- James Milner,, associate professor in climate change, environment, and health12,
- Rosemary Green, professor of environment, food, and health23
1Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
2Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
3Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
Correspondence to: J Milner james.milner{at}lshtm.ac.uk
The world is dangerously off-track in its efforts to prevent the worst effects of climate change.1 Based on current trends, global average temperatures over 2025-29 will be 1.2-1.9°C higher than the pre-industrial average.2 China is the world’s largest emitter of climate warming emissions (although its per capita emissions are below those of some other economies).3 As such, its recent announcement that it will cut its greenhouse gas emissions by 7-10% by 2035 is welcome.4
China has historically prioritised economic development over environmental protection, with its emission reduction targets expressed in relation to growth. For example, the country’s 2021 nationally determined contribution (national climate plans required under the Paris agreement) committed to a 65% reduction in CO2 emissions per unit of GDP by 2030 compared with 2005.5 The 2025 announcement is the first time China has set an emissions target in absolute terms. Although the level of ambition is modest, it is a step in the right direction.
China has already made substantial progress in transitioning to green energy and is the world’s leading supplier of clean technologies such as solar panels.6 Details of how it plans to cut emissions further are vague, but targets have been set to increase the non-fossil fuel share of primary energy, expand forests (to absorb carbon), and increase solar and wind power capacity.7
If China’s emission reduction targets are increased appropriately over time, the potential to limit the effects of the climate crisis on global health could be considerable.8 A further argument for scaling up the ambition of China’s climate targets is provided by the more immediate health benefits that can be expected. There is considerable and growing evidence that many actions required to mitigate climate change can result in ancillary short to medium term improvements in health.9 These are the so called health co-benefits of climate mitigation.
Potential health gains
Phasing out the use of coal for electricity production would benefit health by reducing exposure to harmful air pollutants, including fine particulate matter (PM2.5) and nitrogen dioxide (NO2), and would continue China’s “war on pollution,” which has had considerable success.10 Stopping the use of coal could lead to 30-50% reductions in concentrations of air pollutants across China11 and is estimated to avoid 41.7% of premature deaths and 54.5% of disability adjusted life years (DALYs) caused by anthropogenic PM2.5.12 Although China continues to invest in new coal power capacity, primarily for energy security and stability, there are signs this expansion is nearing an end.13
Tackling emissions from housing presents further opportunities for reducing exposure to air pollution. Household air pollution, including PM2.5, from the use of solid fuels (mainly firewood and coal) is associated with increased death rates.14 In China, exposure to indoor pollution for cooking and heating is estimated to have resulted in 966 000 deaths between 2000 and 2022 (22% of total mortality) among the rural population.15 Reducing the use of coal for heating during the winter would improve air quality and health, particularly in rural areas.16 Furthermore, household energy consumption is intrinsically linked to health, and measures to improve the energy efficiency of housing can improve residents’ health.17
Next, reducing energy use from the transport sector—for example, by improving the efficiency of vehicles and shifting to low emission vehicles—would result in further benefits for air quality and health.18 Even more substantial health gains could be achieved through policies that encourage active forms of travel (eg, walking and cycling), which are already more common in China than many other settings.19 Efforts to improve China’s transport systems and promote active travel will, however, be complicated by existing urban design that favours the use of cars.20
Finally, there are opportunities for positive action on climate and health in the food and agriculture sector. Chinese diets commonly include large amounts of refined grains, excessive meat consumption, and low consumption of fruit and milk compared with global reference diets.21 Modelling shows the potential for large climate and health benefits through increasing the uptake of healthy and sustainable diets in China,22 although widespread adoption may be hindered by cultural preferences and cost.23 Large regional differences in dietary patterns will also require careful consideration in planning food policy.24
Although China’s recent announcement is encouraging, it is only the start. China will ultimately need to enact more stringent climate targets to phase out greenhouse gas emissions and aim to achieve this through policies that enhance health and wellbeing and reduce existing health inequalities. At a time when the US is reneging on previous climate targets,25 China has an opportunity to establish itself as a global climate leader and to reap the associated benefits for the health of its population.
