Protecting Sistan’s Rural Elderly: Policy Solutions for Energy-Driven Health Risks during Heatwaves

Abstract

Introduction: Climate change and energy poverty threaten health and healthcare access among rural older adults in Sistan, Iran, a region characterized by extreme heat, dust storms, and limited infrastructure. This policy brief synthesizes evidence from a qualitative study on the intersection of energy poverty, heatwaves, and healthcare access.

Materials and Methods: This policy brief is derived from an interpretive phenomenological qualitative study conducted in rural Sistan, Iran, between March 2025 and January 2026. Thirty-eight rural older adults aged 60–81 years participated in in-depth, semi-structured, face-to-face interviews lasting 45–90 minutes. Purposive maximum-variation and snowball sampling were used. Interviews were transcribed verbatim and analyzed using thematic analysis guided by interpretive phenomenological principles. Trustworthiness was ensured using Lincoln and Guba’s criteria. Findings were translated into policy recommendations through a systematic evidence-to-policy process involving theme mapping, policy option identification, prioritization, and member checking.

Results: Six themes emerged: (1) inefficient energy subsidies; (2) weak electricity infrastructure and equipment damage; (3) geographic barriers and prohibitive healthcare costs; (4) absence of a robust monitoring and evaluation system; (5) poor inter-sectoral coordination; and (6) inadequate training and capacity building. Participants reported high monthly electricity bills, daily power outages of 2–3 hours, voltage fluctuations damaging oxygen concentrators and refrigerators, costly repairs of medical equipment, distances of 14 km to health houses and 35–50 km to hospitals, and prohibitive healthcare visit costs. These conditions created a healthcare–energy trade-off and a spatial–energy trap.

Conclusion: Energy poverty and extreme heat jointly produce compound climate vulnerability among rural older adults in Sistan. Priority policy actions include tiered real electricity subsidies, home-based care and telehealth, integrated monitoring and training, voltage stabilization and compensation funds, and a joint inter-sectoral task force. These measures should be implemented through short-, medium-, and long-term phases to protect health and improve healthcare access.