Improved air quality from China's clean air actions alleviates health expenditure inequality.

Clean air actions aimed at improving air quality in China have brought about significant health benefits, thereby generating substantial savings in air-pollution-related healthcare spending. Yet, uneven regional air quality improvements and economic developments may alter existing inequality in health expenditures in the context of scarce healthcare resources. Here, we developed an econometric model that resolves individual characteristics at the city level to examine the disparity of public health expenditures in air quality improvements across regions differing in economic development and healthcare coverages and projected a range of future health expenditure savings under different air quality targets. We find that of the estimation on four air-pollution-related diseases (COPD, LRI, IHD, and stroke) in 98 cities over the year 2015-2017, a decline of 8.26 % in average hospitalization days and 10.21 % in hospitalization expenses was achieved, leading to a reduction of 8.09 % in total health expenditures as the implementation of clean air actions. Improved air quality has declined health expenditure inequality in low-middle cities and cities with imbalanced healthcare coverage. For example, the total expenses for the four diseases declined significantly in the low (-11.31 %) and medium (-7.34 %) per capita GDP groups, as well as a remarkable decline in the fewer medical resources. Health savings in some future scenarios are significant, showing substantial health expenditure savings under different air quality targets, but the savings will be greatly offset by an aging society. For example, In the Low-Level Improvement Pathway of air quality targets with aging (LLIPA scenario), health expenditure savings will be about 3537, 464, and 311 million CNY in the eastern, central, and western regions in 2035, respectively. Our findings thus highlight the importance of strengthening air pollution control policies and considering the equality of alleviating regional public health costs.

[1]  Yufeng Wu,et al.  Air quality improvement effect and future contributions of carbon trading pilot programs in China , 2022, Energy Policy.

[2]  Zhixiong Weng,et al.  Effect of China's carbon market on the promotion of green technological innovation , 2022, Journal of Cleaner Production.

[3]  Dan J Stein,et al.  Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019 , 2022, The Lancet.

[4]  Mengcheng Li,et al.  Assessing the evolution of PM2.5 and related health impacts resulting from air quality policies in China , 2022, Environmental Impact Assessment Review.

[5]  L. Clarke,et al.  Role of climate goals and clean-air policies on reducing future air pollution deaths in China: a modelling study. , 2022, The Lancet. Planetary health.

[6]  Jinnan Wang,et al.  Fund gap to high air quality in China: A cost evaluation for PM2.5 abatement based on the Air Pollution Prevention and control Action Plan , 2021 .

[7]  A. Baccarelli,et al.  Short-Term Ambient Particulate Air Pollution and Hospitalization Expenditures of Cause-Specific Cardiorespiratory Diseases in China: A Multicity Analysis , 2021, The Lancet regional health. Western Pacific.

[8]  Zhongfei Chen,et al.  Air pollution, health care use and medical costs: Evidence from China , 2021 .

[9]  Stephen S. Lim,et al.  Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019 , 2020, The Lancet. Planetary health.

[10]  Tijian Wang,et al.  Changes of air quality and its associated health and economic burden in 31 provincial capital cities in China during COVID-19 pandemic , 2020, Atmospheric Research.

[11]  Zhongfei Chen,et al.  Cost of economic growth: Air pollution and health expenditure. , 2020, The Science of the total environment.

[12]  C. Nielsen,et al.  Health benefits of on-road transportation pollution control programs in China , 2020, Proceedings of the National Academy of Sciences.

[13]  F. Bull,et al.  Air pollution, physical activity and health: A mapping review of the evidence , 2020, Environment international.

[14]  Jiming Hao,et al.  Drivers of improved PM2.5 air quality in China from 2013 to 2017 , 2019, Proceedings of the National Academy of Sciences.

[15]  D. Jacob,et al.  A two-pollutant strategy for improving ozone and particulate air quality in China , 2019, Nature Geoscience.

[16]  T. Masui,et al.  Comparison of health and economic impacts of PM2.5 and ozone pollution in China. , 2019, Environment international.

[17]  A. Hansell,et al.  Associations between daily air quality and hospitalisations for acute exacerbation of chronic obstructive pulmonary disease in Beijing, 2013–17: an ecological analysis , 2019, The Lancet. Planetary health.

[18]  A. Soucat,et al.  Public spending on health: a closer look at global trends , 2019 .

[19]  Wenling Liu,et al.  Does air pollution affect public health and health inequality? Empirical evidence from China , 2018, Journal of Cleaner Production.

[20]  M. Arora,et al.  PM2.5-related health and economic loss assessment for 338 Chinese cities. , 2018, Environment international.

[21]  Bing-Chang Zhang,et al.  Air pollution and healthcare expenditure: Implication for the benefit of air pollution control in China. , 2018, Environment international.

[22]  P. Perel,et al.  The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review , 2018, BMC Public Health.

[23]  Xinbiao Guo,et al.  Health impact of China's Air Pollution Prevention and Control Action Plan: an analysis of national air quality monitoring and mortality data. , 2018, The Lancet. Planetary health.

[24]  Sayem Ahmed,et al.  Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda , 2018, The Lancet.

[25]  Haniye Sadat Sajadi,et al.  Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40 , 2018, The Lancet.

[26]  Xi Chen,et al.  The impact of exposure to air pollution on cognitive performance , 2018, Proceedings of the National Academy of Sciences.

[27]  K. He,et al.  Air quality improvements and health benefits from China’s clean air action since 2013 , 2017 .

[28]  J. Bi,et al.  Trade-driven relocation of air pollution and health impacts in China , 2017, Nature Communications.

[29]  M. Greenstone,et al.  New evidence on the impact of sustained exposure to air pollution on life expectancy from China’s Huai River Policy , 2017, Proceedings of the National Academy of Sciences.

[30]  Eyal Oren,et al.  Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015 , 2017, The Lancet.

[31]  S. Médina,et al.  The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project , 2016, The European Journal of Health Economics.

[32]  A. Gouldson,et al.  To what extent can China’s near-term air pollution control policy protect air quality and human health? A case study of the Pearl River Delta region , 2015 .

[33]  Michael Jerrett,et al.  Atmospheric science: The death toll from air-pollution sources , 2015, Nature.

[34]  M. Greenstone,et al.  Evidence on the impact of sustained exposure to air pollution on life expectancy from China’s Huai River policy , 2013, Proceedings of the National Academy of Sciences.

[35]  Michael Greenstone,et al.  Massachusetts Institute of Technology Departnnent of Economics Working Paper Series Winter Heating or Clean Air? Unintended Impacts of China's Huai River Policy , 2022 .