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Ger district is formed as a result of increasing population of Ulaanbaatar. The number of migrants to Ulaanbaatar has increased since 2000 and this led to the increasing population living in Ulaanbaatar[1]. Better access to healthcare system, quality of education and greater job opportunities are some of the reasons responsible for the increase in the number of migrants in Ulaanbaatar. As most of the rural areas in Mongolia lack proper social services[2], one of the main problems arising from Ulaanbaatar’s growing population is the insufficient supply of housings. According to Adding Capacity report, such housing deficit is a result of inward migration[3]. As such majority of people who have moved to Ulaanbaatar formed what is now known as the “ger district.”

Ger district covers approximately 60 percent of housing in Ulaanbaatar’s population covering more than 9,701.03 ha area of the city[2]. Another problem caused by such increased population in the ger district is both indoor and outdoor air pollution. Due to contributing factors such as Mongolia’s unique geographical characteristics, extremely cold weather, and heating, ger residents have a higher tendency of relying heavily on coal-burning stove for warmth[4]. Thus, causing Ulaanbaatar to be one of the cities with the worst air quality in the world[5].

There are two prominent dwelling types in the ger district: ger and detached house. The detached house is mostly built using either wood or brick. Ger is a Mongolian traditional house with the structure of rounded tent, and it consists of wooden skeleton covered with cloth and vinyl[6]. According to a study conducted from 2003 to 2004, out of 1994 households in the ger district, 19.9 percent was detached houses, 47.1 percent was gers, and the remaining 33 percent had both detached houses and gers[7]. In the ger district, families lived within a small fenced area called ‘hashaa’, and the size of land was restricted by law[2]. In terms of income level, amongst the extremely poor, 39 percent lived in gers, 39 percent lived in non-ger detached houses, and 22 percent lived in apartments[8]. Social determinants of health such as the living environment have a significant effect on health status and access to health services[9]. Since the ger district in Ulaanbaatar is one of the most populated areas in Mongolia[10], it needs to receive more attention, especially regarding its living condition. Therefore, the purpose of this study was to conduct a descriptive analysis on the lifestyle of Mongolians living in ger, especially with regard to their family structures and behavioral factors such as eating habits, sanitation, and use of fuels for heating and cooking.

This study was conducted on ger residents living in Ulaanbaatar, Mongolia. Observations were conducted in January 2016 and January 2018. In each year, 9 students participated in the field trip. The total number of gers visited was 72, each student was allocated to a ger where they spent most of their time (approximately from 9am to 6pm) observing daily routines of the residents, filling out survey questions for socioeconomic information, health status, and awareness on indoor air pollution.

Data were collected from three different sources mentioned below:

Most of the Ger residents lived closely with their family members, taking care of their elderly member and children. Families living within the same hashaa visited each other’s ger often. Such relations might have a positive health effect on child and elderly care as parents of the children were about early to mid-20s and they needed someone to look after their children when they were out for work. Family members were supportive to each other helping out household chores.

Low consumption of alcohol and low level of physical activity were some of the characteristics of residents’ health behavior. Greater attention needs to be paid on such low level of physical activity (lack of exercise) considering the result of dietary intake being highly dependent on red meat and dairy products and high prevalence of obesity rate in Mongolia[12-13]. Additional efforts to improve the level of physical activity amongst the residents are required. However, low consumption of alcohol has positive aspects in preventing chronic diseases that could otherwise be worsen by high alcohol consumption. This result was discordant with the average daily intake of alcohol in Mongolia reported by WHO (32.4g/day)[14]. Probable reason for this result is that most of the occupants were women and observation was conducted during the day time. Although cultural background and cold weather are some of the factors that contribute to such high level of alcohol consumption in Mongolia[15], this was not applicable to all of the ger residents who were part of our observation.

Traditional ger residents recognized the severity of air pollution and this was reflected in the 2018 perception survey results, where ger residents’ perception towards environmental pollution were questioned. Such recognition towards air pollution was reflected in the behavioral pattern of choosing to smoke outdoor rather than indoor. However, with regard to the severity of indoor and outdoor air pollution, ger residents seemed to consider the indoor air pollution less severe than outdoor. This could also be seen in the choice of ventilation. Since indoor air pollution was perceived as less severe than outdoor, not many ger residents ventilated. Health effect of such perception and behavior might have led to high proportion of medical symptoms on eyes, heart, nose, and throat.

Red meat took the highest proportion in both food storage and intake, egg and fruit took the lowest proportion. However, there were some differences in the rank of proportion among other ingredients such as tea/beverage and dairy product. Since the proportion of dietary intake was counted based on the main ingredients used for their meals, tea/beverage did not take high proportion compared to others. Even though vegetables and potatoes were second and third highest in the proportion of dietary intake, the rank itself may have limited implication as it did not represent the amount of the intake. In fact, when we observed the whole cooking process of ger residents, vegetables such as onions and potatoes were the essential ingredients of their main dish (mainly meat and noodles/rice soup). However, it was difficult to compare the exact amount of intake. Dietary patterns of the residents were irregular as they ger residents had their meals for 21 minutes on average showing wide variation of eating pattern from 9am to 5pm, rather than having meals at regular timings. Unbalanced diet with high consumption of red meat and irregular eating patterns can contribute to the high obesity rate and ultimately to high incidence rate of cardiovascular diseases.

In addition, the choice of taking shoes off inside the ger significantly impacted the hygiene status of each ger. For the assessment of hygiene, observers’ additional comments were also considered as overall hygiene was widely varied from ‘good’ to ‘poor.’ The common factors used for assessing the overall hygiene status as ‘good’ or ‘poor’ was whether ger residents separated areas where outdoor shoes are allowed or not inside the ger. Even if they did not take off their shoes, some tried to wash the dust off when they came into the ger. Wearing the same set of shoes inside and outside of ger could worsen the indoor air quality as most roads in the ger district in Ulaanbaatar are unpaved. One of the dwellers who lived in both detached house and a ger shared his thoughts about the indoor air pollution of traditional ger. Within the same hashaa, his family move from one to another by the seasons (detached house during summer and ger during winter). According to observers’ daily reports, one of the reasons why gers were more polluted than detached houses was due to the dust from the dust mainly coming from the shoe soles. When outdoor air pollution is severe, the pollutants tend to easily penetrate through dwellers’ shoes. Lifestyle related to hygiene and indoor dust can cause health problems related to respiratory system and heart diseases. For these reasons, a small behavioral change such as taking shoes off inside the ger might lower the health risks of such diseases.

income level and types of stove used were not associated in our study. In fact, the Mongolian government implemented policies to provide monetary support for those who switched from old stove type to the new one until 2014. The aim of Mongolian government was to reduce the emission rate caused by the stove. As ger residents were highly dependent on stove for cooking, convenience for cooking when using the new type of stove was another important factor that needs to be considered. For example, the design of the new stove type is not suitable for putting a large pot on top of it. In addition, heating function and fuel efficiency were the most important factors to be considered during its usage in winter. From a survey results, the main problem with the new low-emission stove was that users had to start off a fire twice a day, and it was difficult to refuel[16]. Another main reason that users did not switch to new stove type was the financial burden. Even with subsidies, users had to pay additional US$25, which can create financial burden (especially for the ger residents) as the monthly average income per households of ger residents in 2014 was 693,000 MNT (US$289) including pensions and allowance[17]. Therefore, in order to encourage the ger residents to switch to the new low-emission stove, policies should consider not only monetary supports but also multidimensional aspects influencing ones’ choice when switching to a new type of stove.

This study had limitation that the indoor air quality was not compared based on the ger residents’ perception and behavioral pattern. This was because of the segmented study design within study group. Further study is needed to analyze air quality, perception, and behavioral pattern comprehensively. In addition, more information such as physical characteristics (weight, height) and basic health outcome (heart rate, blood pressure) should be supplemented on baseline characteristics of population for detailed analysis on health issues related to medical symptoms and hygiene status.

Lifestyle and living environment of ger district residents had both positive and negative aspects in terms of their health. Family structure and low consumption of alcohol had positive effects on caregiving and preventing alcohol related diseases. Lack of exercise, unbalanced and irregular diet require implementation of new interventions to reduce the high prevalence of obesity in Mongolia. Perception on indoor air pollution seemed to have an impact on related health behaviors such as the choice of ventilation and smoking outdoor. With regard to hygiene, the number of times that ger residents washed their hands before meals and brushed their teeth after meals were low and wearing shoes inside ger indicated to be one of the main reasons for the presence of indoor dust inside the gers. Small behavioral changes such as taking shoes off and differentiating indoor and outdoor area can improve the hygiene status. Moreover, using new type of stove had no significant relationship with household income. In addition, the choice of ventilation and cooking on the stove did not increase the amount of fuel use significantly. Type of stove used could also be influenced by other factors such as the users’ convenience when using the stove for heating and cooking.