Health and the environment: Push and pull in China

Chinese woman wearing a polution mask

Economic growth has pulled millions of people in China out of extreme poverty. But the country faces enormous environmental challenges that threaten the health of its people.

Air pollution in China—from industries, vehicles, construction, and indoor sources such as burning coal and wood—leads to more than 800,000 premature deaths per year from respiratory and other diseases. Meanwhile, more than half of China’s large rural population relies on unsafe drinking water sources, and only half have access to basic sanitation.

At the same time, the Chinese population has migrated from rural to urban areas in record numbers—some 422 million from 1978 to 2007—trading old environmental risks for new ones. Rural migrants leave behind traditional problems such as unsafe drinking water and indoor air pollution caused by burning coal for cooking. But these gains are offset by new risks, such as outdoor air pollution from vehicle exhaust and industrial accidents. Compounding those issues is a steep rise in greenhouse gas emissions that have driven China’s economic growth but also contributes to global climate change.

A March 27, 2010, review in The Lancet reports on the scope of China’s large-scale, long-term environmental risks. China needs fundamental efforts at the national policy level—building legal, regulatory, and compliance capacities—rather than short-term, uncoordinated individual solutions, says Justin Remais, who led the study and is a China scholar and expert on waterborne diseases at Emory’s Rollins School of Public Health.

The Lancet review pointed out the need to target environmental interventions to address China’s growing health inequalities. Environmental solutions should be designed to disproportionately benefit the poor, says Remais. “Every unit of intervention generally has a larger effect if it reaches a poor household rather than an affluent household.” For example, investments in rural water, sanitation programs, and subsidies for high-quality, clean-burning stoves that prevent indoor smoke from coal and wood fuels are high-priority places to start.

Remais remains hopeful that China can make significant and lasting headway against its environmental challenges. When there is political will by the Chinese government, we’ve seen dramatic change for the better, he says.

For example, during the Beijing Olympics, China enacted extraordinary pollution-control measures. Among them, the government eliminated half of all cars from roadways in Beijing by alternating driving days for vehicles with even and odd license plate numbers. Removing 1.5 million cars from the roads worked: key air pollutants dropped by half, and all of Beijing’s population, including the Olympic athletes, benefited from the improved air quality.

While compiling the review, Remais and his colleagues (from Rutgers, Princeton, Peking University, Harvard, and Ohio State) found a paucity of reliable data on environmental risks in China. To remedy the information gap, the group is now taking on more detailed analyses of the health risks from waterborne pathogens, industrial pollution, and climate change.

Reliable data is essential to influencing policymakers, and influencing policymakers lies at the heart of whether China will succeed in overcoming its enormous environmental challenges. Currently, Emory public health students are contributing by gathering data on the environmental drivers of parasitic diseases, developing models to predict environmental quality under future climate conditions, and evaluating the benefits of sanitation systems that could have a global impact. These “biogas systems” collect and treat household waste in a septic tank where methane gas is generated through anaerobic digestion. Households then capture the methane to use as cooking fuel for stoves, replacing wood and coal with a clean-burning, renewable fuel, improving indoor air quality, and reducing emissions of greenhouse gases.

“That’s an example of a structural environmental solution with benefits at all levels, from the household to the community to the global population,” says Remais. —Rhonda Mullen

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