Contents lists available at ScienceDirect Environment International journal homepage: www.elsevier.com/locate/envint Quantifying regional consumption-based health impacts attributable to ambient air pollution in China Yanxia Zhang a,b,1 , Shen Qu c,1 , Jing Zhao a , Ge Zhu a , Yanxu Zhang d,e , Xi Lu f,g , Clive E. Sabel h , Haikun Wang a, ⁎ a State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China b Key Laboratory of Soil Environment and Pollution Remediation, Institute of Soil Science, Chinese Academy of Sciences, Nanjing 210008, China c School for Environment and Sustainability, University of Michigan, Ann Arbor, MI 48109-1041, USA d John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA e School of Atmospheric Sciences, Nanjing University, Nanjing 210093, China f School of Environment and State Key Joint Laboratory of Environment Simulation and Pollution Control, Tsinghua University, Beijing 10084, China g State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China h Department of Environmental Science, Aarhus University, 4000 Roskilde, Denmark ARTICLE INFO Keywords: Air pollution Public health Trade China ABSTRACT Serious air pollution has caused about one million premature deaths per year in China recently. Besides cross- border atmospheric transport of air pollution, trade also relocates pollution and related health impacts across China as a result of the spatial separation between consumption and production. This study proposes an ap- proach for calculating the health impacts of emissions due to a region's consumption based on a multidisciplinary methodology coupling economic, atmospheric, and epidemiological models. These analyses were performed for China's Beijing and Hebei provinces. It was found that these provinces' consumption-based premature deaths attributable to ambient PM 2.5 were respectively 22,500 and 49,700, which were 23% higher and 37% lower than the numbers solely within their boundaries in 2007. The difference between the effects of trade and trade-related emissions on premature deaths attributable to air pollution in a region has also been clarified. The results illustrate the large and broad impact of domestic trade on regional air quality and the need for comprehensive consideration of supply chains in designing policy to mitigate the negative health impacts of air pollution across China. 1. Introduction Ambient PM 2.5 has been estimated to be responsible for 1.2 million premature deaths in China in 2010, or nearly 35% of such deaths worldwide (Lim et al., 2012; Xie et al., 2016; Yang et al., 2013). Beside local sources of air pollution, the air quality of a province might be affected by atmospheric transport of pollution from other distant pro- vinces (Li et al., 2015; Xue et al., 2014) and even from other countries (Anenberg et al., 2014; Lin et al., 2014; Liu et al., 2009; Verstraeten et al., 2015). In addition to physical atmospheric transport, trade also relocates air pollution and its related health impacts because goods are produced in one region and consumed in other regions (Zhang et al., 2017). China is a vast country with substantial disparities across pro- vinces in terms of resource and energy endowment, economic devel- opment, and population density, encouraging trade between provinces with consequent embodied pollution (Jiang et al., 2015; Wang et al., 2017; Zhao et al., 2017). In recent years, emissions have grown rapidly in some inland provinces but stabilized or even decreased in many coastal regions (Liu et al., 2013), partly because inland provinces export emission-intensive products (e.g., raw materials or energy) to support production and consumption of finished goods in coastal regions (Feng et al., 2013; Wang et al., 2015; Zhao et al., 2015). In this paper, we focus on two areas: Hebei province, which sur- rounds the capital Beijing, and Beijing itself, both locate in the region of China that suffers the most serious air pollution and consequent health impact, i.e., Beijing-Tianjin-Hebei. Beijing's rampant air pollution, especially in the winter, has already been reported frequently in recent years (Yuan et al., 2012; Zeng et al., 2017). As the national capital, Beijing is usually seen as a mirror reflecting severe air pollution in China and it has become a domestic and even global focus of attention. https://doi.org/10.1016/j.envint.2017.12.021 Received 12 October 2017; Received in revised form 13 December 2017; Accepted 13 December 2017 ⁎ Corresponding author. 1 Yanxia Zhang and Shen Qu contribute equally to the paper. E-mail address: wanghk@nju.edu.cn (H. Wang). Environment International 112 (2018) 100–106 0160-4120/ © 2017 Elsevier Ltd. All rights reserved. T