Cardiovascular Impacts of China’s Rural Clean Heating Policy

Nearly 3 billion people rely on wood- and coal-fueled stoves as their primary energy source for cooking and heating. These stoves emit high levels of household air pollution into homes and communities, and are responsible for an estimated 4.6 million cardiovascular deaths in China. New research published by and the Health Effects Institute (HEI) report indicates that clean household energy policies that replace solid fuel stoves with electric heaters can improve indoor environments and cardiovascular health.  

In 2015, the government of China launched an ambitious clean heating policy that aimed to transition tens of millions of coal-burning household to electric or gas-fueled heaters. The policy was gradually rolled out across northern China, which allowed researchers to evaluate its impact using a quasi-experimental approach. Though collaborative efforts between 91ºÚÁÏÍø researchers Jill Baumgartner and Sam Harper and multiple universities in China, the researchers leveraged this unique large-scale natural experiment and evaluated the environmental and cardiovascular impacts of this large-scale policy  

In the Lancet , the researchers used township data on cardiovascular events and village-level treatment by the policy for all of Beijing over the past decade to show that exposure to the policy reduced heart attacks by ~6.6%. In a second four-year field study conducted in 50 villages, 20 of which were enrolled into the policy during the study, the researchers collected detailed field-based measurements over four years. In villages enrolled into the policy, wintertime indoor air quality improved (~20 µg/m³, on average) and homes were warmer (+1–2°C). They also found improvements in blood pressure (~1.5 mmHg lower systolic and diastolic) and respiratory signs and symptoms. Health benefits were largely mediated by improvements in indoor air quality and temperature and were stronger in earlier treated villages. 

While the transition showed measurable environmental and health benefits, these studies also highlight remaining challenges, such as continued use of biomass fuels and regional air pollution, which kept air pollution levels above the WHO’s health-motivated guidelines in many homes. 

Together, these findings underscore the public health importance of clean household energy policies—and the need for sustained, equitable implementation to maximize their impact. 

Full-text links:  

• (The Lancet Planetary Health, 2024)  

• How Do Household Energy Transitions Work? (In Press, 2025)