Mortality trends on the road towards environmental sustainability: a case study with a focus on ambient air pollution effect in China

Abstract

China experienced rapid economic growth following the introduction of a series of open market reforms in 1978, leading in turn to considerable societal and health transformation in the country. While the resultant economic growth, spurred by the establishment of special economic zones and infrastructure development in cities and urban areas, benefitted the country in terms of elevating millions out of poverty, it also widened income and health inequalities and augmented environmental degradation driven by unprecedented industrialisation and urbanisation. This thesis investigates the regional inequalities and trends in mortality and exposure to ambient air pollution in China and quantifies their potential association within a broader context of regional economic and social development. Mortality is widely acknowledged as a robust indicator of socioeconomic development. The UN Sustainable Development Goal SDG-3.9 specifically calls for urgent efforts to reduce the number of deaths and diseases attributed to environmental hazards including ambient air, water and soil pollution. This is particularly relevant in China where the growth of mega and large cities has been unprecedented over the last two decades with substantial population movements and infrastructural development. On the other hand, with a growing number of pollution prone industries and the steady increase in the use of motor vehicles, cities and urban areas in China have become increasingly exposed to air pollution and congestion. The extent of the impact of these external environmental factors on human health and survival in China has not been systematically analysed or quantified.
This thesis presents findings from three interrelated analyses of different sources of aggregate data, investigating how mortality in China has been influenced by changes in environmental conditions. First, we explain the trends and factors underlying regional differences in the relationship between mortality and economic growth in China. Second, we investigate the extent of environmental inequalities by analysing the differential effect of selected economic and industrial factors on air pollution levels in cities. Third, we analyse the effect of long-term ambient air pollution exposure, measured in terms of PM2.5, on mortality at the regional and provincial levels. The level of
relationship between economic growth and mortality is found to be to be unexpected and, in some cases, indirect.
Results indicate that mortality trends have been on decline and the macro factors that are the most significant in explaining the improvement in mortality are adult illiteracy, rural-urban economic inequality and health care provision. On the other hand, economic growth has a diminishing effect on mortality outcomes across different geographical regions in China, but it has contributed indirectly to reducing inequalities in mortality through better health care for children and adults. While examining the environmental inequalities and the underlying effect of economic and industrial factors on ambient air pollution in cities, we observed substantial regional disparities. Although regional environmental inequalities were stark, economic conditions and economic inequalities between cities and regions had no perceptible effect on ambient air pollution. Industrial activities turned out to be more relevant in explaining regional differences in air pollution. According to China National Ambient Air Quality Standards (CNAAQS), 78.6 % of cities exceeded annual PM2.5 standards in 2015. Our estimations show as high as 2.8 million deaths associated with long-term exposure to PM2.5 in the same year. The results indicate that highly polluted central provinces suffer the most in terms of air pollution exposure attributed to mortality.
The thesis concludes by highlighting the urgent need to address environmental inequalities underlying region-specific mortality differences in China, with a reflection on recent policy and legislation measures to tackle ambient air pollution in cities and urban areas. Despite the rigorous policy making, China seems to continue its struggle in reducing environmental and health inequalities. The findings call for improvement in mechanisms to monitoring implementation of health and environment policies. Inequalities are both a cause and outcome of environmental problems, and local governments should be encouraged to prioritise addressing environmental equalities over GDP growth.
Keywords: Mortality; Life expectancy; Ambient air pollution; Regional inequality; Environmental inequality; Sustainable Development; China

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ORCID for Jane Falkingham: orcid.org/0000-0002-7135-5875

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