In the following interview, Alex Heikens, the representative of UNICEF Mongolia, discusses how air pollution affects children’s health, the importance of improving the air quality, and the details of the report called “Mongolia’s Air Pollution Crisis: A call to action to protect children’s health” done by UNICEF and National center for public health in Mongolia in February 2018.

The report contained a lot of data and information that are highly concerning. But for years, we have been seeing similar information almost every single day, which means we get used to this kind of information. Were you shocked by the data when you were working on the report?

I was actually surprised about how little was spent on health services for children. Because if you look at the amount spent on healthcare in relation to children suffering from air pollution related diseases, these figures are not very massive. We all know the city has outrageously high levels of air pollution during the cold season. We all hear many stories about parents coming to the family health centers and hospitals with their children and not being able to get sufficient healthcare. What I suspect is that we actually underestimate how much should be spent on healthcare for children during the cold season.

It is important to put these numbers on the table. Because we need to understand how much or how little we are spending, and where there is also room to improve the quality of the spending.

It is also really important for us to understand that the situation in Ulaanbaatar is not just about a city with some people. Ulaanbaatar represents about half of Mongolia’s population including children and pregnant women - that is what people should be really worried about. On one hand, we should address the immediate health impacts on pregnant women and children every winter, on the other hand we also have to think through what it means to people’ health, productivity, and future health costs. Twenty years from now, many people in their 40’s and 50’s will be at significant risk of suffering from respiratory diseases, problems with their vascular systems and their hearts, and higher risk of lung cancer. The ongoing pollution crisis is building that into society now. That is extremely worrying.

You said we have not fully covered all the health risks that air pollution might do to us when you were introducing the report. Could you clarify what are the possible risks we as Mongolians have in the future?

I think, the biggest concern that we don’t know enough about yet is damage to DNA and the brain. Recently Dr. Federica Perera from Columbia University and colleagues have done a study in China. They found an evidence that a pregnant woman’s exposure to air pollution already affects DNA of an unborn child. This is very alarming because healthy DNA is the foundation for good health during your life. Also, I am concerned that a damage to the DNA of an unborn child may be passed on to the next generation. Adding to the risks is that poor families in Ulaanbaatar often burn waste which can produce extremely toxic chemicals but nobody is measuring those.

The other thing the study highlighted is that air pollution can also affect brain development of the unborn child. Much of the human brain is developed when the baby is still in its mother’s womb and during first years of life. Adding to it is the evidence that when children are exposed to air pollution, ultrafine particles can get very close to their brain and cause micro inflammations.

There is a lot that we still don’t know but the fact that those very serious health risks have been found elsewhere should raise big alarm bells here in Mongolia because during the winter the air pollution is amongst the worst on the planet.

Also, lets not forget we already see a sharp increase in children with pneumonia, bronchitis, and asthma over the last ten years in Ulaanbaatar. Those kids will likely continue to have significant health problems.

The report says by 2021 air quality can be improved. Is it realistic?

The report looked and analyzed the existing policy of the Government. The action plan promises cleaner air by 2021. However, there are few big challenges with that. If you thoroughly analyze the action plan, not only the budget needs to be made available, but you then also need to implement the programmes successfully.

There is a lot that can be done to reduce air pollution, but it needs to be done in such a way that is sustainable. So, for example, with fuel efficient stoves, you have to ask yourself questions like “Have you created the conditions whereby people really want and can afford these stoves, and will continue using those? Are local suppliers and manufacturers able and interested to produce those stoves? Will they abandon the production of dirty stoves?”.

Even if you have the legislation, you would still have to enforce it. Of course, it is a good idea not to use raw coal. At the same time, there needs to be viable alternatives. When it is -40 C and you cannot heat your home, you are going to freeze to death. Heating is not a luxury here, it is a matter of survival. For example, if raw coal would be banned, there has to be affordable, and desirable alternative in place.

Do you think the Mongolian Government has done enough to protect its children?

I think we are moving in the right direction. It has taken a while for people to wake up. Not only the Government but also the research community, civil society and people on the streets start to realize air pollution is not just annoying, it is a massive health hazard.

What I have seen over the last two years is the Ministry of Health increasingly started actively engaging with public. People are talking about it, and it is making organizations and institutions to take action.

We also need to provide information and guidance to public on what they can do to reduce their exposure. Because, frankly speaking, I was surprised walking on the street during winter here: oftentimes the only person wearing a mask is me. Why are not many people trying to protect themselves? Is it because they find masks inconvenient or not fashionable? I think people do not necessarily understand that they need to do whatever it takes to reduce their exposure.

It needs to be clear that Mongolians are not more immune to air pollution than the foreigners are. Foreigners may complain more about it, but lets not forget that inside our bodies are the same.

Of course, the only long term solution is to move to clean air. But that may take 5-10 years. So what are we going to do in next 5-10 years? Hold our breath? There is more the Government, civil society and private sector should be doing, can be doing and increasingly is also willing to do. It is the combination of investing in cleaner and more efficient energy, reducing exposure, and strengthening health care.

We observe that strict laws and policies help countries to overcome their obstacles. What kind of policies or laws does Mongolia need to develop?

I think it’s the right mix of laws and implementation of the laws. You do need to have the laws around energy, coal, heating, electricity, and increasingly we need to be concerned about the traffic as well. Importing second hand vehicles is not helping with the air quality. During the winter, most of the air pollution is coming from burning coal and rubbish. But throughout the year the traffic is adding air pollution.

With regard to banning people from moving to Ulaanbaatar, I expect they will still be coming even if there is a ban, but won’t register. This creates other concerns about children’s rights, such as access to education and health. So it is important to think through the pros and cons of laws and policies.

What should we do to educate our people on air pollution?

There is an important role for civil society organizations to educate the community on clean air, and that it will take a number of years, thus multiple governments to be involved in solving the problem. I think it is about helping people to understand what are realistic and ambitious promises and what are not.

Speaking of elections, there is going to be an election in 2020 before the government reaches its goals to improve the air quality by 2021. How do you think the upcoming election may affect this goal?

I hope that it will be seen as an opportunity to showcase results. Because you would expect that if you really want to deliver something by 2021, you already must have delivered quite a lot by 2020. So, by 2020 we should be well on the way in terms of having cleaner air.

I hope that all political parties will see air pollution as an opportunity to come up with the best possible ideas and ambition, but also be realistic when they put it in their campaigns. In the end, it will require everybody’s involvement, regardless of political affiliation, to provide a clean and safe environment for children.

Thank you for your time and work in Mongolia.

Thank you.