The Lancet's special issue on China (March 27) highlighted the daunting task for China of safe guarding environmental quality and human health while developing its economy. Positive developments such as greater life expectancy and improved survival and health of children were highlighted.The current huge shift in China's population from rural to urban areas,predicted to continue with nearly 200 million moving over the next decade,2 should focus attention and resources on some future needs and opportunities.Properly managed urbanisation can result in improvements in environment and health through centralised wastewater treatment, better quality drinking water, a more mixed and nutritious diet,and access to better health care. But rapid and unplanned or unregulated urbanisation can also result in poor environmental quality and health problems.Intensive consumption of energy and materials in urban centres causes discharge of toxic chemicals and excess nutrients via atmospheric deposition and the reuse of reclaimed wastewaters into the periurban environment, where food is produced. Reported increases in birth defects in China3 are clearly a concern that could have an environmental link.
The coming years are likely to see rapid changes in disease distributions and types in China,requiring increasing focus on urban environment and health manage- ment. Reliable monitoring systems—capable of distinguishing between regional and urban/rural trends—in environmental quality, key food items, and human health will be needed to inform decision makers at all levels.
A major challenge for China is to move towards more “sustainable cities” through risk-based environ-men tal management. The time isright. China can embrace state-of-the-art technologies in pollution control and remediation, and can benefit from better awareness of environmental quality and stringent environ mental standards now, to avoid “old” problems.We declare that we have no confl icts of interest.
