Health impact assessment of greenness promotion on mortality in 98 cities in China

The China government issued the National Land Greening Plan Outline (2022–2030), which set a greenness coverage target of 43 % in urban area and 32 % in rural area. However, the implementation of local policies to effectively maximize the impact of the target remains unclear. Our study aims to conduct a health impact assessment to evaluate the potential and effectiveness of the outline target in 98 major Chinese cities. Generalized additive model was applied to translate the outline target into measurable Normalized Difference Vegetation Index (NDVI) at a 1 × 1 km grid scale. Based on the estimated target and remote sensing imagery on green space, we estimated the potential of NDVI improvement and corresponding annual preventable deaths. Additionally, we evaluated and compared the effectiveness of greenness promotion across different regions. We found that achieving the outline target has the potential of preventing 86,375 (95 % CI: 78,279, 94,542) deaths annually, accounting for 1.78 % of the total mortality. The health benefits of the target are mainly observed in urban areas and larger cities. East and North China show the greatest health benefits, with the highest preventable deaths in megacities like Shanghai (6,809, 95 % CI: 6,083, 7,538), Tianjin (5,496, 95 % CI: 5,163, 5,830), and Beijing (4,238, 95 % CI: 4,062, 4,413). Urban areas have lower NDVI and higher population densities, leading to more preventable deaths compared to rural areas. The health impact analysis results underscore the need for strategic greenness development, prioritizing urban areas and vulnerable populations considering potential inequities in greenness access and health disparities. The findings provide evidence-based recommendations for policymakers and stakeholders to promote healthy and sustainable development.