China and the Environment

Average Total Suspended Particulates 

China, with 1.3 billion people, is the most populous country in the world.  The percent of the population living in its urban centers (39%) is growing rapidly, with over 170 cities in China having populations greater than 1 million people.  With an economy that ranks third in the world and is growing at a rate three times the world average, severe and growing environmental problems (outdoor and indoor air pollution, water pollution, etc.), and profound changes in life style (diet, physical activity, consumer product use, etc.) are of increasing concern.  For example, China has 16 of the world’s 20 most polluted cities, with concentrations of many air pollutants orders of magnitude above standards recommended by the World Health Organization.  This pollution contributes to an estimated 400,000 deaths per year.  Water quality has likewise worsened, with as many as 500 million people estimated to have no access to safe drinking water.  Thus, the tremendous growth that China is experiencing is resulting in significant deleterious changes, which impact not only China, but the world.

The Challenge
As the standard of living increases, and the quality of the environment deteriorates, there is growing recognition and concern among China’s leaders that the adverse health effects associated with these changes must be addressed.  However, China lacks a cadre of trained health professionals to study these issues and to recommend policy and programmatic changes.

Our Response
After several visits by Yale School of Public Health faculty to China and a visit to Yale of high- ranking Chinese health officials in August, 2007, a collaborative research and environmental health professional training agreement has been reached to address some of China’s most pressing health problems.  Two research projects formed under this agreement, Air Pollution and Respiratory Health Study and the Chinese Physician and Nurse Cohort Study, will be the first of their kind ever conducted in China and are the largest ever undertaken anywhere. 

A formal collaboration between Yale and China can begin to address the challenges outlined above in two ways: First, design and launch of a series of longitudinal and cross-sectional population studies to assess the impact of current levels of environmental pollution, particularly air pollution, and life-styles on health.  These studies will also help to project the likely impact of continued deterioration in the environment and health behaviors and to determine the effectiveness of policies to improve these risk factors.  Second, environmental health professionals from China need to be trained to design and conduct studies to assess the impact of the environmental and life-style changes and the impact of health-related policies.

What We Hope to Achieve
Our goal is to work with our Chinese partners to build a Yale-China Center for Environmental Epidemiology.  The Center will be dedicated to undertaking population-based studies examining the association between environmental factors and health in China, and to training a new generation of Chinese environmental epidemiologists.  Current projects include: 


  • Studies (air pollution and respiratory health) are being designed to examine the relationship between mortality and changes in air pollution, the role air pollution may play in chronic diseases in women ages 50-65 years, and the relationship between air pollution and respiratory health in elementary school-age children.  These studies are scheduled to begin in the summer of 2008 in at least four cities (Taiyuan, Shanghai, Nanjing, and Qingdao). It is likely that more studies of this kind will be conducted.
  • Women will be recruited during their first trimester of pregnancy and their children will be followed to 18 years of age (multi-center birth cohort study). The focus of this birth cohort study is the relationship between early life exposures and reproductive health, childhood development, as well as puberty development. This project, funded by local hospitals and health departments, is currently underway in two cities (Lanzhou and Taiyuan) and will be expanded to other cities.    
  • In collaboration with China’s Ministry of Health (MOH), a study of Chinese physicians and nurse cohorts is about to be launched (Chinese physician and nurse cohort study). All physicians, nurses, and health professionals in China, approximately 6,000,000, are required to take the exam every five years.  This prospective study, which follows approximately 300,000 subjects, will assess the impact of environmental, life-style, and genetic factors on disease.
  • The relationship between serum levels of organochlorines and risk of liver cancer will be studied (multi-center case-control study of liver cancer).  Funding for this study is provided by the Xiamen Center for Disease Control.  The identification of cases and controls was started in 2007. 


  • In early 2007, the School of Public Health was awarded a Federal grant to train over 200 environmental scientists in China. An additional 13 Chinese scientists will come to the U.S. to work and train with School faculty. 

Partnership for Change
We are committed to working with China to achieve significant and lasting improvements in health. To accomplish this goal we need resources to:

  • Establish the Yale-China Center for Environmental Epidemiology at Yale, which will provide the infrastructure crucial to supporting and expanding current collaborations
  • Cover the cost of Yale faculty time and effort, travel, and other costs associated with current training and research projects
  • Develop seminars, pilot studies, etc. to encourage and facilitate collaborations among a broad range of Yale researchers who may have an interest in China-based health studies, particularly in the areas of immunology, chronic disease, genetics, pulmonary medicine, policy formulation, and health impact of climate change
  • Develop a University-wide seminar series on human health and climate change
  • Fund fellowships at the undergraduate, masters, doctoral, and post-doctoral levels for interdisciplinary research on the environment and health.  Such fellowships would build upon and expand the current Yale-China training program 

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