Green spaces and preventable disease and economic burdens in China from 2000 to 2020: A health impact assessment study

Abstract

Evidence on the preventable disease and economic burdens associated with increasing green spaces for the Chinese population remains lacking. This health impact assessment study aimed to provide such evidence for China between 2000 and 2020. Using two green space proxies (percentage of green space [GS%] and normalized difference vegetation index [NDVI] within a 300-m buffer around each grid cell) and three burden indices (all-cause adult mortality, years of life lost [YLLs], and economic costs), we applied a comparative risk assessment framework to estimate the preventable burdens associated with increasing GS% and NDVI within the 300-m buffer to 25% and 0.35, respectively. Moreover, we monetized the health gains using the “value of statistical life” metric. In 2020, we found that increasing GS% within the 300-m buffer to 25% could prevent 0.05 (95% uncertainty interval: 0.00–0.14) million deaths, equivalent to 1.02 (0.00–2.51) million YLLs and an economic value of $113.73 (0.00–286.53) billion. Similar estimates were observed for NDVI within the 300-m buffer. The estimates of preventable burdens were unevenly distributed within China, with urban, eastern, or high-GDP regions—such as Jiangsu and Guangdong provinces—showing higher estimates than other areas. From 2000 to 2020, the preventable burdens estimated via the GS% proxy showed a significant increase, whereas a notable decreasing trend was observed with the NDVI proxy. These findings provide quantitative evidence supporting the health and economic benefits of green spaces and highlight the necessity for greening initiatives in China, particularly in economically developed areas.