ZEF organizes workshop on global environmental change and water-related diseases in Tashkent, Uzbekistan, May 2-6, 2011

April 15, 2011.  

This workshop on global environmental change and water-related diseases in Central Asia is organized by ZEF with the support of the Volkswagen Foundation, the World Health Organization and the Ministry of Health of the Government of Uzbekistan. The workshop brings together risk managers from different countries, organizations and disciplines to develop a collaborative research and capacity building program on the issue for the region.


Workshop report


Tashkent, May 2, 2011.

More than 50 experts from around 10 countries in the field of Public Health attend the workshop in Tashkent, which started with a number of opening and welcome addresses. The country representative of the WHO in Uzbekistan, Michel Louis Marie Tailhades, pointed out in his welcome address that environmental deterioration is causing in increasing number of deaths in the European region observed by the WHO. Since water is intimately linked to health issues, improving water, sanitation and hygiene can lead to better health conditions of the populations and hence increase economic and social productivity. In Uzbekistan, sectoral and international collaboration are required to address water-related public health issues effectively.


The Honorable Deputy Minister for Health, Assameddin Kamilov, uttered in his opening address that he appreciated the solution-driven approach of this workshop and that he was hoping for answers to issues like intestinal diseases of children, anemia etc. He also expressed the hope that the workshop would identify methodologies to identify vulnerable groups.


Saravanan Subramanian, Senior Researcher at ZEF emphasized in his welcome note that the envisaged close collaboration between Europe and Uzbekistan could improve risk assessment strategies in Uzbekistan and prepare Europe for the growing health insecurity generated by global change.


Panel 1 on the water and health nexus stated that in a globalized world, national borders are no safeguard against diseases anymore: The globalization of people brings about an increased spreading of diseases and a changing epidemiology of endemic diseases. This was indicated by Thomas Jaenisch of the Clinical Tropical Medicine section of University Hospital, Heidelberg. Another area of concern he raised is salinity of the drinking water in Uzbekistan, which is increasing the risk of cholera and typhoid (marker of unsafe drinking water) in Uzbekistan.

Olga Mirshina of the Department of Public Hygiene, Ministry of Health, Uzbekistan informed that man-made pressure on the environment is getting worse, e.g. related to water use. For example, 90 % of the water resources in Uzbekistan are used for irrigation purposes, whereas 5 million people don’t have access to centralized water supply schemes. Another area of concern is increasing waste water by local industries, especially in down stream territories like Karakalpakstan.


Dilorom Fayzeva of the Institute of Water Problems in Uzbekistan revealed the inadequacies of the existing laboratories in Uzbekistan in testing if water quality meets ISO standards (17025).


Panel 2 focused on research-based tools for improving health governance. Joerg Szarzynski of the United Nations Office for Outer Space Affairs (UNOOSA) Platform for Space-based Information for Disaster Management and Emergency Response (UN-SPIDER), Bonn related on the spatial aspects of water-related health problems. Remote sensing and GIS- (Geographical Information System) based maps can be helpful tools in addressing complex emergencies and improving inter-sectoral collaborations. However, quality of data is an issue in Uzbekistan. A reliable data center is required to enable a better access to data for analysis and use.


Feruza Alimova of theTashkent Institute of Irrigation Melioration in Uzbekistan showed practical examples of the use of GIS for mapping water borne diseases. She also emphasized the lack of registration of diseases in Uzbekistan, for example of diarrhea. Self-treatment is very common in this case and setting up effective surveillance and early warning systems of water related diseases can be a helpful tool to monitor the disease situation regionally.


May 3, 2011.

The second day started with panel 3, focusing on the importance of health governance in Uzbekistan. Faisal Abbas of ZEF, University of Bonn, presented the broader picture of public health economics for Uzbekistan. He indicated that there is an urgent need for studies on almost all aspects of mainstream health economics research in and on Uzbekistan.


Mehmood Ul Hassan of ZEF, University of Bonn, presented a case study from the Khorezm province in Uzbekistan, showing the relationship between well-being and access to health care. He concluded that health services are mostly unaffordable for the poor in the rural areas, constituting 20% of rural Khorezmians.

Bahriddin Nishanov of the Institute of Water Problems in Tashkent presented research results on water pollution caused by agricultural sources. He concluded that the amounts of pollutants of agricultural origin were rather residual and much below threshold levels.


Sa’nat Shaumarov, Head of the Research Institute of Health in Uzbekistan explained the institutional arrangements for health care in Uzbekistan.


Feruza Madaliyeva of the International Secretariat for Water in Uzbekistan presented the hygiene training strategy of the "Rural Water Supply project", which uses a cascade training system for training health and education professionals.


Islam Usmanov of the Institute of Water Problems in Tashkent presented a few ideas on drinking water quality standards and their monitoring in Uzbekistan.


Nodir Djanebekov of ZEF, University of Bonn presented key concepts of traditional and bio-medical knowledge and its implications for Uzbekistan.


Laurel Saito of the University of Nevada presented results of lake water quality monitoring conducted in Khorezm and concluded that the pollution levels in Khorezmian lakes were below risk levels. Aquaculture, therefore, is a possibility.


At the end of the second day, the session chairs, moderated by Dilorom Fayzieva, summarized each panel’s conclusions.


Panel 1: Water and health nexus

(Chair: Michel L M Tailhades; Discussant: V.S. Saravanan)

• Need to develop a composite index to improve risk assessment strategies to address water-related diseases.

• Need to develop a water safety plan for the Uzbekistan context, to provide feedback for reflecting the water-safety plan of the WHO.

• Need to assess the economic, social and institutional feasibility of existing drinking water quality standards and the respective regulatory framework in Uzbekistan.

• Strengthening capacity of water quality testing in laboratories of partner institutions so the ISO standards 17025 can be fulfilled.

• Lack of information about impact on human health by overuse of fertilizers and pesticides.


Panel 2: Research-based tools for improved health governance

(Chair: Thomas Jänisch; Discussants: Mehmood Ul Hassan, Dilorom Fayzieva)

• Need to apply GIS tools for epidemiological studies assessing risk from water-related diseases.

• Lack of appropriate geo-reference data on water-related diseases.

• Need for scenarios projecting future occurrences of water-related diseases taking into account global environmental change.


Panel 3: Health governance in Uzbekistan

(Chair: John Lamers; Discussant: Laurel Saito)

• Need to examine the economic aspects of public health care in Uzbekistan.

• Need to study the disparity and distribution of diseases (regional, gender and age-specific).

• Need to device approaches to identify people and groups vulnerable to water-related diseases.

• Need to strengthen the public health care system towards achieving more human well-being, especially among the poor and vulnerable.


Panel 4: Health education and research in Uzbekistan

(Chair: Mehmood Ul Hassan; Discussant: Akmal Akramkhanov)

• Lack of adequately trained researchers for risk assessments of water-related diseases.

• Inadequate knowledge of the role and status of traditional vis-à-vis biomedical approaches to address water-related diseases.

• Inadequate capacity and knowledge about appropriate approaches to train staff for creating awareness on public health care issues.


On the third day, May 4, the workshop participants visited a Rural Health Center, located around 30 kilometers from Tashkent. The trip was organized by the national Ministry of Health of Uzbekistan. (See picture on top of his page).




Saravanan Subramanian

Dr. Saravanan Subramanian