Epidemiologic studies have consistently reported associations between outdoor fine particulate matter (PM2.5) air pollution and adverse health effects. Although Asia bears the majority of the public health burden from air pollution, few epidemiologic studies have been conducted outside of North America and Europe due in part to challenges in population exposure assessment. We assessed the feasibility of two current exposure assessment techniques, land use regression (LUR) modeling and mobile monitoring, and estimated the mortality attributable to air pollution in Ulaanbaatar, Mongolia. We developed LUR models for predicting wintertime spatial patterns of NO2 and SO2 based on 2-week passive Ogawa measurements at 37 locations and freely available geographic predictors. The models explained 74% and 78% of the variance in NO2 and SO2, respectively. Land cover characteristics derived from satellite images were useful predictors of both pollutants. Mobile PM2.5 monitoring with an integrating nephelometer also showed promise, capturing substantial spatial variation in PM2.5 concentrations. The spatial patterns in SO2 and PM, seasonal and diurnal patterns in PM2.5, and high wintertime PM2.5/PM10 ratios were consistent with a major impact from coal and wood combustion in the city’s low-income traditional housing (ger) areas. The annual average concentration of PM2.5 measured at a centrally located government monitoring site was 75 μg/m3 or more than seven times the World Health Organization’s PM2.5 air quality guideline, driven by a wintertime average concentration of 148 μg/m3. PM2.5 concentrations measured in a traditional housing area were higher, with a wintertime mean PM2.5 concentration of 250 μg/m3. We conservatively estimated that 29% (95% CI, 12–43%) of cardiopulmonary deaths and 40% (95% CI, 17–56%) of lung cancer deaths in the city are attributable to outdoor air pollution. These deaths correspond to nearly 10% of the city’s total mortality, with estimates ranging to more than 13% of mortality under less conservative model assumptions. LUR models and mobile monitoring can be successfully implemented in developing country cities, thus cost-effectively improving exposure assessment for epidemiology and risk assessment. Air pollution represents a major threat to public health in Ulaanbaatar, Mongolia, and reducing home heating emissions in traditional housing areas should be the primary focus of air pollution control efforts.

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Portable HEPA filter air cleaners can lower indoor PM concentrations and SHS exposures in highly polluted settings.

HEPA filter air cleaner use in a high pollution setting was associated with greater birth weight only among babies born at term.

Following the 2009 signing of the stability agreement between the Mongolian Government and Canadian mining company Turquoise Hill Resources (formerly known as Ivanhoe Mines), researchers from Simon Fraser University secured funding from the Canadian Institutes for Health Research to conduct applied knowledge translation (KT) research that introduces health impact assessment (HIA) to Mongolia's rapidly emerging resource sector. HIA is a highly regarded informed decision-making tool that helps to identify, assess and mitigate (or promote) potential positive and negative human health impacts of policies, projects and programs. We engaged in a series of knowledge synthesis, KT and dissemination activities with key public and private sector stakeholders as well as community representatives. Our goals were to develop consensus on a socially and culturally appropriate approach to equity-focused HIA, draw on this consensus to develop a contextualized HIA toolkit, build local HIA capacity based on this toolkit, strengthen the HIA regulatory environment and provide evidence-based support for efforts to institutionalize HIA in the resource sector. These efforts have resulted in the inclusion of HIA in the environmental impact assessment law of Mongolia, and the focus has now shifted from KT to further supporting HIA institutionalization and practice.