Assessment Of The Public Health Co-benefits In Relation To Greenhouse Gas Emission Reductions In China

Objectives 1)To review and synthesize comprehensively the current evidence of the public health co-benefits of GHG emissions reduction to improve our understanding of the health co-benefits,the economic sectors involved in GHG mitigation,potential mechanisms,and relevant uncertainties,as well as to identify knowledge gaps and provide recommendations to promote further development and implementation of climate change response policies at both national and global levels.2)To investigate the knowledge of,attitudes toward,and perceptions of urban residents,decision makers and other carbon emissions-related stakeholders on the GHG mitigation and the accompanying health co-benefits,as well as the potential influencing factors in three Chinese cities and national ministries in China,to provide information reference and evidence support for further low-carbon transition in China.3)In order to demonstrate indirectly the potential health co-benefits of low-carbon transition in China,the associations of GHG emissions with air pollution and socio-economic development were explored by using surveillance existing data.4)To summarize the existing GHG mitigation measures or plans in China and the experience of low-carbon transition in the UK,to clarify the significant contributions of China to global GHG mitigation actions and the potential shortcomings of existing measures.The potential role and value of the health co-benefits associated with GHG reductions in low-carbon transition of China was also discussed.The findings can further promote the development and implementation of GHG mitigation policies in China.Methods 1)A comprehensive literature search and screening of information on the topic of health co-benefits in relation to GHG mitigation were conducted using PubMed,Embase,Web of Science and ScienceDirect(Elsevier)databases.The search focused only on studies published in English through March 2015.Reference lists from these articles were reviewed and manual searches were performed to supplement relevant studies.The identified records were screened based on inclusion criteria.We extracted data from the final retrieved papers using a pre-designed data extraction form and a quality assessment was conducted.Various heterogeneities across studies precluded meta-analysis and instead,evidence was synthesized using narrative summaries.2)For the field questionnaire survey,Beijing,Ningbo and Guangzhou were selected for this survey.Participants were recruited from randomly chosen committees,following quotas for gender and age in proportion to the respective population shares.Chi-square or Fisher’s exact tests were employed to examine the associations of individuals’behaviors of low carbon and perceptions of the health co-benefits related to GHG mitigation with the socio-demographic and other independent variables.Unconditional logistic regression analysis was performed to investigate the influencing factors of respondents’ low carbon activities and awareness status about the health co-benefits of GHG reductions.For the focus group discussion,a total of 37 government officials and experts were invited from Beijing,Ningbo,Guangzhou and the national ministries to conduct the focus groups on the topic of GHG reductions and the related health co-benefits.Before the focus groups began,the moderator stated the anonymity and confidentiality of the contents.Recorder was used to record the contents of the focus groups,and the recordings then were replayed and transcribed into electronic version manuscript.The Combination of Deductive and Inductive Thematic Framework Analysis was employed to encode,classify and identify the key content of the focus groups,and this process was completed through the qualitative data analysis software Nvivo 11.3)Data of China’s GHG emissions(CO2),air pollutants and relevant socio-economic indicators were collected from the websites of different organizations.Time series analysis or correlation analysis were conducted to indirectly reveal that GHG mitigaton may bring about potential public health co-benefits by reducing air pollution and improving air quality.All statistical analyses were performed using Microsoft Excel 2016,IBM SPSS 23 and Stata 12.4)Through the official websites of relevant Chinese government departments involving GHG reductions and PubMed database,related information of policy documents or literature reports on the topic of GHG mitigation and the related health co-benefits were searched,collected,and filtered.The experts from our project research group were also consulted about the same topic.Similar methods were employed to access to relevant information about the UK’s experience of low-carbon transition.Finally,based on the information collected,the narrative summaries and synthesiso f interested evidence were provided.Results 1)Twenty-nine studies from developed and developing countries were identified.Evidence on GHG emissions,abatement measures,and related health co-benefits has been observed at regional,national,and global levels,involving both low-and high-income societies.Despite various uncertainties,GHG mitigation strategies in five domains-energy generation,transportation,food and agriculture,households,and industry and economy-are usually,although not always,estimated to co-benefit public health.Additional health gains are likely to be multiplied by comprehensive measures integrating several economic sectors.2)A total of 1159 participants were included in the final analysis.85.85%reported that they have chosen some kind of low carbon lifestyles during their daily life or work.Those who were older,more educated,married,and with registered urban residence,were more likely to follow low carbon lifestyle in their daily life or work.Age,with registered urban residence,attitudes toward air pollution,suffering from respiratory diseases,and be aware of the health co-benefits associated with GHG reductions are significant predictors of respondents’low carbon activity.15.9%reported that they were familiar with the health co-benefits of GHG emission reductions.Those who were younger,more educated,with higher family income,and with registered urban residence,were more likely to be aware of health co-benefits.Age,attitudes toward air pollution and governmental efforts to improve air quality,suffering from respiratory diseases,and following low carbon lifestyles are significant predictors of respondents’ perceptions on the health co-benefits.Six themes including perceptions of the health co-benefits associated with GHG reductions,fields of GHG abatement and mechanisms of the co-benefits,the role of experts,multi-sectoral cooperation,difficulties of low carbon transition,and influencing factors of low-carbon lifestyles were identified.Experts’ awareness levels of the health co-benefits were generally not high,while transport system,residential and household,energy and industry were the fields of GHG mitigation most talked.3)Over the past decade,China’s CO2 emissions showed a sharp upward trend,but there was a turning point for CO2 emission in 2014.In China,there were positive correlations between CO2 emissions and relevant socio-economic indicators such as urban population,passenger volume,energy consumption,electric power consumption,GDP,and household consumption expenditure.The positive correlations between CO2 and various air pollutants(e.g.PM2.5,PM10,SO2,CO,N2O and BC)were even stronger.4)China’s GHG mitigation measures or action plans include improving energy efficiency,decreasing CO2 intensity,reducing the consumption of fossil fuel,increasing the proportion of clean renewable energy,industrial restructuring and upgrading,clean development mechanism projects,domestic cap and trade scheme,and development of low-carbon economy,which were mainly related to energy,industry and economy,and residential construction.During the low-carbon transition,UK has implemented GHG abatement initiatives involving various social or economic sectors(e.g.energy,transportation,agriculture,household,and industry),and is not limited only to energy efficiency improvement,the use of renewable energy,and carbon trade market.Conclusions 1)GHG mitigation strategies can bring about substantial and possibly cost-effective public health co-benefits.Findings from this study can play a role not only in motivating large GHG emitters to make decisive changes in GHG emissions,but also in facilitating cooperation at international,national,and regional levels to promote GHG mitigation policies that protect public health from climate change and air pollution simultaneously,as we have entered an era of increasing concerns over these public health challenges.2)Respondents’ low carbon activity during daily life or work are influenced by the factors including age,with registered urban residence,attitudes toward air pollution,self-reported being suffered from local air pollution,and be aware of the health co-benefits associated with GHG reductions.Whereas age,attitudes toward air pollution and governmental efforts to improve air quality,suffering from respiratory diseases,and following low carbon lifestyles are significant predictors of respondents’ awareness levels on the health co-benefits associated with GHG reductions.These findings may not only provide helpful information to policy-makers to develop and implement public welcome policies of GHG mitigation in China,but also help to bridge the gap between GHG mitigation measures and public engagement as well as willingness to change health-related behaviors.The focus group discussion,by inviting policy makers and other stakeholders,to conduct focus group discussions about the knowledge of,attitudes toward,and perceptions of GHG mitigation and the related health co-benefits.The findings may provide useful information reference and evidence support for further low carbon transition in China,and the development and implementation of further GHG mitigation policies,should take these information into account.3)With the improvement of energy efficiency and decrease in CO2 intensity,the positive correlation between socio-economic development and growth in carbon emissions in China showing a partial decoupling.The positive correlations between CO2 and various air pollutants indicate that the source and evolution of GHG and air pollutants may largely the same or similar.This findings imply indirectly that addition to reduce GHG emissions,GHG mitigation measures in China may also bring about ancillary health benefits through reduce air pollutant emissions and improve air quality,that is,the public health co-benefits of GHG reductions.4)China’s current GHG mitigation measures are mostly limited to the fields of energy,industry and economy,and residential construction,while agriculture,transportation and medical care system have not been focused on.In light of the experience of low-carbon transition from the UK,public health professionals,GHG reductions-related health education campaigns and public advocacy,health risk assessment of climate change,and assessment of the health co-benefits in relation to GHG reductions can play a more active role in low-carbon transition in China.