Post on 09-Oct-2020
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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!