Analysis in this chapter supports an overall trend of decline in the percentage of polluted days since 2012. Yet, stricter and more centralized policy enforcement measures do not have truly significant, across-the-board effects in reducing pollution in China, and the fall in PM2.5 concentration has not translated into significant and sustained health benefits. The chapter also examines the success and failure of the government in tracking the ongoing targets it set for achieving final policy goals, paying special attention to the following issue areas: reduction of toxic emissions, attacking water pollution, energy, and industrial restructuring, policy coordination, public participation, and the use of market mechanisms. The mixed outcome in addressing air pollution highlights the constraints and flaws of China’s environmental governance model. It also suggests that decades of reform and opening up have not fundamentally changed the impromptu, non-participatory, unaccountable, and mobilizational policy process, which often leads to undesirable and unintended policy outcomes.

This chapter looks at China’s environmental crisis and its impacts on public health. In examining the health impacts of air pollution, it highlights ambient PM.25 as the number one killer of all the risk factors for pollution-related mortality in China. Besides air pollution, water and soil pollution also has a significant and independent effect on people’s health. The health impact of pollution is further complicated by exposure to heavy metals such as arsenic and lead. The posited health effects of air, water, and soil pollution are epitomized in the phenomenon of cancer villages. Additional links between the environment and health, including trash and public health, pollution and mental health, pollution and sperm quality, and pollution and antibiotic resistance, are also examined.

When Xi Jinping took the helm in 2012, one of his major concerns was how to connect the wheel to the rudder: eliciting compliance from lower levels. Unlike previous party leaders, Xi rapidly recentralized his political power to a level that rivals Mao’s. The recreation of the Maoist bandwagon polity reshaped the institutional contours of policy implementation. Pollution control was a key element of this shift. The central leaders pushed for the enactment of three pollution-related action plans. With the elevation and embedding of environmental health issues, the power and prestige of central environmental protection agencies have been strengthened. Policy implementation has also been facilitated by the introduction of new policy instruments and mechanisms aimed at improving accountability and policy coordination. Still, many of the inherent policy implementation problems continue to be left untouched. They include upward accountability, lack of public participation, conflict between functional departments and territorial governments, and the central state’s inability to effectively monitor and evaluate bureaucratic performance.

The book concludes with a summary on how the environmental health crisis is undermining China’s international ascendance, as well as implications for China’s political development. It contends that the crisis and government response reveal a Chinese state whose political system is both resilient and fragile, and that the China model does not constitute a viable alternative to liberal democracy.

This chapter explains why environmental health issues carry profound implications for China’s future and how they threaten to severely weaken the nation’s economic growth, undermine its sociopolitical stability, and complicate China’s foreign relations. Environmental health issues not only exact a significant economic toll but also have profound sociopolitical implications. With the growing public attention on air quality, pollution has increasingly become a political issue that tests the Chinese government’s ruling capacity. The environmental health problems, in conjunction with other mounting domestic challenges, will constrain Chinese leaders’ ability to mobilize the resources and internal support necessary for China to play a global leadership role.

The introduction proposes environmental health challenges as an obstacle to China’s global leadership. Following a discussion of the unique features of environmental health problems in China, it explains why social response to the crisis is embedded in a political milieu dramatically different from the Mao era. It also touches upon issues of state response, including the challenges of policy implementation. Furthermore, it explains why the discussion fits squarely within the debate over Chinese state’s capacity to revamp itself and the prospect for China’s global leadership. It ends with a discussion of the analytical framework and organization of the book.

In accounting for the shift in China’s environmental health policy, there is no denying that domestic actors – politicians, bureaucrats, intellectuals, environmentalists and social forces – are instrumental in setting the new agenda. However, a close look at the policymaking process also highlights the influence of international actors and networks in creating new policy norms and practices, as evidenced by US Foreign Service’s role in including PM2.5 control as a core tenet in the government’s pollution control efforts. The shift to a new monitoring system, in turn, forced the government to take more action on pollution. Ultimately, the PM2.5 crisis of 2013 weaved the problem, policy, and political streams together, pushing all toward serious policy change. By April 2015, the government had put in place three action plans to tackle the country’s air, water and soil pollution problems, respectively. Nevertheless, the same process also reveals the inherent dilemmas, constraints, and limitations China faces in pursuing required policy change.