Clearing the Air: The Health and Economic Damages of Air Pollution in China (review)

China's economic expansion over the past quarter of a century has been one of the strongest in world history. Such an economic expansion, however, is driven by fossil fuels, which increase its emissions of both local air pollutants and greenhouse gases dramatically. Since 2006, China has overtaken the United States as the largest emitter of carbon dioxide emissions. Although China has achieved great progress in the control of air pollution, it is still among the countries with the worst air pollution level in the world. There has been a large body of studies documenting an ever widening range of adverse health effects of air pollution in China.¹ The increased cardiopulmonary risks found in China are similar in magnitude, per amount of pollution, to the risks found in other parts of the world. But the importance of these increased risks for illness, hospital admission, and mortality are much greater than in Europe and North America because air pollution levels in China are so much higher. This spring, a World Bank study concluded that outdoor air pollution was already causing 350,000 to 400,000 premature deaths per year in China.² Other international organizations with access to Chinese data have published similar results. Energy, air pollution, and health are now becoming one of the biggest challenges for sustainable development in China during high economic growth.

Clearing the Air: The Health and Economic Damages of Air Pollution in China presents results of U.S. and Chinese scientists on these issues, undertaken as Harvard University's China project. In a path-breaking and interdisciplinary U.S.-China collaboration, Clearing the Air quantitatively assessed the health and economic damage nationwide caused by China's degraded air quality. The approaches the authors used were in line with those employed elsewhere and widely used in environmental impact assessment. The results illustrated that an effective energy and environmental policy would play an active role in the reduction of air pollutant emission, improvement of air quality, and, hence, the promotion of public health. In fact, I believe this is the most comprehensive report on economic costs and human health impacts of air pollution ever undertaken in China.

Moreover, the authors should be applauded that their damage estimates were allocated by sector, thereby making it possible for the first time in China to judge whether, for example, power generation or transportation causes the greatest harm to air quality. Such innovative analyses can help China reset policy priorities.

The results of this book, combined with past such studies, also have potentially critical relevance to the challenge that faces all nations in the world. The man-made contribution to the climate change pollutants is largely caused by the same activity that causes air pollution. So if China acts to reduce the combustion of fossil fuels and the resultant air pollution, it will reap not only the climate change benefits but also the health benefits associated with improvement of air quality. Therefore, these air pollution–related health benefits might be a strong inducement for Chinese government to act to reduce climate change pollution. Meanwhile, following the well-known principle of "thinking globally and acting locally," Western countries also have a responsibility to help China build environmental protection into its growth.

From the perspective of an air pollution health person, there are several technical issues in this book deserving attention and further discussion.

Analyzing the total burden of ambient air pollution on public health in a big country like China is always challenging, given the gaps in scientific knowledge about the health effects of air pollution and the wide range of uncertainties characterizing many parts of this process. The authors innovatively used the concept of intake fraction (iF) to examine the influence of emission source location on population exposure to air pollutants in China. Intake fraction provides a simple summary measure of...