A China Environmental Health
Project Research Brief
Child Mortality and Water Pollution in
China: Achieving Millennium Development Goal 4
July 20, 2007
This research brief was produced as
part of the China Environment Forum’s partnership with Western
Kentucky University on the USAID-supported China Environmental
By Debbie Yan
China is a country of contradictions. Its 27
years of economic boom have brought 400 million people out of
poverty and created large urban centers bustling with trade.
Many Chinese urbanites live in very comfortable conditions.
Yet, in much the countryside, poverty rates of rural citizens
remain high, for farmers are increasingly losing out in
China’s economic reforms. According to an October 2006 Gallup
WorldPoll, between 2004 and 2006 the incomes of urban dwellers
rose by an average of 4,000 Yuan while rural residents saw an
increase of only 3,300 Yuan. This gap has lead to significant
challenges in equal access to a clean environment. For
example, 94 percent of urban residents claim to have running
water in their homes—a luxury that only 47 percent of rural
residents say they possess. 
Environmental degradation and pollution are two serious
factors that exacerbate poverty in China’s countryside, while
also threatening the health of vulnerable rural populations,
The Chinese government has
increasingly prioritized investment to alleviate rural poverty
issues, launching various rural development campaigns and
increasing investment into rural infrastructure in its
five-year plans. In 2006, China budgeted 50 billion Yuan for
rural construction, targeting water, roads and schools. 
In May 2007, the central government promised to give
allowances to all needy rural dwellers in an effort to shrink
the poverty gap between rural and urban citizens.
China also joined all the other UN members in signing the
United Nations Millennium Development Goals (MDGs) that aim to
cut poverty in half by 2015, from 1990 rates. There are eight
goals: (1) eradicate extreme poverty and hunger, (2) provide
universal primary education, (3) promote gender equality and
empower women, (4) reduce child mortality, (5) improve
maternal health, (6) combat HIV/AIDS and other infectious
diseases, (7) ensure environmental sustainability, and (8)
develop a global partnership for development. 
Each individual goal has one or more targets associated with
it, providing indicators for success.
According to the
2005 China’s Progress to the Millennium Development Goals
Report released by China’s Ministry of Foreign Affairs and
the United Nations in China, the country “will probably
achieve” most of the goals by 2015. 
However, when one examines the current progress towards
individual goals, the situation is more complex. Particularly
striking are China’s efforts to meet MDG 4, which aims for a
two-third reduction of the under-age-five mortality rate
between 1990 and 2015.
China’s Progress on MDG
China’s under-five child mortality rate was 27 (out
of 1,000 live births) in the year 2005, a 44 percent drop from
the 1990 rate of 49. 
India, a country of comparable size and population to China,
had an under-five child mortality rate of 74 in 2005, more
than double that of China. 
Yet a comparison with less-developed countries in East Asia
shows that both China and India are lagging behind. By the
publication of the UN Human Development Report 2005,
Vietnam had surpassed China in improving child mortality
with a 2005 under-five child mortality rate of 19. 
In the same year, Malaysia’s under-five child mortality rate
was 12. 
In order to meet the 2015 target of a two-thirds reduction in
under-five child mortality rate, China has to lower its rate
to around 16. On the surface, this goal appears achievable
after such a huge rate decrease in only 15 years, but a closer
look shows that disparities within the country may affect
China’s ability to achieve the targets of MDG
Regional and Environmental Challenges to
Lowering China’s Under-Five Mortality Rates
mortality is studied at the regional level, clear divisions
become apparent. Wealthy areas along the coast have child
mortality rates similar to those found in developed countries.
The further inland and more remote the area, the higher the
child mortality rates become. 
The causes of child mortality also vary according to region.
In the wealthier coastal areas where medical care is more
available, child death is mainly due to accidents, diabetes
and other non-communicable diseases—similar to the causes of
child death in developed countries. In remote rural areas,
birth-related reasons, acute respiratory infection, tetanus,
and diarrhea are the common child-killers. 
The majority of child deaths in rural China are preventable
with health care, education, and access to safe drinking water
and a clean environment. MDG 7, which focuses on environmental
sustainability, includes a number of targets that, if met,
would significantly improve the pollution problems currently
impacting the health of China’s rural
Clean Water and Sanitation Woes in
MDG 7 highlights the need for environmental
sustainability and includes specific targets for safe drinking
water and sanitation, both of which have strong implications
for the under-five child mortality rate. According to the
UN Human Development Report 2006, contaminated drinking
water and poor sanitation are jointly the second largest cause
of child mortality in the world. Diarrhea caused from dirty
drinking water alone causes five times the number of child
deaths that are caused by HIV/AIDS. Providing access to safe
drinking water has far greater implications than just improved
health. Water-related disease significantly impairs education,
causing missed school days and diminished learning potential.
A 2004 World Bank policy research working paper
studied the effect of environmental factors on child mortality
in rural China. 
The authors found that access to safe drinking water could
potentially cut the number of under-five child deaths from
diarrhea by over 50 percent, and the number of deaths from
acute respiratory infection by almost 40 percent. In China,
more than 300 million rural citizens, about a quarter of the
country’s total population, lack access to clean drinking
Target 10 of MDG 7 calls for a 50 percent reduction in
the number of people lacking “sustainable access” to safe
drinking water. 
In 2003, China’s State Environmental Protection Administration
reported extremely high pollution levels in its waters: more
than 70 percent of the water in five of seven major river
systems was deemed unsuitable for human use. 
In 2004, 88.8 percent of China’s urban population had access
to clean drinking water, but availability is often
significantly lower in rural areas. 
Water supply is also a serious issue, particularly in northern
China, which has less than a quarter of the per capita water
capacity of the south and thus uses its supply at
unsustainable levels. [19,20]
The Chinese government, in its Eleventh Five-Year Plan period,
aims to address water supply and pollution problems by
strengthening law enforcement and monitoring, as well as
constructing both rural and urban water supply facilities. 
China has been very successful in the past in increasing
access to water, but pollution is still a serious problem in
both rural and urban areas, and can greatly and negatively
affect the health of its people, especially the very young. 
11, also under MDG 7, is to “increase the proportion of the
rural population with access to better sanitation.” 
Diseases that are associated with poor sanitary conditions and
unsafe drinking water are still prevalent in China. Diarrhea
is still a leading cause of child death in rural areas—the
OECD Environmental Indicators in China report issued in July
2007 estimated 30,000 rural children die each year from
diarrhea caused by polluted water. 
Far fewer people—less than half—have access to adequate
sanitation than to safe water, and if no action is taken, this
gap will only widen. 
In urban China, approximately 70 percent of the population has
access to sanitation, but in rural China, this figure drops to
below 30 percent. 
Rural Guizhou, in particular, is lagging behind with only 10
percent of its population having access to adequate
Even in urban areas, sewage disposal is a problem. In rural
areas, sewage is sometimes simply dumped into the fields,
becoming a prime breeding ground for such deadly pathogens as
E. coli, giardia, and those that cause encephalitis. 
the mid-1990s, rural sanitation has become an important part
of the China’s health policy. In response to its water
sanitation problems, China has adopted a total sanitation
campaign, a community-led effort to improve sanitation and
increase awareness and education of basic hygiene and
sanitation issues. 
Yet China still has a long way to go to achieve water
sanitation levels comparable to some of its less wealthy
neighbors, such as Vietnam and Indonesia.
under-five child mortality rate is an indirect measure of
access to health care and the level of exposure to
environmental pollution. Increased sanitation, accessible and
affordable health care, and access to clean drinking water top
the list of rural China’s needs, as well as basic education
for expectant mothers. In order to achieve a two-thirds
reduction in under-five child mortality by 2015, the Chinese
government must better address the needs of its poorest
regions. By increasing investment in rural areas, preventing
the migration of dirty industries from eastern urban areas to
the rural west, creating more livelihood opportunities for
rural farmers, and committing to provide affordable and
accessible health care in its poorest regions, China can go a
long way towards not only achieving MDG4, but the overall aim
of the MDGs: the eradication of poverty.
Lee received her Master of Public Policy from the School of
Public Policy at the University of Maryland, specializing in
environmental policy. She is currently a program associate at
the Washington, D.C.-based nonprofit facilitator RESOLVE, Inc.
She can be reached at mailo:firstname.lastname@example.org.
 Wu, Tao. (2007, March 28).
“Urban-rural divide in China continues to widen.” Gallup
WorldPoll. [On-line]. Available: http://www.gallupworldpoll.com/content/?ci=27028.
 Chinese Government’s Official Web Portal.
(2006, July 4). "Central government to invest 50 bln Yuan on
rural construction." [On-line]. Available: http://english.gov.cn/2006-07/04/content_327274.htm.
 Chinese Government’s Official Web Portal.
(2007, May 24). “Government decides to subsidize all rural
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 UN Millennium Project. (2007, March 13).
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China's progress towards the millennium development
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UNICEF. (2007, February 15). “At a glance: China.” [On-line].
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development failures; region's fast growing economies could
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 Ibid., 22.
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 UNDP, 14.
 Ibid., 57.
 UN Millennium
 OECD. (2007). OECD
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 Ministry of Foreign Affairs of the
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 UNDP, 54.
 Ministry of Foreign Affairs of the People’s
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 Ministry of Foreign Affairs of
the People’s Republic of China, United Nations System in
China, p. 59.
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