The 2021 China report of the Lancet Countdown on health and climate change: seizing the window of opportunity
Authors: Wenjia Cai, Chi Zhang, Shihui Zhang, Siqi Ai, Yuqi Bai, Junzhe Bao, Bin Chen, Nan Chang, Huiqi Chen, Liangliang Cheng, Xueqin Cui, Hancheng Dai, Bawuerjiang Danna, Qian Di, Wei Dong, Wenxuan Dong, Dejing Dou, Weicheng Fan, Xing Fan, Xiaoyi Fang, Yuan Gao, Tong Gao, Yang Geng, Dabo Guan, Yafei Guo, Yixin Hu, Junyi Hua, Cunrui Huang, Hong Huang, Jianbin Huang, Ian Hamilton, Qiaolei Jiang, Xiaopeng Jiang, Piyu Ke, Gregor Kiesewetter, Pete Lampard, Chuanxi Li, Ruiqi Li, Shuangli Li, Lu Liang, Borong Lin, Hualiang Lin, Huan Liu, Qiyong Liu, Xiaobo Liu, Yufu Liu, Zhao Liu, Zhu Liu, Xinyuan Liu, Shuhan Lou, Chenxi Lu, Yong Luo, Zhenyu Luo, Wei Ma, Alice McGushin, Yanlin Niu, Chao Ren, Zengliang Ruan, Wolfgang Schöpp, Yuli Shan, Jing Su, Taochun Sun, Qiong Wang, Can Wang, Sanmei Wen, Yang Xie, Hui Xiong, Bing Xu, Meng Xu, Yu Yan, Jun Yang, Lianping Yang, Xiu Yang, Le Yu, Yujuan Yue, Yiping Zeng, Yao Zhang, Shaohui Zhang, Zhongchen Zhang, Jing Zhang, Liang Zhao, Qi Zhao, Zhe Zhao, Jiyao Zhao, Mengzhen Zhao, Jingbo Zhou, Zhenghong Zhu, Margaret Chan Fung Fu-Chun, Peng Gong
Journal: The Lancet Public Health (2021)

China, with its growing population and economic development, faces increasing risks to health from climate change, but also opportunities to address these risks and protect health for generations to come. Without a timely and adequate response, climate change will impact lives and livelihoods at an accelerated rate. In 2020, the Lancet Countdown Regional Centre in Asia, led by Tsinghua University, built on the work of the global Lancet Countdown and began its assessment of the health profile of climate change in China with the aim of triggering rapid and health-responsive actions. This 2021 report is the first annual update, presenting 25 indicators within five domains: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. The report represents the contributions of 88 experts from 25 leading institutions in, and outside of, China. From 2020 to 2021, five new indicators have been added and methods have been improved for many indicators. Where possible, the indicator results are presented at national and provincial levels to facilitate local understanding and policy making. In a year marked by COVID-19, this report also endeavours to reflect on China's pathway for a green recovery, ensuring it aligns with the carbon neutrality goal, for the health of the current and future generations. The findings presented in this China report of the Lancet Countdown reaffirm those of the previous report—namely, that the climate-related health threats are worsening in China. In 2020, the heatwave exposures per person in China increased by 4·51 days compared with the 1986–2005 average, resulting in an estimated 92% increase in heatwave-related deaths. The resulting economic cost of the estimated 14 500 heatwave-related deaths in 2020 is US$176 million (indicators 1.1.1 and 4.1.1). Increased temperatures also caused a potential 31·5 billion h in lost work time in 2020, which is equivalent to 1·3% of the work hours of the total national workforce, with resulting economic losses estimated at 1·4% of China's annual gross domestic product (indicators 1.1.2 and 4.1.2). Although the population-weighted fire risk has decreased, actual population exposure to wildfires has increased in 20 provinces from 2001–05 to 2016–20 (indicator 1.2.1). Additionally, the vectorial capacity for the transmission of dengue by Aedes mosquitoes in China has increased by 25·4% in 2016–19 compared with 2004–07 (indicator 1.3). The frequency and intensity of flood events in China continue to increase and, although the emergency response capacity has reduced the number of people affected by floods, the extreme floods in 2020 and 2021 have the potential to reverse this progress (indicator 1.2.2). The sixth assessment report of the Intergovernmental Panel on Climate Change makes it clear that the health threats from climate change will increase in the coming decades, even if mitigation efforts limit global temperature rise to 1·5°C, which emphasises the necessity of health adaptation. Each region in China faces its specific health threats, depending on its local environmental and socioeconomic conditions. The most concerning trends are the rising heat-related mortality, labour loss, and dengue risk in Guangdong province; flood and drought risks in Sichuan province; and wildfire exposures in Liaoning and Jilin provinces. Developing tailored policies according to these threats is essential to improve the efficiency and effectiveness of climate adaptation responses. The COVID-19 pandemic and the announcement of China's carbon neutrality goal have increased the news coverage and awareness of public health and climate change in China (indicators 5.1.2 and 5.2). However, the growth in awareness has not been sufficient to catalyse actions in all aspects of adaptation and mitigation, and the indicators in these domains identify mixed progress. For adaptation efforts, there has been steady progress in local adaptation planning and assessment in 2020, urban green space growth in 2020, and health emergency management in 2019. 12 of 30 provinces reported that they have completed, or were developing, provincial health adaptation plans (indicator 2.1). Urban green space, which is an important heat adaptation measure, has increased in 18 of 31 provinces in the past decade, and the capacity of China's health emergency management increased in almost all provinces from 2018 to 2019 (indicators 2.2.3 and 2.2.1). However, additional actions are needed given the absence of a stand-alone national health adaptation plan, the absence of assessment and adaptation planning process in the majority of provinces, the sparse engagement of climate information services in public health policy making (indicator 2.3), and the absence of reference to climate change in the responsibilities of the newly established National Bureau of Disease Control and Prevention. Looking towards China's plan for peak emissions before 2030 and to achieve carbon neutrality before 2060, there were some positive signs, marked by the improving energy investments, the continuous rise in clean energy, and the steadily decreasing carbon intensity of the energy system (indicator 3.1). Despite the shock of COVID-19, low-carbon investments still increased from 2019 to 2020, which are now 9·5 times higher than those of coal, and fossil fuel subsidies in 2019 were 40% lower than in 2018, reversing the upward trend that was seen during the previous 3 years (indicators 4.2.1 and 4.2.3). As a result of China's persistent efforts to clean its energy structure and control air pollution, the premature deaths due to exposure to ambient particulate matter of 2·5 μm or less (PM2·5) and the resulting costs continue to decline. However, 98% of China's cities still have annual average PM2·5 concentrations that are more than the WHO guideline standard of 10 μg/m3 (indicator 3.3). China announced strict control on coal-fired power plants in April, 2021, which will greatly benefit both carbon mitigation and air pollution control. Despite the worldwide call for a green recovery, after a steep but temporary drop in the first quarter of 2020, the overall carbon emissions in China increased by 1·28% in 2020. During this important junction in time, the health policy makers in China are reflecting on COVID-19 and have established a new and more powerful National Bureau of Disease Control and Prevention to improve overall public health. At the same time, climate policy makers and macroeconomic planners are designing China's National Climate Change Adaptation Strategy 2035 and are exploring how to achieve short-term economic recovery while ensuring long-term carbon neutrality. However, the dialogues between these different groups of decision makers are limited by their scope and recognition of their intersecting agendas and impacts. The risk of decisions made in isolation is that China might not fully realise the health and economic benefits of addressing the pandemic alongside tackling climate change, which is likely to be a larger global public health threat than COVID-19 in the long run. Therefore, we propose four recommendations for the key stakeholders in health and climate change in China. The first proposal is to promote systematic thinking in the related departments and strengthen multidepartmental cooperation. Given the huge gap between current global climate commitment and the 1·5°C target, the potential health benefits of climate change mitigation, and the health threats from climate change (even with 1·5°C of warming), addressing health threats from climate change requires long-term and compound efforts in both mitigation and adaptation. Therefore, multiple departments should work together on this issue to comprehensively protect and improve the health of people in China. The health-care sector, especially the newly built National Bureau of Disease Control and Prevention, should recognise climate change as a major health threat in China and mount a commensurate response. Furthermore, sectors related to climate and development in China should incorporate health perspectives into their policy making and actions, demonstrating WHO's and President Xi Jinping's so-called health-in-all-policies principle. The second proposal is to do additional assessments of the health impacts of climate change and make national and region-specific adaptation plans. It is necessary to include clear goals and timelines for climate-related health impact assessments and health adaptation plans at both the national and the regional levels in the National Climate Change Adaptation Strategy 2035. A new domain in the annual Healthy China Work Priorities that focuses on reducing the climate-related health risks is also urgently needed. This domain should include specific priorities on improving early warning and response networks for climate-related health risks, on promoting systematic health risk and vulnerability assessments, and on increasing the preparedness of health-care agencies to climate-related health risks. The third proposal is to strengthen China's climate mitigation actions and ensure health is included in China's pathway to reach carbon neutrality. Considering the prominent health co-benefits related to air quality improvement from coal phase-out, a carbon neutrality pathway with over-reliance on coal combined with carbon capture and storage might lead to additional morbidity and mortality attributable to air pollution, despite the alleviated threats from climate change. Therefore, coal phase-out is imperative for China if it is to opt for a carbon neutrality pathway that maximises the health benefits for people in China. On the basis of the country's first coal phase-out commitment, it is important to send strong signals to the investors and producers and stop financing new coal activities. Specifically, by promoting investments in zero-carbon technologies and reducing fossil fuel subsidies, the current rebounding trend in carbon emissions will be reversed and lead to a healthy, low-carbon future. The fourth proposal is to increase awareness of the linkages between climate change and health at all levels. Health professionals, the academic community, and traditional and new media should raise the awareness of the public and policy makers on the important linkages between climate change and health. Local and national campaigns that link the response to climate change with health benefits for people today, and protect future generations, will be crucial for building confidence and support in mitigation and adaptation actions. The health impacts of climate change continue to worsen in every province in China and there is mixed progress in the adaptation and mitigation responses. With several key health and climate decisions being developed, the country has a unique opportunity to increase its leadership in committing to global climate mitigation actions that benefit and protect health. After the painful lessons from COVID-19, this important opportunity to protect the health of people in China, both now and in the future, cannot be missed.