Time for health to enter China's climate action framework
Authors: John S Ji
Journal: The Lancet Public Health (2019)

In 2015, the Paris Agreement was globally adopted by nearly every country at the UN Framework Convention on Climate Change 21st Conference of the Parties. Key to the climate actions under the Paris Agreement is the nationally determined contributions (NDCs), a declaration with broad and specific plans for measures in adaptation (reducing vulnerabilities in a changing climate) and mitigation (reducing the emission of greenhouse gases).1Watts N Amann M Arnell N et al.The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come.Lancet. 2018; 392: 2479-2514Summary Full Text Full Text PDF PubMed Scopus (439) Google Scholar The National Development and Reform Commission, an agency with a strong visible hand on economic developments, drafted China's NDC, putting forth its voluntary targets: achieve peak carbon dioxide emissions by 2030, making best efforts to peak early; reduce carbon dioxide emissions per unit of GDP by 60–65% from the 2005 level; increase the share of non-fossil fuels in primary energy consumption to about 20%; and increase the forest stock volume by around 4·5 billion m3 versus the 2005 level.2Department of Climate ChangeNational Development and Reform Commission of ChinaEnhanced actions on climate change: China's intended nationally determined contributions.https://www4.unfccc.int/sites/ndcstaging/PublishedDocuments/China%20First/China%27s%20First%20NDC%20Submission.pdfDate accessed: July 29, 2019Google Scholar The political priority of these commitments is reflected in China's 13th 5-year plan (2016–21), which included chapters dedicated to responding to climate change and developing green and environmentally friendly industries.3People's National Assembly of ChinaThe 13th five-year plan for economic and social development of the People's Republic of China. Central Compilation & Translation Press, Beijing2016–2020http://en.ndrc.gov.cn/newsrelease/201612/P020161207645765233498.pdfDate accessed: July 29, 2019Google Scholar Econometric analysis based on trends indicates that a deceleration in China's emission trajectory is needed to meet the targets. China's emissions are likely to peak before 2030 and the implementation of power-sector reform and a national emissions-trading system will be needed.4Gallagher KS Zhang F Orvis R Rissman J Liu Q Assessing the policy gaps for achieving China's climate targets in the Paris Agreement.Nat Commun. 2019; 10: 1256Crossref PubMed Scopus (100) Google Scholar, 5Yang Y Zhang J Wang C Forecasting China's Carbon intensity—is China on track to comply with its Copenhagen commitment?.Energy J. 2018; 2: 1944-9089Google Scholar Progress in these efforts are visible on the streets of Chinese cities, for example in the increasing presence of electric vehicles, marked by their green license plates, and mandatory waste recycling in some cities. A crucial and under-recognised externality in China's climate action is the immediate and long-term co-benefits for population health. Fossil fuels are a common source of greenhouse gases and air pollution. Many regions of China have PM2·5 levels far greater than the WHO-recommended level. Greenhouse gas mitigation-mediated reductions in air pollution can reduce premature death due to non-communicable diseases such as stroke, heart disease, COPD, lung cancer, and Alzheimer's disease.1Watts N Amann M Arnell N et al.The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come.Lancet. 2018; 392: 2479-2514Summary Full Text Full Text PDF PubMed Scopus (439) Google Scholar Furthermore, increasing forest stock to act as a carbon sink through photosynthesis will lead to downstream public health benefits. Forests and greenness improve both physical and mental health by reducing stress, promoting physical activity, and preventing mortality.6Ji JS Zhu A Bai C et al.Residential greenness and mortality in oldest-old women and men in China: a longitudinal cohort study.Lancet Planet Health. 2019; 3: e17-e25Summary Full Text Full Text PDF PubMed Scopus (85) Google Scholar Policy makers need to be made more aware of these co-benefits for health of greenhouse gas mitigation, which are supported by cost–benefit analyses.7Markandya A Sampedro J Smith SJ et al.Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study.Lancet Planet Health. 2018; 2: e126-e133Summary Full Text Full Text PDF PubMed Scopus (291) Google Scholar, 8Vandyck T Keramidas K Kitous A et al.Air quality co-benefits for human health and agriculture counterbalance costs to meet Paris Agreement pledges.Nat Commun. 2018; 94939Crossref PubMed Scopus (103) Google Scholar Ultimately, climate change mitigation can contribute to China's Healthy China 2030 plan to increase its citizens’ life expectancy from 76 years in 2015 to 77 years by 2020 and 79 years by 2030. Health can be a double-edged sword. Although climate change mitigation has positive effects on health, achieving and maintaining a healthier population will require more health-care services. The health-care sector generates greenhouse gases from care delivery, product procurement, technological equipment use, and from a carbon-intensive supply chain of manufacturing, transportation, and waste disposal. Although there are no extensive measurements of the health-care sector carbon footprint, some estimated that in China, as with Organisation for Economic Co-operation and Development countries and India, health care accounts for 5% of the national carbon dioxide footprint, similar to the outputs of the food, aviation, or shipping sectors.9Pichler P-P Jaccard IS Weisz U Weisz H International comparison of health care carbon footprints.Environ Res Lett. 2019; 14064004Crossref Scopus (152) Google Scholar In advanced economies, the burden is even greater; the USA health-care sector was estimated to contribute to 8·0–9·9% of total national greenhouse gas emissions, and the UK NHS carbon footprint is equivalent to 39% of public sector emissions.10Bouley T Roschnik S Karliner J et al.Climate-smart healthcare: low-carbon and resilience strategies for the health sector. The World Bank, 2017http://documents.worldbank.org/curated/en/322251495434571418/pdf/113572-WP-PUBLIC-FINAL-WBG-Climate-smart-Healthcare-002.pdfDate accessed: July 29, 2019Google Scholar With China's ageing population and the rising epidemic of non-communicable diseases, the health-care sector emission trajectory will only increase. Each member of the Paris Agreement is scheduled to communicate an updated NDC by 2020. Countries should recognise the health co-benefit of mitigation of greenhouse gas emissions and target the health-care sector mitigation efforts. China in particular should involve more governmental entities to enhance ownership of the NDC beyond the National Development and Reform Commission and create policies in conjunction with the 25 other cabinet-level executive departments. As the countdown to the second NDC begins, the question of whether China will lead in climate action will soon be answered. I was a short-term consultant for The World Bank Group.