Environment-friendly diet and policy priorities to promote sustainable healthy aging across China

Abstract

Rapid population aging and growing environmental pressures pose dual challenges to sustainable development, especially in developing countries. The region-specific reference diet (RRD), a culturally appropriate variant of EAT-Lancet Planetary Health Diet, has been recently proposed for China, but its role in promoting sustainable healthy aging remains unclear. We hypothesize that combining RRD with social determinants can enhance sustainable healthy aging and reduce health disparities. Using 2020 food consumption data from the National Bureau of Statistics of China (NBSC), we estimated provincial RRD adherence and its association with healthy life expectancy (HLE) and Green Development Index (GDI). Based on the data from NBSC, the social return on investment identified five core social determinants, pension coverage, telephone subscriptions, senior care workforce, physician access, and internet use, that significantly reduced the unexplained variance in sustainable healthy aging after adjusting for RRD. Scenario-based simulations were performed by comparing four conditions: (1) 2020 status, (2) 2030 projection, (3) RRD adoption alone, and (4) RRD combined with synergistic social determinants. The integrated strategy based on RRD yielded greater improvements in HLE and GDI compared to the 2020 status and 2030 projection, while also significantly reduced regional and gender disparities compared to all other three conditions. These findings underscore the limitations of dietary interventions in isolation and highlight the potential of a multi-sectoral strategy for advancing equal sustainable healthy aging. Future studies are warranted to assess the impact of RRD-based integrated strategy in sustainable healthy aging in real world, and validate the findings in other countries.