OK in a heatwave.

Many have adapted their houses to suit the climate. Less so for those that rent. Fear can prevent people opening their house at night. No air conditioning (AC) supplied in public housing.

2

Some women in new communities are illiterate. Concern for veiled women in the heat.

Middle Eastern men often don’t drink enough water.

Vitamin D deficiency common in Middle Eastern females, kidney stones in males. People fearful of melanoma.

The heat is very different and dry. People not told about the heat. Assumptions can be made about people’s heat tolerance.

Mothers on Women at Risk visas in low quality rental housing - pull down blinds, open up house, use fans.

3

Older African people are unable to keep cool in traditional ways. The children are unable to speak the dialects of the older people. Education needed in the communities about dressing for hot weather

Cold water can be unpalatable to some.

Being confined to the home during the heat can be emotionally disturbing. Some believe it is unhealthy to have a fan blowing directly on them.

Not as hot in Africa as in Australia. People who work on farms in Africa jump in streams to cool down. Here they sit inside the house.

4

Some cultures prefer hot food to cold; but cooking heats up houses. Food spoilage can be an issue. Asian women use sun umbrellas. In older persons first culture reversion can lead to overdressing.

In some cultures drinking water is more acceptable than in others.

Some people will not use air conditioning if they are not feeling well.

Different climate pattern in Australia. Drier heat which may not cool down in evening. Assumption that people from hot climates can adapt. Sunburn can be a problem.

Past issues with new arrivals not knowing how to use household appliances.

5

Many are wary of local government. Church representatives may be able to relay heat messages.

Older people often think they will cope like a younger person. Visual impairments in the aged can lead to air conditioners being set to ‘heat’ not ‘cool’.

Some Italian and Greek migrants have lush gardens and significant trees that shade houses.

6

Ramadan can be an issue if it falls in hot weather. Cultural sensitivity require the wearing of cultural garments in the heat. Education needed re dressing children for hot weather. Dark clothing can be worn during periods of grieving.

Some people prefer to drink hot rather than cold water.

Some shopping centres have removed seating. Access to air conditioning can save lives but some won’t use it.

In Australia it is different to Africa where it is tropical, with a cool wind. The newly arrived don’t know how hot it gets. Heat is dry here.

Many live in homes without AC or in old homes that take days to cool down. In first 6 months accommodation is basic, crowded. Asylum seekers may have no secure housing.

7

Electrical appliances can be new to refugees. Swimming often not part of cultural norm. People socialise less with neighbours here. Cultural issues with fluid intake and Ramadan, and cultural dress codes during hot weather.

Some in new communities get dehydrated - need to be reminded to drink water. Some don’t like the taste. Water required boiling in refugee camps.

Sun here burns the skin. Gallstones common as people don’t drink enough. There can be religious and cultural barriers for CALD women seeking health care and treatment in emergency departments.

Different type of heat and it doesn’t cool down at night. The heat is very direct, dry, and uncomfortable. Incorrect assumptions that people from hot countries are used to the heat.

Houses may not be in good condition. There should be fans in each bedroom. If their house is hot people will go to shopping centres.

8

People can feel a responsibility to financially support family in their home country. Some with distinguishing skin colour feel as if they stand out in shopping centres. People may not intuitively know how to dress for the heat.

Many don’t find cold water palatable.

Having doors open can let in hot air and be dangerous. Those without AC at home or in the car can find it very tormenting.

Hotter, drier than in Africa. Even the breeze is hot.

Some refugees buy fans but have windows and doors open so just hot air blowing. Houses often have no AC.

14

Information in two dimensional formats can be new to some without literacy skills.

Cognitive impairments and chronic conditions add to vulnerability. People can be unaware of the impact heat and dehydration can have on the elderly. Electricity concessions are available to some.

Some homes are old, no AC, no insulation. People spend most of their time in the house. Focus should be on improving housing for the most vulnerable with the least income.

No.

Isolation

Language barrier

Low literacy

Power costs

SES

Transport

1

Ethnicity can add to feeling of isolation in older people. Some have no family, don’t know their neighbours and have no support network. Difficult to get information to the isolated.

Language a barrier in new communities. Not only the language but the context can be a problem – the term ‘heatwave’ may not be understood.

Low literacy levels in some CALD populations. Many obstacles to getting literature translated.

People won’t put AC on if they can’t afford it no matter what their nationality. Older people won’t use AC due to cost.

If people are of low socio-economic status (SES) e.g. refugees, they won’t use AC. Older migrants are frugal.

Not all councils have community transport to get people to community centres. Messages could be disseminated via TV on buses.

2

Clients are well connected with their extended families so isolation should not be a problem.

Some young female Liberian immigrants are not literate in their language.

Young Liberian mothers can have poor literacy and can’t access warnings. African culture can be verbal-oral rather than literal.

Young refugee mothers with babies won’t use AC due to the cost of electricity.

Low SES people can’t afford the cost of electricity

Most refugees don’t drive. Have to use public transport and stand at bus stops without shelters in the heat.

3

Confinement in the house when it is hot can be emotionally disturbing.

Much harder for older people to learn new language. African children may not speak the dialects of the older people.

People don’t want to use AC because of the financial aspect

People can’t afford to register at a swimming pool. Financial barriers in low SES families.

Refugees may not drive or have vehicles. Difficult for older ones to learn to drive.

4

First language reversion common in the elderly due to age, dementia, stroke. Lesser need for migrants to use English as they age.

People in new communities may not be familiar with AC and can’t afford power costs.

More money equals better rights to information and more choices.

5

Older people can be socially isolated. Less isolation in extended families.

Having poor English is a huge barrier. Elderly people can revert to their first language. Information needed in other languages.

People might not be literate in English or their own language. Many older migrants had low literacy skills when they emigrated.

The increasing cost of power is a huge issue for older people. They won’t use AC because of stress about getting the bill.

Older people can be asset rich, cash poor so will not get new AC or get the old one fixed

Older people can be isolated and unable to access transport

6

Some have no family and friends. Service providers may be their only contact. Asylum seekers may not be connected at all. New arrivals may not know who to contact for help.

Language specific radio stations are popular with older migrants.

The elderly won’t turn on AC because of the cost. They will put up with a few days of heat rather than waste the money.

SES a key factor. New arrivals have basic accommodation at first. Asylum seekers may have no income, Medicare, accommodation, phone or TV.

Caution required when recommending older people leave home in the heat if they have to catch a bus. Council’s community buses are useful.

7

Neighbours don’t socialise as much in Australia.

Information not in own language can’t be understood. Lack of interpreter can be a barrier to health care.

Some migrants have never been to school and can’t read information pamphlets

Many are concerned with power costs and won’t use fans.

Difficulties using public transport with babies and prams. Some bus drivers are unhelpful.

8

People won’t get messages if they’re in English, but not practical to have in all dialects. Need information at orientation instead.

Low income refugees can’t afford to run AC. They will open windows instead.

Refugees go without so they can send money to family back home. Strong sense of responsibility to help relatives.

14

Those with no family connection are isolated and vulnerable. People can be invisible in the community. Non-English speaking clients can’t access services in English.

Translating written material is ineffective. Phone contact best. Interaction the key. First language reversion occurs with dementia.

Translating is a problem as some people are illiterate in their own language. Some post WWII migrants had little schooling.

The cost of electricity is a barrier for clients

Financial assistance required for some to install AC. Most vulnerable with least income have inefficient heating, cooling.

Transport for clients cancelled when hot for health reasons. People are advised to go to cooler places but the elderly often cannot.