Beyond the halving commitment: China can do more to achieve clean air for global health

Clean air is fundamental to safeguarding public health, a consensus robustly supported by scientific evidence. During the World Health Organization’s (WHO) 2nd Global Conference on Air Pollution and Health, a target was proposed to accelerate actions toward air pollution control. The WHO is calling on all countries to commit to reducing the health impacts of air pollution by 50% by 2040 relative to 2015 levels—a target now termed the “halving commitment.”

While several indicators can assess the health impacts of air pollution, attributable death remains the most commonly used metric. According to Global Burden of Disease (GBD) assessments,2 China shows promising progress, leading in reducing the disease burden from fine particulate matter (PM2.5), the primary air pollutant causing premature deaths (Figures 1A–1C). China recorded the highest PM2.5-associated deaths (1.86 million), followed by India, Indonesia, Egypt, and Pakistan. However, between 2015 and 2021, China achieved a 19% reduction in disease burden, outperforming the other four countries.

Globally, high- and high-middle-SDI (sociodemographic index) countries have come the closest to reaching the halving target (19% reduction). This progress is partly explained by the sublinear exposure-response association, a phenomenon where improvements in air quality at lower pollution levels yield greater health benefits per unit of reduction.

Developing countries, particularly those with middle- and low-middle SDI scores—where 59% of PM2.5-associated deaths occur—continue to face environmental challenges while balancing economic growth. These nations may benefit from adapting China's proven air quality management strategies to overcome barriers to meeting the halving commitment.

China’s progress stems from its establishment of the first national PM2.5 standard in 2012 and a series of multi-phase clean air policies, including the "Air Pollution Prevention and Control Action Plan (2013–2017), the Three-Year Action Plan for Winning the Blue Sky Defense Battle (2018–2020), and the Continuous Improvement of Air Quality Action Plan (2021–2025). Prior assessments show that PM2.5 concentrations dropped by 21.8 μg/m3 in the first phase and 11.3 μg/m3 in the second and are projected to decrease by 4.8 μg/m3 in the current phase.

Extended assessments through 2024 and projections to 2040 reveal potential pathways toward achieving the halving commitment (Figure 1D). Estimated PM2.5-associated deaths subsequently decreased from 2.17 million (95% confidence interval [CI]: 2.03 to 2.32) in 2015 by 7.1% (1.6 to 12.9) in 2017, by 17.6% (10.9 to 23.5) in 2020, and by 4.3% (−1.1 to 10.8) in 2024. Climate policy is expected to play a critical role in long-term outcomes: under the low-emission scenario (SSP-126), China could potentially exceed the halving commitment with a 57.7% reduction by 2040. However, the wide uncertainty range (48.2%–68.0%) means that this target is not guaranteed. Under medium- and high-emission scenarios (SSP-245 and SSP-585), reductions fall to 35.0% and 21.6%, respectively. In addition to adhering to its 2025, 2030, and 2060 environmental and climate goals, China also pledged at the WHO conference to improve national air quality standards, strengthen health protection systems, and enhance international cooperation.