Evidence Based Health Policy, Management & Economics

en Protecting Sistan’s Rural Older Adults: Policy Solutions for Energy-Driven Health Risks during Heatwaves Health Policy خلاصه سیاستی Policy Brief <div style="text-align: justify;">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 May and July 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 Interpretive Phenomenological Analysis (IPA) as the primary analytical approach, supported by thematic organization and constant comparison. 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) perceived absence of a responsive monitoring and feedback system; 5) poor inter-sectoral coordination; and 6) inadequate training and capacity building. Participants reported high monthly electricity bills, daily power outages lasting approximately 2–3 hours, voltage fluctuations damaging oxygen concentrators and refrigerators, costly repairs of medical equipment, long distances to health facilities, 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 targeted, tiered electricity subsidies (exact thresholds to be determined by economic evaluation), home-based care and telehealth, integrated monitoring and evaluation with community feedback, voltage stabilization and compensation funds, accredited training and heat warning systems, 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.</div> Climate Change, Energy poverty, Healthcare Access, Heat Waves, Rural Older Adults, Sistan, Iran 28 41 http://jebhpme.ssu.ac.ir/browse.php?a_code=A-10-545-3&slc_lang=en&sid=1 Mahdieh Poodineh Moghadam mahdiehpoodienhmoghadam@gmail.com 0000-0002-6245-7749 No Department of Nursing, School of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran Aliyeh Bazi aliyehbazi@gmail.com 0000-0002-2914-5081 No Department of Clinical Pharmacy, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran. Monireh Shamsaei MONIREHSHAMSAIE@GMAIL.COMAI 0000-0001-9385-2568 No Department of Health Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran Parvaneh Isfahani p.isfehani@gmail.com 0000-0002-3606-1185 Yes Department of Health Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran