Construction activities drive half of China's ambient PM_2.5 health burden

Construction activities generate substantial air pollutants and greenhouse gas emissions, contributing heavily to ambient PM_2.5 exposure and associated mortality worldwide. In China, rapid urbanization has driven a massive expansion of the construction sector, with emissions arising from building material production, onsite operations, upstream supply chains, and operational energy use in buildings. Although end-of-pipe controls have markedly lowered pollutant emissions since 2013, further reductions are increasingly costly, and air quality and climate policies remain poorly integrated. The full lifecycle health burden imposed by construction-related air pollution, its temporal evolution, and the scope for health co-benefits from decarbonization-particularly across urban and rural divides-have been incompletely characterized. Here we integrate a detailed construction emission inventory, input-output analysis, inverse atmospheric modelling, and health impact assessment to quantify these impacts in China from 2000 to 2019. We show that construction-related emissions, including upstream power and industrial sources, caused 1.10 million (95% CI: 0.83-1.37 million) premature deaths in 2019, accounting for 50% (95% CI: 38-62%) of national ambient PM_2.5-attributed mortality. Health burdens evolved through three phases: rapid increase with 130% CO₂ growth during intense urbanization (2000-2008), decoupling via pollution controls that averted 0.36 million deaths despite rising CO₂ (2008-2015), and synergistic declines from energy-mix optimization and technology upgrades (2015-2019). Urban mortality stems predominantly from upstream industrial emissions, whereas rural mortality is driven by residential heating; decarbonizing power and heavy industry offers the largest urban co-benefits, while rural clean-electricity heating requires concurrent power-sector greening to prevent CO₂ penalties. These results position the construction sector as a pivotal target for integrated policies that jointly advance air quality, public health, and climate objectives.