Outbound Medical Tourism from Mongolia: a Qualitative Examination of Proposed Domestic Health System and Policy Responses to this Trend

Background: Medical tourism is the practice of traveling across international boundaries in order to access medical care. Residents of low-to-middle income countries with strained or inadequate health systems have long traveled to other countries in order to access procedures not available in their home countries and to take advantage of higher quality care elsewhere. In Mongolia, for example, residents are traveling to China, Japan, Thailand, South Korea, and other countries for care. As a result of this practice, there are concerns that travel abroad from Mongolia and other countries risks impoverishing patients and their families.   Methods: In this paper, we present findings from 15 interviews with Mongolian medical tourism stakeholders about the impacts of, causes of, and responses to outbound medical tourism. These findings were developed using a case study methodology that also relied on tours of health care facilities and informal discussions with citizens and other stakeholders during April, 2012.   Results: Based on these findings, health policy changes are needed to address the outflow of Mongolian medical tourists. Key areas for reform include increasing funding for the Mongolian health system and enhancing the efficient use of these funds, improving training opportunities and incentives for health workers, altering the local culture of care to be more supportive of patients, and addressing concerns of corruption and favouritism in the health system.   Conclusions: While these findings are specific to the Mongolian health system, other low-to-middle income countries experiencing outbound medical tourism will benefit from consideration of how these findings apply to their own contexts. As medical tourism is increasing in visibility globally, continued research on its impacts and context-specific policy responses are needed. &nbsp

Radiocarbon age of a Holocene terrace of the Chikoi River at the Russia-Mongolia Border

A well-developed terrace was identified along the Chikoi River at the Russia-Mongolia border. The terrace deposits consist of massive fine sands of more than 8 m with numerous organic-rich paleosol horizons. Resulting radiocarbon ages for paleosol horizons suggest that floodplain emergence and terrace formation occurred in the early Holocene

The effect of portable HEPA filter air cleaners on indoor PM2.5 concentrations and second hand tobacco smoke exposure among pregnant women in Ulaanbaatar, Mongolia: The UGAAR randomized controlled trial

Background Portable HEPA filter air cleaners can reduce indoor fine particulate matter (PM2.5), but their use has not been adequately evaluated in high pollution settings. We assessed air cleaner effectiveness in reducing indoor residential PM2.5 and second hand smoke (SHS) exposures among non-smoking pregnant women in Ulaanbaatar, Mongolia. Methods We randomized 540 participants to an intervention group receiving 1 or 2 HEPA filter air cleaners or a control group receiving no air cleaners. We followed 259 intervention and 253 control participants to the end of pregnancy. We measured one-week indoor residential PM2.5 concentrations in early (~11weeks gestation) and late (~31weeks gestation) pregnancy and collected outdoor PM2.5 data from centrally-located government monitors. We assessed blood cadmium in late pregnancy. Hair nicotine was quantified in a subset (n=125) to evaluate blood cadmium as a biomarker of SHS exposure. We evaluated air cleaner effectiveness using mixed effects and multiple linear regression models and used stratified models and interaction terms to evaluate potential modifiers of effectiveness. Results The overall geometric mean (GM) one-week outdoor PM2.5 concentration was 47.9?g/m3 (95% CI: 44.6, 51.6?g/m3), with highest concentrations in winter (118.0?g/m3; 110.4, 126.2?g/m3). One-week indoor and outdoor PM2.5 concentrations were correlated (r=0.69). Indoor PM2.5 concentrations were 29% (21, 37%) lower in intervention versus control apartments, with GMs of 17.3?g/m3 (15.8, 18.8?g/m3) and 24.5?g/m3 (22.2, 27.0?g/m3), respectively. Air cleaner effectiveness was greater when air cleaners were first deployed (40%; 31, 48%) than after approximately five months of use (15%; 0, 27%). Blood cadmium concentrations were 14% (4, 23%) lower among intervention participants, likely due to reduced SHS exposure. Conclusions Portable HEPA filter air cleaners can lower indoor PM2.5 concentrations and SHS exposures in highly polluted settings.Canadian Institute of Health Research (MOP 142380)Simon Fraser University, Faculty of Health Sciences (Mowafaghian Child Health Faculty Award

The adoption of Health Impact Assessments in the Mongolian mining sector: A case study of the diffusion of policy innovation

Mongolia’s rapid economic growth, propelled by rapid development of the extractives sector requires that the country be better prepared for potential negative impacts to the health of the people and the country. People are both excited for the remarkable development opportunities that mining promises and are concerned with the potential social, environmental and health risks it could bring. As a country highly dependent on the mining sector, Mongolia has realized that it needs to develop a strategy and institutional process to manage the public health impacts of mining activities. With the support of an SFU-based team of researchers and policy advocates, Mongolia is thus in the process of adopting Health Impact Assessments (HIA), a policy innovation tool that has potential to inform the decision making process through assessing underlying health problems and generating evidence-based recommendations. However, the values, principles, methods and deliverables of HIA are not easily understood in capacity-limited Low and Middle Income Country (LMIC) settings, including Mongolia, which makes full adoption and proper use of HIA a difficult process to achieve. The overall goal of the research was to evaluate the uptake and adoption rate of the HIA concepts, tools and methods in the emerging Mongolian mining sector. This evaluation process involved key informant interviews, observations, literature reviews and policy analysis as data collection methods. To understand the processes of HIA adoption, the theory of the Diffusion of Innovations (DOI) was used as an analytical lens. Analysis of HIA adoption processes suggested that DOI theory was a useful framework to understand and improve the rate of uptake of new public health policy innovations such as HIA in that it assists with understanding both the attributes of innovation and the communication actions that influence adoption. The existing literature on HIA lacks analysis of how it is adopted and implemented in diverse settings. This research thus contributes to the knowledge needed to inform discussion of how to improve the rate and success of HIA adoption. I conclude that the adoption of systematic methods to manage the public health impacts of mining in Mongolia, centered on the HIA, is generally off to a good start. However, there are many remaining challenges, including: a lack of government leadership, poor collaboration between relevant public and private institutions, low levels of capacity to conduct and evaluate HIAs, poor quality or non-existent baseline data. These challenges will need to be addressed in order to keep the momentum going. Following from the research, I offer the following recommendations: to develop HIA management system, to implement existing MoU between relevant ministries, to create HIA training center, and to enact an independent HIA law. In conclusion, the currently legislated system, which incorporates HIAs into a newly redesigned licensure system based on international standard environmental impact assessment methods, must be implemented. Ideally, the development of an independent HIA system will be required if Mongolia is to build and sustain an effective public health system in mining-affected regions