Climate Change and Health

assessment, Mongolia
B.Burmaajav
October 13, 2010
Ulaanbaatar, Mongolia
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.
Participatory organisations
• Ministry of Health
• Ministry of Nature and Environment
• Ministry of Food and Agriculture
• Public Health Institute
• Institute of Meteorology and Hydrology
• National Institute of Geo-ecology
• Health Department, Government agency
• Emergency Centre, UB city
• State professional inspection agency
• Water agency
• Air quality agency
• Emergency Agency
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 and presented at the “National

Climate change and Health Symposium” on 29 July 2009 in
Ulaanbaatar.

• The report amended and corrected according to the comments of

WHO consultation team
Assessment methods

• Steps:
▫ Methodology training: Feb.2009
▫ Establishment 4 teams: 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
▫ National symposium: CC&H, 29 July, 2009
Scope of the assessment

Subject Parameter Source Unavailable

data
Meteorology Temperature Institute of Meteorology -
and Hydrology
Air quality SO2 Air Quality Office Ozone, Carbon
monoxide
NO2
Health Total morbidity Health Department, Daily data
Respiratory disease Government Agency Daily data
Circulatory disease Daily data
Mortality Daily data
Detailed description of the variables for air
group
Morbidity and respiratory diseases

Collected data Sampling area Period

Total morbidity of UB city and aimags Yearly, 1966-2008
respiratory disease (J00-
J99)
Acute respiratory Emergency center of UB Yearly, 1978-2002
disease (J00-J06) city Monthly, 2003-2008
Asthma Emergency center of UB Yearly, 1978-2002
(J45) city Monthly, 2003-2008
Acute pneumonia Emergency center of UB Yearly, 1978-2002
(J15) city Monthly, 2003-2008
Detailed description of the variables for air
group
• Morbidity and circulatory diseases
Collected data Sampling area Period
Total morbidity of UB city and aimags Yearly, 1966-2008
Circulatory diseases (I00-
I99)
Hypertension Emergency center of UB Yearly, 1978-2002
(I10-I15) city Monthly, 2003-2008
Stroke Emergency center of UB Yearly, 1978-2002
(I64) city Monthly, 2003-2008
Angina pectoris Emergency center of UB Yearly, 1978-2002
(I20) city Monthly, 2003-2008
Intracerebral haemorrhage Emergency center of UB Yearly, 1978-2002
(I61) city Monthly, 2003-2008
 Detailed description of the variables

• Mortality
Collected data Sampling area Period
Total mortality UB city and aimags Yearly, 1990-2008

Mortality from UB city and aimags Yearly, 1990-2008

respiratory diseases
Mortality from UB city and aimags Yearly, 1990-2008
circulatory diseases
Detailed description of the variables for air
group
• Independent variables
Collected data Sampling area Period
Air quality data
Sulfur dioxide (SO2), UB city and aimags Monthly average, 1996-2008
µg/m3
Nitrogen Dioxide (NO2), UB city and aimags Monthly average, 1996-2008
µg/m3
Meteorology data
Temperature , °C UB city and aimags Yearly, 1978-2002
Monthly average, 2003-2008
 Detailed description of the variables on
water group
• Underground water
Collected data
chemical composition and
quality (CI-, SO42-, Ca2+,
Mg2+, mineralization,
hardness, NH4+, NO2-,
NO3-).
Hydro-chemical data (pH,
Ca, Mg, permanganate
value, NH4+, NO2-, NO3-) as
well as some hydro-
biological data (total
bacteria count and
coliform count)
Sampling area Data source Period
Ulaanbaatar city Institute of Geo-ecology, 1970-2008
and State and aimag specialized
21 aimags inspection agencies, and
Public Health Institute
Ulaanbaatar Water Laboratory of the State 1993-2005
Regulatory Agency for Professional
Inspection under the Prime Minister’s
Cabinet. While a substantial amount
of data was available from a number
of different organizations, not all the
data was available digitally
Detailed description of the variables on
water group
Waterborne disease

Collected data Sampling area Data source Period

Incidence of Ulaanbaatar Department of 1996-2008

waterborne and 21 aimags Health Statistics of
diseases (number the State
of cases and rate Implementation
per 10,000 Agency Health
population) Department
Detailed description of the variables on
infectious disease group
• Infectious diseases and health
Diseases Sampling area Data source Period

meningococcal 21 aimags and National Center for 1996-2008

infection, TB, Ulaanbaatar Communicable
typhoid, viral Disease (NCCD) and
hepatitis A, National Centre for
dysentery, Communcable
plague, tick Disease with Natural
borne Foci (NCIDNF)
encephalitis,
anthrax
Detailed description of the variables on
infectious disease group
• Extreme weather and health
Meteorology Sampling area Data source Period
aridity index (ratio of 21 aimags NGEI 1940-2008.
precipitation and potential (province)
evopotranspiration)

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

Total mortality Mortality rate from CVDs Mortality rate from RSDs
90.0 82.7 80.2
79.0
80.0 75.7
70.7
70.0 66.4 64.9 63.5
60.8 61.7 59.0 60.4 60.7 60.8 60.7 60.7 61.3 60.8
60.0 56.8

50.0
40.0
30.0
20.0
10.0
0.0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Respiratory disease mortality has decreased while

cardiovascular disease mortality has increased.
Major findings, air group
Morbidity due to Respiratory diseases, Cardiovascular diseases morbidity, per 10,000
Mongolia, 1974-2008 population, 1974-2008

3000
700.0
2500 600.0
per 10 000 population

500.0
2000
400.0

10 000 õ¿í àìä

1500 300.0
1000 200.0
100.0
500
0.0

1974
1977
1979
1981
1983
1985
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
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

Respiratory disease morbidity has decreased while cardiovascular

disease morbidity has increased
Figure 16. Acute respiratory disease per 10,000 population, by year and month in Ulaanbaatar, 2003-2008
Source: Emergency Center, UB city, 2003-2008

Major findings, Air group

10

9 3

8
2.5
7

6 2

5
1.5
4

3 1

2
0.5
1
0
0
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
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

Acute respiratory disease per 10,000 Prevalence of asthma, by year and month,
population, by year and month in 2003-2008, per 10,000 pop.
Ulaanbaatar, 2003-2008

There is a seasonal variation to the prevalence of respiratory

diseases, with higher morbidity rates in the winter season.
Figure 16. Acute respiratory disease per 10,000 population, by year and month in Ulaanbaatar, 2003-2008
Source: Emergency Center, UB city, 2003-2008

Major findings, Air group

Prevalence of Hypertension in Ulaanbaatar city Ischemic Heart Disease morbidity per 10,000
per 10,000 population, by year and month, population, by year and month, 2003-2008
2003-2008

20 7

6
10000 õ¿í àì ä

15
5

4
10
3

2
5

0 0
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 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

There is a seasonal variation to the prevalence of cardiovascular

diseases
Health & Air Quality Parameters by Season

Major findings, air group

Health & Air Quality Parameters by Season

Parameters Summer Winter Spring/fall

(UB city) mean (±SD) mean (±SD) 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)

There is a correlation analysis between angina pectoris and weather parameters, and
between respiratory diseases, air pollutants and weather parameters.
Major findings, water group

• 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 Concentrations of sulfate and chloride
Mongolia (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
Research findings, water group

Sulfate, chloride and air Correlation between sulfate

temperature and air temperature

There was a weak correlation between air temperature and

mineralization, sulfate, ammonia, nitrate and total coliform
Research findings, water group

Precipitation and incidence of Precipitation and incidence of

salmonellosis dysentery

Prevalence of salmonellosis and dysenteria increased as

precipitation increased with the highest rate
Research findings, water group

Dysentery cases by month Salmonellosis cases by month

 Research findings, infectious disease group
Morbidity of shigellosis by months, nationwide, per 10000
population
4500 25

4000

3500

3000

2500
0
2000

1500

1000

500

0 -25
1 2 3 4 5 6 7 8 9 10 11 12

Morbidity Temperature

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
 Research findings, infectious disease group
100 120

90
100

80
80
70

60
60

50 40

40
20

30
0
20

-20
10

0 -40
2008

2006

2007

2008

2006

2008

1996

1997

1998

1999

2000
2001

2002

2003

2004

2005

2006

2007

2008
2006

2007

2008

2006

2007

2007
Central Eastern Gobi Western City

Per 10000 population Precipitation Temp_average

ILI weekly morbidity and air temperature and precipitation of

the same period of time

A moderate indirect correlation between weekly air temperature

and ILI weekly morbidity in Ulaanbaatar city was observed (r = -
0.68, p<0.000).
 Research findings, infectious disease group
2 160

2 140

120
1
100
1
80
1
60
1
40
1
20
0
0

0 -20

0 -40

1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
1996
1997

2006
2007
2008
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Central Eastern Gobi Western City
Per 10000 population Precipitation Temp_average

Meningococcal infection morbidity and air temperature and

precipitation, nationwide

There was a weak indirect correlation between national monthly

meningococcal infections and monthly average air temperature for
1998 and 2008 (r =-0.2870, p<0.0011) .
Research findings, infectious disease group
12.0 160

140

10.0
120

100
8.0

80

6.0 60

40

4.0
20

0
2.0

-20

0.0 -40
2007
2008
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
1996
1997
1998

2003
2004
2005
2006
2007
2008
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006

1999
2000
2001
2002
Central Eastern Gobi Western City

Per 10000 population Precipitation Temp_average

Morbidity of viral hepatitis A per 10,000 population and

average air temperature, nationwide

There was a direct weak correlation between the highest air

temperature and morbidity due to viral hepatitis in the third week
(at the national level r=0.37)
 Major findings, infectious disease group
Tick-borne encephalitis
0 .3 5

0 .3

0 .2 5

0 .2

0 .15

0 .1

0 .0 5

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
Extreme weather and Human Health
• 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 (Figure 92).
• 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
The number of hot days and mortality of CVD
90.0 7000

80.0
6000
70.0
Number of hot days

5000
60.0
50.0 4000

40.0 3000
30.0
2000
20.0
1000
10.0
0.0 0
1961 1966 1971 1976 1981 1986 1991 1996 2001 2006

25< 30< 33< mortality of cardiovascular disease

However 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
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

•It was new approach and new topic for the team (stakeholders were not well informed,
lacking with knowledge and etc)

•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

• The national strategy is now under discussion (related

local Governmental and Non Governmental
organizations and international organizations including
UN)
Activities in 2010
• Assessments have been done:

• Mental health status assessment of herdsman after dzud

• Water and sanitation survey of population during the

dzud

• Preliminary assessment of health sector vulnerability

and preparedness

• The findings of above assessments introduced at the 2nd

Climate change and health symposium, 15 September
2010
Activities in 2010
• Regional Framework of protection human health
from CC has been translated into Mongolian and
distributed

• Climate change and health study for 2010-2012

has been started

• Representative of MOH participated for

development of draft of National CC program
and National Adaptation Strategy
Future needs

• To conduct CC&H assessment according to

WHO/PAHO guidance in order to determine the
health sector vulnerability and preparedness

• To approve and implement the national strategy

and action plan
Thank you