Divining the Future of Air Pollution in China: Huge Gains in Health Can Be Achieved, but Much Work Remains

Article, see p 1575 Over the past 20 years, China has emerged as the world’s largest economy, becoming the leading manufacturer of consumable goods in the world. Although this economic development has coincided with substantial improvements in human health, China now faces a staggering burden of disease attributable to air pollution. The recent Global Burden of Disease (GBD) 2016 reports that ambient particulate matter air pollution is the third leading mortality risk factor in China,1 with 1.1 million attributable deaths, 56% of which are caused by cardiovascular diseases (CVDs).1 Average annual concentrations of particulate matter 99% of the population lives in locations where the World Health Organization (WHO) air quality guideline of 10 µg/m3 annual average is exceeded.2 Although population exposure since about 2010 appears to have stabilized, mean population-weighted concentrations in 2015 were 18% above those in 1990.2 Combined with population growth, population movement from rural areas to more polluted cities, aging, and consequent increasing prevalence of ischemic heart disease, stroke, lung cancer, and chronic obstructive pulmonary disease, deaths attributable to PM2.5 in outdoor air have similarly increased. These demographic trends, combined with continued high exposures, present ongoing challenges for China to reduce the population health impacts from outdoor air pollution. In this issue of Circulation , Huang et al3 estimate the potential cardiovascular health benefits that could be gained through reductions in air pollution in 190 cities in urban China. Huang et al report that reductions in the urban population-weighted mean annual PM2.5 from current levels (61 µg/m3) to the levels during the Beijing Olympic games (55 µg/m3 …