View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Crossref Liang and Wang Health Research Policy and Systems 2013, 11:41 http://www.health-policy-systems.com/content/11/1/41 RESEARCH Open Access Developing a new perspective to study the health of survivors of Sichuan earthquakes in China: a study on the effect of post-earthquake rescue policies on survivors’ health-related quality of life Ying Liang1* and Xiukun Wang2 Abstract Background: Sichuan is a province in China with an extensive history of earthquakes. Recent earthquakes, including the Lushan earthquake in 2013, have resulted in thousands of people losing their homes and their families. However, there is a research gap on the efficiency of government support policies. Therefore, this study develops a new perspective to study the health of earthquake survivors, based on the effect of post-earthquake rescue policies on health-related quality of life (HRQOL) of survivors of the Sichuan earthquake. Methods: This study uses data from a survey conducted in five hard-hit counties (Wenchuan, Qingchuan, Mianzhu, Lushan, and Dujiangyan) in Sichuan in 2013. A total of 2,000 questionnaires were distributed, and 1,672 were returned; the response rate was 83.6%. Results: Results of the rescue policies scale and Medical Outcomes Study Short Form 36 (SF-36) scale passed the reliability test. The confirmatory factor analysis model showed that the physical component summary (PCS) directly affected the mental component summary (MCS). The results of structural equation model regarding the effects of rescue policies on HRQOL showed that the path coefficients of six policies (education, orphans, employment, poverty, legal, and social rescue policies) to the PCS of survivors were all positive and passed the test of significance. Finally, although only the path coefficient of the educational rescue policy to the MCS of survivors was positive and passed the test of significance, the other five policies affected the MCS indirectly through the PCS. Conclusions: The general HRQOL of survivors is not ideal; the survivors showed a low satisfaction with the post- earthquake rescue policies. Further, the six post-earthquake rescue policies significantly improved the HRQOL of survivors and directly affected the promotion of the PCS of survivors. Aside from the educational rescue policy, all other policies affected the MCS indirectly through the PCS. This finding indicates relatively large differences in the effects of different post-earthquake rescue policies on the HRQOL of survivors. Keywords: Health-related quality of life, Post-earthquake rescue policies, SEM, SF-36, Survivors * Correspondence: [email protected] 1Department of Social Work and Social Policy, School of Social and Behavioral Sciences, Nanjing University, Nanjing 210023, People’s Republic of China Full list of author information is available at the end of the article © 2013 Liang and Wang; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Liang and Wang Health Research Policy and Systems 2013, 11:41 Page 2 of 12 http://www.health-policy-systems.com/content/11/1/41 Background employment, poverty alleviation, and other aspects that Sichuan is a province in China that has experienced urgently needed protection and support from the gov- many devastating earthquakes, thus increasing the suf- ernment, the plan particularly proposed rescue policies fering of its residents. On 12 May 2008, an earthquake in education, orphans, employment, poverty, legal, and with a magnitude of 8.0 on the Richter scale hit Wench- social security [5]. uan. This earthquake was the most devastating since the However, specific studies regarding post-earthquake founding of New China. The earthquake also resulted in rescue policies are weak and there is a research gap on 5,335 students presumed dead or missing, more than the effect of government support policies. Recovery and 7,000 people becoming disabled, 152 million losing their reconstruction comprise a complicated systematic pro- jobs and lands, and 1,449 victims becoming lone people ject, which can be divided into transition and overall pe- (orphans, elderly, and disabled people) [1]. On 30 June riods [6]. First, several studies have focused on the 2009, a 5.6 earthquake hit Mianzhu, Deyang, Sichuan. performance of the government in emergency rescue Two hours after the earthquake, aftershocks of 3.3 and during the transition period. Generally, the speed and 3.7 on the Richter scale occurred. Previous to these, quality of the government initiated and directed rescue more than 57,000 aftershocks had occurred in Sichuan were relatively high. The outcome of the rescue depen- with strengths of 4.0 to 6.4 on the Richter scale [2]. On ded on a clear plan, effective coordination, cooperation, May 2010, 11 earthquakes above 3.0 hit Sichuan, the lar- and support of all the participants [7]. Compared with gest with a strength of 5.0 [3]. On 20 April 2013, a se- the outcome of the Tangshan earthquake in 1976, the vere 7.0 earthquake hit Lushan, Ya’an, resulting in 193 economic development of China has significantly im- deaths, 12,211 injured, and more than 1,990,000 people proved the government’s ability to respond to natural affected [4]. Thus, frequent earthquakes have caused loss disasters [8]. Second, the perspectives for studies on of lives, property, and economic-social development, and post-disaster reconstruction are diverse. On the one survivors in post-disaster areas are in need of assistance hand, many studies have focused on the interaction be- to restore normal production and improve their living tween the government and non-governmental organiza- conditions (Figure 1)a. tions during the reconstruction; both the government Post-disaster reconstruction has become the govern- and non-governmental organizations contributed [9,10] ment’s top priority task. On 23 September 2008, less and the reconstruction was successful. The government than half a year after the Wenchuan earthquake, the allowed non-governmental organizations to participate General Office of the State Council released the docu- in the reconstruction and was also more inclined to cre- ment “National Master Plan on Post-Disaster Restor- ate a moderate policy-based environment [11,12]. On ation and Reconstruction of Wenchuan Earthquake.” the other hand, some studies have tried to provide sug- The plan proposed 1 trillion yuan for the completion of gestions concerning reconstruction. Advanced infor- reconstruction of hard-hit areas in Sichuan, Gansu, and mation and communication technologies played an Shaanxi within three years. The plan aims to make the intermediary role in transmitting information during a basic living conditions and economic social development disaster [13]. Thus, the openness and transparency of in- levels of survivors reach or exceed pre-disaster levels. formation help the government win the support of the The plan covers fiscal, tax, financial, land, industrial, and people during reconstruction [14,15]. The establishment aid policies and counterpart support. For education, of an easily operated and widely covered disaster rescue model also helped the local government gain the survi- vor’s trust survivors [16]. Other studies have focused on the evaluation of the effect of specific government pol- icies. One study assessed the implementation effect of the fertility assistance program that aimed to help cou- ples achieve their reproductive desires. They found women were currently pregnant under the assistance program [17]. For the protection of forests, there was an increase in forest coverage rate since the enactment of the conservation programs [18]. However, to date, no studies have been conducted concerning the effects of the implemented rescue policies aiming to provide social and livelihood security. The health condition of earthquake survivors is a con- troversial issue. However, many studies on survivors’ Figure 1 Collapsed houses in Guangyuan after the earthquake. health have focused on the prevalence rate of mental Liang and Wang Health Research Policy and Systems 2013, 11:41 Page 3 of 12 http://www.health-policy-systems.com/content/11/1/41 disorders and their risk factors. It was found that 22.6% Can the post-earthquake rescue policies affect the of the adolescent respondents were depressed, whereas HRQOL of earthquake survivors? A previous study 10.6% were reported to have suicidal ideation one month found that the HRQOL of survivors has generally im- after the earthquake [19]. Three months after the earth- proved after receiving social support over time [26]. quake, people who lived in temporary shelters or lost Thus, we propose the first hypothesis; Hypothesis 1: The their families were more likely to report health problems post-earthquake rescue policies can significantly improve [20]. Post-traumatic stress disorder (PTSD) also caused the HRQOL of survivors. concerns. The important risk factors of PTSD include Can different post-earthquake rescue policies affect gender (female), age (elderly), and guilt regarding death the HRQOL of survivors to the same degree? The degree or injury [21,22]; losing a child was also a significant of damage in all social areas caused by the earthquake predictor of mental problems [23]. Nevertheless,