Real progress in improving China's health and environment will take integrated policies that address regional differences and inequalities, say Jennifer Holdaway and Wang Wuyi
Over the last year or so, people living in China have been bombarded almost daily by media reports about the health impacts of environmental pollution, including air, soil and water pollution, as well as an alarming array of food-safety problems.
This groundswell of public attention marks a turning point for environmental protection in China. But where do we go from here? What difference does the new focus on health make? And what will it take to deal with these problems over the long term?
Environmental health is a notoriously challenging policy area in any country because pollution-related health impacts have complex causality and require a multi-faceted governance response. They also often provoke conflicts of interest and contestation over responsibility not just between communities and polluting industries but also between whole jurisdictions and regions.
In China, the first set of problems is compounded by a lack of good data and public information, and by inadequate monitoring and enforcement capacity. The second set of problems is exacerbated by uneven development and by the way in which responsibilities and fiscal resources are distributed across central and local government.
The challenge now is to design effective policies to reduce the health impacts of environmental degradation. But different pollutants have different effects on health over different time frames and geographies. Although overall reductions in emissions will have benefits across the board in the long run, reducing specific health risks in the shorter term requires targeted policy and careful allocation of resources.
For example, risks to health from food vary widely from product to product and present very different kinds and levels of threat to human health from sources including heavy metal contamination, pesticides and veterinary drugs. The same is true of different types of air and water pollution, which have different composition, sources and impacts, from short term acute exposure to long term cumulative effects through climate change and the degradation of ecosystems.
A health-based approach
To get an accurate understanding of different kind of problems and their distribution over places and populations, China’s environmental protection and health systems will need to make significant change to their priorities and resource allocations. Currently, environmental monitoring still focuses on one medium (water, soil or air) at a time and because many monitoring points are not related to population concentrations they cannot capture exposure levels. Although emissions standards are getting progressively stricter, standards and enforcement are also still focused primarily on achieving aggregated reductions rather than on controlling pollutants most damaging to health.
Similarly, China’s health sector is ill-equipped to monitor and address the health effects of pollution. The focus of health policy has been shifting from problems associated with poverty towards non-communicable diseases associated with growing affluence. Many of these diseases (cancer, respiratory and cardiovascular diseases) are also affected by environmental factors, but as in other countries, China’s health system concentrates mostly on lifestyle factors such as smoking, diet and exercise. Local health authorities currently have no mandate and no funding to monitor exposure to pollution.
China’s size, uneven economic development and regional diversity make establishing better monitoring more difficult because different localities face very different bundles of problems that are related to their specific environmental conditions and development pathways. Because of this, and also because it will be impossible to scale up monitoring and enforcement uniformly and quickly, many experts are calling for a more locally tailored and targeted approach to both environmental protection and health monitoring and service provision.
Longer term solutions focused on prevention will require the engagement of other agencies beyond environment and health; particularly those responsible for land use and development planning. The best way to estimate the prevalence of environmental health risks – and to anticipate them - is to look at clusters of industry and livelihood strategies. Experience also shows that unless enforcement efforts have traction with the local political economy, they are not effective over the long run.
Corruption and local protectionism are often cited as the main barriers to enforcement but they are not the only issue: people need jobs and income, and local government needs revenue to provide public services. If policies do not support them in moving onto more sustainable and healthy development pathways, local leaders and communities have little incentive to cooperate with environmental protection policy. The inability of Beijing to consistently enforce emissions standards in Hebei is an example of this problem; the province is economically dependent on polluting industries.
Integrating considerations of environmental and health impacts into development policy and regional and local planning is particularly important now, as China enters a new period in which rapid urbanisation is accompanied by industrial restructuring and the transfer of industry. In many ways, processes of regional development within China mirror relations between developed and developing countries at the global level. Although the share of industry in China’s GDP is falling overall, public concern about pollution in rich coastal areas, the search for lower land and labour costs, and policies to promote more balanced regional development are all encouraging the movement of industry into the hinterland and west. These trends will produce new patterns of pollution-related health problems.
The central government cannot ask that poor areas forgo the benefits of economic growth already enjoyed by residents of coastal regions. In principle, China is committed to a leapfrog development strategy, but the challenges involved in doing this should not be underestimated. Although some areas may be able to “leap” from subsistence agriculture into clean industries, organic agriculture, tourism or other service industries, there are many places for which these options will be difficult or impossible. Industrialisation is already proceeding apace in China’s western provinces and a combination of strong enforcement and positive green development policies will be needed to keep pollution and negative health effects in check.
Meanwhile, the latent health effects of cumulative previous exposure will continue to manifest themselves in earlier industrialising areas for years to come, creating challenges for healthcare provision and social stability. In many cases, the polluting industries will have moved or closed, and the challenge will be determining responsibility for the costs of healthcare and lost earning capacity, as well as cleaning up soil and water pollution. Establishing causality and attributing responsibility will be impossible in many cases, and the costs of remediation will probably fall on the government.
The costs of failure
If the outlook seems grim, China’s biggest problem is in another sense a powerful motivator. If pollution is not controlled, its health effects will fall upon Chinese people and the government or private citizens will have to bear the financial burden. Both humanitarian and financial concerns therefore provide strong incentives to address head-on problems which the early industrialising nations had the luxury of displacing or deferring. For the Chinese government, these motivations are further bolstered by concerns about social stability and legitimacy.
But if this head of steam is to translate into effective policy, the government needs to resist a campaign-style approach to these problems and develop targeted policies based on careful assessment of the problems facing different regions and populations; and the way in which these will be affected by industrial restructuring and urbanisation.
It must do this under the scrutiny of public opinion, which brings its own dangers. The public has a tendency to focus on easily detected risks over others that may be more serious over the long term; and privileged social groups usually have the strongest voice. Beijing’s air pollution is indeed bad, but it receives a disproportionate amount of attention because it is a highly visible problem that affects the most privileged city in China. In the universe of food safety, problems that have a high “yuk factor,” like “gutter oil”, or that involve corrupt or criminal behavior attract more media and public attention than others that are a bigger threat to public health, such as the emergence of antibiotic resistant bacteria due to overuse of veterinary drugs.
Of course, this is not to say that the public should be passive and leave these issues to government officials and experts. But the danger is that in the absence of good public information about the actual severity and prevalence of different risks, media reports fuel a kind of free floating public anxiety, and contribute to the danger that policy will respond to problems that have the most vocal constituencies.