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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)


city

Yearly, 1978-2002

Monthly, 2003-2008

Acute pneumonia

(J15)


city

Yearly, 1978-2002

Monthly, 2003-2008

Morbidity of respiratory diseases


air group

• Morbidity from circulatory diseases


Total morbidity of

Circulatory diseases (I00-

I99)


Hypertension

(I10-I15)


city

Yearly, 1978-2002

Monthly, 2003-2008

Stroke

(I64)


city

Yearly, 1978-2002

Monthly, 2003-2008

Angina pectoris

(I20)


city

Yearly, 1978-2002

Monthly, 2003-2008

Intracerebral haemorrhage

(I61)


city

Yearly, 1978-2002

Monthly, 2003-2008

Detailed description of the variables, air

group

• Mortality


Total mortality UB city and aimags Yearly, 1990-2008

Mortality from

respiratory diseases


Mortality from

circulatory diseases



air group


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


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


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


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


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


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


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



0

5

10

15

20


10

000 õ

¿í

àì

ä

0

1

2

3

4

5

6

7

8



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


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


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

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