Air pollution threatens the health of children in China.

CONTEXT . China's rapid economic development has come at the cost of severe environmental degradation, most notably from coal combustion. Outdoor air pollution is associated with >300000 deaths, 20 million cases of respiratory illness, and a health cost of >500 billion renminbi (>3% of gross domestic product) annually. The young are particularly susceptible to air pollution, yet there has been only limited recognition of its effects on children's health and development. DATA SOURCES/DATA EXTRACTION: To fill this gap, we reviewed relevant published environmental studies, biomedical and molecular/epidemiologic research, and economic and policy analyses. RESULTS China relies on coal for approximately 70% to 75% of its energy needs, consuming 1.9 billion tons of coal each year. In addition to CO(2), the major greenhouse gas, coal burning in China emits vast quantities of particulate matter, polycyclic aromatic hydrocarbons, sulfur dioxide, arsenic, and mercury. Automobiles emit nitrogen dioxide and benzene in addition to particulate matter and polycyclic aromatic hydrocarbons. Seventy percent of Chinese households burn coal or biomass for cooking and heating, which contaminates indoor air. Adverse effects of combustion-related air pollution include reduced fetal and child growth, pulmonary disease including asthma, developmental impairment, and increased risk of cancer. A prospective molecular epidemiologic study of newborns in Chongqing has demonstrated direct benefits to children's health and development from the elimination of a coal-burning plant. CONCLUSIONS Recognition of the full health and economic cost of air pollution to Chinese children and the benefits of pollution reduction should spur increased use of renewable energy, energy efficiency, and clean-fuel vehicles. This is a necessary investment for China's future.