Shifting from concentration-based to health-oriented air pollution control in China

The global shift from air quality attainment to mitigating the health impacts of air pollution, exemplified by the 2025 World Health Assembly's goal to halve pollution-related deaths by 2040, demands a new generation of policy tools. However, existing frameworks remain rooted in static assessments of population vulnerability, despite rapid demographic shifts and socioeconomic transformations. Here, we introduce a Dynamic Response Surface Model (DRSM) that integrates time-varying age structures, nonlinear atmospheric chemistry, and interregional pollution transport into a unified decision architecture to formulate a health-oriented air pollution control strategy. Applying the DRSM to China, it reveals that current policies fail to curb rising health burdens in most provinces, despite ongoing reductions in anthropogenic emissions. Population vulnerability will increasingly offset the health returns of emission reductions and exacerbate inter-provincial inequities until approximately 2060. To halt the deterioration of air pollution-related mortality, annual national emission reduction of at least 2.7% for PM2.5 precursors and 5.8% for ozone precursors is required. A health-optimized mitigation pathway for 2035, shifting control priorities from traditional megacity clusters toward central China, demonstrates a highly favorable benefit-cost ratio. This strategic reallocation not only improves cost-effectiveness but also corrects long-standing spatial imbalances in environmental policy. The DRSM establishes a new paradigm for air quality governance that transcends ambient pollutant metrics, redefining policy success by its capacity to deliver cost-effective and equitable improvements in global health and longevity.