The Paris Agreement saves lives in China
Authors: Jonathan A Patz, J Jason West
Journal: The Lancet Planetary Health (2018)

The Paris Agreement to address climate change could bring substantial public health benefits from reducing air pollution, by shifting away from polluting energy resources toward cleaner alternatives. Perhaps no nation will benefit more from greenhouse gas controls than China, where a large population are exposed to severe air pollution, and where coal dominates the energy landscape. Under the Paris Agreement, China has pledged for its carbon dioxide (CO2) emissions to peak around the year 2030. Since China's emissions growth led the world over the past two decades, this pledge is an important step toward slowing global climate change. In the Lancet Planetary Health, Wenjia Cai and colleagues1Cai W Hui J Wang C et al.The Lancet Countdown on PM2·5 pollution-related health impacts of China's projected carbon dioxide mitigation in the energy generation sector under the Paris Agreement: a modelling study.Lancet Planet Health. 2018; 2: 151-161Summary Full Text Full Text PDF Scopus (46) Google Scholar analysed China's nationally determined commitments (NDC) under the Paris Agreement, and concluded that 18–62% of implementation costs at the national level could be offset by the health benefits in 2030. The overall health benefits in 2050 could increase to 3–9 times the implementation costs. The reduction of fine particulate matter (PM2·5) pollution in China would, on average, cause about 20 000 fewer deaths per year in 2030, and about 370 000 fewer annual deaths in 2050. The largest benefits would accrue from reducing the number of deaths from strokes, ischaemic heart disease, and lung disease. This study is consistent with similar studies, building on more than 20 years of research on co-benefits.2Working Group on Public Health and Fossil Fuel CombustionShort-term improvements in public health from global climate policies on fossil fuel combustion: an interim report.Lancet. 1997; 350: 1341-1349Summary Full Text Full Text PDF PubMed Scopus (84) Google Scholar, 3Nemet GF Holloway T Maier P Implications of incorporating air-quality co-benefits into climate change policymaking.Environ Res Lett. 2010; 5: 014007Crossref Scopus (289) Google Scholar For example, the US Clean Power Plan—a 30% reduction in CO2 emissions from the 2005 levels by 2030 to support its Paris Agreement pledge—would result in a 25% cut in emissions of sulphur dioxide (SO2) and nitrogen oxides (NOx), and an estimated 3500 premature deaths avoided annually by 2020.4Driscoll CT Buonocore JJ Levy JI et al.US power plant carbon standards and clean air and health co-benefits.Nat Clim Chang. 2015; 5: 535-540Crossref Scopus (126) Google Scholar This outcome is comparable to Cai and colleagues'1Cai W Hui J Wang C et al.The Lancet Countdown on PM2·5 pollution-related health impacts of China's projected carbon dioxide mitigation in the energy generation sector under the Paris Agreement: a modelling study.Lancet Planet Health. 2018; 2: 151-161Summary Full Text Full Text PDF Scopus (46) Google Scholar findings when considering both higher population and air pollution concentrations in China. Completely eliminating coal combustion could save far more lives, according to a US study5Prehoda EW Pearce JM Potential lives saved by replacing coal with solar photovoltaic electricity production in the U.S.Renew Sust Energ Rev. 2017; 80: 710-715Crossref Scopus (31) Google Scholar that reported that 52 000 deaths in the USA could be avoided annually. Other studies that compared the costs of greenhouse gas controls with the monetised air pollution-related health benefits also reported similar results. One lifecycle analysis in the USA found that the health benefits of a national low-carbon energy plan would offset energy investment costs by 26% to 1050%—or up to ten times.6Thompson TM Rausch S Saari RK Selin NE A systems approach to evaluating the air quality co-benefits of US carbon policies.Nat Clim Change. 2014; 4: 917-923Crossref Scopus (157) Google Scholar At the global level, West and colleagues7West JJ Smith SJ Silva RA et al.Co-benefits of global greenhouse gas mitigation for future air quality and human health.Nat Clim Chang. 2013; 3: 885-889Crossref PubMed Scopus (403) Google Scholar monetised health co-benefits from avoided mortality due to reductions in PM2·5 and ozone with global averages ranging from US$50/tonne to $380/tonne of CO2 emissions avoided. Regional estimates of co-benefits are as follows: $30–600 for the USA and Western Europe; $70–840 for China, and $20–400 for India. In east Asia, these air quality-related health benefits are 10–70 times the abatement costs in 2030. Although the main conclusion from the study of Cai and colleagues1Cai W Hui J Wang C et al.The Lancet Countdown on PM2·5 pollution-related health impacts of China's projected carbon dioxide mitigation in the energy generation sector under the Paris Agreement: a modelling study.Lancet Planet Health. 2018; 2: 151-161Summary Full Text Full Text PDF Scopus (46) Google Scholar was that overall health benefits substantially outweigh implementation costs of cleaner technology, they also found that air pollution initially could worsen as a result of the NDCs in the northwest of China, because the electric power system will respond to the NDCs with less coal consumption nationally, but will increase in the northwest. Such a result shows the value of subnational studies for co-benefits. The study of Cai and colleagues has some limitations. The study only considers the power generation sector and not the full economy, and it only considers PM2·5 resulting from changes in emissions of NOx and SO2. Although power generation is clearly an important source of air pollutants in China, considering other sectors might also be important for the overall results—eg, because reducing fossil fuel consumption could increase biofuel use, causing possibly greater emissions.8Ou Y Shi W Smith SJ et al.Estimating environmental co-benefits of U.S. low-carbon pathways using an integrated assessment model with state-level resolution.Appl Energy. 2018; 216: 482-493Crossref Scopus (37) Google Scholar Likewise, the study does not examine the health benefits outside of China's borders, which could be substantial, especially for ozone, nor the health benefits within China of greenhouse gas reductions in other nations under the Paris Agreement.9Zhang Y Smith SJ Bowden JH Adelman Z West JJ Co-benefits of global, domestic, and sectoral greenhouse gas mitigation for US air quality and human health in 2050.Environ Res Letts. 2017; 12: 114033Crossref Scopus (35) Google Scholar Finally, other health benefits are likely to result from greenhouse gas reductions, including from the increase in exercise-promoting active transportation and potential changes in diet.10Patz JA Frumkin H Holloway T Vimont DJ Haines A Climate change: challenges and opportunities for Global Health.JAMA. 2014; 312: 1565-1580Crossref PubMed Scopus (282) Google Scholar, 11Chang KM Hess JJ Balbus JM et al.Ancillary health effects of climate mitigation scenarios as drivers of policy uptake: a review of air quality, transportation and diet co-benefits modeling studies.Environ Res Lett. 2017; 12: 113001Crossref Scopus (38) Google Scholar This study adds to the body of knowledge that reducing greenhouse gas emissions also reduces air pollution and benefits health, and does so in the particularly important context of China. This study, like others, finds that the monetised co-benefits for air pollution and health are comparable to, or might exceed, the costs of greenhouse gas reductions, even without accounting for the other health benefits of slowing the impacts of climate change, through reduced heat stress, infectious diseases, severe storms, and access to food and water.12Patz JA Campbell-Lendrum D Holloway T Foley JA Impact of regional climate change on human health.Nature. 2005; 438: 310-317Crossref PubMed Scopus (1960) Google Scholar These health benefits should be an important motivator for public health and medical professionals to speak on the importance of climate change, and for governments to act on reducing greenhouse gas emissions. This online publication has been corrected. The corrected version first appeared at thelancet.com/planetary-health on April 27, 2018 This online publication has been corrected. The corrected version first appeared at thelancet.com/planetary-health on April 27, 2018 We declare no competing interests. The Lancet Countdown on PM2·5 pollution-related health impacts of China's projected carbon dioxide mitigation in the electric power generation sector under the Paris Agreement: a modelling studyOur results suggest that cost–benefit analysis of climate policy that omits regional air pollution could greatly underestimate benefits. A compensation mechanism for inter-regional interests (including financial, technological, and knowledge support) should be established for regions that give up their human health benefits for the sake of the whole nation to realise the climate change targets. Full-Text PDF Open AccessCorrection to Lancet Planet Health 2018; 2: e147–48Patz JA, West JJ. The Paris Agreement could saves lives in China. Lancet Planet Health 2018; 2: e147–48—The title should have read "The Paris Agreement saves lives in China". This correction has been made as of April 27, 2018. Full-Text PDF Open Access