Electronic Health QR Code and Chinese Elderly Population
Self-quarantined for 2 months after an unknown pandemic hit your town, until this morning, you heard on the radio that people are free to travel. You were excited to see your newborn granddaughter. However, on your way, the bus driver stopped you and asked for “健康码 [health QR codes]”. Having no idea about the code, you decided to walk. Just before arriving, security staff stopped you again for similar reasons. You failed to see your granddaughter. Later, you were constantly asked for that mysterious code wherever you went. Without that code, you were stuck. This was my grandma’s experience during the Covid-19 pandemic. When China developed electronic health QR codes to effectively keep infectious rates down, millions of grandparents without smartphones or don’t know how to generate the code faced similar difficulties. To help them, some believe that letting the aged population rely on young people is enough, like Shanghai Province’s printed health QR code service operated by young staff on self-service machines. However, reliance means dependency which makes seniors vulnerable whenever young people are not on hand to help. Considering this, I believe in education that equips the elderly with skills to use new technologies independently. Specifically, China should adopt America’s peer-to-peer education model, which fits the elderly’s learning habits, and provide it on radios to reach the most seniors.
China’s health QR codes effectively prevent Covid-19 from spreading, proven by the country’s significantly low positive rate. The health QR codes refer to a project started in early 2020 through Ant Financial, “a sister company of the e-commerce giant Alibaba” (Mozur et al.). People put their travel history, health condition, etc., into “Ant’s popular wallet app, Alipay”, through smartphones, and get health QR codes (Mozur et al.). The codes change colors — green, yellow, or red — to indicate whether one is free to travel, recommended to quarantine for 7–14 days, or must quarantine for at least 2 weeks. The mechanism behind is to record areas where infected people stay as dangerous zones. If a healthy person stays there long, he/she may be infected, thus, turning from “green” to “yellow” or “red”. The QR codes keeping potentially infected people in quarantine cut off the respiratory illness COVID-19’s transmission route through human close contact, thus helping prevent the pandemic from spreading. The scope that this system covers is impressive, being used in 200+ cities (Mozur et al.). Almost every public space requires green codes. As a result, China nearly has no infectious rate. From February 2020 to 2022, according to World Health Organization, China’s total confirmed cases are only 174,486. Compared to its 1.402 billion population, this result is astounding (“Population, Total — China”). Such a low positive rate is almost the same as if Covid-19 has not happened to China. In contrast, during the same time period without health QR codes, America with 329.5 million population had 77,808,032 total confirmed cases (“Population, Total — United States”; World Health Organization). Hence, health QR codes undeniably protect China so that fewer people suffer from the illness.
However, the health QR code policy is not perfect because it forgets the elderly population who have difficulties accessing new technology due to financial burdens. Signing up for a QR code through Alipay heavily relies on smartphones. The problem is that smartphones are expensive. When the average monthly pension in Beijing, China’s capital city, is 4,365 yuan ($685), average smartphones cost $363 in 2021 (Sun; Lake). Who would spend half of their limited budget just for a phone, when they need the money to eat, pay for medical care, etc.? Not to say those in rural areas and earn far less than $685. As a result, the percentage of Chinese elderly population accessing smartphones is low. According to Qi et al., 65.5% of Chinese aged 60 years and above use phones, but only 14.3% use smartphones. About 80% of all Chinese elderly could not access proper technology or health QR codes. When most places require QR codes, these elderly can’t go there and are constrained in mobility. I never forget the news of an elderly citizen stopped by subway station staff crying out “没有的事，谁给我？你没给我。[What is the health e-code? I don’t know about it. No one gives it to me]” (“别让他们成为时代的‘局外人’[Don’t Make Them the Outsiders]”). We don’t know what he is desperately heading to — it might be his partner needing help in hospital miles away or his starving grandchildren at home. What we know is that he couldn’t go, by taking subway which is often the cheapest, only because he doesn’t have a phone or health QR code. This is bad — preventing Covid shouldn’t equal depriving old adults’ mobility. Regarding these, some argue to get rid of the whole health QR code system: without QR codes, no one troubles. However, they undervalue the codes. Without the system to track and quarantine those needed, more infections may happen. If aged people get infected, they are more likely to experience severe symptoms and die! Consequently, we should keep the health QR code. The next step becomes, how can we adjust it to benefit more people?
To solve technology access difficulties, Chine provided paper health QR codes, which unfortunately couldn’t solve deeper issues of digital devices usage barrier. Electronic health QR code is no longer the only way to track one’s health status. In Shanghai province since August 2021, aged people over 60 can get their health QR code printed “at district administrative service centers or community service centers” (Yang et al.). This change prevents aged people from having to buy a cell phone. As the printed code is valid for 180 days, the elderly are unconstraint to travel. However, if we look closer, paper QR codes are provided by young staff printing through “a super self-service machine” (Yang et al.). This approach is just to let the young people do technical parts for old people. What if there are no staff in district administrative service centers at 6:00 a.m. — when seniors usually go out — to help them get printed copies? When seniors are alone with self-service machines, smartphones, or any new technology, explored by Song et al., they are often “confused, vulnerable, and struggled”. Why? Because they “do not have much experience in using digital technologies” and need technical support (Song et al.). Having access to new-tech devices is great, but only when one knows how to use them — and currently the elderly don’t. Therefore, we should target seniors’ usage barriers and improve in this aspect.
Education with peer support is the key, as it equips seniors with adequate skills which empower them to depend less on others for new technology use. Academic research has proved peer supporters’ role in helping aged people learn about new technology. As stated in Lindsay et al.’s research, given no access barriers, within 6-months of informal learning, experimental group seniors who interact with peers in a closed-group discussion forum had “significantly differences [better] in computer skills”, compared to control groups without peer support (319, 322). This comparison suggests peer-support education’s power in equipping one with technical skillsets. Even more, within the experimental group, 35% more of them (86.5%) actively used search engines than before (Lindsay et al. 327). This growth implies that education has empowered their independence. Why is it? Imagine something they are looking for can be only found online. With more computer skills, more seniors can and actively search by themselves, instead of having to wait for others’ help. Their capability to take initiative demonstrates their independence. Again, how do they become capable? It is through education with peer support. Theoretically proved to be effective, we then explore how education with peer support is used in reality.
Extending the idea of peer support, America’s GetSetUp provides peer-to-peer education, where China should learn to facilitate older adults’ learning and bridge digital device usage barriers. On GetSetUp, “the largest and fastest-growing online community of older adults”, the elderly can join community social events, guest lectures, and particularly live classes which are all taught by the elderly who are great in their fields (GetSetUp). Such a peer-to-peer education is especially essential in bridging technical usage divides. Young people, often experts in new technology, sound like good teachers. However, aged teachers better engage their students. Unlike younger generations who learn computer skills on laptops, people in their 60s or 70s mostly learn through teachers’ handwriting on blackboards. When young teachers teach, they usually explain things based on laptop learning experiences that seniors cannot relate to. By comparison, aged peers teach, exemplify, and refer to their common learning experiences which connect their students and make learning easier. In other words, GetSetUp’s peer-to-peer education expedites American elderly’s learning process, which China should learn and help our elderly. However, instead of adopting the whole GetSetUp system, we need some modifications. As stated above, GetSetUp is online. When less than one-fifth of Chinese aged 65+ own a smartphone/access the internet, they couldn’t reach the platform (Qi et al.). Without access capability in the first place, they are unable to learn, nor escape from usage inability. As a result, China needs peer-to-peer education to happen on a more accessible medium.
Because of Chinese elderly’s familiarity, radio is the best choice to hold peer-teaching courses and bridge digital device usage barriers. Unlike smartphones, most people aged 65+ already own or have experience using radios. According to my 75-year-old grandma, since the 1980s, nearly every family owned “三大件” — watches, bicycles, or radios. Thomala also confirms radio’s popularity — “In 2020, 99.38 percent of the population had access to radio”. Almost everyone has access to radios, so seniors wouldn’t face the same access difficulties as when they deal with smartphones that prevent them from studying health QR codes. Thus, radios are effective means to provide educational programs and empower the most Chinese elderly. What would it look like to hold such a radio show? In every episode, we cover one topic that seniors care about. As the Covid-19 pandemic continues, an episode covering self-service machine uses and printed health QR codes becomes helpful. We could interview seniors who are familiar with using those machines. They don’t need to be industrial experts but neighbors, family friends, or anyone are willing to help their peers. Not only they are encouraged to share learning experiences, but also go through the process of operating machines and printing QR codes step by step at their pace. Hearing their voices, more seniors around the country can learn and become independent in dealing with health QR codes. With QR codes, they travel freely. Ultimately, educational radio shows empower aged communities to have agency over their mobility.
In conclusion, while keeping electronic health QR codes prevents the Covid-19 pandemic from spreading, China needs to consider its aged population who are unable to get the codes due to their inability to access or use smartphones. Beyond providing self-service machines — which only bridge access gaps — we should learn from America and provide more seniors chances to learn from their peers on how to use those machines. These peer-to-peer education programs can be carried out through radio, considering its high coverage rate. Then, Chinese aged adults equipped with better technical skills will no longer rely on young people to print health QR codes and can travel freely. Not only helping Chinese elderly, this finding could inspire South Korea, with 16.5% of its population as aged people, where also mandates health QR codes during the pandemic (Arin; Yonhap). They may not need radio programs, but could incorporate peer support into other means and empower their elderly. In a more general sense, as we all will grow old one day, we should always consider aged community.
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