The 2023 China report of the Lancet Countdown on health and climate change: taking stock for a thriving future

With growing health risks from climate change and a trend of increasing carbon emissions from coal, it is time for China to take action. The rising frequency and severity of extreme weather events in China, such as record-high temperatures, low rainfall, severe droughts, and floods in many regions (along with the compound and ripple effects of these events on human health) have underlined the urgent need for health-centred climate action. The rebound in the country's coal consumption observed in 2022 reflected the great challenge faced by China in terms of its coal phase-down, over-riding the country's gains in reducing greenhouse gas (GHG) emissions. Timely and adequate responses will not only reduce or avoid the impacts of climate-related health hazards but can also protect essential infrastructures from disruptions caused by extreme weather. Health and climate change are inextricably linked, necessitating a high prioritisation of health in adaptation and mitigation efforts. The 2023 China report of the Lancet Countdown continues to track progress on health and climate change in China, while now also attributing the health risks of climate change to human activities and providing examples of feasible and effective climate solutions. This fourth iteration of the China report was spearheaded by the Lancet Countdown regional centre in Asia, based at Tsinghua University in Beijing, China. Progress is monitored across 28 indicators in five domains: from climate change impacts, exposures, and vulnerability (section 1); to the different elements of action, including adaption (section 2) and mitigation, and their health implications (section 3); to economics and finance (section 4); and public and political engagement (section 5). This report was compiled with the contribution of 76 experts from 26 institutions both within and outside of China. The impending global stocktake at the UN Framework Convention on Climate Change 28th Conference of the Parties (COP28), the UN initiative on early warning systems (which pledged to ensure the world was protected by the end of 2027), and China's action plans to reduce air pollutants and GHGs illustrate that global climate action has moved from talk to concrete plans. These initiatives could deliver major health benefits, but none of them explicitly list health as a policy target or indicator. The results of the global stocktake could guide health-focused and feasible interventions. The first Health Day and climate-health ministerial meeting that will be hosted at COP28 underline the trend to mainstream health in the global climate change agenda. Health risks arising from human-induced climate change, and production-based and consumption-based CO2 and ambient particulate matter (PM2·5) emissions (indicator 4.2.4) indicate the urgent need for mitigation by identifying human contributions to carbon emissions and climate change. Early warning systems for health risks (indicator 2.4) and the city-level human comfort index provide bottom-up examples of adaptation practices. The record-breaking heat and droughts of 2022 were associated with increased adverse health outcomes. Wildfire exposure increased by 54% (indicator 1.2.1) compared with the historical baseline and heatwave-related mortality increased by 342% (indicator 1.1.1). Heat-related work loss increased by 24% (indicator 1.1.2), safe outdoor physical activity loss increased by 67%, and the resulting hours available for safe outdoor activities decreased by 9·6% (indicator 1.1.3). Human-caused climate change was responsible for 49·4% of heatwave-related mortality, 30·9% of heat-related labour productivity loss, 98·8% of populations affected by drought, and 7·6% of populations affected by flood in the previous 20 years. Heat-related economic loss also broke all previous records, with costs of heat-related labour productivity loss reaching 1·91% of gross domestic product (GDP; US$313·5 billion; indicator 4.1.2). Future concerns must not be overlooked: in the case of future sea level rise, the ratio of exposed populations to the total population in coastal provinces is expected to be 7·7% in 2050 and 12·9% in 2100 under high emission scenarios (indicator 1.4)—putting these populations at risk from the hazards of coastal erosion, floods, and water and land salinification, and at risk of physical harm on coastal infrastructure. Growing capacity building to adequately respond to public health emergencies (indicator 2.1.1), expanding coverage of early warning systems (indicator 2.3), and improvements in cross-sectoral information sharing (indicator 2.2) all exemplify China's steady progress in climate change adaption, which involves responses to health risks that are imminent or have already occurred. In response to rising temperatures, use of air-conditioning increased, providing heat protection. However, this use also contributed to increased GHG emissions. Meanwhile, there was no substantial increase in urban green space coverage, which can provide sustainable cooling, while also delivering direct benefits to people's physical and mental health. Transitions in the energy system coupled with air quality control measures have considerably lowered GHG emissions and air pollution in the past 10 years. Indeed, between 2015 and 2020, improvements in PM2·5 air pollution reduction resulted in 282 400 deaths avoided, and 1·5% less CO2 was emitted in 2022 than in 2021 as a result of substantial reductions in emissions from industrial processes. However, as electricity generation from hydropower and other low-carbon energy sources was threatened by extreme weather events in 2022, coal power was used to fill the gap and secure the energy supply. Consequently, since 2011, coal consumption has grown by the second largest rate (4·3%), posing a persistent health risk related to air pollution. Hence, there is an urgent need to diversify China's energy mix and increase access to diverse sources of renewable energy as safe and stable alternatives to coal power generation. Without a health-centred focus, China risks bypassing the energy transition and getting stuck in a high-carbon entrapment. With the impacts of climate change on health becoming increasingly visible, the coverage of climate change and health grew substantially from 2021 to 2022 on Weibo and among individual users of Baidu. However, engagement from professional channels such as newspapers, academic journals, and government websites on the climate change–health nexus has remained practically unchanged over the past 2 years, and health was rarely mentioned or prioritised in current mitigation and adaptation actions. Current early warning systems are mainly based on meteorological signals, such as extreme heat, ignoring health implications. Although there is a health section in the National Adaptation Strategy 2035, the absence of a stand-alone nationwide health adaptation strategy exposed the low priority of health in the country's adaptation agenda. Meanwhile, the ratio of public engagement (media, academic, and government) on climate and health to public engagement on climate-only items has grown very slowly over the past 20 years, also implying the low prioritisation of health by the public climate change agenda. Since the first report in 2020, the China reports of the Lancet Countdown have been taking stock of progress on climate change and health and reporting findings that have helped to inform and accelerate further policy progress. Issues around climate change and health have been increasingly prominent in relevant policies at both national, regional, and sectoral levels, such as the climate content in health policies such as the annual working priorities of Healthy China. However, overall progress has so far been poor. Therefore, we present five evidence-informed policy recommendations to harness opportunities to deliver a safer, healthy future for people in China: Investing in renewable energy infrastructure can reduce GHG emissions and promote energy diversity and resilience. Research and development efforts on grid integration and energy storage can enhance the efficacy, reliability, and affordability of renewable technologies, making them more accessible for widespread adoption. By prioritising these investments, China can cut its long-term reliance on coal power, and pave the way for a cleaner, more sustainable energy system that mitigates climate change and fosters a healthier environment for present and future generations. By capitalising on the interconnections between carbon reduction and improved air quality, China can protect human health, enhance environmental wellbeing, and build resilient communities for generations to come. Transitioning to cleaner and renewable energy sources, promoting energy efficiency in all sectors, and implementing sustainable transportation systems are all components of this strategy. In addition, imposing stringent emission standards for industries, promoting reforestation and conservation actions, and promoting sustainable agricultural practices all contribute to the reduction of carbon emissions and air pollutants. China should develop a population health-oriented meteorological early warning system that accounts for climate health hazards. Such a system will enable the issuing of warnings when climate characteristics or conditions have health concerns and the implementation of targeted and preventive actions for these concerns. Creating an advanced early warning system that provides comprehensive protection for the health of vulnerable populations, such as older people, children, pregnant women, and patients suffering from chronic diseases, can help reduce the toll of climate-related hazards in China. Characterising the interconnected and complex nature of extreme weather events, such as heatwaves, floods, and cyclones can help inform health-protective mechanisms targeted at protecting vulnerable populations, crucial infrastructure, and ecosystems susceptible to cascading climate effects. In addition, charaterising the interactions between sectors such as water, energy, or agriculture and health enables the development of comprehensive response strategies. There is a need for empirical research on the health effects of response strategies such as enhanced early warning systems, improved infrastructure resilience, community preparedness and response plans, and the implementation of nature-based solutions. By promoting relevant research, China can increase its understanding of the compound and cascading effects of extreme weather events and develop effective strategies to mitigate their effects, safeguard lives, and nurture resilient societies. These guidelines should provide specific recommendations and strategies for various stakeholders, including local governments, health-care systems, communities, and individuals. Local governments can launch local health adaptation plans and vulnerability maps that reflect local contexts. Health-care systems should develop protocols and training programmes to enhance their capacity to respond to climate-related health challenges. Communities can be empowered through education and awareness campaigns that promote climate-resilient practices and the protection of vulnerable populations. Individuals can be provided with practical guidance on adapting their lifestyles to reduce the health risks associated with climate change. By tailoring guidelines to different actors, China can foster a coordinated and comprehensive approach to health adaptation, ensuring the wellbeing and resilience of communities in the face of a changing climate. 2023 is a crucial moment; the Lancet Countdown's stocktake on health and climate change helps identify and define opportunities for accelerated climate action. Looking back at the causes and impacts of climate change in China highlights the need for urgently accelerating mitigation and adaptation efforts. Extreme weather events are stifling mitigation work, and a positive reaction to climate change will enable China to speed up mitigation measures, lead the zero-carbon transition, and deliver immediate health benefits to its people.