Despite a strong push to improve air quality, China's citizens will suffer over 2 million premature deaths annually due to pollution for decades to come, according to a recent report.
The study released last month by the Paris-based International Energy Agency (IEA) follows World Health Organization (WHO) estimates that air pollution causes at least 6.5 million premature deaths a year worldwide.
In 2014, the WHO put the death toll from air pollution for 2012 at 7 million, calling it "the world's largest single environmental health risk."
The new IEA estimate includes 3 million fatalities due to outdoor air pollution and 3.5 million more from poor indoor air quality, largely from cooking and heating with wood, coal and biomass fuels.
One-third of the deaths are occurring in China, including 1 million from outdoor pollutants and 1.2 million indoors, the IEA said in its 266-page study, which also profiled other countries and regions including India, Africa and the United States.
Bad air has shortened the average life expectancy in China by over two years, it said.
The huge toll is continuing despite major environmental efforts and an anti-smog action plan announced by China's government in 2013.
Over the past decade, the country's total sulfur dioxide (SO2) emissions fell by one-third thanks to power sector controls, while releases of the most dangerous fine particles, known as PM2.5, dropped 19 percent, the report said.
China also leads the world in renewable energy investment, pursuing its goal of doubling the low-carbon share of its energy mix to 20 percent by 2030, said the IEA.
But all the progress in China has made only a dent in its pollution problems, since coal continues to be its main source of power.
A six-fold surge in car ownership rates over the past decade has helped to drive up smog-forming nitrogen oxide (NOx) emissions by one-third.
New policies scenario
One striking conclusion of the study is that even if China follows through on all of its current air quality policies and plans through 2040, the annual number of air pollution fatalities will rise rather than fall.
Under its "new policies scenario" for China, the IEA projected that premature deaths from outdoor air pollution will increase to 1.5 million a year from 1 million in 2015, largely because the country's ageing population will be more vulnerable to health threats, particularly in cities.
At the end of 2015, China had 222 million people aged 60 or older, representing 16.1 percent of the population, the Ministry of Civil Affairs reported last week.
By 2050, one in three registered residents in Beijing will be over 60, up from 23.4 percent last year, a Civil Affairs Bureau official said.
Older citizens are likely to suffer disproportionately from vehicle exhaust in urban areas.
Despite the health effects of pollution, the average life span in Beijing has been growing, according to official figures.
Life expectancy in the capital rose slightly in 2015 to 81.95 years, the Beijing Municipal Commission of Health and Family Planning said in February.
The top fatal diseases were listed as cancer, heart diseases and cerebral vascular diseases, the official Xinhua news agency reported.
The IEA study noted that transport is not the biggest source of China's air pollution, but it stressed that "action in this sector is critically important because of the high level of human exposure to transport-related pollutants, in particular PM2.5."
The IEA expects a 40-percent decline in China's overall PM2.5 emissions by 2040 due to tougher emissions controls on power plants and industry along with cleaner fuels. But it estimated that more than 80 percent of passenger car and nearly 60 percent of road freight activity now takes place in cities.
"They just keep building more infrastructure to put more vehicles on the road," said Mikkal Herberg, research director for Asian energy security at the Seattle-based National Bureau of Asian Research.
"Even as they improve fuel quality and mileage requirements for new vehicles, the scale effect of this volume of more vehicles on the road is overwhelming the improvement in standards," he said.
Transport emissions may prove tougher to reduce than emissions from coal, which is expected to cover less than half of China's total energy needs by 2040.
"I think it's easier to make progress on the coal side than it will be on the transportation side because there's a less effective substitution opportunity," said Herberg, adding that large-scale electrification of transport is still a long way off.
New fuel standards are expected to cut NOx emissions from passenger cars by 45 percent, the study said.
So far, China's megacities have tried to control the exhaust problem by slowing the growth of new registrations. Beijing's current five-year plan would limit the number of cars on the road to 6 million by the end of next year, rising to 6.3 million in 2020, state-run ECNS news said.
The IEA said that efforts to curb indoor air pollution will succeed in reducing premature deaths to an annual rate of 970,000 in 2040 with demographic shifts, safer stoves and cleaner fuels, but 170 million people will still be using biomass for cooking and heat.
Despite the improvements, the bottom line is that reductions in indoor pollution deaths will not be enough to offset increases in outdoor pollution fatalities with policies that have been laid out so far.
By 2040, the annual rate of premature deaths in China will rise from 2.2 million now to 2.5 million, the report said.
The IEA study, which is part of its forthcoming World Energy Outlook, urges a greater environmental commitment by all countries, arguing that a 7-percent increase in total energy investment by 2040 could lower premature deaths by 3.3 million, or some 50 percent.
Clean air scenario
The "clean air scenario" includes a broadly-worded combination of more ambitious and accelerated air quality goals, new strategies for the energy sector, more effective monitoring and tougher enforcement.
Strategies would seek to boost efficiency and provide energy without combustion of fuels.
Among the specifics to reduce deaths from indoor air pollution, countries would ensure access to liquefied petroleum gas (LPG) as a substitute for wood, coal and biomass fuels.
The general approach of the IEA's policy recommendation stops short of setting specific national targets.
"There is no uniform policy prescription for air quality that is applicable to all countries and regions," it said.
But the agency argued that major life-saving advances are achievable at a worldwide cost of an additional U.S. $2.3 trillion (15.3 trillion yuan) in advanced pollution control technologies, mostly for vehicles, and another U.S. $2.5 trillion (16.6 trillion yuan) for faster energy sector transformation.
While the study provides no breakdown of the costs for China, it projects that the combination of new clean air policies would limit premature deaths from outdoor pollution to 1 million annually while reducing indoor pollution deaths to 560,000 a year.
It is unclear whether the IEA's call for greater investment will be met with an unexpected wave of international political will, but it may help to spur China's air quality campaign.
Herberg argued that the visible effects of air pollution are more likely to push the Communist Party and the government to take action, compared with the less tangible results of climate change.
"That is what's so dangerous about air pollution. They can't hide it," he said.
"They can arrest people, they can put them in prison, they can make a lot of things go away. But that's one thing they can't," Herberg said.
On Sunday, China's Ministry of Environmental Protection (MEP) issued an upbeat assessment of progress in fighting air pollution in 338 monitored cities.
Beijing, Tianjin and 11 main cities in industrialized Hebei province recorded air quality rated as "good" in 57.4 percent of the first half of this year, an improvement of 11 percentage points from the year-earlier period, Xinhua said.