China underwent many years of turmoil and rapid societal shifts during the latter half of the 20th Century, and the causes of disease and death have similarly varied wildly over the same period. However, publicly available documents from the Ministry of Ecology and Environment show that environmental pollution is now one of the four leading causes of health issues and death in the country.


The effects of environmental pollution on the human body can be separated into acute and chronic effects. Acute poisoning is when a population of people are exposed to a large amount of a toxic substance within a short time (due to a major discharge of pollution or environmental emergency) which causes them to suffer adverse reactions and even death; while chronic damage occurs when toxic and hazardous pollutants exist in the environment at low concentrations, over long periods of time, harming the health of those around.

Environmental health survey work first began in China in the 1970s, but national environmental health surveys were not consistently carried out until 1981. The Ministry of Ecology and Environment began focusing on prevention and risk management in environmental health work during the 11th Five-Year Plan (2006-2010), and by dawning of the 13th Five-Year Plan (2016-2020) China had already issued multiple environmental health standards and specialized policies, including: the National Action Plan for Health and the Environment (2007-2015), the 12th Five-Year Plan for the Environmental Health Work of National Environmental Protection, and the 13th Five-Year Plan for the Environmental Health Work of National Environmental Protection.

Various national environmental health management pilots were also implemented at all levels during the same period, the initial steps of which included working to understand major environmental issues and their changing effects on population health in key areas, key river basins, and key industries and then filtering out several toxic and hazardous pollutants that pose a particularly high risk to environmental health, as well as the construction of a number of key laboratories for national environmental protection/environmental health.

Building on this work, the environmental and health-related development requirements that were subsequently laid out in major programmatic policy documents as we entered the 14th Five-Year Plan era (2021-2025) –such as those included in the Outline of the 14th Five-Year Plan (2021-2025) for National Economic and Social Development and Vision 2035 of the People’s Republic of China, the 14th Five-Year Plan: Ecological and Environmental Protection Plan, and the Healthy China Initiative (2019-2030) – were more in-depth, and China has now put in motion targeted plans to improve current poor policy cohesion, address a lack of technical reserves, increase risk prevention awareness and capacity, and invest in human capital.


1. Major Policies, Regulations and Standards released for the 14th Five-Year Plan

A summary of all major new Environmental Health policies, regulations and standards issued by the Chinese Central Government during the 14th Five-Year Plan can be found below.

Table 1  Major New Environmental Health Policies Post-2022

Document Name Issue Date Issuing Authority
Notice on Organizing the Recommendations and Declarations needed to Implement the 2023 National Environmental Health Management Pilot 03/05/2023 General Office of the Ministry of Ecology and Environment
14th Five-Year Plan: Specific Plan for Ecological and Environmental Technical Innovation 09/19/2022 Ministry of Science and Technology, Ministry of Ecology and Environment, and others
14th Five-Year Plan: Environmental Health Work Plan 07/27/2022 General Office of the Ministry of Ecology and Environment


1.1. The 14th Five-Year Plan: Major Environmental Health Targets and Tasks

 The Outline of the 14th Five-Year Plan (2021-2025) for National Economic and Social Development and Vision 2035 of the People’s Republic of China released in March 2021 stated a requirement to ‘establish a post-evaluation mechanism and a public health impact assessment system for ecological and environmental emergencies and, in November of the same year, the Central Committee of the Communist Party of China and the State Council clarified the need to ‘strengthen eco-environmental and health management’ in the Opinions on Further Promoting the Fight against Pollution.

The 14th Five-Year Plan: Environmental Health Work Plan was published by the General Office of the Ministry of Ecology and Environment in July 2022 to aid implementation of the above, as well as other relevant policy requirements. The Work Plan comprehensively addresses all New Era environmental health work and sets out major targets and tasks based on current performance and National New Era Development Requirements.


(1) Major Targets

Targets to achieve by 2025:

  • Fundamentally understand the distribution of significant sources of environmental health risk in key areas nationwide and lay the foundation for a framework to monitor risks to environmental health
  • Further improve environmental health standards systems and develop a range of technical specifications for environmental health risk assessment, as well as software to calculate the needed models
  • Launch environmental health management pilots in 10 to 15 regions to implement multilevel, diversified, and specialized environmental health management developments
  • Build specialized teams and train a total of 50,000 individuals to perform the implementation work needed
  • Create an atmosphere where everybody in society supports and participates in environmental health work and where a minimum of 20% of Chinese residents have achieved environmental health literacy


(2) Major Tasks

Improve Environmental Health Risk Monitoring and Assessment

  • Understand the current distribution of risks
  • Monitor risk trends
  • Expand the range of risk assessment parameters

Relentlessly Seek out Environmental Health Management Strategies

  • Promote defense measures against environmental health risks
  • Increase efforts to expand pilot work
  • Participate in creating child-friendly cities

Increase Technological Skill Levels in Environmental Health

  • Further improve standards and regulations
  • Encourage technological innovation and development
  • Strengthen data resource management


1.2. Support Measures designed to Mitigate Environmental Risks and Improve the Environment

In 2005 the Ministry of Ecology and Environment began focusing on environmental health work and actively seeking to construct a system to manage environmental health as they slowly began to develop a clear understanding of where the environmental health baseline was at the time.

The official launch of Environmental Health Risk Management Pilots in 2018 was built on the back of this work. These pilots were intended to demonstrate how environmental health risk management systems could be implemented and operated, and the experience gained during the pilots has proved to be replicable, educational, and suitable for application at larger scales. These results have helped towards further securing environmental health safety for the population at large.

Yunhe County (Lishui City, Zhejiang) and Wulian County (Rizhao City, Shandong) were selected as the first of the pilot regions for the Environmental Health Risk Management Pilots. The next pilot regions to be selected (in 2019) were Shanghai, Chengdu, Lianyungang, and the Wudang Mountains Special Economic Zone (Shiyan City, Hubei).

One of the targets set out in the eco-environment section of the 14th Five-Year Plan is to ‘launch environmental health management pilots in 10 to 15 regions. In March 2023, the MEE issued the Notice on Organizing the Recommendations and Declarations needed to Implement the 2023 National Environmental Health Management Pilot. These pilots are to be implemented in cities/districts at a county level or above, national-level new districts, and typical industrial and manufacturing parks and will focus on the practical exploration of systemic and technical innovations in the fields.

The pilots must complete these six major tasks:

  1. Create lists of regional environmental health risk source
  2. Monitor and assess environmental health risks
  3. Facilitate control of environmental health using classification and zoning systems
  4. Increase the influence of environmental health on eco-environmental monitoring and management
  5. Encourage the development of Environmental Health+ industries
  6. Vigorously promote and increase environmental health literacy among the general population


1.3. Increase Scientific Precision in Environmental Management and Facilitate Increased Monitoring and Control by Regional Ecology and Environment Authorities

Environmental pollution is highly hazardous to human health but can be a hidden threat — the effects may not become evident for many years, and the various influencing factors can make it too difficult to establish clear causal relationships. This is why it is so necessary to commit to the technological research and development needed to increase the level of scientific precision in environmental management.

Improve Standards, Technical Specifications, and Technical Guidelines

Since 2017, the Ministry of Ecology and Environment has issued Technical Guideline after Technical Guideline, including the Environmental Health Field Surveys: Technical Regulations (Cross-Sectional Surveys) (HJ 839-2017), the Technical Guidelines for Assessing Population Exposure to Environmental Pollutants (HJ 875-2017), and the Technical Guidelines for the Statistical Analysis of Environmental Health Cross-Sectional Survey Data (Ministry of Ecology and Environment Bulletin No. 63, 2017).

The Technical Guidelines for Eco-Environmental Health Risk Assessment—General Principles (HJ 1111-2020) were then issued in March 2020 to regulate general principles, procedures, content, methodology, and technical requirements for eco-environmental health risk assessments, further demonstrating that China is well on its way to developing an environmental health baseline.

Improve Environmental Health Risk Monitoring and Assessment and Increase Technological Skill Levels in Environmental Health

The 14th Five-Year Plan: Environmental Health Work Plan issued in July 2022 by the General Office of the Ministry of Ecology and Environment listed improving environmental health risk monitoring and assessment, increasing technological skill levels in environmental health, and creating professional environmental health teams as major environmental health tasks to be completed during the 14th Five-Year Plan.

The scientific precision of environmental management must be increased across the board, including aspects such as data sourcing, data precision, the establishment and refinement of research method models, the analysis and evaluation of development trends, and the refinement and revision of parameters. The Plan also indicates that eco-environment authorities at all levels must make effective use of environmental health surveys and monitoring data to create targeted policies for better collaborative governance.

Strengthen Technological Innovation and R&D

September 2022 saw the release of the 14th Five-Year Plan: Specific Plan for Ecological and Environmental Technical Innovation by the Ministry of Science and Technology and four others. The health hazards and their mechanisms and exposure characteristics in humans of pollutants in different media (e.g., water, air, soil, etc.) are specified, as are details for the corresponding health risk assessments, health diagnoses, health assurances, pollution exposure route control systems, etc.

The Specific Plan emphasizes the need to develop corresponding health risk classification, zoning, and control technology when researching and developing health risk assessments. Corresponding R&D requirements for the whole-process management of the eco-environmental health risks posed by new pollutants are also declared, as well as requirements for R&D into noise and human health risk benchmarks and assessment technology.


1.4. Encourage Public Participation

The Chinese Citizen Environmental Health Literacy (Pilot Implementation) launched by the former Ministry of Environmental Protection in September 2013 debuted the concept of environmental health literacy in China by listing 30 environmental health items selected to help the Chinese population improve basic environmental health understanding, knowledge, and skills.

June 2017 saw the subsequent Technical Guidelines for Assessing Environmental Health Literacy in the Population (Pilot Implementation). The population was surveyed to measure the level of environmental health literacy in 2018, and indices for its continued measurement were then incorporated into the Healthy China Initiative. Improving the environmental health literacy of residents was including in the Healthy China Initiative (2019-2030) in July 2019 under ‘promoting environmental health’. Chinese Citizen Environmental Health Literacy was then released in 2020 to popularize scientific and environmental health knowledge.

Increasing the level of health literacy amongst citizens is intended to educate the people about the value of the ecology and environment and its impact on our health, arm people with the knowledge necessary to protect the eco-environment and prevent risk, encourage people to practice a green and healthy lifestyle, and empower people to protect both their eco-environment and their own health.

The Ministry of Ecology and Environment officially launched 2022 National Residents Environmental Health Literacy monitoring work on April 9, 2022. 31 provinces, autonomous regions, and municipalities were subject to this monitoring, as well as Xinjiang Production and Construction Corps from 188 counties, cities, districts, and banners, for a planned total of 44,000 people between 15 and 69 years old. The results have not yet been published by the relevant authorities.


2. Future Direction

In October 2016, the Central Committee of the Communist Party of China and the State Council jointly issued the Outline for the “Healthy China 2030” Plan. The Outline notes that, as of 2020, the targets for the percentage of days with good air quality in cities at the prefectural level or above (%) and for the percentage of water bodies with a surface water quality of Grade III or above (%) have both been exceeded; however, targets for at least 20% of the population to achieve environmental health literacy (i.e. at least 20 people of every 100 who take the questionnaire should answer a minimum of 70% of the questions correctly) have not been met.

  1. Eco-environment indicators in China have gradually been improving as policies and standards are developed and implemented; however, collaboration between eco-environmental and public health bodies needs to be improved at all levels to further the formulation and revision of corresponding environmental health management policies and technical standards in stages based on the status of the eco-environment itself and national exposure characteristics;
  2. From a science and technology standpoint, detailed and accurate environmental health monitoring data is vital for both trend analysis and the development of policies and standards, and authorities at all levels and in all regions must implement environmental risk monitoring measures appropriate to their locales. All scientific research units must engage in in-depth research on the impacts of environmental health, subsequently engage in environmental health management technology R&D, and ultimately increase the level of flexibility of environmental health in the environment of residents.
  3. On the industrial developments front, Environmental Health+ industries must successfully decrease environmental health risks to the population and increase the sense of environmental happiness among the population. Enterprises must shoulder their corporate responsibility to vigorously develop environmental health infrastructure and cultural industries.