MONGOLIA: PUNCTUATE (R)EVOLUTION AND SOCIAL CHANGE

Ellen Silbergeld, PhDJohns Hopkins University Bloomberg School of Public Health A FOGARTY PARTNERSHIP BETWEEN JHSPH AND HSUM

What am I talking about?

Punctuate evolution – in evolution, organisms change, but not monotonically

Public Health – “we save lives millions at a time”

What’s the importance of environmental health

• Scientifically– “Genes load the gun, but the environment pulls the

trigger” Ken Olden, former Director, NIEHS

• Economically– Environmental regulations are the most cost-

effective measures to prevent disease

“We were surprised to find”…Environmental interventions: The highest cost-effectiveness ratio of all (Chokshi and Farley NEJM (2012) 367: 295)

MONGOLIA – A STRATEGICALLY IMPORTANT COUNTRY

Fogarty Project: Millennium NonCommunicable Diseases Research and Training Program NIH

• Partnerships between institutions involved in public health research and training

• Build resources in research and intervention science in public health related to national chronic disease prevention priorities

• Transfer knowledge and technology

• Advance science in support of disease prevention

Our program: A partnership between Johns Hopkins and Health Sciences University of Mongolia SPH

• Training teachers to train the next generation of public health leaders

• Responding to increasing burden of chronic disease (cardiovascular, respiratory, diabetes)

• Working with all sectors of civil society• Focussing on problems identified by several

sectors• Strategizing creatively• Learning from the experts

Project accomplishments• Training

– In-country short courses (5 rounds)

– MSPH faculty in Hopkins Institutes (Epi/Biostat; Health Policy; Air Pollution Monitoring and Modeling)

– Visiting fellows in laboratory training

– Master’s students (5)• Research

– Second hand smoke exposure in public spaces

– Air pollution from unincorporated areas in UB

– Arsenic exposure potential in Omnogovi• Other

– Conference presentations

– Transfer of all Open Course ware

Mongolia: long before and after Chinggis Khaan

MONGOLIA – WHAT AND HOW

•WHAT•A parliamentary democracy in Central Asia•No major ethnic or religious tensions (Mongolia has had freedom on religion since CK)•Commitment to civil society processes and institutions

•Consensus based process of minerals development •Consultation with Norwegian National Fund

•HOW•Rapid dissolution of ties with Soviet Union - 1990•Retention of mixed state/privatized economy•Referenda on major issues•Small population•Balance of powers “our big brother and our big

sister”

MongoliaPopulation: 2.7 Million

2 neighboring countries: Russia (N) and China (S)

Economic growth: 17% (Q2 2011 vs. Q2 2010)

Minerals are Mongolia’s most important export

Share of total exports by commodity group, cumulative % share

mining

Change at the speed…of a Mongolian Przewalski horse

Prof Lkhasuren Oyuntogos, (Togos) co PI on our project and sister of leading race horse breeder

Mineral resources as the engine of economic development

MINING AND TRADITIONAL CULTURE

Mining at all levels of technology and scale

“Ninja” gold miners, artisanal small scale

Soviet-era coal mine, old technology

Oyu Tolgi, largest copper mining development in history

The first international license at Oyu Tolgoi: largest copper and gold mine in history (RTZ and Ivanhoe Mining 64/36 shares)

Mongolia: multiple issues in mining development

• The “Dutch Disease”– Negative economic impacts of rapid natural resource

exploitation on overall growth of the economy

• Ensuring equity in economic development– Social impacts of rapid economic development

– Rapid cultural change, loss of traditional livelihoods

• Maintaining autonomy– Mongolia and China

– Geographic situation

• Fragile ecosystems• Health and safety

Coal at Tavan Tolgoi: Peabody Energy and Mongolia

• Estimated 6 billion MT of coal reserves • Conditions for bidding on Tavan Tolgoi

– Training of Mongolian workforce

– Occupational and environmental protection

– CLEAN UP THE SOVIET MINE

Risks opportunities for environmental health research

• Understanding implications of rapid socioeconomic transition on public health/predicting health resource needs

• Existing and near term health risks– Smoking and alcohol use

– Traffic and accidents

– Lead exposures

– Rural urban inmigration: air pollution and other issues

– Arsenic in drinking water• Special issues in Mongolia

– Highly restricted diet

– Gene:environment in a “bottle neck” population

Nutrition and genetics

• Traditionally restricted diets– Micronutrient deficiencies – Zn, vitamin D, Fe,

vitamin A, Se, folate

• Diets in transition– Westernization; increased meat and salt intake;

saturated fats

• Distinctive genotype– Traced to European and Amerindian populations

(Geppert et al (2011) Foresc Sci Int Genet)

Sociodemographic changes: urbanization (Ochir et al 2007 report to MoH)

• Ulaanbaatar has grown by 1.8 fold over last 20 years

• 60% of Ulaanbaatar residents recently relocated from country side and nomadic culture

• Rates of internal migration to UB increased 2.5 timtes from 2006 to 2007

• 48% of new migrants are not legally registered

POSITIVE AND NEGATIVE DRIVERS OF INTERNAL MIGRATION: economic and social opportunities; (Dzud) drought, loss of lands

Traffic and urbanization

Air pollution

• Urbanization• Energy generation• Cook stoves• Dust

Health impacts of biomass cookstoves (WHO)

• 2.5 billion use biomass for cooking and heating• Major source of indoor air pollutants

– CO, ozone, NOx, hydrocarbons, PM, free radicals, aldehydes

• Disease risks: pneumonia, chronic respiratory disease, lung cancer

• 1.6 millions deaths/year

• Impacts ambient air quality as well

Mongolia is a high use country (2004 data)

ARSENIC: A GLOBAL HEALTH RISK and A NATURAL PROBLEM AGGRAVATED BY HUMAN ACTIONS

150 MILLION PEOPLE WORLD WIDE EXPOSED TO HAZARDOUS LEVELS IN DRINKING WATER

Mongolia: “Hot spots” for mining development…and arsenic?

Arsenic in Inner Mongolia – range up to 1480 μg/L

Data from arsenic_gw.pdf 2006

Is there arsenic in Mongolia: Groundwater resources in Dornogovi (Oyu Tolgoi and Tavan Tolgoi

Mapping arsenic in surface and ground water: a collaborative project between JHSPH, HSUM, OT, and Mongolian Academy of Sciences

Dr Purevdorj Baljinnyam, MPH student now head of EHS, HSUM

Its not just lat/long, also depth: three classes of deep wells: 10-100; >100 to 300; .300

CLUSTERING OF ELEVATED As

Herders well

As level

(mg/L)

OT

Undai

GH

GG

Monitoring borehole

As level

(mg/L)

OT

Undai

GH

GG

Arsenic and other toxic metals: an opportunity to advance science and prevent health impacts during development

• Comprehensive map of arsenic in GW (with MAS)

• Informing plans for water resource development (with WB, ADB)

• Identifying high risk populations– Nutritional interactions

– Gene:environment interactions

PROOF OF PRINCIPLE FOR OUR COLLABORATION!