The National Security Implications of Anthropogenic Climate Change on Health: A Case Study on China
The three most severe plague pandemics in recorded history were connected to changes in the Earth’s climate. Prior to Justinian’s plague in 1540, temperatures worldwide dropped unexpectedly. In the five years preceding the Black Death, the weather was unusually wet and warm. Wetter, warmer weather also preceded the most recent modern plague pandemic that originated in China in the eighteenth century and spread to the Indian subcontinent.[i] The last 115 years have been the warmest period in history. Twenty-first century anthropogenic climate change contributes to an increase in infectious diseases and pollution-related illnesses that adversely affect human health. These negative health effects will be especially burdensome for governments of countries, such as China, with large populations and weak disease surveillance infrastructure.
Though some security studies practitioners question securitizing unconventional security issues, the impact of fossil fuels on climate change and health must be securitized. Previous research centered on securitizing pandemic disease has demonstrated that there are potential positive outcomes associated with securitizing non-traditional security topics.[ii] Securitizing non-traditional security issues, such as climate change and health, galvanizes national and international resources to guard against security implications associated with unconventional security threats.[iii] The Chinese government has been reluctant to label climate change as a security issue as it fears that appearing weak amongst the international community is an invitation for foreign intervention.[iv] To some extent, the Chinese government has securitized climate change; however, the government must treat the health implications of climate change seriously to uphold China’s security.[v] As recently as 2019, the Chinese government has begun to recognize climate change as a security issue as the government recognizes that rather failing to address health issues related to climate change may likewise prompt humanitarian intervention as other states recognize climate change’s security implications.[vi]
Fully securitizing the health effects of climate change could take various forms. For instance, China’s leadership can fully securitize the issue by speaking about climate change and health as a security threat amongst the public and elites. Framing climate change and associated negative health outcomes as a security threat brings heightened attention to the issue amongst China’s citizens, private corporations, and elites. The early effects of anthropogenic climate change on human health are becoming increasingly apparent amongst China’s 1.4 billion citizens; these health outcomes will adversely impact Chinese national security.[vii] Specifically, fossil fuel-driven health consequences threaten China’s economic security, its military strength, and the Chinese Communist Party’s (CCP) legitimacy.
The article begins with an analysis of two effects that climate change, namely as a result of burning fossil fuels that release greenhouse gases into the atmosphere, will have on human health in China and in other countries that rely on fossil fuels. These effects include higher rates of vector-borne disease and pollution-related illness. This article’s second segment highlights the long-term security implications facing the Chinese government. The section reinforces the argument that China’s leadership must fully securitize climate change and the associated negative health effects, as these health outcomes could impact China’s economic growth, military strength, and internal stability. The third section provides two recommendations to mitigate the effects of climate change on China’s health and overall security. These recommendations include fully securitizing climate change and its effects on health to garner resources and support and extending alternative fuel sources to more communities within China. The article concludes with a summary of the argument and urges the Chinese government to adapt its policies to protect China’s economy, military, and internal security from the ill effects of climate change on human health.
Climate Change and Human Health: China and Elsewhere
There is growing literature on fossil fuel-driven climate change and its connections to human health. Increased prevalence of vector-borne diseases and higher rates of cancer and respiratory illnesses are two of the most likely, and serious, effects of fossil fuel-driven climate change that will negatively impact human health and security in China and elsewhere.[viii]
The most salient risk associated with a rise in global temperature is the alteration in the development, reproduction, behavior, and population dynamics of arthropods.[x] As arthropods[xi] are ectothermic, cold-blooded organisms, they are sensitive to changes in air temperature.[xii] Higher temperatures influence the speed at which parasites, such as malaria, develop in a mosquito vector and also serve to accelerate the mosquito vector’s development. The quicker the mosquito develops, the larger the number of mosquito generations, thus creating an abundance of transmission vectors for diseases like malaria. As global temperatures rise, the areas where vector-borne diseases are found expands as changes in climate increase the number of hospitable environments for mosquitos and other disease-carrying arthropods.[xiii] Currently in China’s southwest and central regions there is a heightened risk of contracting malaria compared to other regions in northern China, Hong Kong, and Macau.[xiv] However, as greenhouse gases emitted through fossil fuel use warm the atmosphere, the distribution of malaria-carrying mosquitos could broaden to include previously unaffected areas.
Changes in precipitation as a result of anthropogenic climate change could also increase the incidence of arboviral[xv] diseases. When precipitation is heavier or lighter than previous years, this affects the prevalence of arboviral diseases transmitted via arthropod vectors. Infectious diseases such as Dengue, Chikungunya, and Yellow Fever increase in prevalence during drier seasons as households store water for peri-domestic use.[xvi] Warmer temperatures and longer dry seasons thus provide an ideal breeding environment for disease vectors like mosquitoes. Ae. aegypti mosquitoes are pervasive throughout Asia; however, yellow fever, which is commonly carried by this species of mosquito, has never been recorded on the continent. This could change as Earth’s temperature warms and Chinese cities continue to experience an average temperature increase of 1.3 degrees Celsius each year.[xvii] Heavier, more frequent rainfall and increasingly violent storms could eliminate swaths of mosquitos and other arthropods leading to a decrease in the prevalence of vector-borne diseases.
The link between climate change and vector-borne disease is complex. The potential for drastically altered precipitation patterns presents a challenge for scientists in predicting the overall effect of climate change on arthropod populations and vector-borne disease transmission rates. Due to the complex relationship between climate change and vector-borne disease and a dearth of long-term health data on this topic, more research is required to precisely predict the effects of higher global temperatures and altered precipitation patterns on vector-borne disease distribution.[xviii] Currently, there is no unequivocal evidence, in either direction, regarding the effect of changes in temperature and precipitation on vector-borne disease. The lack of conclusive evidence is not evidence that there is no link between climate change and vector-borne disease.[xix]
Household Pollution and Illness
Many households in rural China rely on solid fossil fuels, such as coal, that lead to high levels of indoor air pollution and add to China’s dangerous levels of outdoor air pollution. In spite of China’s rapid shift toward environmentally sustainable energy options, such as solar, wind, and hydropower, more than 60 percent of China’s population is located in rural areas that rely on coal and other solid fuels, such as biomass, for household power generation.[xx] The pollutants released through burning coal are converted into products of incomplete combustion (PICs). Some of the PICs released from burning coal include deadly gases like carbon monoxide, nitrogen dioxide, and forms of particulate matter.[xxi] Additional contaminants that are a byproduct of coal, such as sulfur, arsenic, lead, and mercury further pollute household air and increase the risk of life-threatening illnesses and respiratory dysfunction.[xxii]
Illnesses associated with PICs released through indoor coal use are common throughout China and could worsen if China’s rural areas do not switch to cleaner-burning alternatives. High indoor concentrations of PICs are linked to lowered immune system function and carbon monoxide poisoning. More serious health effects, such as cancer, are becoming increasingly prevalent amongst Chinese villages that use coal as their predominant fuel source.[xxiii] Cancer is having a significant impact on villages that rely on coal for energy generation, so much so that the literature has begun to referring to these communities as “cancer villages.” The World Health Organization estimates that household use of coal-based fuels contributes to 420,000 premature deaths annually in China.[xxiv] Many of these deaths are amongst women and children as they are in the home most often.[xxv] The estimated number of premature deaths as a result of household coal use is nearly 40 percent more than the estimated number of premature deaths linked to outdoor air pollution in Chinese cities with populations greater than 100,000 people.[xxvi] The health effects resulting from vector-borne diseases and pollution disproportionately impact urban dwellers and impoverished individuals in rural communities.
Climate Change’s Uneven Impact on Human Health
Understanding the impact of climate change on health and China’s overall security necessitates an evaluation of how the health effects would be distributed throughout China’s populace. The impacts of anthropogenic climate change on human health affect China’s population unevenly, as certain socioeconomic groups are more vulnerable to climate change-related effects.[xxvii] Vulnerability factors include high levels of population growth in cities, particularly in impoverished areas such as urban slums. China’s population growth rate has stagnated around half a percent annually; however, China represents nearly 20 percent of the global population. [xxviii] An estimated 10 percent of China’s population has migrated from rural to urban areas; this floating urban population constitutes the most disadvantaged group in China.[xxix] Climate change will result in more frequent extreme heat days and higher levels of air pollution that require households to use air conditioning to combat higher amounts of pollution and more heat days. Households able to afford air conditioning and insulation will feel lesser health impacts of climate change as compared to individuals from lower socioeconomic backgrounds who cannot afford such amenities or live in urban slums. Urbanization thus further exacerbates the poor social and environmental conditions for many individuals who move to large Chinese cities.
Climate change also presents health vulnerabilities for impoverished socioeconomic classes in China’s rural areas. For instance, effective and comprehensive disease surveillance and well-functioning public health infrastructure are necessary to control new and emerging vector borne diseases. In rural areas, China struggles with occasional malaria outbreaks. As previously mentioned, the prevalence of malaria in China could increase due to ongoing intensive fossil fuel use that contributes to warming global temperatures and shifts in weather patterns.[xxx] Malaria is one of the most sensitive vector-borne diseases to its environment; China’s malaria surveillance, reporting, and response mechanisms may be overwhelmed if malaria-carrying mosquitoes spread across larger areas of China’s territory and begun to affect rural populations living in China’s north.[xxxi] Overall, China’s disease surveillance infrastructure remains underfunded in impoverished rural areas, making timely and accurate reporting a concern.[xxxii]
During the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS), the Chinese government and its health authorities had difficulties collecting data on the scale and spread of the virus as China’s disease surveillance and reporting systems were lacking. China’s public health infrastructure and capacity for disease monitoring has drastically improved since the 2003 SARS outbreak; however, despite these improvements in disease surveillance, China continues to experience issues with disease surveillance in impoverished, rural areas.[xxxiii]
Compounding China’s weak disease reporting systems, the Chinese government, in the case of the SARS outbreak, was slow to implement infectious disease prophylaxis and prevention protocols in response to the growing outbreak, as the government believed reporting the outbreak would damage China’s international prestige.[xxxiv] As climate change progresses, insufficient disease surveillance and reporting systems could lead Chinese officials to systematically underreport disease outbreaks, as the current disease surveillance and reporting mechanisms fail to adapt to changes in the location and spread of vector-borne diseases.
Long-Term Security Implications
There are three long-term security implications that the Chinese government should consider as the Communist Party plans for China’s future. Climate change and its effects on human health, particularly amongst China’s most vulnerable groups, have the potential to jeopardize China’s economic security, military strength, and internal stability.
China’s Economic Security Suffers
Fossil fuel-driven climate change and its effects on human health will negatively impact China’s economic security. Wang and Mauzerall conducted a study in Zaozhuang, a city in eastern China that is dependent on coal for power generation and found that each ton of coal burned resulted in $230 in health damages due to extremely high levels of air pollution. Coal is widely used because it is a cheap energy source for power generation within China. However, once Wang and Mauzerall included environmental externalities in the price of coal, coal’s 2020 market price was seven times the current projected price.[xxxv] By 2020, Zaozhuang is projected to consume 11.5 million tons of coal, which would cost the city $2.645 billion due to adverse health outcomes linked to air pollution.[xxxvi]
Researchers from the Massachusetts Institute of Technology (MIT) also found that air pollution produced additional economic costs for China. From 1975 to 2005, MIT researchers estimated that China’s welfare losses as a result of coal use grew from $22 billion to $112 billion.[xxxvii] By 2050, researchers at MIT concluded that China would lose $120 billion in welfare due to increased pollution as a result of coal-burning power generation.[xxxviii] The World Bank estimates that between 1995 and 2003, damage to human health from air pollution in China was between 4 to 5 percent of the total GDP.[xxxix] Overall, air pollution’s effects are having, and will continue to have, a deleterious effect on the Chinese economy.[xl]
Fossil fuels could also have an indirect impact on the Chinese economy as human health in China deteriorates. Illnesses such as asthma, pneumonia, respiratory infections, and esophageal cancer are becoming common as China continues to use coal and other solid fuels in predominantly rural regions of the country.[xli] Most of the studies conducted on climate change’s impacts on human health in China were undertaken at the national or regional level to measure the economic impact of a higher burden of ill-health. Unfortunately, these high-level studies do not address inequalities within counties and cities; those most vulnerable to illness, such as those living in urban slums and rural areas, are excluded from the estimated health and economic damage associated with climate change.[xlii]
As both mild and serious terminal sickness become increasingly prevalent, China may also experience a decrease in worker productivity as employees work at a slower pace or must take time off due to illness. The burden of illness would be felt within China’s healthcare and welfare systems. The Chinese government could see a rise in the number of working-age individuals enrolling in disability or other forms of welfare programs because of illnesses connected to high levels of pollution. The larger disease burden on China’s healthcare system could further exacerbate China’s aging problem that already places a larger burden on China’s welfare and healthcare programs. As a result of decreased birth rates and longer life expectancy, China is experiencing a demographic shift.[xliii] The number of retirees and individuals over 65 years of age will increase; by 2050, most of China’s population will be over the age of 50.
The demographic shift, coupled with effects of ill-health due to higher levels of air pollution, has negative implications for China’s economy. The economic effects of a smaller working-age population are exacerbated by more individuals experiencing pollution-related illnesses that prevent them from productivity at work or prevent them from going to work. Taking both the aging and ill-health phenomena into consideration, China’s manufacturing wages are likely to increase and result in profit decreases in the manufacturing sector.[xliv] Regional rivals, like India, are projected to surpass China’s working population which could lead to a broader shift in manufacturing jobs from China to India.[xlv] In sum, the Chinese government must assume a larger role in strengthening China’s social welfare and disability system in response to climate change’s health effects that exacerbate China’s ongoing demographic transition.
China’s Military Deteriorates
China’s ongoing natural demographic shift coupled with the negative health effects of anthropogenic climate change impacts China’s military strength. As the health effects of climate change become more apparent, the Chinese military may have issues recruiting enough healthy individuals to fill its ranks. A shrinking Chinese military could force China to implement a draft to create their future fighting force; resorting to a draft may contribute to domestic backlash as individuals unwilling to complete military service would be forced into serving.
Alternatively, if China did not resort to a draft to expand its shrinking military, China could feel less secure and its adversaries may perceive China as weak and deteriorating. An insecure China may resort to aggressive and poorly calculated military action and non-military forms of aggression, such as fake news and disinformation campaigns designed to project an illusion of security to China’s domestic constituency, allies, and adversaries.[xlvi] Weakness vis-à-vis rivals like India and the United States could undermine China’s stature as the Asian hegemon and degrade China’s position in its ongoing strategic competition with the United States. Some security implications stemming from military weakness could include a smaller military presence in the South China Sea and a retrenchment of China’s Belt and Road Initiative. A weakened Chinese military thus threatens China’s ongoing strategic activities that project Chinese influence abroad and heighten China’s international prestige.
The CCP’s Legitimacy Weakens
The adverse economic and military impacts associated with a larger burden of ill-health amongst China’s population could foment domestic unrest that challenges the CCP’s legitimacy. A sicker Chinese population that cannot work full- or part-time jobs, coupled with ongoing demographic shifts, could strain healthcare and welfare systems beyond current capacity.[xlvii] Responding to a larger burden of ill-health requires the Chinese government to increase federal spending on social programs like welfare and public healthcare programs. Though China has increased its spending on social programs to nine percent of the country’s GDP as of 2012, national spending on social programs is underwhelming. Comparatively, OECD countries spend on average 22 percent of their GDP on public social programs.[xlviii] Given China’s large population, the government’s current level of public spending is insufficient to support an older, and much sicker population in the coming decades.
A situation could arise where China’s social programs are unable to support the growing number of people with climate change-related illnesses. In fact, Chinese people have already begun to protest against the negative effects of climate change, namely pollution, on their quality of life.[xlix] These events have been largely peaceful; however, future protests could turn violent as the health effects associated with climate change become more serious and widespread. Should the Communist Party fail to adequately provide for its citizens, general anti-government sentiment could result in government led violence against the Chinese people as the CCP fears appearing weak at home and abroad.
A weaker Chinese government could also have international ramifications for China. In a July 2015 report, the United States Department of Defense (DoD) identified the impacts of climate change on health in fragile or ill-equipped states as needing greater outside intervention in the form of humanitarian assistance and aid.[l] Other states could attempt to deliver health and food aid to China to combat higher rates of vector-borne disease and illnesses linked to dangerous levels of air pollution and a warming climate. Adaptation to environmental change thus requires a responsive government that can cope with a rapidly changing natural environment.[li] The Chinese government must respond quickly to the secondary health effects of climate change to protect the government’s domestic and international legitimacy. If the government fails to do so, China will experience threats to its economic and military security along with growing domestic unrest that challenges the CCP’s domestic and international legitimacy.
Recommendations for China’s Future Energy and Health Security
China should consider the following two recommendations to protect its economy, military, and domestic social order. China should fully securitize the health effects linked to climate change to elevate the salience of climate-related health concerns on China’s security agenda. Securitizing the issue is likely to propel more financial and human resources devoted to improved disease surveillance and reporting, and research into cleaner fuel sources. Securitizing climate change and its effects on health also sends a signal to the international community that China takes climate change seriously and does not require outside assistance to improve domestic environmental and health outcomes. Though securitizing climate change and the associated health effects may benefit China, securitizing non-traditional security issues could lead other states to securitize issue areas to elevate the salience of their chosen issues. Over-securitization may have the opposite of the desired effect as speaking about an array of issues as security threats devalues the salience previously associated with identifying a limited number of topics as security threats.
Second, China should extend alternative fuel sources, such as wind, solar, and hydropower to more of its regions to lessen the state’s reliance on coal. The Chinese government must extend these renewable alternatives to impoverished rural areas that rely on coal and other solid fuels for power generation. Though off-grid alternatives, such as solar-powered mini-grids, do not provide solutions to socioeconomic challenges in low-income and rural communities, mini-grids could mitigate the severity of illnesses associated with indoor and outdoor air pollution and rising global temperatures.[lii] Overall, solar-powered mini-grids may prevent higher incidences of vector-borne disease along with cancers and respiratory illnesses associated with high levels of pollution because these grids do not release hazardous byproducts into the atmosphere. Mini-grids, however, may be limited in their effectiveness at reducing industrial pollution, as solar powered mini-grids only produce enough energy for domestic use.
Slowing climate change must be one of the Chinese government’s top priorities as the CCP plans for China’s future. The government should continue to invest in renewable and alternative resources to decrease China’s use of coal and expand these cleaner energy sources to rural and impoverished communities in China. Investing in alternative sources of energy is necessary to protect China’s economic and military security and preserve domestic stability.
Climate change will adversely affect human health, both in China and elsewhere. These effects include higher rates of vector-borne disease and increased incidences of pollution-related illnesses. The impacts of climate change on human health disproportionately affect impoverished socioeconomic groups in both rural and urban areas. In turn, health outcomes linked to climate change test China’s disease surveillance apparatus and the Chinese government’s capacity to adapt to changing environmental conditions. Failure to adequately adapt to the health challenges linked to a warming planet and higher levels of air pollution threatens China’s economic and military security. Additionally, a larger burden of illness associated with climate change may undermine the Chinese Communist Party’s domestic legitimacy. A beleaguered Chinese government highlights China’s weakness to the international community as China’s health and social welfare programs are stretched to their limits.
Preventing a deterioration of China’s security environment requires the Chinese government to take two near-term actions as the Chinese government begins to acknowledge climate change and the associated health effects as security threats. First, the Chinese government must fully securitize climate change and health to signal its intent to treat the issue seriously. Securitizing climate change and its effects on health may also make available state funds to broaden China’s disease surveillance and reporting system. Second, China’s government must improve access to substitutes to coal for energy generation that are effective and low-cost. The government must work to provide widespread access to alternative energy sources to offset the outsized negative effect of indoor air pollution on human health particularly within rural communities. Solar powered mini-grids could provide alternatives to fuels such as coal, kerosene, and biomass. Addressing the impacts of climate change on human health should be one of the government’s top priorities in order to lessen China’s future disease burden that threatens the state’s economic, military, and domestic security.
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[i] Kenneth L. Gage et al., “Climate and Vectorborne Diseases,” American Journal of Preventative Medicine, vol. 35, 5 (2008), p. 443.
[ii] See Susan Peterson, “Global Health and Security: Reassessing the Links,” in The Oxford Handbook of International Security, ed. Alexandra Gheciu and William C. Wohlforth, (Oxford University Press, 2018), p. 4.
[iii] Hali Czosnek, “Responding to International Health Emergencies: Comparing the World Health Organization Response to Ebola and Zika,” (Undergraduate thesis, College of William and Mary, 2017), p. 14-15, 43.
[iv] Scott Moore and Michelle Melton, “China’s Pivot on Climate Change and Security,” Lawfare, April 2, 2019. https://www.lawfareblog.com/chinas-pivot-climate-change-and-national-security
[vii] Hai Dong Kan, “Climate Change and Human Health in China,” Environmental Health Perspectives, vol. 119, 2 (February 2011), p. A60.
[viii] Jonathan A. Patz, et al., “Global Climate Change and Emerging Infectious Diseases,” Journal of the American Medical Association, (February 1996), vol. 275, 3, p. 217.
[ix] A disease vector is defined as an agent that carries or transmits an infectious pathogen to other living organisms. Examples include mosquitos, ticks, flies, fleas, and aquatic snails. See World Health Organization, “Vector-borne diseases,” October 31, 2017. Accessed April 30, 2019. https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases.
[x] Gage et al., “Climate and Vectorborne Diseases,” p. 436.
[xi] Arthropods include species of mosquitoes and other insects.
[xii] Jonathan A. Patz et al., “Disease Emergence from Global Climate and Land Use Change,” Medical Clinics of North America, vol. 92 (2008), p. 1474.
[xiii] Daniel R. Coats, “Worldwide Threat Assessment of the National Intelligence Community,” February 13, 2018. p. 17.
[xv] Arboviruses are a group of viruses transmitted by organisms such as mosquitos, ticks, and other species of arthropods. Examples of arboviruses include Japanese and Tick-borne encephalitis, West Nile virus, dengue, yellow fever, and Chikungunya.
[xvi] Gage et al., “Climate and Vectorborne Diseases,” p. 440.
[xvii] Michael Xiaoliang Tong et al., “Infectious Diseases, Urbanization and Climate Change: Challenges in Future China,” International Journal of Environmental Research and Public Health, vol. 12 (2015), p. 11030.
[xviii] Kevin D. Lafferty, “The Ecology of Climate Change and Infectious Diseases,” Ecology, vol. 90, 4 (April 2009), p. 898.
[xix] Jonathan A. Patz, “A human disease indicator for the effects of recent global climate change,” PNAS, vol. 99, 20 (October 1, 2002), p. 12508.
[xx] Junfeng Zhang and Kirk R. Smith, “Household Air Pollution from Coal and Biomass Fuels in China: Measurements, Health Impacts, and Interventions,” Environmental Health Perspectives, vol. 115, 6 (June 2007), p. 848.
[xxi] Ibid., p. 849.
[xxiii] Robert Finkelman, Harvey Belkin, and Baoshan Zheng, “Health impacts of domestic coal use in China,” PNAS, vol. 96 (1999), p. 3431.
[xxiv] Zhang and Smith, “Household Air Pollution from Coal and Biomass Fuels in China: Measurements, Health Impacts, and Interventions,” p. 848.
[xxvii] Alistair Woodward, Simon Hales, and Philip Weinstein, “Climate change and human health in the Asia Pacific region: who will be most vulnerable?” Climate Research, vol. 11 (1998), p. 31.
[xxix] Tong et al., “Infectious Diseases, Urbanization and Climate Change: Challenges in Future China,” p. 11029.
[xxx] Ibid., p. 11027.
[xxxi] J.A. Patz et al., “Climate change and infectious diseases,” in Climate Change and Human Health: Risks and Responses, ed. A.J. McMichael et al. (Geneva: World Health Organization, 2003): p. 112.
[xxxii] Tong et al., “Infectious Diseases, Urbanization and Climate Change: Challenges in Future China,” p. 11027.
[xxxiii] Tong et al., “Infectious Diseases, Urbanization and Climate Change: Challenges in Future China,” p. 11026.
[xxxiv] Moore and Melton, “China’s Pivot on Climate Change and Security."
[xxxv] Xiaoping Wang and Denise L. Mauzerall, “Evaluating Impacts of Air Pollution in China on Public Health: Implications for Future Air Pollution and Energy Policies,” paper submitted to Atmospheric Environment, July 28, 2005, p. 18.
[xxxvi] Ibid., p. 13.
[xxxvii] Kira Matus et al., “Health Damages from Air Pollution in China,” (Massachusetts Institute of Technology: March 2011), p. 13
[xxxviii] N.E. Selin et al., “Global health and economic impacts of future ozone pollution,” Environmental Research Letters, vol. 4 (2009), p. 5.
[xxxix] Matus et al., “Health Damages from Air Pollution in China,” p. 17.
[xl] Ibid., p. 20.
[xlii] Sari Kovats and Rais Akhtar, “Climate, climate change and human health in Asian cities,” Environmental and Urbanization vol. 20, 1 (April 2008), p. 171.
[xliii] China Power Team, “Does China have an aging problem?”
[xlvi] Office of the Director of National Intelligence, “Paradox of Progress,” https://www.dni.gov/index.php/global-trends/near-future
[xlvii] Tania Branigan, “China’s welfare system: difficult, inflexible, and blatantly unfair?” The Guardian, April 23, 2013. https://www.theguardian.com/global-development/2013/apr/23/china-welfare-system-inflexible-unfair
[xlviii] “Promoting a Fair and Sustainable Welfare System in China,” Organization for Economic Cooperation and Development, March 23, 2014. http://www.oecd.org/social/promoting-a-fair-and-sustainable-welfare-system-in-china.htm
[xlix] Rachel Leung, “Hundreds of Hong Kong students skip school in call for action on climate change, joining global day for protest,” South China Morning Post, March 15, 2019. https://www.scmp.com/news/hong-kong/article/3001908/hundreds-hong-kong-students-skip-school-call-action-climate-change
[l] United States Department of Defense, “National Security Implications of Climate-Related Risks and a Changing Climate,” July 23, 2015, p. 4.
[li] Woodward, Hales, and Weinstein, “Climate change and human health in the Asia Pacific region: who will be most vulnerable?” p. 34.
[lii] Michael Aklin et al., “Does basic energy access generate socioeconomic benefits? A field experiment with off-grid solar power in India,” Science Advances, vol. 3 (May 2017), p. 4.