Can climate-resilient city construction promote healthier middle-aged and older adults? Evidences from China

To proactively mitigate climate risks, address the growing challenge of population aging, and promote sustainable well-being among older adults, the Chinese government launched a pilot program for climate-resilient cities (CRC). However, empirical evidence on the health impacts of CRC initiatives for middle-aged and older populations remains limited. This study integrates data from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020) with the China City Statistical Yearbook. The difference-in-difference (DID) estimation strategy was applied to assess the causal effects of CRC implementation on health outcomes among middle-aged and older adults. The construction of climate-resilient cities significantly improved self-rated health. The health benefits of CRC development were mediated through reduced exposure to extreme weather events, improved air quality, enhanced energy efficiency, and better outcomes in cognitive function, social participation, and thermal adaptability. Subgroup analyses revealed stronger positive effects among individuals with chronic diseases, as well as those living in urban areas and western regions of China. Climate-resilient city initiatives substantially enhance the health and well-being of middle-aged and older adults, particularly in vulnerable populations and regions. These findings highlight the importance of incorporating climate resilience into urban planning and public health strategies to address both environmental challenges and population aging.