Study on the Construction of a Health Lifestyle for Older People in the Longevous Area in China

Abstract

During the past 40 years of reform and opening-up, China has witnessed great progress in people’s health status. Both the occurrence of diseases and people’s understanding of health have undergone profound changes. Scholars are focusing on changing socioeconomic factors to maintain health lifestyles, and creating healthy “human–land” relations to prevent diseases. From the perspective of health geography, this research conducted field work in Bama, a longevous area in the Guangxi province in China, and applied the theoretical framework of health lifestyles theory to clarify the construction process of health lifestyles for older people in Bama. The roles and characteristics of different social relations in creating health lifestyles are revealed. The findings of this research can provide a new paradigm for China’s health practice research from two aspects: (1) the production of health lifestyles is a knowledge construction process, taking into account the influence of social circumstances, politics, economy, culture, policy, and values; and (2) social attributes affect health lifestyles by reconstructing and improving social relations.

1. Introduction

The understanding that health means the absence of diseases can no longer be the interpretation of health research in the future. Life expectation has largely increased from less than 35 (1950s) to 78 (2022) years old [1]. Similarly, global disease patterns show a shift from large-scale population epidemics to more complex chronic and degenerative diseases [2]. Since the 19th century, China has successfully prevented large-scale epidemic diseases, such as cholera and pestis, by installing safe water supply and drainage systems, and reducing food prices through the introduction of agricultural mechanization. Since the 1960s, because of the vast use of vaccination and the discovery of broad-spectrum antibiotics, typhoid, tetanus, diphtheria, and other malignant diseases have been effectively curbed; instead, heart disease, cancer, and cerebrovascular diseases have replaced influenza, pneumonia, and tuberculosis as the primary diseases that threaten the population’s health in China [3]. Since the 21st century, China has gradually entered the “post-medical era”, and disease patterns and death of the population largely originate from social and environmental factors [1].

2. Literature Review

Discussions on health lifestyles began in the 1930s. At first, researchers treated doctors and patients in the same social system, structuring traditional, single-element etiological observation into the social and physical environment, and discussed the effects of health lifestyles and social behaviors. As more attention has been paid to the relation between lifestyle and people’s health outcomes, researchers have focused on the relation between organizations and power mechanisms, analyzed the interaction of different factors, and clarified how lifestyles affect people’s health in different regions.

Friedrich Engels combined health with the hierarchical structures of policy, economy, and social class [4]. Marxist political economy suggests that the personal possession of production (income) determines the outbreak of diseases and people’s attitude towards diseases [5]. The negative effect of income on life expectancy is more obvious in low-income, developing countries [6]. However, the health effects of income are less obvious in Scandinavian counties, Canada, and other high-income, developed counties [7].

Max Weber pointed out that socioeconomic status (SES) determines people’s health status [8]. There is a positive correlation between income and people’s self-rated health (SRH), especially for low-income populations, and the increase in income can significantly improve their health outcomes. A positive correlation can also be found between education level and people’s SRH, in which people with good education generally report good health [9]. According to life-course theory, income has a more significant impact on older people’s health status than education. Building healthy environments, such as those with friendly community environments, supportive facilities, closely neighborhood relations, low crime rates, and good community reputation, has proved to have positive health influences [10]. Post-medical research has stressed that health lifestyles take priority over other factors in determining people’s life expectancy. The negative influences of physiological factors on people’s health can be compensated by social environmental factors [11]. Therefore, doctors and disease control systems constantly emphasize the significance of adopting health lifestyles to maintain well-being and prolong life expectancy.

Pierre Bourdieu analyzed the mechanisms connected with health lifestyles by researching diet and exercise [12]. He did this by taking combined universal and persistent health practices/behaviors that are interchangeable in a system. Health practices/behaviors are unconsciously reproduced in different circumstances (denoted as Field), and can be reformed into healthy activities (denoted as Habitus); eventually, constructing them into practices (denoted as Particular facts) has long-lasting influences (so-called health lifestyles) [13]. On the other hand, health lifestyles are constantly modified and reconstructed through social practices [14]. For instance, the low-income class is at a disadvantageous position when it comes to health lifestyles; accordingly, a person with a high income and of a well-educated class is more inclined to consume organic, green, and pollution-free food; they are more involved in sports and fitness activities, try to avoid alcohol, tobacco and drug abuse, and take good use of health prevention services (e.g., physical examination, dental care, cancer and heart diseases screening, and vaccinations). The individual’s health behaviors are organized and structured [15]. Finally, they constructed the health lifestyle of the high-income class, which has been wildly spread and accepted by more people.

Cockerham presented the health lifestyle theory to explain the process of the individual practicing health lifestyles, the interactions between health lifestyles, and the influence on individuals [1,16]. According to the health lifestyle theory, socioeconomic status is the dominant factor in determining people’s health status [17]. Meanwhile, demographic characteristics (e.g., age, gender, and race), as structural variables, provide social backgrounds for the organization and structure of health lifestyles. Secondly, the individual’s health behaviors need to be internalized into social empirical practices through continuous training. Thirdly, interactions between life choice and life opportunity construct health practices, and this is called the ‘Habitus’ in different ‘Fields’ [18]. These healthy habitus are constantly realized by individuals in daily practice, by providing evaluation and supplement through practices (action), such that health habitus are constructed into health lifestyles. Finally, health lifestyles are revised, reconstructed, and reproduced through social–culture feedback mechanisms, becoming well-developed health lifestyles.

There are complicated relations between the health status of society, population, and various social factors. The occurrence of diseases is correlated to specific social lifestyles. Firstly, traditional disease patterns have been replaced by post-medical patterns, such as cardiovascular disease and diabetes, while chronic diseases cannot be effectively cured through medical treatment. Secondly, a large number of studies show that certain lifestyles can lead to certain diseases, such as HIV/AIDS and silicosis. Thirdly, the public health system and mass media constantly address changes in health lifestyles and personal health responsibility. Health issues are deeply rooted in the operation of social life and have great potential to change moral norms, values, habits, and lifestyles worldwide, such as tuberculosis, SARS, and COVID-19. Therefore, health geographers encourage people to solve health issues by improving lifestyles and creating friendly social and human–land relations.

Contrary to pure medical research, the theory of health lifestyles socializes the mechanical concept of health in epidemiology and medicine, emphasizing the health effects of non-medical factors. This theory links health to social class, but it fails to explain the health effects of different social relations within the same class. The effects of health lifestyles are different in multiple situations (e.g., individual/group/community), and the expression is not the same. For this reason, in different fields, a same lifestyle could have different expressions. In recent years, the concept of “tourism image” has been proposed for a specific site, which helps to attract tourists [19]. This aims to establish “health tourism”, which contributes to a type of social factor that influences the health status of travelers [20,21]. The concept of health tourism has been applied to analyze the cases from different countries all over the world. For example, health expenditure and domestic health consumers were considered to have a great impact on health tourism [22]. Based on a survey in China, therapeutic landscape and health tourism are found to interrelate with each other [23]. A combined factor-clustering method was adopted to define the socio-demographic, behavioral and psychographic characteristics of tourists in Poland [24]. Similarly, there was a positive long-term effect of tourism demand on health-related tourism spending in Canada [25]. People start to become aware of the importance of health travel, but the level of participation is still low compared to other travel activities [26]. Interestingly, the climate has been found as a crucial component in environmental life for entertainment and tourism, which can shape health lifestyles [27]. However, it should be emphasized that the manner in which health lifestyles are related to the surrounding factors has never been investigated with the focus being on older people.

To sum up, different countries are facing aging issues, and China is one of the most critical countries for aging problems. However, limited research has been performed to understand the impact of problems associated with aging. Research on health issues is being extensively conducted, with a limited focus on the health lifestyles of older people. Cases from China are even more limited. There is a need to understand how health lifestyles can influence people’s lives with the focus on China.

The Bama county, as an longevity township, has been certified both internationally and domestically. It has attracted a large number of tourists who visit it for recreation and healthcare purposes. In the context of social transformation, Bama strives to create a unique health brand of “health place, longevous Bama”. Governments, developers, local residents, ‘snow birds’, and other groups are actively participating in tourism development in Bama [28]. They are also constructing a set of health lifestyle and human–land relations with the local characteristics. It is hypothesized that the heath lifestyle theory is applicable to the Bama situation, and the formation of health lifestyles is affected by social relations. This research applies qualitative methods to analyze and clarify the socio-cultural operating mechanism behind the diversity and the complexity of various health expressions, in terms of health geography, to explain the formation and mechanism of health lifestyles in Bama, in order to enrich and expand social cultural research. The objectives of the study can help to address: (1) how a set of heath lifestyles can be established for Bama based on different social circumstances and factors, rather than pure natural science; and (2) how social relations influence the formation of health lifestyles from the perspectives of local government, developer, local residents, and ‘snow birds’.

3. Field Site and Methods

3.1. Field Site

In this research, the Bama Yao autonomous county, Hechi city, Guangxi Zhuang Autonomous region (see Figure 1), was selected as a case study. Among the 76 longevous areas in China, Bama is the only longevity township that has been certified both internationally and domestically. In recent years, with the promotion of “Health China” strategy, Bama has been built into a typical longevous tourism destination with the theme of “Great health, great tourism”.

In 2020, there were 102 older people aged 100 years in the Bama county, accounting for 0.04% of the total population. This is 5.7 times than the international standard for “longevous area”. According to the statistics in 2019, there were about 140,000 ‘snow birds’ in Bama, and more than 80% of them lived in the Panyang river basin.

According to the statistics, in an interval of 10 years from 2008 to 2018, the total number of tourists in Bama increased from 651,500 in 2008 to 6,548,500 in 2018, and the total tourism consumption increased from CNY 422 million in 2008 to CNY 2833 million in 2018. When searching for Bama-related keywords in CiteSpace in CNKI, the results of “health and longevity”, “older people”, and “health care” are found as hot topics, as illustrated in Figure 2.

3.2. Methods

This research used interviews and participant observations to collect the data.

Table 1. Profile of the older people who participated in this research.

Sample size (people)	36
Age range (years)	61–108
Gender	Male: 12/Female: 24
Nationality	Chinese

summarizes the demographic characteristics of all participants. The research was divided into the following stages:

• Pre-investigation, which was conducted in April 2018, through online surveys, news reports, tourist travel notes, and advertisements. A general picture of the the human–land environment, policy orientation, and tourist’s impression of Bama was achieved.
• Investigation, which was conducted in July 2018, based on the pre-investigation. In this stage, in-depth interviews and participant observations were adopted to interview the workers of local government, residents, and tourists to obtain more detailed information. The questions included: What are the obstacles that you have encountered in the process of policy implementation? What are the main concerns/ entanglements you have during your investment in Bama? How do you feel, any confusion regarding the influx of tourists? Have there been any changes in your daily life before and after the arrival in Bama? How is your health experience since you have arrived Bama? Through interviews, first-hand data on the local population, economy, and society were collected.
• Supplementary research, which was conducted in August 2018. In this stage, field work data and multi-media data were collected, and all recordings were transcribed. Based on the theories of health geography, cultural geography, and other disciplines, a textual analysis of the survey data was conducted.

A convenience sampling strategy was used to recruit the participants. People aged 50 years and over, which can be classified as older people [29], were randomly selected from the local communities, parks, and places where they were likely to meet and socialize. Since most “snow birds” concentrate in the Panyang river, the participants in this research primarily live in the Poyue village and Jiazhuan village. Each interview lasted from a minimum of 14 min to a maximum of 71 min. All interviews were denoted as BM-xxx (i.e., from BM-001 to BJ-036). All interviews between BM-001 and BM-036 were carried out by the first author.

4. Results

4.1. Construction of Health Lifestyles Is Essentially a Process of Knowledge Construction

Health lifestyle theory contributes by challenging traditional medical knowledge. In the context of social transformation, economic development, and changes in disease patterns, people maintaining health, preventing disease, and creating health impressions no longer mechanically follow the health ‘guidelines’ of epidemiology and preventive medicine. Good health relies on the diffusion and popularization of health lifestyles. The construction of health lifestyles is essentially a process of knowledge construction, which follows the construction of general social knowledge. Individuals’ daily health behaviors exist in the micro-social relations. In order to prolong life expectancy and maintain their health state for a long time, people try their best to avoid harmful behaviors and learn healthy behaviors. This not only includes active exercise, considering their nutrition, regular work and rest, and quitting smoking, but also maintains an orderly and peaceful neighborhood to create a civilized and safe social environment. In recent years, “square dancing” and “brisk walking” become popular among older people. Sustainable food networks promoted in suburbs, the separation of non-smoking areas in public places, management of urban smog, and the substantial increase in the ratio of older volunteers participating in public affairs have a positive impact on the increase in the life expectancy of the population and maintaining a youthful state of the body.

According to the concepts of “behavior”, “field”, and “habitus”, an individual’s knowledge (behavior) is guided by his or her own cognition and is restricted by external conditions (field). Once entering a new field, the original knowledge (behavior) will be adjusted consciously or unconsciously to adapt to the new environment (field), and then stimulate the creation of new knowledge (behavior). The new knowledge (behavior) is constantly performed by individuals to construct new habitus. New habitus collects and reconstructs a new discourse system.

Bama’s ideal natural environment provides a superior natural base for performing health lifestyles. Bama is located in the south-western mountainous area in the Guangxi province, with well-developed karst landforms, no heavy industrial pollution, and a high rate of forest (≥71%). The humid (50–70%) clean air effectively prevents the occurrence of respiratory diseases. The high concentration of negative oxygen ions in the air can alleviate nervous tension and improve the activity of antioxidant enzymes in the body. Small molecule groups of weak alkaline water can penetrate cell walls, promote the metabolism, and prevent cardiovascular diseases.

“For some of my friends, the indicators (blood pressure, blood glucose, blood lipids) turn normal immediately once they have come to Bama … However, everything goes wrong when they go back to home. We are addicted to Bama; in other words, we cannot survive outside Bama!”

(BM-005, female).

“The water (Panyang river water) is so cold now, and in summer, many people swim in the river. Now, we can only take shower (with the Panyang river water), and my landlord boils the water (Panyang river water) for us to take a shower everyday……I take shower with and also drink the river water. It is so good for our health!”

(BM-024, female).

The superior natural environment fulfills people’s desire for a high-quality natural environment considerably, which attracts a large number of older migrants, or ‘snow birds’. They usually stay in Bama for half a year. People from the north will stay in Bama in winter and leave in summer, while people from the south will stay in Bama in summer and leave in winter. A time–space migration habitus is constructed accordingly.

“I come from Shenyang, where winter is too cold to stay. I stay here (Bama) for half a year, from October to March”.

(BM-015, female).

Newly adjusted health behaviors are performed in different ways (field) in Bama. The path leading to the mountain for fetching water has become a natural trail for daily walks; the square in front of the Baimo (a karst cave) cave has become a natural platform for older people to rest, dance, and social. Because the Baimo cave is rich in oxygen, it has become a natural “oxygen bar”. Thick branches of plants have become natural fitness equipment. Older people go to local markets to buy fresh and organic vegetables where only local residents used to eat. A friendly, mutually, and helpful neighborhood has been built, and people practice their health lifestyles in a new environment (see Figure 3).

“At the very beginning, it was only my wife and I who came to Bama; now, more and more people came from Hangzhou……we lived close to each other, and we made rice dumplings together (with people from Hangzhou) two days ago……We have been here (Bama) for eight years, and “bought” a house with limited property rights (a house is built on collective land, and people can live there for years with no ownership by buying it) two years ago. I can live in the house for eight years for 100,000 yuan. More and more people are coming to Bama, and I can get everything I want to. Food quality is good, since food are all grown by the farmers themselves and no pesticide is used. A while ago, I bought some sweet potatoes for my eldest son from the local market”.

(BM-003, female).

Personal health lifestyle experiences (habitus) are spread through exchanging and interactive learning among older peers. These experiences (habitus) are practiced by different people in different environments (field), and then they finally come into new health lifestyles (a new discourse system).

“Blue belt (an NGO organized by snow birds in Bama) organized our older people together, and arranged different activities for us every day. My wife and I take Xinjiang dance class in front of the Baimo cave on Tuesday, Wednesday and Friday afternoon for two hours every time, hahaha……”

(BM-011, male).

In certain natural and human environments (‘fields’), original knowledge (behavior) is negotiated and optimized, which stimulates the construction of new habitus.

“Older people get up early. We wake up at 5 a.m., pack up and go to the mountain to fetch water…… The annual pass (Baimo cave) is cost-effective. In the morning, we climb the mountain for one and a half hours, and then we come down with water and spend the whole morning absorbing oxygen inside the Baimo cave…… the cave is cold and we take our own mats and quilts, or sometimes take a nap. In the afternoon, we go home for lunch with the water we got in the morning. Activities are well organized by them (Blue belt), and all the classes are scheduled according to our specialties. My husband is good at singing, hahahaha, he is a leading singer……some people even go back to the cave for oxygen in the afternoon. I usually practice singing with them (snow birds)”.

(BM-012, female).

The natural environment and friendly circumstances among older people provide essential ‘fields’ for the construction of new knowledge (behavior and habitus). The local government (including NGOs), developers, and ‘snow birds’ assemble different ‘health habitus’ into a healthy discourse system, constructing new health lifestyles in Bama.

The construction of health lifestyles is essentially a process of knowledge construction. It is not a one-way process or a homogeneous mechanical repetition, but a continuously modified, reconstructed, and completed feedback system.

4.2. Production and Reconstruction of the Local Health Culture in Bama

The formation and development of health geography is attributed to the understanding between different people and variable social factors. Unlike purely medical research that focuses on disease and pathogenic factors, Marxist political economy theory, Neoliberalism, and Bourdieu’s and Cockham’s theoretical models connect people’s health status with their social class. However, they fail to discuss the differences in health connections within the same class. Combined with the Bourdieu’s theory, this research believes that the construction of health lifestyle is an assembling process of health habits in different fields by different stakeholders. It is a paradigm that people practice to maintain their health and prevent diseases. This research discussed the production and construction process of health lifestyles in Bama, from four perspective: government, developer, ‘snow birds’, and local residents.

4.2.1. Production and Construction of Health Lifestyles by the Local Government

The central government has projected a series of policies and measures to build a ‘healthy China’. The Chinese society is undergoing a social transformation. With the improvement of economy and public health, people are paying more and more attention to the issue of “living well” to “living”.

The Guangxi provincial government and the Bama county government are actively creating an image of ‘healthy Bama’. In order to promote the construction of ‘healthy China’, they take good advantage of ‘the Belt and Road’ by cooperating with the China National Tourism Administration, the people’s government of Guangxi Zhuang Autonomous Region, and other entities to hold the ‘China-ASEAN International Forum on traditional medicine and health tourism’ (abbreviated as the “Bama forum”) in Bama every year. With the help of the National Poverty Project, governments cooperate with Shenzhen to build a ’Special pilot zone for great health cooperation’, which has greatly increased the popularity of Bama as a ‘hometown of longevity in the world’. In addition, the Bama County government holds the ‘Bama international Marathon’ every year, attracting many well-known enterprises to invest and build a ‘Bama longevity and health international tourism zone’. Local governments have made great efforts to improve urban and rural environments, redesign the landscape, renovate dilapidated houses, and repave the roads. In the core area of the longevous area, the government paid for the decoration of traditional houses and painted the “life pattern” of the white river on a green background, presenting the word ‘life’ in Chinese calligraphy, as shown in Figure 4. With the help of the local government, Bama is attracting more and more people internationally and domestically to experience the fabulous natural environment as well as the local culture.

With the increasing popularity of Bama, many cancer patients come to Bama, hoping to receive medical treatment. As the number increases, swindlers, Qigong masters, so-called panaceas, and irresponsible media reports tarnish the local community. The “longevity county” was distorted into a “cancer county”, which led to a decrease in tourism. For this reason, the Bama county government has organized forces and carried special activities to eliminate the negative effects, took strong measures against counterfeit medical activities, refuted false rumors, and re-established the tourism image of Bama. After several years of consistent efforts, Bama has become a ‘cyber spot’, and ‘longevity and health’ have become the keywords representing Bama.

With the help of administrative power, the government projects a series of policies and measures to carry out macro-control regulations over the construction of activities in Bama. The Civil Affairs Bureau especially establishes personal files for older people, issues living subsidies according to age, assigns doctors to centenarians, and encourages filial piety for the society. These administrative activities enable older people to have dependency and security in and happy later life. Additionally, Bama also established the first longevous museum in China. The museum has become an important window for Bama to show itself to the world.

4.2.2. Production and Construction of Health Lifestyles by Developers

Developers have taken the advantage of the resources of Bama to achieve their economic goals; at the same time, they strive to promote Bama in their own way. After entering the administrative region of Bama, the first thing that catches the eye is the various advertisements of “Bama water”. At present, there are 14 mineral water and drinking water factories, and 19 registered drinking water brands (an example can be seen in Figure 5). The development of water resources has brough vast economic benefits. With the development of health tourism, Bama attracts developers from all over the country to ‘panne gold’, including the real estate tycoon Country Garden group as well as many other small–medium developers. They cooperated with local enterprises and residents, building healthcare centers, apartments, and limited property right houses. Developers have built a comprehensive and multi-level healthcare system for older people in Bama.

Developers not only develop local resources but also try their best to advertise Bama, striving to create a “holy place for health care”. With the participation of capital, natural resources have been put on the cloak of “prolonging life”, “relieving diseases and preventing disasters”, and “being beauty”. Developers are trying to cultivate a healthy circumstance in Bama in many ways. For instance, because the oily fish growing in the Panyang river lives in cold water (see Figure 6), it is advertised as a good source of Omega 3. It is said that taking oily fish helps to reduce blood lipids and cholesterol, protect heart, and prevent cardiovascular and cerebrovascular diseases. For this reason, the price of oily fish has increased. Cheap and easy-to-obtain ingredients have become too expensive after capital operation. Fructus cannabis (see Figure 6) is a common local crop. It is used as animal fodder; people only appease their hunger with fructus cannabis during the hard period of natural disaster. Nowadays, fructus cannabis is packaged as a ‘longevous seed’, and fructus cannabis soup, fructus cannabis cake, fructus cannabis oil, fructus cannabis powder, and many other fructus cannabis-related produce fill the market.

Around the world, developers not only achieve benefits by developing Bama’s natural resources, but also create a healthy circumstance to attract people, especially older people. They are proposing health lifestyles and producing healthy produces, in order to meet the needs of people.

4.2.3. Production and Construction of Health Lifestyles by the Local Residents

The development of Bama’s economy and the arrival of tourists have had a great impact on the daily life of the local residents. People intentionally or unintentionally participate in the production and construction of health lifestyles in Bama. The random development of natural resources (e.g., water) infuriated local residents, while they ignored or even resisted the disordered development activities in Bama in the early stages.

“‘It is nonsense, how can you be healthy with such little money?!’, ‘These (fructus cannabis advertisements) are false propaganda and misleading. It (fructus cannabis) is chicken fodder, (traders are) cheating tourists.’ ‘It does not matter if you are healthy or unhealthy, who will do the farm work (if older people do not do farm work)?’”

(BM-035, Male)

In recent years, more and more local residents have participated in tourism development. First and foremost, improvements in family income and life quality have gradually changed the negative and passive attitudes of the local residents towards tourism development. Local residents made considerable benefits through the commercialization of their agricultural products (Bama pig, fructus cannabis, and oily fish). Some of them achieved a stable rental income by selling or renting their homestead and running guesthouses.

In the process of transformation from agricultural population into tertiary industrial employees (taxi driver, tour guide, and small business owners), they started to be aware of the values of “diabolic tricks and wicked craft” that were overlooked by the local residents for a long time. With the encouragement of official policy, multi-media propagation and tourists’ enthusiasm toward ‘healthy product’, farmers began to understand the external health value of ordinary agricultural products, reassessed the value of ‘’diabolic tricks and wicked craft”, and gradually participated in the production and construction of the health culture in Bama.

“Fructus cannabis grows in Bama is 100% organic, with no pesticides. This green food is good for your health”.

(BM-035, Male)

With the influence of the external environment, local residents have gradually accepted and adapted to the health lifestyles, and thus guide their daily life practices. Bama had a high rate of centenarians by the year 2019; there were 98 older people aged over 100 years. The town attracts hundreds of tourists and migrates to explore the ‘longevity secret’. Grandma Huang is 108 years old with a good health. She sits in front of her house and is visited by tourists every day. Whenever people ask about her “longevity secret”, she always says ‘being happy’. Her family member always add the statement of ‘(she) eats organic fresh food (oily fish and fructus cannabis), drinks mineral water and goes out for fresh air’. The concept for health lifestyles is being gradually accepted by local residents and performed in their daily life.

4.2.4. Production and Construction of Health Lifestyles by ‘Snow Birds’

‘Snow birds’ play a significant role in the production and construction of health lifestyles in Bama. They come to Bama with the aim of seeking good healthcare, taking natural medical treatments, and practicing their previous health lifestyles. ‘Snow birds’ also integrate with the natural and cultural environment, continuously adjust and reorganize their previous lifestyles, and then construct a set of health habits, which are suitable for Bama. Through communication with and performance by ‘snow birds’ and their peers, new health habits are strengthened by different participants (local government, developers, and residents) and are reconstructed as the health lifestyles in Bama. Health lifestyles not only meet the needs of various groups of people, but also are set as the criteria attracting more people to practice them.

While practicing health lifestyles by themselves, ‘snow birds’ also introduce and exchange their health experience to the peers.

‘My neighbor (in Bama) is my neighbor (in Shengyang). We came to Bama first, and then I introduced them (neighbor) to come. Because they saw my blood pressure fell and my health status went well, they tried and only stayed for ten days, and finally made their mind to stay in Bama. Hahahaha, now, we are neighbors again’

(BM-015, female).

‘Snow birds’ have a double identity, being health lifestyle practitioners and healthy information sources.

5. Discussion

The construction of health lifestyles is a process of continuous adjustment and reconstruction. Health lifestyles are both heterogeneous and homogeneous. They can represent individual characteristics and collective attributes. When the external environment or operating ‘field’ changes, health lifestyles are adjusted accordingly through continuous performance. In the longevous area, health lifestyles are affected by both natural environments and social circumstances, and they are reconstructed by the continuous performance of various people/groups.

People’s demographic characteristics and their social status have significant impacts on people’s health status. Both age and gender affect people’s health. Income, education level, marriage status, occupation, and other factors also influence people’s health decision making. This research tried to clarify the construction process of health lifestyles for older people and reveal the roles and characteristics of different social relations in creating health lifestyles. The mechanisms of how health-related factors shape older people’s health lifestyles, especially for the “snow birds”, need to be further explored.

Because of the limited budget, 36 people were interviewed. With respect to gender, there were 24 female and 12 male participants in this research. All the participants were randomly selected, and it seems that females were more willing to participate in interviews compared to males. Additionally, interviews were performed in outdoor settings, so older people who were in poor health or too weak to go outside are missing from this research. This could mean that the perspectives from some older people in the study area are missing, and even more importantly, the findings cannot be generalized beyond the study area in Bama.

6. Conclusions

First, the production of health lifestyles is a process of knowledge construction. With the transformation of disease patterns and society, health knowledge is no longer a product of pure natural science; instead, it is a combination of multiple factors, including politics, economy, culture, policy, and values. Traditional medical knowledge only helps to partially regulate health lifestyles. A set of health lifestyles is a product of various social circumstances, and many factors contribute to the production and construction of health lifestyles.

Secondly, health lifestyles have social attributes, which existing in social relations among different people. Health lifestyles not only include personal value judgments, but also reflect the product of social reaction and cooperation. Health lifestyles should be updated by reconstructing and improving social relations. For instance, the local government cooperated with developers to eliminate negative influences to create a healthy circumstance for Bama. During this process, they encountered misunderstanding and resistance from the local residents. Through economic leverage and policy inclination, the local residents have gradually participated into health lifestyle production and construction. The contradiction was resolved, and a set of health habits suitable for Bama was created.

It should be noted that all findings are limited to the conditions of Bama, and interpretation for other locations must be with caution. Furthermore, the sampling method was rather limited, drawing the data from only 36 samples. All participants were those who were able to talk and relatively healthy to perform outdoor activities. The sampling method could be biased, since older people who cannot perform outdoor activities freely were eliminated from the dataset. Only a qualitative analysis was performed, but a quantitative analysis should be carried out in the future to better understand the health lifestyle issue.