Global Health Governance and Health Equity in the Context of COVID-19: A Scoping Review

### **Effects of Environmental Degradation in the Aral Sea Region of Uzbekistan on Human Health**

**Gulara Afandiyeva1, Dominik Dietler1, Otabek Eshmuradov2, Astrid Knoblauch 1, Helen Prytherch1 , and Kaspar Wyss1**

1Swiss Tropical And Public Health Institute, Allschwil, Switzerland;

2Ministry of Ecology, Uzbekistan

Over the past decades, the saline Aral Sea has declined to less than 10% of its original area due to changes in

atmospheric circulation associated with global warming, hydrological changes, and excessive irrigation for cotton cultivation. The sinking water table has freed-up sediments loaded with toxic salts and minerals originating from extensive pesticide use. Winds from the dry lake distribute these substances across distances reaching up to several hundred kilometers, exposing humans to high levels of water, air, and soil pollution and food contamination. How and to what degree this environmental disaster affects human health in this region and beyond is still poorly documented. Findings from a literature review, epidemiological data, and information gained in key informant interviews with healthcare providers and focus group discussions with community members were triangulated to assess the documented and perceived health impacts of the environmental degradation in the Aral Sea region. Available evidence points to high exposure levels of the population to toxic substances, but the literature on health outcomes associated with these exposures is scarce and outdated. Key informants recognized increased rates of cerebrovascular, gastrointestinal, renal, respiratory diseases, neoplasms, and genetic disorders and highlighted the importance of climatic, environmental, and socio-economic determinants. In recent years, community members perceived an increase in non-communicable diseases, specifically cardiovascular diseases and cancers, which also noticeably increased in the younger generation. For them, these trends were linked to widespread air and water pollution, the high salt content of drinking water, and lifestyle habits. The climate was described to have changed towards hotter summers and colder winters, with more frequent drought episodes and more intense dust storms exacerbating the deposition of toxic chemicals from the Aral Sea. The combination of environmental degradation and economic and social challenges resulted in an increased burden of disease in the Aral Sea region. The Government of Uzbekistan, in collaboration with other countries in Central Asia, made substantial efforts to solve the Aral Sea conundrum and rehabilitate the affected region by restoring the delta and wetland areas, improving living conditions, and implementing a number of health sector reform projects.

*Figure 1. Focus group in Nurafshon (left) and key informant interview in Muynok (right), 2021.*

> *Figure 5. Most common discharge diagnosis where discharge diagnoses have been recorded.*

*Figure 3. Map of the Republic of Karakalpakstan, showing the percentage of samples exceeding the national maximum permissible air pollution levels by district in 2019.*

*Karakalpakstan.*

*Figure 4. Map of the Republic of Karakalpakstan, showing the percentage of samples exceeding the national maximum permissible chemical drinking water levels by district in 2019.*

#### Results and Discussion

Available evidence points to the population having high exposure levels to toxic salts and minerals, but the literature on health outcomes associated with these exposures is generally scarce and outdated. Key informants recognized increased rates of cerebrovascular, gastrointestinal, renal and respiratory diseases, neoplasms and genetic disorders, and highlighted the impacts of climatic, environmental and socioeconomic determinants. Community members have perceived an increase in noncommunicable diseases in recent years, specifically cardiovascular diseases and cancers, which were also more noticeable in the younger generation. For them, these trends were linked to widespread air and water pollution, the high salt content of drinking water and lifestyle habits. The climate was described as having changed towards hotter summers and colder winters, with more frequent drought episodes and more intense dust storms exacerbating the deposition of toxic chemicals from the Aral Sea.

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#### Authors

Gulara Afandiyeva1,2, Dominik Dietler1,2, Otabek Eshmuradov3, Astrid Knoblauch1,2, Helen Prytherch1,2, and Kaspar Wyss1,2

<sup>1</sup> Swiss Tropical and Public Health Institute, Switzerland

2University of Basel, Switzerland

3 Department on Radiation and Nuclear Safety, State Committee on Industrial Safety of the Republic of Uzbekistan

#### Introduction

Over the past decades, the saline Aral Sea has shrunk to less than 10% of its original area, due to changes in atmospheric circulation associated with global warming, hydrological changes and excessive irrigation for cotton cultivation. The sinking water table has freed up sediments loaded with toxic salts and minerals originating from extensive pesticide use. Winds from the dry lake distribute these substances across distances reaching up to several hundred kilometers, exposing humans to high levels of water, air and soil pollution and food contamination. How and to what extent this environmental disaster affects human health in this region and beyond is still poorly understood.

#### Methods

Findings from a literature review, epidemiological data and information gained from key informant interviews with health care providers and focus group discussions with community members were triangulated to assess the documented and perceived health impacts of environmental degradation in the Aral Sea region.

#### Conclusions

The combination of environmental economic hardship and social challenges has resulted in an increased burden of disease in the Aral Sea region. The Government of Uzbekistan, in collaboration with the other countries in Central Asia, is making substantial efforts to solve the Aral Sea conundrum and rehabilitate the affected region by restoring the delta and the wetland areas, improving living conditions and implementing a number of health- sector-reform projects.
