Not long ago, environmental health risks in China paled in comparison to threats from malnutrition and infectious diseases. But as China modernized, these ominous risks were brought under control, decreasing the total death rate from 20 per 1,000 in 1949 to approximately 6 per 1,000 in 1995. Today, diseases from air pollution are among the largest threats to public health in China, ranking with smoking as the most frequent cause of death. This study combines data from a series of Chinese epidemiologic studies, official disease statistics, and previous measurements of air pollutant levels in China to estimate the nationwide death toll from air pollution.  The results suggest that air pollution is responsible for more than 1 million deaths per year in China, or one in every seven deaths nationwide. Although Chinese run lower risks than Americans from a number of hazards, their individual risk of death from air pollution is 7 to 10 times higher.  The largest sources of population risk are indoor heating and cooking stoves fueled by biomass or coal.  It is estimated that there are about four times as many air pollution deaths in China's rural areas than in China's cities.

A follow on study, currently in progress, is examining the uncertainty inherent in estimating air pollution health effects in China in light of multiple forces that influence mortality and morbidity from lung and heart disease.

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