How does the construction of China’s ecological civilization affect the health burden of urban and rural residents?

Accelerating the construction of ecological civilization and promoting the management of health environment problems is one of the core elements of the implementation of the “Beautiful China” and “Healthy China” strategies with Chinese characteristics in the new era. Based on the scientific connotation of ecological civilization, this paper systematically assesses the level of interprovincial ecological civilization construction in China using the combined CRITIC empowerment method and explores the impact of ecological civilization construction on the health burden of urban and rural residents using interprovincial panel data from 2003 to 2018 with the help of panel feasible generalized least squares, simultaneous equation estimation, and the extended regression model. It is found that there is a significant inverted U-shaped relationship between provincial ecological civilization construction and urban and rural residents’ economic health burden, as well as a significant U-shaped relationship between ecological civilization construction and urban and rural residents’ disease burden. Fiscal decentralization, urbanization, and industrialization are the three important indirect mechanisms through which ecological civilization affects the health burden of urban and rural residents, and fiscal decentralization plays a typical role in crowding out the health effect of ecological civilization. In the eastern and central regions, ecological civilization construction has effectively reduced the health burden of urban and rural residents, but it is more significant for improving the economic health burden of rural residents. While the “catching-up trend” of the progress of ecological civilization construction in the western region is obvious, ecological civilization plays an important role in alleviating the economic health burden of urban residents. After the robustness test, the conclusion still holds. This study provides an important empirical basis for local governments to improve the accuracy of their policies in promoting the “Beautiful China” and “Healthy China” strategies.