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Countdown
www.thelancet.com/public-health Published online November 18, 2023 https://doi.org/10.1016/S2468-2667(23)00245-1
1
The 2023 China report of the Lancet Countdown on health
and climate change: taking stock for a thriving future
Shihui Zhang*, Chi Zhang*, Wenjia Cai*, Yuqi Bai, Max Callaghan, Nan Chang, Bin Chen, Huiqi Chen, Liangliang Cheng, Hancheng Dai, Xin Dai,
Weicheng Fan, Xiaoyi Fang, Tong Gao, Yang Geng, Dabo Guan, Yixin Hu, Junyi Hua, Cunrui Huang, Hong Huang, Jianbin Huang,
Xiaomeng Huang, John S Ji, Qiaolei Jiang, Xiaopeng Jiang, Gregor Kiesewetter, Tiantian Li, Lu Liang, Borong Lin, Hualiang Lin, Huan Liu,
Qiyong Liu, Xiaobo Liu, Zhao Liu, Zhu Liu, Yufu Liu, Bo Lu, Chenxi Lu, Zhenyu Luo, Wei Ma, Zhifu Mi, Chao Ren, Marina Romanello,
Jianxiang Shen, Jing Su, Yuze Sun, Xinlu Sun, Xu Tang, Maria Walawender, Can Wang, Qing Wang, Rui Wang, Laura Warnecke, Wangyu Wei,
Sanmei Wen, Yang Xie, Hui Xiong, Bing Xu, Yu Yan, Xiu Yang, Fanghong Yao, Le Yu, Jiacan Yuan, Yiping Zeng, Jing Zhang, Lu Zhang, Rui Zhang,
Shangchen Zhang, Shaohui Zhang, Mengzhen Zhao, Dashan Zheng, Hao Zhou, Jingbo Zhou, Ziqiao Zhou, Yong Luo†, Peng Gong†
Executive summary
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 eects 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 eorts. 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 eective 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 dierent 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 parti culate 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.
Humans at the centre: stocktaking the health impacts
of climate change and human contributions to rising
health hazards
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 aected
by drought, and 7·6% of populations aected 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.
Lancet Public Health 2023
Published Online
November 18, 2023
https://doi.org/10.1016/
S2468-2667(23)00245-1
*Contributed equally
†Co-chairs of the Lancet
Countdown Asia
Business Intelligence Lab,
Baidu Research, Beijing, China
(J Zhou PhD); School of
Economics and Management,
Beihang University, Beijing,
China (Y Xie PhD,
Shao Zhang PhD); School of
Airport Economics and
Management, Beijing Institute
of Economics and
Management, Beijing, China
(Zha Liu PhD); School of
Management and Economics,
Beijing Institute of Technology,
Beijing, China
(Prof C Zhang PhD, M Zhao PhD);
School of Environment, Beijing
Normal University, Beijing,
China (Prof B Chen PhD);
Meteorological Impact and
Risk Research Center, Chinese
Academy of Meteorological
Sciences, Beijing, China
(Prof X Fang PhD); National Key
Laboratory of Intelligent
Tracking and Forecasting for
Infectious Diseases, National
Institute for Communicable
Disease Control and
Prevention, Chinese Center for
Disease Control and
Prevention, Beijing, China
(Prof Q Liu PhD, Prof X Liu PhD,
L Zhang BM); Key Laboratory of
Environment and Population
Health, National Institute of
Environmental Health, Chinese
Center for Disease Control and
Prevention, Beijing, China
(Prof T Li PhD, Prof Q Wang PhD);
Department of Atmospheric
and Oceanic Sciences &
Institute of Atmospheric
Sciences (Prof X Tang PhD,
Prof J Yuan PhD) and Integrated
Research on Disaster Risk
International Centre of
Countdown
2
www.thelancet.com/public-health Published online November 18, 2023 https://doi.org/10.1016/S2468-2667(23)00245-1
Excellence on Risk
Interconnectivity and
Governance on Weather/
Climate Extremes Impact and
Public Health (Prof X Tang,
Prof J Yuan), Fudan University,
Shanghai, China; Pollution
Management Research Group,
Energy, Climate, and
Environment Program,
International Institute for
Applied Systems Analysis,
Laxenburg, Austria
(G Kiesewetter PhD,
L Warnecke MS, Shao Zhang);
Mercator Research Institute on
Global Commons and Climate
Change, Berlin, Germany
(M Callaghan PhD); School of
Public Health, Nanjing Medical
University, Nanjing, China
(N Chang BM); School of
International Affairs and Public
Administration, Ocean
University of China, Qingdao,
China (J Hua PhD); College of
Environmental Sciences and
Engineering (Prof H Dai PhD,
Z Zhou MS) and Department of
Physical Education (F Yao PhD,
R Zhang MS), Peking University,
Beijing, China; School of
Management, Qufu Normal
University, Rizhao, China
(T Gao PhD); Department of
Epidemiology, School of Public
Health, Cheeloo College of
Medicine (Y Yan MS,
Prof W Ma PhD) and Climate
Change and Health Center
(Prof W Ma), Shandong
University, Jinan, China; School
of Economics and
Management, Southeast
University, Nanjing, China
(Y Hu PhD); School of Public
Health, Sun Yat-sen University,
Guangzhou, China (H Chen BM,
L Cheng BS, H Lin PhD,
D Zheng MS); Faculty of
Architecture (C Ren PhD),
Institute for Climate and
Carbon Neutrality
(Prof P Gong PhD), Department
of Earth Sciences and
Department of Geography
(Prof P Gong), The University of
Hong Kong, Hong Kong Special
Administrative Region, China;
Department of Earth System
Science (Prof W Cai PhD,
Prof X Huang PhD,
Shi Zhang PhD, Prof Y Bai PhD,
J Shen PhD, Y Sun BEng,
R Wang BS, Prof D Guan PhD,
Zhu Liu PhD, Y Liu BS,
Prof B Xu PhD, L Yu PhD,
Shan Zhang BS, Prof Y Luo PhD),
School of Journalism and
Communication (Q Jiang PhD,
W Wei BA, S Wen MS,
Steady improvements with little emphasis on health
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.
Exploring future opportunities for health-centred
responses
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 oppor-
tunities to deliver a safer, healthy future for people in
China:
1. Increase investment and research in renewable energy to
avoid the lock-in effects of coal power
Investing in renewable energy infrastructure can reduce
GHG emissions and promote energy diversity and
resilience. Research and development eorts on grid
integration and energy storage can enhance the ecacy,
reliability, and aordability 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.
2. Harness the synergies in actions to reduce carbon and air
pollutants
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 eciency 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.
3. Establish meteorology-informed early warning systems for
health
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 suering from chronic
Countdown
www.thelancet.com/public-health Published online November 18, 2023 https://doi.org/10.1016/S2468-2667(23)00245-1
3
J Zhang MS), Institute of Public
Safety Research (X Dai BS,
Prof W Fan PhD,
Prof H Huang PhD), Department
of Engineering Physics (X Dai,
Prof W Fan, Prof H Huang),
School of Architecture
(Y Geng PhD, Prof B Lin PhD),
Vanke School of Public Health
(Prof C Huang PhD, J S Ji Dsc),
School of Environment
(Prof H Liu PhD, Z Luo MS,
Prof C Wang PhD), School of
Humanities (J Su PhD),
Institute of Climate Change
and Sustainable Development
(X Yang PhD), Schwarzman
Scholars (Y Zeng MA), Institute
for Urban Governance and
Sustainable Development
(H Zhou PhD), Tsinghua
University, Beijing, China;
Institute for Global Health
(M Romanello PhD,
M Walawender MPh) and the
Bartlett School of Sustainable
Construction (Prof Z Mi PhD,
X Sun MS), University College
London, London, UK; College of
Resources and Environment,
University of Chinese Academy
of Sciences, Beijing, China
(J Huang PhD); Belfer Center for
Science and International
Affairs, Harvard Kennedy
School, Cambridge, MA, USA
(C Lu PhD); Priestley
International Centre for
Climate, University of Leeds,
Leeds, UK (M Callaghan);
Department of Geography and
the Environment, University of
North Texas, Denton, TX, USA
(L Liang PhD); Office of the
WHO Representative, World
Health Organization, Geneva,
Switzerland (X Jiang MPH);
National Climate Center, China
Meteorological
Administration, Beijing, China
(B Lu PhD); Artificial
Intelligence Thrust Area and
the Department of Computer
Science and Engineering,
Hong Kong University of
Science and Technology,
Guangzhou, China
(Prof H Xiong PhD)
Correspondence to:
Prof Peng Gong, Department of
Earth Sciences and Department
of Geography, The University of
Hong Kong, Hong Kong Special
Administrative Region, China
diseases, can help reduce the toll of climate-related
hazards in China.
4. Promote research on the compound and cascading effects of
extreme weather events and efficient response strategies
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 eects. 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 eects 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 eects of extreme weather events and develop
eective strategies to mitigate their eects, safeguard
lives, and nurture resilient societies.
5. Develop health adaptation guidelines tailored to different
actors
These guidelines should provide specific recom men-
dations 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 dierent 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 eorts. 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.
Introduction
2022 was a year of dangerous weather conditions for
Chinese people, with the second highest national average
temperature on record, the lowest precipitation since
2012, a long drought across summer and autumn in the
southern region, and extreme rainfall and flooding in the
Hunan and northeastern regions.1 Over 900 million
people in China (65%) were aected by a scorching heat
that lasted for over 70 days in the summer of 2022.2 Such
hazards have triggered compound and cascading impacts
on human health in both the short term and the long
term, requiring more flexible and timely adaptation
responses. Taking the consecutive heat and drought in
Sichuan last summer as an example, the substantial
increase in heat stroke incidence was a short-term and
direct health impact, whereas the electricity and water
supply shortages due to low water levels were long-term
and indirect threats for human health and wellbeing.3,4
Furthermore, China’s coal power generation rebounded
in 2022, largely to maintain a stable supply of energy
when low-carbon electricity generation was threatened
by extreme weather events. Therefore, increasing
numbers of extreme weather events in the country
highlight the need for urgent mitigation and adaptation.
In the meantime, global climate policy is entering a
new era, with opportunities to accelerate action and
implementation. The clock is ticking, and the health
impacts of anthropogenic climate change are becoming
more prominent, highlighting the need for mitigation
of anthropogenic GHG emissions. The UN’s global
stocktake process marks a worldwide opportunity for
reflection, accounting, and renewed ambition for action
incentives and evidence-based solutions. The Chinese
Government has launched several policies that will
undoubtedly protect human health from climate
change, such as the Synergising the Reduction of
Pollution and Carbon Emissions Implementation
Scheme.5 Although the announcement of the first
Health Day, which will be hosted at COP28, marked the
rising political profile of health in climate change issues,
health is not explicitly listed as a target in climate
policies. It is crucial that health is suciently prioritised
in governmental climate action, to ensure health co-
benefits from climate actions.
The 2023 China report of the Lancet Countdown is the
third annual update, tracking progress in climate and
health across five sections through 28 indicators: 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 (panel 1). To better
capture the role of human emissions and present
solution opportunities, this year’s report includes two
new indicators and two new panels. A panel exploring
the attribution of health risks from climate change to
human-induced changes in climatic conditions
(panel 2, figure 1) and an indicator monitoring the
attribution of production-based and consumption-based
CO2 and PM2·5 emissions (indicator 4.2.4) emphasise the
urgency of mitigation actions. Indicators tracking the
Countdown
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www.thelancet.com/public-health Published online November 18, 2023 https://doi.org/10.1016/S2468-2667(23)00245-1
progress of early warning services for health risks
(indicator 2.4) and the city-level human comfort index
(panel 3) monitor progress on local solutions for
adaptation. Where possible, the methodologies of other
indicators have been improved on from last year’s report
with either updated data or methodologies.
Section 1: climate change impacts, exposures,
and vulnerability
Anthropogenic climate change is causing substantial
health threats to people in China through various
pathways. This section monitors the health risks of
climate change with six indicators that cover heat and
health (indicators 1.1.1–1.1.3), health and extreme
weather events (indicators 1.2.1–1.2.2), climate-sensitive
infectious diseases (indicator 1.3), and rising sea levels
(indicator 1.4). Whenever possible, the impacts or risks
that can be attributed to human-induced climate change
are identified (panel 2).
Indicator 1.1: health and heat
Indicator 1.1.1: heatwave-related mortality
In 2022, China saw the most severe heatwave since
records began in 1961 in terms of intensity, duration, and
the area aected. Exposure to extreme temperatures can
overload the body’s thermoregulatory and circulatory
systems, which can induce heat-related diseases,
aggravate underlying conditions, and even lead to
premature death.8,9 The record-breaking heatwave
contributed to the average number of heatwave days
experienced by each Chinese person reaching 21·0 days
in 2022, which was 293% (or 15·6 days) higher than the
historical baseline (1986–2005) average. Consequently,
heatwave-related mortality was estimated to reach a
record high of about 50 900 deaths in 2022, more than
twice the number in 2021. The annual average mortality
over the past 5 years (2018–22) was 169% higher than the
historical baseline, highlighting the pressing health
threats from heat under a changing climate. Of the
31 provinces, heatwave-related deaths were highest in
Henan, followed by Shandong, Jiangsu, and Sichuan,
which accounted for 15·5%, 8·7%, 8·5%, and 8·1% of
total deaths in 2022, respectively.
Indicator 1.1.2: change in labour capacity
Excessive heat can cause severe physiological strain to
workers and lead to reduced labour productivity.10 In
2022, potential work hours lost due to heat exposure
reached 38·3 billion hours, nearly 1·2 times the baseline
average (1986–2005). Agricultural and construction
workers had a potential work hours lost value that was
24·6-times greater than that of service workers, mainly
because they are engaged in more physically demanding
labour with higher metabolic rates, making them more
susceptible to loss of labour capacity due to heat
exposure. Guangdong and Henan had the biggest losses
in China because of their higher temperature exposure,
larger population sizes, and high proportions of outdoor
workers, underlining the importance of workplace-
specific adaptation measures in these areas.
Panel 1: The 2023 China Lancet Countdown report indicators
Climate change impacts, exposures, and vulnerability
1.1: health and heat
1.1.1: heatwave-related mortality
1.1.2: change in labour capacity
1.1.3: heat and physical activity
1.2: health and extreme weather events
1.2.1: wildfires
1.2.2: flood and drought
1.3: climate-sensitive infectious diseases
1.4: population exposure to regional sea level rise
Adaptation, planning, and resilience for health
2.1: adaptation delivery and implementation
2.1.1: detection, preparedness, and response to health
emergencies
2.1.2: air-conditioning—the benefits and harms
2.1.3: urban green space
2.2: climate information services for health
2.3 early warning services for health risks*
Mitigation actions and health co-benefits
3.1: energy system and health
3.2: clean household energy
3.3: air pollution, transport, and energy
Economics and finance
4.1: the economic impact of climate change and its mitigation
4.1.1: economic costs of heat-related mortality
4.1.2: economic costs of heat-related labour productivity loss
4.1.3: economic costs of air pollution-related mortality
4.1.4: economic costs due to climate-related extreme events
4.2: the economics of the transition to zero-carbon economies
4.2.1: investment in new coal and low-carbon energy and
energy efficiency
4.2.2: employment in low-carbon and high-carbon industries
4.2.3: net value of fossil fuel subsidies and carbon prices
4.2.4: production-based and consumption-based attribution
of CO2 and ambient particulate matter (PM2·5) emissions*
Public and political engagement
5.1: media coverage of health and climate change
5.1.1: media coverage of health and climate change on social
media
5.1.2: newspaper coverage of health and climate change
5.2: individual engagement in health and climate change
5.3: coverage of health and climate change in scientific journals
5.4: government engagement in health and climate change
*New indicators in the 2023 China report.
Countdown
www.thelancet.com/public-health Published online November 18, 2023 https://doi.org/10.1016/S2468-2667(23)00245-1
5
Indicator 1.1.3: heat and physical activity
Doing physical activity in high temperatures and
humidity can increase the risk of exertional heat stress
and can lead to lethal heat stroke,11,12 but allocating
inadequate time for physical activity is associated with
increased cardiovascular diseases, diabetes, or cancer.13–15
For people who engage in physical activity, high
temperatures can present an acute health risk. This
indicator tracked the number of safe physical activity
hours lost per day when a heat index, which combines
temperature and humidity, exceeded a threshold of
33°C.16 China experienced 2·32 activity hours lost per
person per day in 2022. South central China was the
most aected region, with 3·67 activity hours lost in
2022. This is an increase of 0·94 hours (67·8%) for China
and 1·21 hours (49·4%) for south central China compared
with the baseline averages (1986–2005). As a result, the
hours available for safe outdoor activities decreased by
9·6% in China. 3 of the 5 years with the most hours of
safe physical activity lost in China from 1986 to 2022 have
occurred since 2018; in south central China, 4 of the
5 years with most hours lost occurred after 2018.
Indicator 1.2: health and extreme weather events
Indicator 1.2.1: wildfires
While the number of global wildfires has been increasing
due to climate change,17 wildfires in China have garnered
substantial interest from both domestic and international
research and media communities. Of note is the
Chongqing Forest fire of 2022, which was probably
precipitated by a combination of elevated temperatures
and low humidity. In addition to causing injuries and
death, wildfires also threaten land carbon sinks.18 This
indicator monitors the annual average number of days
people were directly exposed to wildfire each year with
satellite observations and population data. In 2018–22,
the national annual average wildfire exposure increased
by 33·65% compared with 2001–05. Meanwhile, the
exposure days per person grew in 23 provinces, with
particularly big absolute increases in Hebei (0·22 billion
person-days) and Heilongjiang (0·21 billion person-days).
Indicator 1.2.2: extreme rainfall and drought
This indicator tracks the temporal change in extreme
rainfall and drought throughout China during the past
Panel 2: The health impacts attributed to human-induced climate change in China
Climate change is an important source of threats to human
health. Quantifying the impacts that are the result of human
activities can help policy makers and the public better
understand the urgency of climate action. Following the
methodology of Vicedo-Cabrera and colleagues,6 this year’s
report calculated the proportion of heatwave-related mortality
(indicator 1.1.1), change in labour capacity (indicator 1.1.2),
exposure to warming (indicator 1.1.4), and extreme rainfall and
drought (indicator 1.2.2) attributable to human-induced
climate change. Factual and counterfactual scenarios from
climate models (appendix pp 116–17) were used to calculate the
contribution of human-induced climate change on overall
effects. Factual scenarios represent the compound forcing of
anthropogenic and natural climate change, whereas
counterfactual scenarios only include natural forcing.
We quantified the contribution of human-induced forcing by
subtracting the counterfactual scenario from the factual
scenario.
Nationally, the proportions of several major climate-related
risks attributable to anthropogenic emissions have been high
over the past 20 years. Compared with the baseline period
(1986–2005), the average summer population-weighted
temperature increased by 0·185°C and decreased by 0·062°C in
2000–20 under the factual and counterfactual scenarios,
respectively, with the anthropogenic impact accounting for
133% of the temperature increase. Average annual heatwave-
related mortality during 2000–20 was 12 798 people and
6473 people for the factual and counterfactual scenarios,
respectively, with 49·4% of heatwave-related mortality
attributable to anthropogenic climate change. 24·9 billion and
17·2 billion working hours were lost annually during 2000–20,
respectively, under factual and counterfactual scenarios due to
high temperatures, with anthropogenic factors accounting for
30·9% of the total work hours lost. In addition to influencing
heat-related outcomes, human factors also accelerate other
climate hazards. For example, the average population affected
by drought is 146·3 and 1·7 (per 100 000 population per year)
for 2000–20 under the factual and counterfactual scenarios,
respectively. Therefore, 98·8% of this exposure to drought can
be attributed to anthropogenic climate change.
At the provincial level, the contribution of anthropogenic
climate change to the indicators varies considerably (figure 1).
The provinces with the highest proportions of annual average
heatwave-related deaths attributable to anthropogenic
climate change in 2000–20 were Guangdong
Province (67·0%), Fujian (60·3%), Hainan (59·3%),
Hunan (59·7%), and Shanghai (60·2%). The contribution of
anthropogenic climate change is generally higher in the
southern region of China than in the northern and western
regions, with provinces such as Qinghai (97·4%), Yunnan
(56·7%), and Xinjiang (58·8%) having much higher
attributable portions than the national annual average
anthropogenic attribution rate of heat-related work hours lost
in 2000–20. However, the total potential working hours lost in
these provinces is minimal and has little effect on the overall
national results. The provinces with the greatest amount of
potential work hours lost are mainly located in south, east,
and central China. Most of the anthropogenic climate change
impact contributions are between 20% and 30% in these
regions, with the contributions in Fujian (42·9%),
Guangdong (39·0%), Hainan (35·9%), and Zhejiang (36·6%)
all exceeding 30%.
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decades.This year, the methodology has been refined to
align with the global report of the Lancet Countdown,
which uses the standardised precipitation evapo-
transpiration index (SPEI) to define drought (an SPEI
value <–1·5 indicates a drought event) by accounting for
precipitation, temperature, and evaporation.19 Compared
with the baseline years (1986–2005), the land area
annually aected by extreme rainfall in China varied less
substantially than the area aected by drought between
2000 and 2022. Areas with a net increase in drought
incidence saw on average 3 extra months of drought than
in the baseline years. The size of the population exposed
to extreme rainfall events increased by 23·0% in 2000–22
compared with the baseline (appendix p 18). Gansu,
Qinghai, and Sichuan had the largest increase in extreme
rainfall events during 2000–22, whereas Tibet, Xinjiang,
and Sichuan recorded the largest increase in drought
occurrence (appendix p 20).
Indicator 1.3: climate-sensitive infectious diseases
Dengue fever is one of the most rapidly spreading
climate-sensitive diseases in the world and has a
considerable impact on public health.20,21 This indicator
includes the vectorial capacity for the transmission of
dengue by Aedes aegypti and Aedes albopictus mosquitos,
human population vulnerability, and the disease burden
of dengue in China.
The vectorial capacity for dengue transmission
increased in 17 provinces in China between 2004 and
2021 due to changing climatic conditions (appendix
pp 25–26). The average vulnerability to severe dengue
outcomes increased by over 10% in 17 provinces, between
2010–15 and 2016–21. The disability-adjusted life-years of
dengue declined sharply, from 883 person-years in 2019
to 2 person-years in 2021, because of the strict border
restrictions and quarantine policies put in place during
the COVID-19 pandemic.22
Figure 1: Growth rates of climate-related health risks and attribution rates of human-induced forcing on health risks in each Chinese province
The bars represent the growth of climate-related health risks from the historical baseline (mostly 1986–2005) to the current level (mostly in 2022) on the left y axis.
The triangles represent the annual average attribution rates of human-induced forcing of climate-related health risks in 2000–20 on the right y axis.
Xinjiang Gansu
Tibet Qinhai Ningxia Shaanxi Shanxi
Heilongjiang
Inner Mongolia Liaoning Jilin
HebeiShandong
Beijing Tianjin
Sichuan Chongqing Hubei Henan Anhui JiangsuShanghai
Yunnan Guizhou Hunan JiangxiZhejiang
Guangxi GuangdongFujian
Hainan
Heat-related mortalities
Heat-related labour capacity loss
Heat-related safe physical activity hours
Exposure to warming
Exposure to wildfire
Population exposure to extreme rainfall
Population exposure to extreme drought
Climate suitability for dengue fever
–2 –0·4
0
Growth
Attribution rate
81·6
0
Indicators
1.1.1
1.1.2
1.1.3
1.1.4
1.2.1
1.2.2
1.2.2
1.3
See Online for appendix
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7
Indicator 1.4: population exposure to regional sea level
rise
Regional sea level rise poses substantial risk to coastal
residents, including from increased flooding, erosion,
storm surges, and saltwater intrusion.23,24 This indicator
predicts population exposure to future regional sea level
rise along the Chinese coast. In addition to regional sea
level projections, new factors were taken into account in
this report to estimate population exposure, including
extreme sea level (ie, the occurrence of exceptionally high
local sea surfaces due to short-term phenomena,
including storm surges, tides, and waves) and population
changes under three future climate and socioeconomic
scenarios (shared socioeconomic pathways [SSPs];
appendix p 26).
The total Chinese population exposed to floods due to
the present sea level rise and the 100-year return period of
extreme sea level is 42 071 641 people. This number is
projected to reach its peak roughly in the middle of this
century before declining under all scenarios, as anticipated
decreases in the population oset the eects of sea level
rise. However, the ratio of the exposed population to the
total population in coastal provinces is projected to increase
compared with the baseline period (1995–2014) across all
three scenarios (eg, the median estimation under the
intermediate Shared Socioeconomic Pathway 2 [SSP2]–4·5
scenario for the present 100-year return period extreme sea
level is 6·9% in 2050 and 9% in 2100), indicating a greater
impact from future sea level changes on Chinese coastal
communities (appendix p 28). The exposure varies by
province. The most aected province is projected to be
Jiangsu, where about 22·4% of the total population is
projected to be threatened by floods at the level of 100-year
extreme sea level under the very high SSP5–8·5 scenario
in 2050 and 34·9% of the population in 2100.
Conclusions
Record high temperatures and drought in 2022 led to a
substantial increase in related human exposure and
health risks. Compared with the historical baseline
(1986–2005), heatwave-related deaths, heat-related loss of
potential work hours, and heat-related loss of time for
safe outdoor physical activity increased by 342%, 24%,
and 67%, respectively, and wildfire exposure increased
by 54%. Over the past 20 years, more than 40% of
heatwave-related mortalities, 25% of heat-related labour
productivity loss, 98% of drought exposure, and 58% of
flood exposure could be attributed to anthropogenic
Panel 3: Moving from provincial-level indicators to city-level indicators—the example of city-level body comfort days
Given the vast territorial area in China and the heterogeneity in
climate and socio-economic status among cities, improving the
spatial resolution of monitoring efforts from the provincial level
to the city level would help people have a deeper understanding
of how climate is changing in their specific regions and how
trends are affecting their health, and provide more targeted and
practical policy recommendations.
Tracking the number of body comfort days in Chinese cities,
a metric developed by the China Meteorological Agency (CMA),
is a potential new indicator for future China reports of the
Lancet Countdown. It was briefly reported annually in the China
Climate Bulletin, an official CMA publication that summarises
the climate in different seasons and different regions in China.
Before the number of body comfort days was calculated, the
CMA developed a body comfort index, which combined daily
temperature, humidity, and wind speed data from each city
level with detailed meteorological observation data owned by
the CMA (see appendix pp 45–46 for detailed formulas to
calculate the body comfort index).7 When the body comfort
index of 1 day is between 59 and 70, the day is defined as a
body comfort day; otherwise it is not.
In 2022, the ratio of comfort days to all days in the year in most
of China’s cities was between 20% and 40%. Southwestern
cities, such as Simao, had higher comfort ratios, usually above
60%, whereas in cities in remote and arid inland regions, the
comfort day ratio was as low as 10%. In cities, such as Beijing
and Shanghai, the comfort day ratio was between 20% and
30%. Generally, the comfort day ratio is positively related to the
population density, probably because people tend to live in
cities with more comfortable climates.
However, 196 of 337 cities (58%) had fewer comfort days in
2022 than the 1986–2005 average, most of which are densely
populated. Liupanshui, Ruili, and Nujiang, which are in remote
southwestern mountainous areas, experienced the greatest loss
of comfort days in 2022 compared with the historical baseline
(1986–2005), with 98 days, 42 days, and 34 days lost,
respectively, owing to rising temperatures in humid locations.
The number of comfort days lost in densely crowded cities such
as Beijing, Shanghai, and Zhengzhou was 14 days, 7 days, and
17 days, respectively, which is substantial when compared with
their historically low comfort days (roughly 100 days in
1986–2005). Meanwhile, some cities experienced an increase in
their comfort days ratios. For example, compared with
1986–2005, the number of human comfort days in Lingzhi and
Kunming, cities with cold climates, increased by 15 days and
35 days, respectively.
This city-level information can help residents learn how to
reduce their exposure to non-comfort days. It could also
stimulate city managers to maintain or even increase the
number of body comfort days in their cities with more effective
climate change adaptation or mitigation measures. In the
future, despite methodological challenges, more efforts will be
given to improve the spatial resolution of the existing
indicators in sections 1 and 2 from the provincial level to the
city level where possible.
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climate change. Although some Chinese people are
aware of the health risks of extreme weather events, they
have not linked them to anthropogenic climate change.
Thus, the media and scientists need to explain this
connection to the public to encourage them to support
reducing global warming to protect themselves
(section 5). Without strict emission reductions, climate
change will threaten the Chinese public health system.
For example, achieving the target of 1·5°C of warming
will prevent tens of thousands of deaths in China.25 Thus,
China needs strict climate change mitigation regulations
to reduce health risks, highlighting the urgent need for
both adaption (section 2) and mitigation (section 3).
Section 2: adaptation, planning, and resilience
for health
Extreme weather events in China in 2022 had substantial
health impacts, particularly as the country faced its most
severe drought and longest heatwave in six decades.26
Both active adaptation, which involves pre-emptive
planning to avoid future health risks, and passive
adaptation, which responds to imminent risks, are
needed. The UN recommends early warning systems as
eective measures to save both lives and livelihoods from
extreme weather events. China has implemented the
real-time release of early risk warning information and
corresponding public health services in some pilot
provinces and cities. To measure progress in health
adaptation to climate change, a new indicator on early
warning services for health risks (indicator 2.3) has been
added to this section alongside indicators on adaptation
delivery and implementation (indicator 2.1.1, 2.1.2, and
2.1.3) and climate information services for health
(indicator 2.2).
Indicator 2.1: adaptation delivery and implementation
Indicator 2.1.1: detection, preparedness, and response to health
emergencies
This indicator uses a multi-level index to measure the
capacity of provinces to respond to public health
emergencies, combining 22 indicators covering risk
exposure and preparedness, health emergency detection
and early warnings, and medical resources (appendix
pp 31–34). Considering the impact of the growing older
population and societal forces on public health
emergencies, two indicators have been added to this
year’s report. From 2020 to 2021, the national average
index score slightly increased from 73·00 to 73·54, with
18 of 31 provinces improving their capacity scores. For
this index, a score of 100 represents the best possible
performance in 2018. Values greater than 100 represent a
better performance than the best registered performance
in 2018. Beijing maintains its top position nationwide
with a score of 104·9. Hubei, which has recovered from
the impact of COVID-19, was the province with the most
progress (value increased by 5·00 points) and performed
even better than in 2019. Hubei was followed by
Guangdong (increased by 2·47 points), Henan (increased
by 2·34 points), and Fujian (increased by 2·27 points).
These improvements are probably due to substantial
eorts in strengthening the pharmaceutical industry,
increasing health-care spending, or promoting social
work in the health sector. However, the emergency
response capacity of some provinces is facing challenges
due to ageing populations, insucient social expenditure,
and recurrent outbreaks of COVID-19. Sichuan (decreased
by 3·14 points), Tianjin (decreased by 2·52 points), and
Hunan (decreased by 3·88 points) experienced rises of
infectious diseases and, during the epidemic, there was
some confusion in their data management, including the
crash of their health code systems.
Indicator 2.1.2: air-conditioning—the benefits and costs
According to data from the Chinese Statistical Yearbook,
the number of air-conditioning units owned per
100 households in China was 131·2 in 2021, a more than
six-fold increase from 2000. The use of air-conditioning
is eective for preventing heat-related mortality and we
estimate that over 23 000 Chinese heatwave-related
deaths were averted by air-conditioning in 2021. However,
air-conditioning also leads to adverse health outcomes,
by increasing urban heat due to the emission of heat
waste, and PM2·5 pollution and GHG emissions due to its
high energy consumption. In China, air-conditioning
contributed to an estimated 8600 deaths attributable to
ambient PM2·5 exposure in 2019, and to 0·3 gigatonnes
(Gt) of CO2 emissions in 2021. Following the Chinese
Government’s introduction of relevant policies, such as
the State Council’s 14th Five-Year Comprehensive Work
Plan for Energy Conservation and Emission Reduction,
more eco-friendly air-conditioning technologies are
being promoted, to avoid the harmful health impacts of
air pollution and rising temperatures. However, testing
the eects and eectiveness of this policy will require
more time.
Indicator 2.1.3: urban green space
Urban green spaces oer numerous benefits to health,
including reducing ambient temperatures. Living near
green spaces can help mitigate the impacts of heat waves
on urban residents.27 We measured green space with the
normalised dierence vegetation index (NDVI) and
satellite imagery. We calculated population densities to
measure the population-weighted NDVI (or green space
exposure) in urban areas. Then, we evaluated the
potential eect on mortality attributable to changes in
urban green space exposure for urban areas within
provinces (appendix pp 39–40). In 2022, two provinces
had a very high level of urban greenness, 11 had high
levels, and ten had moderate levels. Southern latitudes
tended to have higher levels of green space, and urban
green space in most Chinese cities showed an upward
trend over the past decade. In 2022, five provinces or
municipalities had lower greenness levels than in the
For more on 14th Five-Year Plan
see https://www.gov.cn/
zhengce/content/2022-01/24/
content_5670202.htm
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9
past decade, whereas 12 provinces saw an increase of
over 10% in greenness compared with the past decade.
When looking at adults and taking relative risk into
account, the overall green space changes from 2011 to
2022 are estimated to have averted 38 195 (95% CI
28 039–59 747) adult deaths in China.
Indicator 2.2: climate information services for health
Eective climate change adaptation that protects health
needs interdepartmental collaboration. This indicator
includes two sub-indicators. The first sub-indicator
tracks which provincial meteorological departments
provide climate and weather information or products to
the public health sector, and the second tracks which
provincial meteorological departments and public
health departments have ocially collaborated to
provide information. The results of the Annual
Provincial Survey on Climate Change Assessment and
Information Services, which was initiated by the Lancet
Countdown China in 2021,28 show that in 28 of
30 responding provinces, meteorological data are
shared with health-related departments. According to
ocial releases, further collaborations between
meteorological bureaus at the province, city, or county
level and health-related agencies have been found in
22 provinces. These collaborations include data sharing,
emergency responses, early warnings, and scientific
research for climate-related and weather-related health
risks.
Indicator 2.3: early warning services for health risks
Early warning systems for health risks are important
adaptation tools that provide timely and accurate
information to decision makers and the public.29 This
indicator was added this year to track the progress of early
warning systems for health risks at both the provincial
and city level in China. The number of provinces and
cities across China that issued early warnings for health
risks related to climate change increased from two
provinces and two cities in 2020 to six provinces and 24
cities in 2021, and eight provinces and 27 cities in 2022.
The types of early warning considered included ambient
air quality health index warnings, heat-health early
warnings, and cold-health early warnings.30 Warnings can
be issued daily. Warning levels are automatically
estimated by the warning systems on the basis of a pre-
designed algorithm and the monitoring or prediction of
daily temperatures and concentrations of air pollutants.
When given thresholds are exceeded, warnings are
released to the public with some tips for health protection.
The early warning health risk information is mainly
released by local centres for disease control through their
ocial websites, mobile apps, and WeChat ocial
accounts. The population covered by warning services for
heat and cold is much smaller than the population
covered by warning systems for air pollution (31·85
million people vs 183·33 million people in 2022).
Conclusion
In 2022, China steadily intensified its passive adaptation
actions on risk response: the national health emergency
response score rose from 73·00 in 2020 to 73·54 in 2021;
health risk early warnings expanded to cover eight
provinces and 27 cities, shielding 183·33 million people;
and interdepartmental collaborations strengthened with
meteorological data being shared across 28 of
30 provinces. However, the country has not yet done
enough in terms of active adaptation measures: air-
conditioning ownership increased to 131·2 units per
100 households in 2021, averting 23 000 heatwave-related
deaths but contributing to 8600 deaths linked to PM2·5
pollution in 2019 and 0·3 Gt of CO2 emissions in 2021.
Expanding urban green spaces has been pivotal, leading
to 38 195 fewer adult deaths between 2011 and 2022. Both
active and passive adaptation require top-level planning,
so a national health adaptation plan of action remains a
strong need for future adaptation action in China.
Section 3: mitigation actions and health co-
benefits
In 2022, there were eorts from the Chinese Government
to extend the so-called 1+N policy framework, aimed at
achieving its carbon peaking and carbon neutrality
pledges. In this policy, the 1 refers to the long-term
strategy tackling climate change, whereas the N refers to
the various policies ensuring emissions peak before
2030.31,32 A new policy, the Implementation Plan for
Synergistically and Eectively Promoting Pollution
Control and Carbon Emission Reduction, was released in
June, 2022.33 This policy recognises the potential of
interventions aimed at reducing GHG emissions to also
reduce conventional environmental pollutants. This
section tracks China’s progress on transitioning to a low-
carbon energy system, climate change mitigation
(indicators 3.1–3.2), pollution abatement, and the
associated health eects by regions and sector or fuel
types (indicator 3.3).
Indicator 3.1: energy system and health
This indicator tracks changes in the carbon intensity of
the Chinese energy system, coal phase-down, and
renewable electricity development. This year, an in-depth
analysis on the reasons behind coal use change was
added. In 2022, the carbon intensity (kg CO2/US$) of the
Chinese energy system decreased by 4·4% compared
with 2021, driving a 1·5% decrease in CO2 emissions
despite a 3% increase in GDP (appendix pp 49–50). The
decrease in CO2 emissions in China in 2022 mainly came
from a substantial decline in emissions from the
industrial sector due to improved energy eciency and
renewable energy generation,34 rather than from a coal
phase-down. In fact, coal consumption increased by
4·3% in 2022 (the second highest annual growth rate
since 2011), mainly attributable to the soaring demand
from the electricity and heat generation sectors. China’s
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coal consumption in 2022 also increased in response to
the economic recovery from the COVID-19 pandemic,
and the impact of extreme weather events on other
sources of energy generation. With national GDP
growing by 3% and exports increasing by 10·5%
compared with 2021 (39·1% higher than that of 2019
before the pandemic),35,36 a rapid increase was seen in the
demand for electricity. Meanwhile, widespread and
extended periods of extreme heat and drought not only
led to a rapid increase in household electricity demand,
but also a substantial decrease in hydropower generation
capacity.37 Indeed, hydropower electricity generation
decreased by 30% in September, 2022, on a year-on-year
basis.38 Although 8·5% more electricity was produced by
low-carbon sources (ie, hydrological, wind, solar, and
nuclear) in 2022 than in 2021 (an increase of
231·8 terawatt hours [TWh]),34 total electricity con-
sumption (324·4 TWh more than in 2021)37 surpassed the
renewable energy generation capacity, pushing China to
use coal to meet domestic energy needs.
Indicator 3.2: clean household energy
The Chinese Government has implemented a series of
powerful residential energy transition initiatives to
address severe air pollution and reduce carbon
emission.39 From 2010 to 2020, China’s domestic energy
consumption per capita increased by 67·0%, and the
share of solid, highly polluting fuels (eg, coal) in total
energy use decreased by 60·4%, accompanied by a
33·8% decrease in their absolute use. Meanwhile, the
shares of electricity and natural gas (ie, clean fuels at
point of use) use increased by 39·8% and 26·3%,
respectively, accompanied by 111·0% and 133·5%
increases in their absolute use.40 However, a WHO
report41 shows that the mortality rate attributable to
household air pollution in China was 50·7 deaths per
10 000 population in 2019. Energy costs in rural areas
grew at an average annual rate of 6·5% from 2013 to
2017, twice as much as the rate in urban areas (3·0%).
The highest growth rate was among poor rural
households (annual rate of 10·7%), followed by rural
middle-income households (annual rate of 5·6%).
Notably, households switching to cleaner fuels are
dominated by low-income groups (ie, households with
low or extremely low incomes), with a share of about
60%. This finding also helps explain the reason that
households with clean stoves in previous studies tend to
also use solid fuel stoves,42 namely because the use of free
or inexpensive solid fuels and biomass fuels facilitates
lower household energy costs. This implies that support
and carefully designed policies should be given to low-
income groups in rural areas to facilitate a low-carbon
and healthy transition.
Indicator 3.3: air pollution, transport, and energy
From 2021 to 2022, the average level of PM2·5 in Chinese
cities decreased by 4·2% (appendix p 61). In more than
70% of cities, the annual average concentrations of PM2·5
were below 35 μg/m³ (ie, below WHO interim target 1 of
PM2·5 concentrations). However, concentrations are still
substantially above the 5 μg/m³ maximum concentration
recommended by WHO.43 Ozone pollution has worsened
in Chinese cities and ozone concentrations increased by
8·5% from 2021 to 2022 (appendix p 61). This indicator
uses the greenhouse gas and air pollution interactions
and synergies (also known as GAINS) model to estimate
premature deaths related to ambient PM2·5 from dierent
sectors and fuel types and found that some 282 400 of
premature deaths were avoided between 2015 and 2020
due to the implementation of the Three-Year Action Plan
for Winning the Blue Sky Defense Battle.44 Coal
substitution and the implementation of ultra-low
emission standards have led to a substantial reduction in
premature deaths, especially for households (which
avoided 72 600 premature deaths), power sectors (which
avoided 36 600 premature deaths), and industry
(which avoided 23 600 premature deaths). The household
sector was associated with the greatest number of
avoided premature deaths in the north of China
(28 900 deaths) due to the adoption of coal-to-electricity
and coal-to-gas actions (appendix p 66).
Upgrading emission standards in transportation is
estimated to have resulted in 42 100 fewer premature
deaths across China. However, the emission intensity of
passenger transport has continued to rebound since the
COVID-19 outbreak in 2020. By the end of 2022, the
emission intensities of carbon monoxide, hydrocarbons,
nitrogen oxides, and particulate matter from passenger
transport rose by 150%, 164%, 178%, and 152%,
respectively, compared with 2019 pre-pandemic levels. In
2020, the adoption rate of new-energy vehicles for
passenger transport in Shanghai, Tianjin, and Beijing
exceeded 5%. Shifting transport modes (eg, road-to-rail
or road-to-sea) and implementing electric vehicles will be
essential for delivering environmental and health
benefits.
Conclusion
Changing the energy mix and instituting air pollution
control measures led to substantial decreases in the
emission of air pollutants, including GHG and
particulate matter from emissions from industry energy
usage, residential energy usage, and transportation.
However, the highest rate of increase in coal
consumption since 2011 showed a warning sign that
without an ambitious response to climate change,
progress on mitigation could be seriously impeded by
extreme weather, resulting in a forced increase in the
use of fossil fuels. China still faces many challenges in
its pursuit of a zero-emission transition, including how
to secure a reliable supply of electricity generated by
zero-emission sources and how to overcome technical
barriers in energy storage and long-distance power grid
transmission to support the large-scale development of
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renewable electricity. China urgently needs to find
solutions for these challenges to avoid the lock-in eect
and stranded asset risks associated with continued
investment in coal,45 and short-term and long-term
health risks. The promotion of China’s electric vehicles
requires considerations around battery resources and
the power supply of urban electric vehicles, which are
needed for a transition in the most eective and
balanced way.
Section 4: economics and finance
To match the urgency of limiting global warming to
1·5°C, a sharp increase in the development of and
investment in renewable energy is still needed.46 This
section tracks the progress of eight indicators, focusing
on the health-related economic costs of climate change
(indicators 4.1.1–4.1.4) and the transition to zero-carbon
economies (indicators 4.2.1–4.2.4) in China. A new
indicator (4.2.4) was introduced to reveal the flow of CO2
and PM2·5 emissions in China’s trade and to call for
interprovincial and international cooperation to mitigate
climate change and combat air pollution. Data in this
section are presented in 2020 US$.
Indicator 4.1: health and economic costs of climate
change and its mitigation
Indicator 4.1.1: economic costs of heatwave-related mortality
This year the methodology of this indicator was improved
to use the advanced adaptive regional input–output (also
known as ARIO) model to estimate the total economic
cost associated with the loss of workers from the
heatwave-related mortality of working-age people at the
national and provincial level (appendix pp 67–69).47 This
year’s indicator was also updated to evaluate the
economic cost of the proportion of the heatwave-related
mortality of working-age people that is specifically
attributable to human-induced climate change. In 2022,
the national economic costs of heat-related mortality
among working-age people reached a new high
($0·59 billion), 0·32-times greater than in 2017. Despite a
decrease of 8·3% in heatwave-related mortality among
working-age individuals in 2021 compared with 2017, the
total economic losses associated with this mortality have
increased by 17%. This eect can be attributed to
alterations in the geographical pattern of mortality,
leading to a redistribution of labour loss among various
sectors. Notably, sectors crucial to China’s economy
(information technology services, architecture, and
chemical products) have encountered a higher degree of
loss. The indirect costs were found to be 7·33-times
greater than direct costs in 2022. Although some
provinces gained economic benefits through
multiregional trade, costs were found in 80·6% of
provinces. The three provinces with the greatest costs in
2022 were Shaanxi ($0·16 billion; 0·038% of GDP)
followed by Guangdong ($0·10 billion; 0·006% of GDP)
and Gansu ($0·08 billion; 0·055% of GDP).
Indicator 4.1.2: economic costs of heat-related labour
productivity loss
This indicator evaluates the total economic costs of heat-
related labour productivity loss in China over the past
decade (2013–22). The national economic costs of heat-
related labour productivity loss reached a new record
high in 2022, amounting to $313·5 billion (1·91% of
national GDP). 2022 was the first time that the national
costs exceeded $300 billion, indicating the devastating
economic toll of heat on China, and highlighting the need
for further eective measures to mitigate the negative
impacts on labour productivity. In 2022, the central and
southeastern regions of China experienced higher
economic costs (relative to regional GDPs) than other
regions due to extreme heat, with the provinces of
Hainan (4·29% of GDP), Anhui (3·55% of GDP), Jiangxi
(3·51% of GDP), and Hubei (3·17% of GDP) having the
highest costs.
Indicator 4.1.3: economic costs of air-pollution-related
premature deaths
This indicator updates the economic costs of PM2·5-
related premature deaths in 2020 with the latest
population census data of China.48 The national
economic costs of PM2·5-related premature deaths
declined from $7·87 billion (0·07% of GDP) in 2015 to
$7·57 billion (0·05% of GDP) in 2020 (decreasing by
3·79%), indicating promising progress in China’s eorts
to tackle air pollution. The secondary (including
manufacturing, mining, and construction) and tertiary
(including transport, wholesale, retail, catering, and
other services) industries incurred most of the economic
costs, accounting for 50% and 34% of costs, respectively,
in 2020 (see appendix pp 75–76 for the classification of
industries). The northwestern regions of China
experienced greater negative economic eects from the
health impacts of PM2·5 pollution than other regions.
The two provinces that suered the greatest economic
costs in 2020, relative to their GDPs, were Gansu (0·23%
of GDP) and Shaanxi (0·20% of GDP).
Indicator 4.1.4: economic losses due to climate-related extreme
events
This indicator estimates the economic losses due to
climate-related disasters with the latest released versions
of China’s 2018 and 2020 input–output tables.
Disaggregation of direct damage into industrial and
residential sectors is also improved by accounting for
dierent land use types, sourced from the China Urban
Construction Statistical Yearbooks.49 National economic
losses due to climate-related extreme events declined for
the second consecutive year, to $52·0 billion (0·32% of
GDP) in 2022, after peaking at $99·4 billion (0·68% of
GDP) in 2020. Disaster-induced direct damage has
caused extensive indirect economic losses (at a ratio of 1
to approximately 0·76) through the trade connections
between sectors and regions. Although the secondary
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and tertiary industries accounted for a major part
(roughly 61%) of the direct damage, the primary industry
suered the largest indirect losses (roughly 63%)
(appendix pp 81–82). In 2020, economic losses from
extreme weather events in China were spatially dispersed
at the provincial level, with the provinces of Anhui
(5·37%), Jiangxi (5·07%), and Gansu (4·22%)
experiencing the greatest economic losses relative to
their GDPs.
Indicator 4.2: the economics of the transition to zero-
carbon economies
Indicator 4.2.1: investment in new coal and low-carbon energy
and energy efficiency
This indicator tracks investments in new fossil fuel
power generation and low-carbon energy in China,
with the same methodologies employed in previous
reports. The new, additional capacity of thermal power
generation declined from 56·6 gigawatts (GW) in 2020
to 46·3 GW in 2021 and 44·7 GW in 2022. However,
investment in new thermal power generation in China
increased by 25·9% (from $10·7 billion in 2021 to
$13·5 billion in 2022) because the unit cost of installing
new capacity increased by 40·0%. On the other hand,
the new, additional capacity of renewable energy
increased by 15·4% compared with 2021, reaching
148·9 GW in 2022. Investment in renewable energy
increased corres pondingly (by 11%), from $76·0 billion
in 2021 to $84·4 billion in 2022. This investment is
leading to a higher return of new capacity, with the
output–investment ratio increasing from 1·3 GW per
$1 billion in 2021 to 2·0 GW per $1 billion in 2022. The
lower return rate than thermal power (4·2 GW per
$1 billion) might discourage investment, but financial
supports through policy implementation should be
eective at addressing this barrier. The new capacity of
solar energy soared, reaching 87·4 GW in 2022, with a
growth rate of 59·1%. Furthermore, the increasing
unit cost of additional thermal power capacity might
partly explain the decrease in the ratio between
investment in low-carbon energy (including
hydrological, wind, solar, and nuclear power) and
thermal power from 11·5 to 1 in 2021 to 7 to 1 in 2022.
At the provincial level, the top three provinces for
renewable energy investment in 2022 were Hebei
($7·6 billion), Shandong ($7·3 billion), and Guangdong
($5·1 billion).
Indicator 4.2.2: employment in low-carbon nd high-carbon
industries
This indicator tracks employment in renewable energy
sectors and fossil fuel extraction industries with the same
data source as in last year’s report.50–52 In 2021, the
number of people employed in renewable energy
increased to 5·1 million from 4·7 million in 2021,
accounting for 42% of employees in the renewable
energy sector worldwide.51 Conversely, employment in
high-carbon industries has continued to decline since
2013. The number of people employed in the coal sector
decreased to 3·4 million in 2021, half the number
employed in 2013.53 The proportions of total global
workers in the hydropower, solar photovoltaic power, and
total renewable energy sectors employed in China were
as high as 37%, 77%, and 42% in 2021, respectively
(appendix pp 86–87). Jiangsu, Zhejiang, Yunnan, Inner
Mongolia, Ningxia, and Xinjiang benefited the most
from the employment gains of the booming solar
photovoltaic industry because the bulk of China’s
photovoltaic supply chain capacity is located in these
provinces.
Indicator 4.2.3: net value of fossil fuel subsidies and carbon
prices
This indicator includes several sub-indicators: the
value of fossil fuel subsidies in China; China’s share of
total global subsidies (data from the International
Energy Agency);54 and the strength of carbon pricing in
China. After decreasing in 2018–20, fossil fuel
subsidies increased by 125% in 2021, reaching
$49·6 billion. This increase was largely because the
global energy crisis increased the gap between the fuel
market price and the price actually paid by consumers,
which fossil fuel consumption subsidies aimed to
lessen.55 Subsidies to fossil fuel electricity generation
increased substantially from $3·7 billion in 2020 to
$28·7 billion in 2021, due to the electricity shortage
crisis in China.56 In 2021, fuel subsidies per capita and
fossil fuel subsidies as a share of GDP in China
increased substantially, from $18·1 to $35·0 per capita,
respectively, and from 0·17% to 0·61% of GDP,
respectively. However, China’s global ranking by these
metrics dropped from 27th to 31st and from 32nd to
33rd, respectively, out of the 41 countries in the
International Energy Agency database.54
The eight pilot carbon emissions trading markets in
China57 all increased their carbon prices from 2021 to
2022, with an 18% increase in the average carbon price
(from $6·9 in 2021 to $8·2 in 2022). However, despite
this increase, the Chinese average carbon price was far
below the global average carbon price in 2022 ($32).58 In
order to achieve carbon neutrality, China should not only
accelerate its pilot policy but also expand its scope.
Indicator 4.2.4: production-based and consumption-based
attribution of CO2 and PM2·5 emissions
This new indicator investigates CO2 and PM2·5 emissions
generated by the production of goods and services
traded between China’s provinces, to understand the
environ mental impact of one region’s consumption on
the regions where products and services were originally
produced.59,60 In 2017, 24·3% of China’s CO2 emissions
were attributed to the net trade of goods and services
between China’s provinces, and 15·0% were from the
net production of goods and services exported to other
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13
countries. The figures for PM2·5 emissions were 23·9%
and 13·7%, respectively. Provinces with higher GDPs
per capita had larger consumption-based emissions
than production-based emissions, and vice versa. In
Beijing, the consumption-based CO2 and PM2·5
emissions were 2·18-times and 2·90-times higher than
its production-based emissions in 2017, respectively.
On the other hand, the production-based CO2 and PM2·5
emissions of Inner Mongolia were 1·81 times
and 1·55 times its consumption-based emissions,
respectively.
Emissions embodied in net exports flowed from
western and central China to more developed provinces
in the east (figure 2). In the less developed northwest
provinces, 20·3% (306·8 megatonnes [Mt]) of production-
based CO2 emissions were caused by the production of
goods and services that were ultimately consumed in
other regions of China. By comparison, the more
developed provinces on the south coast had the largest
carbon emissions embodied in net imports (134·26 Mt).
The central and central coast provinces had the
largest PM2·5 emissions embodied in net exports
(216·33 kilotonnes [Kt]) and net imports (221·53 Kt),
respectively. Consumption-based emissions show that
less developed inland regions are bearing a high
proportion of production-related emissions, often for
products that are then used in more developed coastal
regions, highlighting the need for interprovincial
cooperation to mitigate climate change and combat air
pollution.
Conclusion
Despite more stringent policies and better preparation
driving down the economic costs of air pollution and
climatic extremes, the economic losses caused by
heatwave-related mortality and heat-related labour
productivity loss both reached new records in 2022.
Without more ambitious and rapid actions, these
climate change-related economic losses will continue
growing in the future. Furthermore, China has not yet
managed to cut its dependency on fossil fuels. The
conflict between Russia and Ukraine, unfavourable
economic conditions, and technological barriers, led to
an increasing unit price of fossil fuels and greater fossil
fuel subsidies in 2022. To achieve its carbon neutrality
goal, the energy system in China needs to phase out
85% of fossil fuels in 30 years.61 Therefore, continued
investment in fossil fuel could result in both economic
and climate risks. To accelerate the low-carbon
transition and protect human health from worsening
climate conditions, fossil fuel subsidies should be re-
allocated towards key low-carbon tech nologies,
including energy storage, long-distance power
transmission, and carbon capture and storage.
Reducing CO2 and PM2·5 emissions embodied in
international and interprovincial trade would also be
important in speeding up the transition. Climate
change presents severe economic threats, with tipping
points amplifying irreversible damages that are not
currently covered by our indicators. Without action, it is
estimated that China might lose 3·55% of its GDP by
2050 due to these risks; yet by transitioning to a low-
carbon economy, these potential losses can be limited
to 1·6% by 2050.62
Section 5: public and political engagement
Public and political engagement is crucial for raising
awareness, driving policy changes, and promoting
actions on climate change and health. Eorts from
dierent actors in society can collectively contribute to a
healthier and sustainable future. This section tracks
engagement with climate change and health by dierent
segments of society, including media coverage through
social media and newspapers (indicator 5.1), individuals
(indicator 5.2), academia (indicator 5.3), and the
government (indicator 5.4).
Figure 2: Net flow of CO2 and PM2·5 emissions in domestic trade among
regions of China in 2017
Net flow of (A) CO2 emissions and (B) PM2·5 emissions. The direction of an arrow
from one region to another indicates the flow of emissions embodied in net
exports from one region to another. The width of (and numbers for) each arrow
indicate the volume of the net flow of emissions embodied in trade.
Kt=kilotonnes. Mt=megatonnes. PM2·5=ambient particulate matter.
58
47 60
12
31
37
17
24
16
24 44
9
Emissions embodied in
net exports (Mt CO2)
310
0 500 1000 km
–310
A
B
Emissions embodied in
net exports (Kt PM2·5)
–220220
33
8
44
37
22
48
21
30
21
11
10 12
92
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Indicator 5.1: media coverage of health and climate
change
Indicator 5.1.1: coverage of health and climate change on
social media
This indicator tracks the coverage of health and climate
change on Weibo, the most popular social media
platform for engagement on public aairs among
Chinese residents.63,64 Posts from seven media Weibo
accounts were selected (@People’s Daily, @Xinhuanet,
@The Beijing News, @The Paper, @HealthTimes,
@China Science Daily, and @China Meteorological
News), covering ocial, commercial, and professional
media in China. From 2010 to 2022, there was an average
of 1424 posts per year discussing climate change across
all seven accounts, of which 121 (8·54%) were related to
health. The ratio of posts on both health and climate
change to all posts on climate change reached an all-time
high of 9% in 2022, an increase from 3% in 2010.
Compared with 2021, the number of posts related to
climate change and health in 2022 increased by 109%
(288 posts vs 138 posts).
Indicator 5.1.2: newspaper coverage of health and climate
change
As mainstream media, newspapers in both print and
online versions play a crucial role in informing and
shaping public and political responses to climate
change.19 This indicator tracked the coverage of health
and climate change from 2008 to 2022 in all provincial-
level administrative divisions in China, with content
analysis of 34 ocial provincial newspapers. Across the
2008–22 period, an average of 25 172 articles per year
were published discussing climate change, with an
average of 1449 articles (6%) per year referring to human
health. The upward trend in newspaper coverage of
climate change continued in 2022, reaching
37 207 articles. Coverage of health and climate change in
2022 included 2490 articles, which was slightly lower
than the spike of 2766 articles observed in 2020.
Indicator 5.2: individual engagement in health and
climate change
The aim of this indicator is to track individual engagement
with health and climate change topics. This indicator
uses query data from Baidu, the most widely used
Chinese search engine. Co-queries related to climate
change and health increased by 669·75% in 2022
compared with the average of the previous 5 years
(2017–21), indicating the growing interest of users about
the health and climate change nexus. Potential
contributing factors include more governmental climate
and health policies, the COVID-19 pandemic, and
increased media coverage of the topic. People with higher
levels of education are more likely to engage in co-
searches around climate change and health; there were
129·25% more queries by people with a bachelor’s degree
or higher than by people with lower educational
qualifications. Users in arid regions in northern and
western China, and areas with hot summers (eg, Hubei,
Hunan, and Jiangxi), had higher proportions of climate-
change-related queries.
Indicator 5.3: coverage of health and climate change in
scientific journals
This indicator tracks the number of scientific articles
related to climate change and health in China published
in both English and Chinese journals. Data from 2009–22
were obtained from OpenAlex and Baidu Scholar for
English and Chinese articles, respectively.65,66 From 2009
to 2022, English journals worldwide published
22 151 articles related to climate change and health, of
which 3150 articles were related to China, accounting for
about 14·22% of the total. Publication of articles on
climate change and health in China grew drastically, with
articles in English-language journals increasing by more
than six-fold (500 articles vs 66 articles) and articles
in Chinese-language journals increasing by 117%
(102 articles vs 47 articles) from 2009 to 2022. The number
of articles on climate change in Chinese journals
remained steady throughout the past decade with growth
since 2019 mainly driven by articles related to extreme
weather events and climate actions such as mitigation
and adaptation (appendix p 112).
Indicator 5.4: government engagement in health and climate
change
This indicator tracks government engagement in climate
change and health according to policy text data from the
four ocial websites of the Chinese Government,
including the China Meteorological Administration, the
National Development and Reform Commission, the
National Health Commission of the People’s Republic of
China, and the Ministry of Ecology and Environment of
the People’s Republic of China. During 2008–22, an
annual average of 1519 articles were related to climate
change, and roughly 92 articles (6·1%) related to a topic
on climate and health.
Conclusion
This section clearly shows that there is already social
concern about climate change in China and that media,
academic, public, and governmental coverage of climate
change has steadily increased over the past decade.
Encouragingly, people’s interest in climate change is
growing, and media communication on climate change
is helping disseminate information. However, there is a
clear scarcity of attention to the relationship between
health and climate change, especially in newspapers.
Conclusion of the 2023 China report of the
Lancet Countdown on health and climate
change
The 2023 China report of the Lancet Countdown found
that the health impacts of rising temperatures have been
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15
substantial in the past 10 years (figure 3) and that
progress on adaptation and mitigation have been steady
but too slow to meet the urgency of the problem. Rapidly
growing awareness from individuals and scholars is not
being fully translated into engagement by newspapers
and governments or accelerated action.
Record-breaking heat and drought in China in 2022 led
to increased exposure to climate-related hazards and
increased health risks. Compared with the historical
baseline, time for safe outdoor physical activity decreased
by 67%, wildfire exposure increased by 54%, heat-related
loss of potential work hours increased by 24%, and
heatwave-related mortality increased by 342%. In the
past 20 years, human-caused climate change has
contributed to almost 49·4% of heatwave-related deaths,
30·9% of heat-related labour productivity loss, 98·8% of
population exposure to droughts, and 7·6% of population
exposure to floods. Economic losses related to heat have
also broken all previous records. Without timely
interventions, economic losses due to climate change are
anticipated to keep increasing in the future. The alarming
upward trend of health risks, combined with the high
proportion attributable to human emissions, calls
attention to the urgent need for mitigation and
adaptation.
The conflict between Russia and Ukraine, unfavourable
economic conditions, and technological barriers have all
contributed to China’s continuing dependence on fossil
fuels. Implementing new interventions and strategies to
reduce local reliance on fossil fuels remains imperative
for responding to climate change, protecting human
health, and enabling a sustainable economy. An
estimated 282 400 lives were saved between 2015 and
2020 thanks to mitigation actions to minimise air
pollutants. Emissions of CO2 from industrial processes
fell by 1·5% in 2022 compared with 2021. However, the
fastest rate of increase in coal consumption since 2011
revealed that progress on mitigation could be seriously
impeded by extreme weather, fluctuations in fossil fuel
prices and supplies, and insucient renewable energy
Figure 3: An overview of the impacts and responses tracked in the 2023 China report of the Lancet Countdown
(A) The absolute value of each indicator. (B) The change in indicators tracking responses. The value is indexed from 0 to 1, with 0 representing the worst actions in the
past two decades, and 1 represents the best possible policy response. The colour in each block represents the magnitude of impacts and responses. The darker the
colour, the more severe the impacts and the more effective the responses.
Heatwave-related mortality
(10000 people)
Costs of heatwave-related mortality
(US$100 million)
Labour productivity lost
(10 billion hours)
Costs of labour productivity lost
(US$100 billion)
Heat-related safe outdoor hours lost
(hours)
Exposure to wildfire
(billion people per day)
Exposure to floods
(100 million people affected)
Exposure to droughts
(billion people affected)
Climate suitability for dengue fever
(media index)
Health emergency management
(0≤ score ≤1)
Reduction of carbon intensity
compared with 2005
Share of non-coal fuel in total
primary energy consumption
Share of low-carbon power
in electricity generation
Share of electricity in household
energy use
Share of cities that meet the PM2·5
concentration standard (35 µg/m3)
Reduction of fossil fuel subsidies
compared with 2018
1·44 1·51 1·86 1·35 1·51 1·61 0·79 2·07 2·52 1·80 1·36 1·61 1·31 2·23 3·59 2·70 2·96 2·25 2·47 5·092·89
1·33 1·37 2·38 2·50 2·67 2·45 2·37 2·63 3·351·71
2·27 2·02
3·29 3·10 3·35 3·40 3·00 3·10 2·80 2·98 3·47 2·76 2·78 2·82 2·55 3·91 3·92 3·94 3·43 3·15 3·30 3·833·663·21 3·40
1·46 1·37 1·40 1·58 1·54 1·49 1·49 1·49 1·70 1·41 1·42 1·40 1·29 1·94 2·04 2·09 1·78 1·81 2·05 2·321·931·54 1·65
0·08 0·11 0·12 0·07 0·02 0·07 0·12 0·14 0·15 0·15 0·19 0·27 0·32 0·37 0·39 0·41 0·44 0·44 0·46
0·51 0·56 0·73 0·74
0·490·210·00 0·02
0·31 0·32 0·31 0·30 0·30 0·27 0·28 0·28 0·31 0·30 0·31 0·34 0·36 0·38 0·39 0·41 0·42 0·43 0·44 0·440·330·28 0·28
0·17 0·19 0·18 0·15 0·16 0·15 0·18 0·17 0·18 0·15 0·18 0·20 0·23 0·24 0·24 0·25 0·26 0·27 0·25 0·29
0·23 0·29 0·31 0·42 0·50 0·60 0·65 0·71
0·18
0·12 0·08 0·25 0·49 0·51 0·04 0·05 0·00 0·38 0·59 0·070·42
0·16 0·15
0·22 0·24 0·24 0·24 0·24 0·31 0·33 0·35 0·36 0·36 0·37 0·39 0·38 0·39 0·40 0·42 0·44 0·450·390·27 0·28
0·25 0·33 0·34 0·33 0·32 0·32 0·35 0·38 0·36 0·36 0·42 0·43 0·44 0·42 0·420·410·35 0·35
1·20 0·63 0·94 1·56 0·63 1·45 1·22 0·53 1·38 0·47 1·71 1·21 1·14 2·45 1·24 2·21 1·59 2·182·431·19 0·87
1·30 1·56 1·26 1·17 0·89 0·80 0·38 0·75 0·55 3·14 0·47 0·34 0·33 0·04 0·17 0·23 0·60 0·300·480·63 1·00
1·67 2·54 4·66 5·48 7·16 7·82 7·24 6·76 7·12 6·55 8·38 7·08 6·45 6·61 6·10 4·75 4·42 4·98 6·088·085·36 5·67
1161
0 0·2 0·4 0·6
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
A
B
0·45 0·43 0·48 0·49 0·52 0·59
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supplies, highlighting the need for sustainable, robust
renewable energies as an alternative. In 2022, fossil fuel
subsidies increased in response to the rising cost of
fossil fuels, which the conflict between Russia and
Ukraine triggered. China’s energy grid must eliminate
85% of fossil fuel use within 30 years if it is to reach its
objective of carbon neutrality.67 The economy and the
environment are already being impacted by climate
change and will be at greater risk if investments in fossil
fuels continue to rise.
2023 is a milestone year for both stocktaking and
outlooks. Looking back at the causes and damages of
climate change in China rearms the urgency of climate
change mitigation and the importance of adaptation.
Despite the potential gains for health and economics,
progress on mitigation is being delayed by extreme
weather events and global events and crises. We highly
recommend that policy makers increase investment in
renewable energy, synchronise carbon and air pollution
reduction eorts, build meteorology-informed early
warning systems for health, promote research on the
compound eects of extreme weather events, and
formulate tailored health adaptation guidelines for
dierent stakeholders. At this pivotal moment, it is
crucial to build on the work of the global stocktake to
assess progress and barriers and seize opportunities for
enhanced climate action.
Contributors
The 2023 Chinese report of the Lancet Countdown on health and
climate change is an academic collaboration, which builds on the
work of the 2015 Lancet Commission on health and climate change
and the Lancet Countdown: tracking progress on health and climate
change, specifically in the context of China. The work for this report
was conducted by five working groups, which were responsible for the
design, drafting, and review of their individual indicators and
sections. All authors contributed to the overall paper structure and
concepts and provided input and expertise to their relevant sections.
The authors who contributed to working group 1 were CH (who was
the lead for working group 1), YB, NC, HC, LC, QL, XL, ZhaL, YLi,
WM, XT, YY, FY, JY, LZ, and RZ. The authors who contributed to
working group 2 were CR (who was the lead for working group 2),
XD, WF, XF, YG, JHua, HH, JSJ, TL, LL, BLi, BLu, and QW. The
authors who contributed to working group 3 were ShaoZ (who was
the lead for working group 3), BC, TG, GK, HLin, HLiu, ZhuL, CL,
ZheL, LW, DZ, and HZ. The authors who contributed to working
group 4 were HD (who was the lead for working group 4), DG, YH,
ZM, JSh, XS, YX, YZ, ShanZ, MZ, and ZZ. The authors who
contributed to working group 5 were JSu (who was the lead for
working group 5), MC, XH, Q J, YS, WW, SW, HX, JZha, and JZho.
The coordination, strategic direction, and editorial support for this
Countdown were provided by ShiZ, WC, CZ, JHuan, XJ, MR, MW,
CW, RW, BX, XY, LY, YLu, and PG.
Declaration of interests
We declare no competing interests.
Acknowledgments
We thank the Wellcome Trust, together with the the National Natural
Science Foundation, China Meteorological Administration Climate
Change Special Program, Energy Foundation, and Cyrus Tang
Foundation for their financial and strategic support, without which this
research would not be possible. The support from these funding sources
was purely financial and strategic. They did not participate in or
influence the design, writing, or any other detailed development aspects
of the report. We thank the authors of the projection sections for
developing the sea level projections and making them available, multiple
funding agencies for supporting the development of the projections, and
the NASA sea level change team for developing and hosting the
Intergovernmental Panel on Climate Change AR6 sea level projection
tool. We would also like to thank the following people for their technical
support: Yujuan Yue (Chinese Center for Disease Control and
Prevention); Baichao Zhang (China Meteorological Administration);
Liang Zhao (Chinese Academy of Science); Jun Yang (Guangzhou
Medical University); Ruiqi Li (Tsinghua University); Wenxuan Dong
(Tsinghua University); Lili Yang (Southern University of Science and
Technology); Hu Jin (Fudan University); Robert E Kopp (Rutgers
University); Yibo Ke (Tsinghua University), and Yuren Yang (Tsinghua
University).
Editorial note: The Lancet Group takes a neutral position with respect to
territorial claims in published maps and institutional aliations.
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