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Climate Change and Health
assessment, Mongolia
B.Burmaajav
July 21, 2010
San Jose, Costa Rica
Mongolia at glance
• Territory: 1.5 mln sq.km
• Population: 2.7 million
• Capital city: Ulaanbaatar
• Language: Mongolian
Mongolia at glance
Climate Change and Harsh winter
Climate Change and Flood
Assessment objective• The goal of the assessment was to determine the association between
climate change and human health, and to develop recommendations for further action for Climate Change and Health.
• Objectives were:
• To determine the association between climate change, air pollution and human health and develop recommendations:
• To make a primary assessment on climate change impacts on water availability and quality and further impacts on human health, and develop recommendations for future actions:
• To study and assess the correlation between selected infectious diseases in Mongolia and climate parameters
• To describe current status of the extreme weather situation by compiling the results of previous research studies; to anticipate future scenarios according to global climate change projections; and to consider the possible impacts of extreme weather on human health in Mongolia.
Approach to Organization
• Ministry of Health,
• WHO/WPRO,
• Ministry of Nature, Environment and Tourism,
• Ministry of Food, Agriculture and Light Enterprise
• National Emergency Management office
• Water Agency,
• Air Quality Agency,
• Health Agency,
• Institute of Public Health,
• Institute of Meteorology and Hydrology,
• National Institute of Geo-Ecology,
• National Centre for Communicable Diseases etc.
Participation of the stakeholders
• HIA working group at the Ministry of Health was headed by Dr.J.Tsolmon. Vice Minister for Health, Mongolia
• The stakeholders provided related data and information
• Data were collected in March to May, 2009 and analysed with technical support of WHO consultants,
• Report was written by national team
• The report amended and corrected according to the comments of WHO consultation team
Scope of the assessment, air group
Subject Parameter Source Unavailable
data
Meteorology Temperature and
Precipitation
Institute of Meteorology
and Hydrology
-
Air quality SO2 Air Quality Office Ozone, Carbon
monoxide
NO2
Health Total morbidity Health Department,
Government Agency
Daily data
Respiratory disease Daily data
Circulatory disease Daily data
Mortality Daily data
Detailed description of the variables,
air group
Collected data Sampling area Period
Total morbidity of
respiratory disease (J00-
J99)
UB city and aimags Yearly, 1966-2008
Acute respiratory
disease (J00-J06)
Emergency center of UB
city
Yearly, 1978-2002
Monthly, 2003-2008
Asthma
(J45)
Emergency center of UB
city
Yearly, 1978-2002
Monthly, 2003-2008
Acute pneumonia
(J15)
Emergency center of UB
city
Yearly, 1978-2002
Monthly, 2003-2008
Morbidity of respiratory diseases
Detailed description of the variables,
air group
• Morbidity from circulatory diseases
Collected data Sampling area Period
Total morbidity of
Circulatory diseases (I00-
I99)
UB city and aimags Yearly, 1966-2008
Hypertension
(I10-I15)
Emergency center of UB
city
Yearly, 1978-2002
Monthly, 2003-2008
Stroke
(I64)
Emergency center of UB
city
Yearly, 1978-2002
Monthly, 2003-2008
Angina pectoris
(I20)
Emergency center of UB
city
Yearly, 1978-2002
Monthly, 2003-2008
Intracerebral haemorrhage
(I61)
Emergency center of UB
city
Yearly, 1978-2002
Monthly, 2003-2008
Detailed description of the variables, air
group
• Mortality
Collected data Sampling area Period
Total mortality UB city and aimags Yearly, 1990-2008
Mortality from
respiratory diseases
UB city and aimags Yearly, 1990-2008
Mortality from
circulatory diseases
UB city and aimags Yearly, 1990-2008
Detailed description of the variables,
air group
Collected data Sampling area Period
Air quality data
Sulfur dioxide (SO2),
µg/m3
UB city and aimags Monthly average, 1996-2008
Nitrogen Dioxide (NO2),
µg/m3
UB city and aimags Monthly average, 1996-2008
Meteorology data
Temperature , °C UB city and aimags Yearly, 1978-2002
Monthly average, 2003-2008
Detailed description of the variables,
water group
Collected data Sampling area Data source Period
chemical composition
and quality (CI-, SO42-,
Ca2+, Mg2+,
mineralization,
hardness, NH4+, NO2
-,
NO3-).
Ulaanbaatar
city and
21 aimags
Institute of Geo-Ecology,
State and aimag specialized
inspection agencies, and
Public Health Institute
1970-2008
Hydro-chemical data
(pH, Ca, Mg,
permanganate value,
NH4+, NO2
-, NO3-) as
well as some hydro-
biological data (total
bacteria count and
coliform count)
Ulaanbaatar Water Laboratory of the State
Regulatory Agency for
Professional Inspection under
the Prime Minister’s Cabinet.
1993-2005
Detailed description of the variables,
water group
Collected data Sampling area Data source Period
Incidence of
waterborne
diseases (number
of cases and rate
per 10,000
population)
Ulaanbaatar and
21 aimags
Department of Health
Statistics of the State
Implementation
Agency Health
Department
1996-2008
Waterborne disease
Detailed description of the variables,
infectious disease group
• Infectious diseases and health
Diseases Sampling area Data source Period
meningococcal infection, TB, typhoid, viral hepatitis A, dysentery, plague, tick borne encephalitis, anthrax
21 aimags and Ulaanbaatar
National Center for Communicable Disease (NCCD) and National Centre for Communicable Disease with Natural Foci (NCIDNF)
1996-2008
Detailed description of the variables,
desertification group
• Extreme weather and health
Meteorology Sampling area Data source Period
aridity index (ratio of precipitation and potential evopotranspiration)
21 aimags (province)
NGEI 1940-2008.
We used data and other materials from the database and study reports of NGEI on aridity index (ratio of precipitation and potential evopotranspiration) according to meteorological observation for the period 1940-2008.
Major findings, air group
Cardiovascular disease mortality has increased while respiratory disease mortality has decreased.
79.082.7
80.275.7
66.470.7
64.9 63.560.8 61.7
59.0 60.4 60.7 60.8 60.7 60.7 61.3 60.856.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Total mortality Mortality rate from CVDs Mortality rate from RSDs
Major findings, air group
Morbidity due to Respiratory diseases, Mongolia, 1974-2008
Cardiovascular diseases morbidity, per 10,000 population, 1974-2008
0
500
1000
1500
2000
2500
3000
1974
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
per 10 000 population
CVD disease morbidity has increased while respiratory disease morbidity has decreased
Major findings, Air group
There is a seasonal variation to the prevalence of respiratory diseases, with higher morbidity rates in the winter season.
0
1
2
3
4
5
6
7
8
9
10
I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI
0
0.5
1
1.5
2
2.5
3
I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI
Figure 16. Acute respiratory disease per 10,000 population, by year and month in Ulaanbaatar, 2003-2008
Source: Emergency Center, UB city, 2003-2008
Figure 16. Acute respiratory disease per 10,000 population, by year and month in Ulaanbaatar, 2003-2008
Source: Emergency Center, UB city, 2003-2008
Acute respiratory disease per 10,000 population, by year and month in Ulaanbaatar, 2003-2008
Prevalence of asthma, by year and month, 2003-2008, per 10,000 pop.
Major findings, Air group
Prevalence of Hypertension in Ulaanbaatar city per 10,000 population, by year and month, 2003-2008
Ischemic Heart Disease morbidity per 10,000 population, by year and month, 2003-2008
There is a seasonal variation to the prevalence of cardiovascular diseases
Figure 16. Acute respiratory disease per 10,000 population, by year and month in Ulaanbaatar, 2003-2008
Source: Emergency Center, UB city, 2003-2008
0
5
10
15
20
I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI
10
000 õ
¿í
àì
ä
0
1
2
3
4
5
6
7
8
I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI I III V VII IX XI
Major findings, air group
Parameters
(UB city)
Summer
mean (±SD)
Winter
mean (±SD)
Spring/fall
mean (±SD)
Health parameters
Hypertension 15.99 (2.06) 17.1 (2.07) 16.29 (2.28)
Intracerebral hemorrhage 1.84 (0.41) 2.18 (0.58) 1.97 (0.46)
Cerebral infraction 0.35 (0.14) 0.42 (0.24) 0.39 (0.17)
Acute respiratory infections 0.76 (0.27) 3.56 (2.11) 1.52 (1.16)
Asthma 1.28 (0.31) 1.88 (0.42) 1.46 (0.27)
Angina pectoris 5.65 (0.59) 6.52 (0.83) 6.00 (0.69)
Acute pneumonia 0.46 (0.17) 0.87 (0.39) 0.52 (0.20)
Air quality parameters
SO2
(Sulfur dioxide) 3.18 (1.20) 27.99 (6.68) 10.01 (6.50)
NO2
(Nitrogen dioxide) 28.59 (5.10) 37.62 (4.91) 30.03 (6.45)
Health & Air Quality Parameters by Season
Health & Air Quality Parameters by Season
There is a correlation between angina pectoris and weather parameters, and between respiratory diseases, air pollutants and weather parameters.
• Water resources and water regimes are under threat from climate change. Mongolia already experiences considerable water stress as a result of insufficient and unreliable rainfall, changing rainfall patterns and flooding
• There is a correlation between climate parameters (air temperature and precipitation) and some waterborne diseases.
Major findings, water group
Major findings, water group
Mineralization (mg/l) from 1960-2008 in Mongolia
Concentrations of sulfate and chloride (mg/l) from 1973-2006 in Mongolia
Drinking water has become increasingly mineralized and concentrations of chloride and sulfate ions have increased, indicating that climate change can impact the quality of surface and ground water
Major findings, water group
Dysentery cases by month Salmonellosis cases by month
Major findings, infectious disease group
Morbidity due to dysentery increased from March, reached a peak in August and than decreased from September to November. Between December and March morbidity rates remained low. This pattern was observed in each region
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1 2 3 4 5 6 7 8 9 10 11 12
-25
0
25
Morbidity Temperature
Morbidity of shigellosis by months, nationwide, per 10000 population
Tick-borne encephalitis
Tick borne encephalitis has been registered in Mongolia since 1969. An increase in cases was observed between 1977 and 1986. Since 2002, morbidity rates have again started to increase
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Major findings, infectious disease group
Major findings, desertification group
• Based on the linear trend of data collected from 41 meteorological stations between 1940 and 2007, average annual temperature has increased by 2.1°C
• Winter average temperature has increased by 3.6°C, spring and fall temperatures by 1.8°C and 1.9°C respectively and summer temperatures by 1.1°C
• Monitoring stations are spaced fairly evenly throughout the country.
• Extreme maximum temperatures have been rising in Mongolia as a result of global warming.
• In 58 out of 64 stations analysed in this study, the maximum recorded temperature occurred since 1991.
Extreme weather and Human Health
Spatial distribution of annual temperature change in last 30 years (oC)
Note: Circles are representing high intensity of warming
Extreme weather and Human Health
Mortality and morbidity data is only available over in a relatively short time period. The comparison showed that both the number of hot days and mortality due to CVD have increases since 1990. As the frequency of the heat waves increases, there are direct and indirect impacts on human health
0
1 0 0 0
2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
0 .0
1 0 .0
2 0 .0
3 0 .0
4 0 .0
5 0 .0
6 0 .0
7 0 .0
8 0 .0
9 0 .0
1 9 6 1 1 9 6 6 1 9 7 1 1 9 7 6 1 9 8 1 1 9 8 6 1 9 9 1 1 9 9 6 2 0 0 1 2 0 0 6
Number of hot days
2 5 < 3 0 < 3 3 < m o r t a l i t y o f c a r d io v a s c u la r d is e a s e
The number of hot days and mortality of CVD
Assessment methods
• Steps:▫ Methodology training: Feb.2009▫ Establishment teams (air, water, infectious
disease and desertification): March 2009▫ Development of assessment methodology: March,
2009▫ Discussion of the methodology at Acad.Council:
March, 2009▫ Data collection: March-May, 2009▫ Data analysing: May-June, 2009▫ Report writing: July, 2009
Major challenges
• The biggest challenge was lacking of the standardized information
•Daily health data on assessment period (1960-2009)
•Health data was not sufficient for revealing a climate change health impact
•Water quality data was not available for conducting an assessment
•Although, we had worked with technical support of WPRO/WHO, local experts were
lacking with conducting the assessment due to not detailed developed assessment
methodology
•This was almost the first multi-sectoral assessment in climate change issues in
Mongolia. So thus, we were faced with difficulties for bringing to those people work
under one goal.
•It was new approach and new topic for the team (stakeholders were not well informed,
lacking with knowledge)
•Duration and capacity (both technical and financial) was not sufficient
Assessment quality
• Due to data lacking some of results were not
completed the initial goal (water related diseases)
• Not addressed to the heath sector’s preparedness to
the climate change
• Due to lacking with software of statistical analysis we
had not fully completed the data analysis in proper
way
Utility of Assessment and Meeting Decision
Needs
• The assessment was the first experience of Mongolia
• Assessment questions were addressed to reveal the health impact of CC rather than health care service preparedness
• During the assessment each group carried out the adaptation strategy
• The result of the assessment was useful to mobilize the attention of public and decision makers on Climate Change and its health impacts
• Recommendations were developed for further decision making by each 4 groups
Utilization of findings of the assessment
• National symposium on Climate Change and Health was organized in Ulaanbaatar, Mongolia, July 29, 2009.
• Based on the assessment findings, the draft of The National climate change and health adaptation strategy and action plan up to 2016 was developed by teams
• The national strategy is now under discussion (related local Governmental and Non Governmental organizations and international organizations including UN)
Future needs
• To conduct CC&H assessment according to WHO/PAHO guidance in order to reveal health sector preparedness
• To approve and implement the national strategy and action plan
Thank you