Health returns to modern heating: evidence from China

ABSTRACT

This study analyses the health effects of modern heating, using China’s centralized home heating infrastructure as a natural experiment. The underlying health mechanism is that the recipients of modern heating do not need to rely on traditional fuels to heat their homes and thus suffer from less exposure to indoor air pollution. Furthermore, the improved quality of heating leads to health improvements. This article exploits spatial and time variation in the implementation of China’s centralized heating program, utilizing a difference-in-difference framework. Spatial variation takes the form of a discrete geographical cut-off between regions that receive centralized home heating and those that do not. Results show that areas with centralized heating have a 0.13% decrease in perinatal deaths and a decrease of 1.17% in the proportion of low-birth-weight infants. This translates into about 7000 fewer deaths and about 60,000 fewer low-birth-weight infants each year. Hence, there are enormous health benefits to the public provision of modern heat as a substitute for traditional heating methods, which are shown to be injurious to early-life health. These results strongly suggest that policymakers in developing countries should consider promoting cleaner heating methods.

KEYWORDS:

• Centralized heating
• indoor air pollution
• infant health

JEL CLASSIFICATION:

• H51
• I18
• O22

Acknowledgements

I am grateful to two anonymous referees, Carlos Dobkin, Justin Marion, Jonathan Robinson, Alan Spearot and various conference and seminar participants for very valuable comments and suggestions.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ 2011 population data, China Statistics Yearbook 2012.

² There are no reliable publicly available data on annual provincial infant mortality rates. On the other hand, perinatal mortality rate is a measure just as good as, or arguably even better than, infant mortality for the purposes of this study. One of the primary differences is that perinatal mortality rate incorporates foetal deaths occurring in the third trimester, which has been strongly linked to air pollution (for example, Jayachandran 2009).

³ In addition, using aggregate data greatly reduces variation and noise that individual-level data may display. See Section III for a more detailed discussion.

⁴ Chinese government did not start publishing Health Statistics Yearbooks until 2003.

⁵ Infant mortality is a good proxy in the sense that it is a similar measure to perinatal mortality. However, it is not available annually at the province level; thus, it is not used as an outcome variable in this study.

⁶ In addition, besides the enormous health benefits to infants, clean indoor heating would likely provide considerable health benefits to adults.

⁷ As of today, there are no reliable publicly available official infant mortality rates at the city level in China. There have been some infant mortality statistics from local city yearbooks published by local governments. These infant mortality data are highly sporadic, inconsistent and selective.

⁸ For example, regional trade agreements (RTAs) with environmental provisions (Zhou, Tian, and Zhou 2017) and carbon taxes (Dong et al. forthcoming).