Why China’s Environmental Policies Are Inadequate for Improving the Nation’s Health

By Corrine Liu, BA Medicine, Health, and Society & German, Expected 2019

Nearly three years ago, Chai Jing, the former CCTV (China’s state television) investigative reporter, made her last public appearance in her documentary, Under the Dome. In the film, she demonstrates the severity of China’s air pollution issues, shows how they have formed, and assigns blame to state-owned petrochemical enterprises as well as openly criticizes the Ministry of Environmental Protection for failing to act against big polluters.

Unprecedented in its scope and range, the film caused an uproar on the Chinese internet; it was soon withdrawn from China’s mainstream websites by the government, with Chai blacklisted from TV work. Nevertheless, her efforts to inform millions of people as to the extent of the country’s environmental crisis have paid off. By revealing her experience of having her unborn daughter operated on to remove a tumor, which possibly resulted from the toxic dust that she inhaled, Chai shed light on pollution’s severe implications on health (Ren et al., 2011). Corroborating studies have shown that exposure to outdoor pollution is carcinogenic to humans and that levels of particulate matter (PM) in outdoor air are associated with lung cancer mortality (Hamra et al., 2014). Among children, long-term exposure to air pollution may increase arterial blood pressure (BP), although breastfeeding may reduce the negative impact of air pollution on BP (Dong et al., 2014). Compared to normal-weight children, overweight and obese children are more susceptible to the inflammatory effects of ambient air pollutant, leading to a higher prevalence of respiratory symptoms and asthma (Dong et al., 2013). In light of Chai’s heartrending story, there is evidence suggesting an association between ambient air pollution and adverse pregnancy outcomes. In particular, exposure to pollutants during vulnerable pregnancy periods is linked to preterm birth, low birth weight, and intrauterine growth retardation. Preterm births and low birth weight remain the most important predictors of neonatal mortality (death in the first 28 days) and infant mortality (death in the first year) in both developed and developing countries, illustrating the disconcerting fact that the effects of the pollution trickle through two generations (Behrman and Butler 2007; Blencowe et al. 2012; Institute of Medicine 2009; National Institutes of Health 2013; World Health Organization 2004).

The film came out not long after the country first started measuring nationwide levels of PM 2.5, which is a particulate air pollutant that becomes a concern for people’s health when levels are elevated, and instigated draconian anti-pollution policies demanded by the infuriated public (Cui, 2016). Collectively called the Air Pollution Prevention and Control Action Plan, the policies state that their “ultimate goal is to achieve environmental, economic and social benefits,” by enacting a strictly monitored, top-down implementation model, placing outright bans on polluting activities and disciplining local governmental officials for subpar emission management. Specifically, if targets of urban PM concentration – a 10% decrease compared with 2012 – would have been met in 2017, the Action Plan was expected to prevent 89,000 premature deaths, 120,000 hospital admissions, and 9.41 million hospital outpatients and emergency room visits. The total health benefit would be approximately 86.7 billion RMB per year (Lei et al., 2015).

Yet the command-and-control measures have failed to address Chai’s, as well as most Chinese’s, concern about the pollution’s actual health impact (Huang, 2018). Despite promising health benefits and encouraging public oversight on air quality control, official reports claiming victory on the all-out war on smog show little regard for the policy’s actual impact on health. A second look at the policies easily reveals why: health benefits are translated into monetary terms that are used to complement the overall economic goals. Environmental policies are guided by the National Development and Reform Commission – China’s economic planning body. As the country’s newly awakened environmental awareness jostles with its traditional energy sectors, political force is used to maintain the dichotomy between development and environment. The goals that are set accordingly are simply inadequate to meet public health demand: Beijing authorities pride themselves on bringing the city’s PM2.5 level below 60 micrograms per cubic meter, yet the World Health Organization recommends a maximum annual mean of 10 micrograms per cubic meter.

With a health-concerned, rather than a health-centered environmental model, many aspects of the environment-health interaction are not addressed due to the haste to fulfill and even overshoot the campaign’s targets. In an effort to avoid being named and shamed by their inspecting superiors, paying fines, or losing their jobs, overzealous local officials made sure to see a reduction in PM 2.5 in major economic zones – namely, Beijing-Tianjin-Hebei, the region surrounding the country’s capital. Yet the government’s pursuit of both clean sky and wealth has shifted the pollution elsewhere. National levels of PM 2.5 were only 4.5% lower in 2017 than in 2016 compared to the reported 54% reduction in Beijing, which implies that pollution rose in southern China.

By giving instructions to stay indoors and wear N95 respirator masks during heavy-smog days, the policies shift the burden of maintaining one’s health from local government to individuals. Additionally, staying in concrete apartment buildings, as most people do to steer clear of bad air, is also associated with risks of respiratory health hazards (Dong et al., 2013). As the country undergoes rapid urbanization and enjoys an improved living standard, an increase in construction work, housing renovation, and intensive usage of various new home decorating materials poses new health threats; associations between indoor pollution and asthma are especially notable among children (Dong et al., 2013). While public interest argument for improving indoor air has been gathering strength, the relationship between household factors and health is often overlooked when regulatory policies are devised (Roxburgh, 2013).

It is not hard to imagine why China, as one of the fastest-growing countries in the world, bases its environmental policies on economic realities. When it comes to sustainability, however, a health-centered approach is needed to fundamentally change the way China interacts with the environment, because ensuring the health of millions of individuals today will pay economic dividends long into the future (International Monetary Fund, 2004).


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