Human health risk
assessment: the
M
Mongolian
li herders
h d
example
p
Craig R. Janes
30 October 2008
SFU
SIMON FRASER UNIVERSITY
FACULTY OF HEALTH SCIENCES
SFU
SIMON FRASER UNIVERSITY
FACULTY OF HEALTH SCIENCES
Problem Definition
• What factors predict the vulnerability of communities,
households, and individuals to climateclimate-related
h
hazards?
d ?
• What are the pathways through which vulnerability
affects health?
• Vulnerability is context dependent
• Vulnerabilityy ((risk)) is an outcome of the
interrelationship of exogenous hazards (climate)
sensitivities, and the capacity of systems and
communities to adapt to these hazards
• Issues of scale
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Management Objectives
• Aspirational
Aspirational:
p
: Reduce vulnerabilityy of rural
populations to climateclimate-related hazards
g
risks for illill• Observational
Observational:: Identifyy and mitigate
health outcomes in vulnerable households &
individuals
• Means
Means:: Reduce vulnerability by decreasing
sensitivity to exogenous hazards, specifically
b ffocusing
by
i on systemsystem
t -level
l
l ((public,
bli gov’t
gov’t)
’t))
’t
institutions
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Indicators of Risk
• Vulnerability is a function of the severity and timing of a
hazard as modified by the sensitivity of, and adaptive
capacities within, a community system
• Relates to the PROBABILITY associated with a
particular outcome (health) occurring within a particular
time period (primary
(primary indicator)
indicator)
• MAGNITUDE of the impact on intervening processes
(livestock mortality)
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Indicators of risk,
risk, continued: Interactions
Across Levels of Analysis
Climate change
Global factors,,
national &
regional
development
Community and
household
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• Regulatory
presence of state
• Infrastructure
supports
• Local
cooperation,
collaboration
• Social networks
and “capital”
Houssehold
• Small-state
solutions
• Infrastructure
disinvestment
• Resource
privatization
• Markets
• Emergency
preparedness
Comm
munity
Glo
obal-Na
ational
Indicators of Risk:
Risk: Sensitivity and
Adaptive Capacity
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• Household labour
• Skills/knowledge
(TEK)
• Household
decision-making
decision
making
• Household
production of
health
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Indicators of Risk,
Risk, continued: Endpoints
• Outcomes
• Livelihood security at level of household and
community
• Effects across lifecourse
• The social determinants of health
• Probabilities:
Probabilities: Greater “risk” for diseases related to
compromised livelihood security
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Rural Mongolian herders
• IF supported
pp
adequately,
q
y, p
pastoralists are well
able to cope with climate perturbations
q
ecosystems
y
• Non
Non--equilibrium
• Political transition of 1990 weakened
infrastructure support and shifted management
of economic risks to individual households
• Market pressures and mining exploration have
to some degree constrained traditional
adaptive strategies
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Our study….
study
• Assess levels of vulnerability to climate
climate--related
hazards in context of the political transition
• Evaluate whether and to what degree
vulnerability compromises livelihood security at
the le
level
el of the ho
household
sehold
• Health of individual members, focusing
specifically on children
• Primary and secondary data collectio
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Sampling
• 12 C
Counties
ti stratified
t tifi d on th
the b
basis
i off SES
(rough measure of communitycommunity-level sensitivity)
and exposure to climate hazards
• Within each county 88-10% of herding
households sampled
• About 380 households reflecting health
experience of 1,500 individuals
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Map of Mongolia Showing Research Counties, 200520052007
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Climate--related hazards
Climate
• Average temperature has risen by 1.8 °C since 1963
• Extended high temperature summer periods (by 88-18
days)
• Reduced number of low temperature winter periods (by
13 days)
• Increasing precipitation in Fall and Winter, decreasing
precipitation in Spring & Summer
• Increasing variability of temperature and precipitation
(expanding area of nonnon-equilibrium systems)
• The ““dzuud
dzuud””
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1993-2002 Annual and Early Season
1993Precipitation Amounts, Rural Mongolia
300.0000
250.0000
200 0000
200.0000
annual precip research counties
150.0000
jan-july precip research counties
annual precip all counties
jan-july precip all counties
100.0000
50.0000
.0000
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
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Temperatures, 19931993-2002
25
20
15
10
5
Summer Temperatures, all counties
Winter Temperatures, all counties
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
-5
-10
-15
-20
0
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1993-2002 Precipitation Averages
Rural Mongolia Research Sites
300
250
200
150
10-yr avg annual precip
10 yr avg Jan-July precip
100
50
0
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Coefficients of Variation, 1993-2002 Precipitation Amounts
for Rural Mongolia Research Counties
45
40
35
30
25
20
Coeff Var Annual Precip
Coeff Var Jan-July Precip
15
10
5
0
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Climate effects
• Livestock health and mortalityy is central p
pathway
y
• Livestock health is linked to the health of those that
depend on them for food and income
• Impact of climate on livestock health is modified by a
number of factors:
• National/regional
• Community
• Household
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Weakened state
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Disinvestment in infrastructure
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Mining & mineral exploration
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Household-level adaptive strategies
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Consequences for Health
• Vulnerability influences health through a “common
epidemiologic pathway” – the social and economic wellwellbeing of the household
ho sehold
• Findings:
• C
Climate
ate variability
a ab ty p
predicts
ed cts livestock
estoc mortality
o ta ty o
over
e tthe
e 10
0 yea
years
s
that we have decent data
• At household level, social networks and herding strategies linked
to economic status
• In xx--sectional analyses, household economic status is linked to
anemia in children
• 10
10--year precipitation values for the county also predict anemia in
children independently of current livestock holdings (multi(multi-level
analysis)
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List of management options considered in
analysis
l i
• Supports for herders
• Regulation of pasture and water resources
• Secure access to “resource patches” in times of
need
• Protection from mining activities
• Better rural services (health and education)
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Uncertainties that were analyzed
quantitatively
• Uncertain states of nature: temperature and
precipitation
i it ti (d
(drought
(drought—
ht—winter
i t blizzard
bli
d
combinations)
• Measured
M
d only
l iindirectly
di tl and
d iimperfectly
f tl
• Temporality issues
• E.g., migration
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Ways of taking into account uncertainties
about inputs to the analysis
Probabilistic inquiry
Kriguing techniques for estimation of climate
parameters in local settings
Indirect methods/proxy measures of key inputs
Triangulation
Comparative methods (strengths and
weaknesses)
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Description of system’s processes / relationships / linkages
From Johnston, Lesley (2008) MINING MONGOLIA: RESOURCE ACCESS, CLIMATE CHANGE AND
VULNERABILITY ON THE STEPPE. MSC THESIS, FHS.
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Analyses of sensitivity of conclusions
• Assumptions…..
• Causality
• Poor control of potential confounders
p
y and loss of key
yp
population
p
• Temporality
groups
• National/regional level parameters
unmeasured
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Acknowledgements
• Research assistants: Oyuntsetseg
Chuluundorj, Ph.D.; Lesley Johnston, MSc
MSc..
• Colleagues in Ulaanbaatar, especially N.
Sumberzul,, Dean of the School of Public
Sumberzul
Health at HSUM
• Funding provided by the U.S. National Science
Foundation
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