Clean-air regulation reduces childhood wasting and overweight in China

Whether large-scale air-quality policies improve child nutrition remains uncertain. Here we show that China’s Air Pollution Prevention and Control Action Plan reduces wasting and overweight among children under five. We use annual data from 2759 counties between 2005 and 2017 and a matched difference-in-differences design to evaluate the policy as a natural experiment. The policy is associated with a 0.760% reduction in wasting and a 3.950% reduction in overweight relative to control areas. Reductions in fine particulate matter explain an estimated 57.7% and 68.9% of these respective effects. The benefits are generally larger in northern regions, resource-based cities, and counties with greater initial pollution or stronger regulation. The policy also generates at least US$120.87 million in direct health-care savings across pilot areas. These findings provide population-level evidence that clean-air regulation improves early-childhood nutrition and suggest that coordinating air-quality management with child-health policy can deliver substantial health and economic benefits in highly polluted settings. In China, the rollout of clean-air regulation has reduced both wasting and overweight in early childhood, according to analyses of county-level health and pollution data.