The 2021 China report of the Lancet Countdown on health and climate change: seizing the window of opportunity

Abstract

China, with its growing population and economic development, faces increasing risks to health from climate change, but also opportunities to address these risks and protect health for generations to come. Without a timely and adequate response, climate change will impact lives and livelihoods at an accelerated rate. In 2020, the Lancet Countdown Regional Centre in Asia, led by Tsinghua University, built on the work of the global Lancet Countdown and began its assessment of the health profile of climate change in China with the aim of triggering rapid and health-responsive actions. This 2021 report is the first annual update, presenting 25 indicators within five domains: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. The report represents the contributions of 88 experts from 25 leading institutions in, and outside of, China. From 2020 to 2021, five new indicators have been added and methods have been improved for many indicators. Where possible, the indicator results are presented at national and provincial levels to facilitate local understanding and policy making. In a year marked by COVID-19, this report also endeavours to reflect on China's pathway for a green recovery, ensuring it aligns with the carbon neutrality goal, for the health of the current and future generations. The findings presented in this China report of the Lancet Countdown reaffirm those of the previous report—namely, that the climate-related health threats are worsening in China. In 2020, the heatwave exposures per person in China increased by 4·51 days compared with the 1986–2005 average, resulting in an estimated 92% increase in heatwave-related deaths. The resulting economic cost of the estimated 14 500 heatwave-related deaths in 2020 is US$176 million (indicators 1.1.1 and 4.1.1). Increased temperatures also caused a potential 31·5 billion h in lost work time in 2020, which is equivalent to 1·3% of the work hours of the total national workforce, with resulting economic losses estimated at 1·4% of China's annual gross domestic product (indicators 1.1.2 and 4.1.2). Although the population-weighted fire risk has decreased, actual population exposure to wildfires has increased in 20 provinces from 2001–05 to 2016–20 (indicator 1.2.1). Additionally, the vectorial capacity for the transmission of dengue by Aedes mosquitoes in China has increased by 25·4% in 2016–19 compared with 2004–07 (indicator 1.3). The frequency and intensity of flood events in China continue to increase and, although the emergency response capacity has reduced the number of people affected by floods, the extreme floods in 2020 and 2021 have the potential to reverse this progress (indicator 1.2.2). The sixth assessment report of the Intergovernmental Panel on Climate Change makes it clear that the health threats from climate change will increase in the coming decades, even if mitigation efforts limit global temperature rise to 1·5°C, which emphasises the necessity of health adaptation. Each region in China faces its specific health threats, depending on its local environmental and socioeconomic conditions. The most concerning trends are the rising heat-related mortality, labour loss, and dengue risk in Guangdong province; flood and drought risks in Sichuan province; and wildfire exposures in Liaoning and Jilin provinces. Developing tailored policies according to these threats is essential to improve the efficiency and effectiveness of climate adaptation responses. The COVID-19 pandemic and the announcement of China's carbon neutrality goal have increased the news coverage and awareness of public health and climate change in China (indicators 5.1.2 and 5.2). However, the growth in awareness has not been sufficient to catalyse actions in all aspects of adaptation and mitigation, and the indicators in these domains identify mixed progress. For adaptation efforts, there has been steady progress in local adaptation planning and assessment in 2020, urban green space growth in 2020, and health emergency management in 2019. 12 of 30 provinces reported that they have completed, or were developing, provincial health adaptation plans (indicator 2.1). Urban green space, which is an important heat adaptation measure, has increased in 18 of 31 provinces in the past decade, and the capacity of China's health emergency management increased in almost all provinces from 2018 to 2019 (indicators 2.2.3 and 2.2.1). However, additional actions are needed given the absence of a stand-alone national health adaptation plan, the absence of assessment and adaptation planning process in the majority of provinces, the sparse engagement of climate information services in public health policy making (indicator 2.3), and the absence of reference to climate change in the responsibilities of the newly established National Bureau of Disease Control and Prevention. Looking towards China's plan for peak emissions before 2030 and to achieve carbon neutrality before 2060, there were some positive signs, marked by the improving energy investments, the continuous rise in clean energy, and the steadily decreasing carbon intensity of the energy system (indicator 3.1). Despite the shock of COVID-19, low-carbon investments still increased from 2019 to 2020, which are now 9·5 times higher than those of coal, and fossil fuel subsidies in 2019 were 40% lower than in 2018, reversing the upward trend that was seen during the previous 3 years (indicators 4.2.1 and 4.2.3). As a result of China's persistent efforts to clean its energy structure and control air pollution, the premature deaths due to exposure to ambient particulate matter of 2·5 μm or less (PM2·5) and the resulting costs continue to decline. However, 98% of China's cities still have annual average PM2·5 concentrations that are more than the WHO guideline standard of 10 μg/m3 (indicator 3.3). China announced strict control on coal-fired power plants in April, 2021, which will greatly benefit both carbon mitigation and air pollution control. Despite the worldwide call for a green recovery, after a steep but temporary drop in the first quarter of 2020, the overall carbon emissions in China increased by 1·28% in 2020. During this important junction in time, the health policy makers in China are reflecting on COVID-19 and have established a new and more powerful National Bureau of Disease Control and Prevention to improve overall public health. At the same time, climate policy makers and macroeconomic planners are designing China's National Climate Change Adaptation Strategy 2035 and are exploring how to achieve short-term economic recovery while ensuring long-term carbon neutrality. However, the dialogues between these different groups of decision makers are limited by their scope and recognition of their intersecting agendas and impacts. The risk of decisions made in isolation is that China might not fully realise the health and economic benefits of addressing the pandemic alongside tackling climate change, which is likely to be a larger global public health threat than COVID-19 in the long run. Therefore, we propose four recommendations for the key stakeholders in health and climate change in China. The first proposal is to promote systematic thinking in the related departments and strengthen multidepartmental cooperation. Given the huge gap between current global climate commitment and the 1·5°C target, the potential health benefits of climate change mitigation, and the health threats from climate change (even with 1·5°C of warming), addressing health threats from climate change requires long-term and compound efforts in both mitigation and adaptation. Therefore, multiple departments should work together on this issue to comprehensively protect and improve the health of people in China. The health-care sector, especially the newly built National Bureau of Disease Control and Prevention, should recognise climate change as a major health threat in China and mount a commensurate response. Furthermore, sectors related to climate and development in China should incorporate health perspectives into their policy making and actions, demonstrating WHO's and President Xi Jinping's so-called health-in-all-policies principle. The second proposal is to do additional assessments of the health impacts of climate change and make national and region-specific adaptation plans. It is necessary to include clear goals and timelines for climate-related health impact assessments and health adaptation plans at both the national and the regional levels in the National Climate Change Adaptation Strategy 2035. A new domain in the annual Healthy China Work Priorities that focuses on reducing the climate-related health risks is also urgently needed. This domain should include specific priorities on improving early warning and response networks for climate-related health risks, on promoting systematic health risk and vulnerability assessments, and on increasing the preparedness of health-care agencies to climate-related health risks. The third proposal is to strengthen China's climate mitigation actions and ensure health is included in China's pathway to reach carbon neutrality. Considering the prominent health co-benefits related to air quality improvement from coal phase-out, a carbon neutrality pathway with over-reliance on coal combined with carbon capture and storage might lead to additional morbidity and mortality attributable to air pollution, despite the alleviated threats from climate change. Therefore, coal phase-out is imperative for China if it is to opt for a carbon neutrality pathway that maximises the health benefits for people in China. On the basis of the country's first coal phase-out commitment, it is important to send strong signals to the investors and producers and stop financing new coal activities. Specifically, by promoting investments in zero-carbon technologies and reducing fossil fuel subsidies, the current rebounding trend in carbon emissions will be reversed and lead to a healthy, low-carbon future. The fourth proposal is to increase awareness of the linkages between climate change and health at all levels. Health professionals, the academic community, and traditional and new media should raise the awareness of the public and policy makers on the important linkages between climate change and health. Local and national campaigns that link the response to climate change with health benefits for people today, and protect future generations, will be crucial for building confidence and support in mitigation and adaptation actions. The health impacts of climate change continue to worsen in every province in China and there is mixed progress in the adaptation and mitigation responses. With several key health and climate decisions being developed, the country has a unique opportunity to increase its leadership in committing to global climate mitigation actions that benefit and protect health. After the painful lessons from COVID-19, this important opportunity to protect the health of people in China, both now and in the future, cannot be missed. No country can avoid the health impacts of climate change.1Watts N Amann M Arnell N et al.The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises.Lancet. 2021; 397: 129-170Summary Full Text Full Text PDF PubMed Scopus (425) Google Scholar, 2Cai W Zhang C Suen HP et al.The 2020 China report of the Lancet Countdown on health and climate change.Lancet Public Health. 2021; 6: e64-e81Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar As the world's largest emitter of greenhouse gas and the home of a fifth of the world's population, China is facing the health threats posed by climate change. Every province in the country is affected by climate change and each province faces unique risks.2Cai W Zhang C Suen HP et al.The 2020 China report of the Lancet Countdown on health and climate change.Lancet Public Health. 2021; 6: e64-e81Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar Without a timely and adequate response, climate change will increasingly threaten lives and livelihoods,3Kjellstrom T Freyberg C Lemke B Otto M Briggs D Estimating population heat exposure and impacts on working people in conjunction with climate change.Int J Biometeorol. 2018; 62: 291-306Crossref PubMed Scopus (81) Google Scholar, 4Yang J Zhou M Ren Z et al.Projecting heat-related excess mortality under climate change scenarios in China.Nat Commun. 2021; 121039Google Scholar, 5Fan J-C Liu Q-Y Potential impacts of climate change on dengue fever distribution using RCP scenarios in China.Adv Clim Chang Res. 2019; 10: 1-8Crossref Scopus (16) Google Scholar jeopardising the realisation of the Healthy China goals and Beautiful China goals (a policy goal proposed by Chinese Government for sustainable development in China, with specific quantified goals for environmental issues, such as air quality).6The State Council of ChinaThe Central Committee of the CPC and the State Council print and issue the outline of the ‘Healthy China 2030’ plan.http://www.gov.cn/zhengce/2016-10/25/content_5124174.htmDate accessed: January 8, 2021Google Scholar, 7The State Council of ChinaFull text of resolution on CPC Central Committee report.http://english.www.gov.cn/news/top_news/2017/10/24/content_281475919786014.htmDate accessed: January 8, 2021Google Scholar With several national health and climate change decisions being developed, 2021 is a very important year for China. The National Bureau of Disease Control and Prevention, a vice-ministerial bureau directly administered by the National Health Commission, was set up in April, 2021,8China's State CouncilChina appoints officials for new agency on disease prevention control.http://english.www.gov.cn/news/topnews/202104/28/content_WS60894146c6d0df57f98d8c23.htmlDate: April 28, 2021Date accessed: May 20, 2021Google Scholar highlighting the country's determination to learn from the COVID-19 pandemic and strengthen early disease intervention. China is also debating how to align short-term economic recovery goals with long-term climate goals to peak emissions before 2030 and achieve carbon neutrality by 2060. The major tasks to be included in the National Climate Change Adaptation Strategy 2035 are also being discussed among scholars and government departments, with the strategy expected to be released at the end of 2021. Furthermore, China has agreed to unveil its carbon neutrality plan before the upcoming climate negotiations at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26), to be held in November, 2021, in Glasgow.9US Department of StateUS–China joint statement addressing the climate crisis.https://www.state.gov/u-s-china-joint-statement-addressing-the-climate-crisis/Date: April 17, 2021Date accessed: May 20, 2021Google Scholar Surrounded by all these important developments, it is crucial that the interlinkages of climate and health are incorporated throughout these policy-making processes. It is also essential to evaluate the adequacy of the health and climate responses in China and highlight policy recommendations to seize the opportunity to improve the health of the current and future generations. To meet these objectives, the Lancet Countdown Regional Centre in Asia, led by Tsinghua University, has produced the first annual update of the China Lancet Countdown report, aimed at tracking the health profile of climate change in China. This report represents the contributions of 88 experts from 25 leading institutions within and outside of China. The 25 indicators tracked in this year's report fall into five domains, mirroring those of the global Lancet Countdown report:1Watts N Amann M Arnell N et al.The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises.Lancet. 2021; 397: 129-170Summary Full Text Full Text PDF PubMed Scopus (425) Google Scholar climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement (panel 1). Many indicators have undergone methodological improvements and, where possible, the indicator results are presented at the national and provincial level to represent the interlinkages between climate and health in China and to facilitate local understanding and policy making. Five new indicators have been added since the 2020 report: flood and drought (indicator 1.2.2); urban greenness (indicator 2.2.3); climate information services for health (indicator 2.3); and newspaper and governmental engagement (indicators 5.1.2 and 5.4). Details of methods, data, caveats, and plans for future improvements of each indicator are provided in the appendix.Panel 1The 2021 China Lancet Countdown report indicatorsClimate change impacts, exposures, and vulnerability1.1.:health and heat1.1.1:heatwave-related mortality1.1.2:change in labour capacity1.2.:health and extreme weather events1.2.1:wildfires1.2.2:flood and drought1.3.:climate-sensitive infectious diseasesAdaptation, planning, and resilience for health2.1.:adaptation planning and assessment2.2.:adaptation delivery and implementation2.2.1:detection, preparedness, and response to health emergencies2.2.2:air conditioning—benefits and harms2.2.3:urban green space2.3.:climate information services for healthMitigation actions and health co-benefits3.1.:energy system and health3.2.:clean household energy3.3.:air pollution, transport, and energyEconomics and finance4.1.:health and economic costs of climate change and benefits from its mitigation4.1.1:economic costs of heat-related mortality4.1.2:economic costs of heat-related labour productivity loss4.1.3:economic costs of air pollution-related mortality4.1.4:economic costs due to climate-related extreme events4.2.:the economics of the transition to zero-carbon economies4.2.1:investment in new coal and low-carbon energy and energy efficiency4.2.2:employment in low-carbon and high-carbon industries4.2.3:net value of fossil fuel subsidies and carbon pricesPublic and political engagement5.1.:media coverage of health and climate change5.1.1:media coverage of health and climate change on social media5.1.2:newspaper coverage of health and climate change5.2.:individual engagement in health and climate change5.3.:coverage of health and climate change in scientific journals5.4.:government engagement in health and climate change Climate change impacts, exposures, and vulnerability 1.1.:health and heat1.1.1:heatwave-related mortality1.1.2:change in labour capacity1.2.:health and extreme weather events1.2.1:wildfires1.2.2:flood and drought1.3.:climate-sensitive infectious diseases Adaptation, planning, and resilience for health 2.1.:adaptation planning and assessment2.2.:adaptation delivery and implementation2.2.1:detection, preparedness, and response to health emergencies2.2.2:air conditioning—benefits and harms2.2.3:urban green space2.3.:climate information services for health Mitigation actions and health co-benefits 3.1.:energy system and health3.2.:clean household energy3.3.:air pollution, transport, and energy Economics and finance 4.1.:health and economic costs of climate change and benefits from its mitigation4.1.1:economic costs of heat-related mortality4.1.2:economic costs of heat-related labour productivity loss4.1.3:economic costs of air pollution-related mortality4.1.4:economic costs due to climate-related extreme events4.2.:the economics of the transition to zero-carbon economies4.2.1:investment in new coal and low-carbon energy and energy efficiency4.2.2:employment in low-carbon and high-carbon industries4.2.3:net value of fossil fuel subsidies and carbon prices Public and political engagement 5.1.:media coverage of health and climate change5.1.1:media coverage of health and climate change on social media5.1.2:newspaper coverage of health and climate change5.2.:individual engagement in health and climate change5.3.:coverage of health and climate change in scientific journals5.4.:government engagement in health and climate change Climate change is threatening human health through many pathways. This section tracks the interactions between climate change and health in China. Building on the previous year's work, five indicators are presented in this section, with updated data and methods, exploring several dimensions of heat and health (indicators 1.1.1 and 1.1.2), health and extreme weather events (indicators 1.2.1 and 1.2.2), and climate-sensitive infectious diseases (indicator 1.3). When people are exposed to consecutive days of heat beyond thresholds, the risk of death increases substantially.10Xu Z FitzGerald G Guo Y Jalaludin B Tong S Impact of heatwave on mortality under different heatwave definitions: a systematic review and meta-analysis.Environ Int. 2016; 89: 193-203Crossref PubMed Scopus (168) Google Scholar Indicator 1.1.1 tracks non-accidental (ie, disease-related) heatwave-related mortality in China. This year's report uses monthly mortality rates and combines provincial relative risks by climate zones to better reflect seasonal and regional patterns of mortality risk during heatwaves (appendix pp 5–7).11Chen R Yin P Wang L et al.Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities.BMJ. 2018; 363k4306Google Scholar In 2020, every person in China had 4·51 more heatwave days than in the 1986–2005 average. The resulting increase in heatwave-related mortality was 92%, with an estimated 14 500 deaths in 2020, 77% of which were people older than 65 years. Although there is annual variation, a clear increasing trend in mortality can be seen during the past two decades. Compared with 2000–04, heatwave-related mortality has increased by 63·6% to an annual average of 17 270 deaths in 2015–20 (figure 1A). Guangdong, Guangxi, and Liaoning provinces had the highest heatwave-related deaths, accounting for 31·7% of total deaths in 2020 in China (figure 1B). With a warming climate and an ageing population, and without additional adaptation measures, it has been estimated that heat-related deaths in China could increase to five to nine times of those in 2010 by the end of this century.4Yang J Zhou M Ren Z et al.Projecting heat-related excess mortality under climate change scenarios in China.Nat Commun. 2021; 121039Google Scholar Heat exposure during work can reduce labour capacity and lead to an increased socioeconomic burden through reduced wages, which worsens health outcomes.12Knittel N Jury MW Bednar-Friedl B Bachner G Steiner AK A global analysis of heat-related labour productivity losses under climate change—implications for Germany's foreign trade.Clim Change. 2020; 160: 251-269Crossref Scopus (12) Google Scholar, 13Zander KK Botzen WJW Oppermann E Kjellstrom T Garnett ST Heat stress causes substantial labour productivity loss in Australia.Nat Clim Chang. 2015; 5: 647-651Crossref Scopus (200) Google Scholar, 14Dunne JP Stouffer RJ John JG Reductions in labour capacity from heat stress under climate warming.Nat Clim Chang. 2013; 3: 563-566Crossref Scopus (298) Google Scholar This indicator uses similar methods to the global Lancet Countdown report,1Watts N Amann M Arnell N et al.The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises.Lancet. 2021; 397: 129-170Summary Full Text Full Text PDF PubMed Scopus (425) Google Scholar with national data and legal work stipulations, and this year's report has been improved to capture the ratio of indoor and outdoor workers (appendix pp 7–9). Potential heat-related productivity loss has increased in the past two decades, reaching 31·5 billion h of work (or 1·3% of the total national work hours) in 2020, a trend that has been affected by the changing labour force and rising temperatures. Although still accounting for 68·9% of total losses, the heat-related productivity loss in China's agriculture sector has decreased along with the reduction of the agricultural labour force; however, the losses in construction and manufacturing sectors have increased rapidly, with annual average growth rates of heat-related productivity loss being 8·4% for the construction sector and 9·5% for the manufacturing sector. The southern provinces of Guangdong and Guangxi had the greatest heat-related productivity losses, accounting for 27·5% of the national total loss. Such a large loss of labour capacity has impacted economic performance and caused large wage losses, particularly for outdoor workers, placing their livelihoods and health in jeopardy.1Watts N Amann M Arnell N et al.The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises.Lancet. 2021; 397: 129-170Summary Full Text Full Text PDF PubMed Scopus (425) Google Scholar, 12Knittel N Jury MW Bednar-Friedl B Bachner G Steiner AK A global analysis of heat-related labour productivity losses under climate change—implications for Germany's foreign trade.Clim Change. 2020; 160: 251-269Crossref Scopus (12) Google Scholar, 13Zander KK Botzen WJW Oppermann E Kjellstrom T Garnett ST Heat stress causes substantial labour productivity loss in Australia.Nat Clim Chang. 2015; 5: 647-651Crossref Scopus (200) Google Scholar A warmer and drier climate is likely to increase wildfires, which cause morbidity and mortality through thermal injuries and smoke exposure. For example, the 2019–20 Australian wildfires caused 33 direct deaths, more than 4400 admissions to hospital, and 400 excess deaths due to smoke exposure.15Royal Commission into National Natural Disaster ArrangementsRoyal Commission into National Natural Disaster Arrangements—report.https://naturaldisaster.royalcommission.gov.au/system/files/2020-11/Royal%20Commission%20into%20National%20Natural%20Disaster%20Arrangements%20-%20Report%20%20%5Baccessible%5D.pdfDate: Oct 28, 2020Date accessed: May 24, 2021Google Scholar, 16Borchers Arriagada N Palmer AJ Bowman DM Morgan GG Jalaludin BB Johnston FH Unprecedented smoke-related health burden associated with the 2019–20 bushfires in eastern Australia.Med J Aust. 2020; 213: 282-283Crossref PubMed Scopus (84) Google Scholar This year, we track model-based wildfire risk (ie, the annual average number of days people are exposed to very high or extremely high wildfire risk;17Vitolo C Di Giuseppe F Barnard C et al.ERA5-based global meteorological wildfire danger maps.Sci Data. 2020; 7: 216Crossref PubMed Scopus (21) Google Scholar defined in the appendix [pp 17–18]) and satellite-observed exposure (ie, the change in population exposure to wildfires).18Giglio L Boschetti L Roy DP Humber ML Justice CO The Collection 6 MODIS burned area mapping algorithm and product.Remote Sens Environ. 2018; 217: 72-85Crossref PubMed Scopus (320) Google Scholar, 19Giglio L Schroeder W Justice CO The collection 6 MODIS active fire detection algorithm and fire products.Remote Sens Environ. 2016; 178: 31-41Crossref PubMed Scopus (534) Google Scholar From 2001 to 2020, there was a reduction in population-weighted wildfire risk, but population exposure to wildfires increased in most years. In 2016–20, national annual average wildfire exposure increased by 24·5% compared with 2001–05, and 20 provinces had an increase in wildfire exposure, with the northeast provinces showing a rise of 331·4% due to increasing temperatures during the fire season. The Daxing’anling forest fire on May 30, 2020, burned around 16 000 m2 and more than 2000 firefighters were directly exposed to fire smoke.20BaiduBaikeDaxing'anling forest fire on May 30th. 2020.https://baike.baidu.com/item/5%C2%B730%E5%A4%A7%E5%85%B4%E5%AE%89%E5%B2%AD%E6%A3%AE%E6%9E%97%E7%81%AB%E7%81%BE/50314340?fr=aladdinDate accessed: March 3, 2021Google Scholar, 21XinhuaOver 2000 sent to put out forest fire in north China.http://www.xinhuanet.com/english/2020-05/30/c_139101370.htmDate: May 30, 2020Date accessed: March 28, 2021Google Scholar One forest fire in Sichuan province on March 20, 2020, killed 19 people, including 18 firefighters.22ReutersForest fire kills 19 in China's Sichuan province: state media.https://www.reuters.com/article/us-china-fire-idUKKBN21I0X9Date: March 31, 2020Date accessed: March 28, 2021Google Scholar See the appendix (pp 19–20) for a detailed description of the method. Floods are among the most frequent natural disasters in China.23Han W Liang C Jiang B Ma W Zhang Y Major natural disasters in China, 1985–2014: occurrence and damages.Int J Environ Res Public Health. 2016; 13E1118Crossref Scopus (31) Google Scholar Climate change tends to alter precipitation patterns and temperature, increasing the risk of local flood and drought events, causing direct injuries, damaging essential infrastructure, and exacerbating the spread of vector-borne and water-borne diseases.24Alfieri L Bisselink B Dottori F et al.Global projections of river flood risk in a warmer world.Earths Futur. 2017; 5: 171-182Crossref Scopus (277) Google Scholar, 25Du W FitzGerald GJ Clark M Hou XY Health impacts of floods.Prehosp Disaster Med. 2010; 25: 265-272Crossref PubMed Scopus (151) Google Scholar This indicator has changed data source since the 2020 report to the Yearbook of Meteorological Disasters in China,26China Meteorological AdministrationYearbook of meteorological disasters in China (2004–2019). Meteorological Press, Beijing2006–20Google Scholar which provides more detailed information about dates, the affected area, the affected population, and economic losses for China (appendix pp 22–26). The number of flood disasters increased substantially during 2000–19, the number of drought disasters remained stable, and overall the damage caused by floods and droughts in China has decreased from 2004 to 2018, due to improvements in emergency response capacity. However, increased extreme precipitation and flooding, such as that seen along the Yangtze River in 2020 and in the Henan province in 2021, has the potential to reverse this downward trend in flood damage. In 2018, there were 35·26 million people affected by floods and 27·43 million affected by droughts, with Sichuan province being the most affected during the past years. In July, 2020, the average precipitation in areas along the Yangtze River reached the highest amount since 1961, threatening the lives and homes of people in 27 provinces across central and southern China.27Guo Y Wu Y Wen B et al.Floods in China, COVID-19, and climate change.Lancet Planet Health. 2020; 4: e443-e444Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar In July, 2021, Henan, one of the most populated and flood-prone provinces in China, saw record-breaking precipitation and more than 300 people were killed in the flood, equivalent to nearly 80% of the total death tolls from floods in China in 2018.28ReutersDeath toll from floods in China's Henan province rises to 302.https://www.reuters.com/world/china/death-toll-flooding-chinas-henan-province-rises-302-2021-08-02/Date: Aug 2, 2021Date accessed: August 9, 2021Google Scholar Without actions taken, China could become the country that is most impacted by floods in the world.24Alfieri L Bisselink B Dottori F et al.Global projections of river flood risk in a warmer world.Earths Futur. 2017; 5: 171-182Crossref Scopus (277) Google Scholar As a result of changing environmental conditions, the suitability for the transmission of many food-borne, water-borne, and vector-borne pathogens is rising.29Caminade C McIntyre KM Jones AE Impact of recent and future climate change on vector-borne diseases.Ann N Y Acad Sci. 2019; 1436: 157-173Crossref PubMed Scopus (134) Google Scholar, 30Semenza JC Herbst S Rechenburg A et al.Climate change impact assessment of food- and waterborne diseases.Crit Rev Environ Sci Technol. 2012; 42: 857-890Crossref PubMed Scopus (90) Google Scholar This indicator tracks the climate suitability for Aedes aegypti and Aedes albopictus and the disease burden for dengue in China (appendix pp 36–41). During 2004–19, as a result of warmer daily temperatures, vectorial capacity for the transmission of dengue fever through A aegypti and A albopictus increased by 25·4% in China. Upward trends are seen in 18 provinces, and only Shanghai had a substantial decrease in vectorial capacity for dengue transmission. Compared with 2005, the all-age disability-adjusted life-year rate of dengue fever increased by 21 times in 2019, reaching 0·66 per 1 000 000 population. The high-risk areas would increase by 2·9 times and the population in these high-risk areas would increase by 4·2 times in the Representative Concentration Pathway of 8·5 W/m2 greenhouse gases in the atmosphere scenarios by the end of this century compared with the average level in the 1981–2016 period.5Fan J-C Liu Q-Y Potential impacts of climate change on dengue fever distribution using RCP scenarios in China.Adv Clim Chang Res. 2019; 10: 1-8Crossref Scopus (16) Google Scholar The health impacts of climate change in China are rising. Although fewer heatwave exposures in 2020 than in 2019 resulted in a slight decrease in heatwave-related mortality and labour productivity losses, the overall trends continue upwards. This year's unprecedented floods have the potential to reverse the previous downward trend in flood damage in China and the vectorial capacity for the transmission of dengue is rising. Without timely responses, such threats will continue to grow and could overwhelm the country's health system.