Place-based ecological restoration and self-rated health: Quasi-experimental evidence from China

Large-scale ecological restoration is increasingly promoted as a strategy for environmental sustainability, but its implications for population health remain underexamined. We study whether China's national ecological restoration pilot improved residents' self-rated health, and through which pathways these effects emerged. Using six waves of the China Family Panel Studies and the staggered rollout of the pilot across prefecture-level cities, we estimate two-way fixed-effects difference-in-differences models linking policy exposure to individual health outcomes. Ecological restoration was associated with a 0.1697-point increase in self-rated health on a five-point scale. Event-study estimates showed no evidence of differential pre-policy trends, and results were robust to placebo tests, Goodman-Bacon decomposition, propensity score matching, double machine learning, instrumental-variable analyses, and adjustment for overlapping environmental policies. Mediation analyses suggest that the health gains operated through environmental and biophysical, economic and material, and psychosocial pathways, including lower PM₂.₅ concentrations, greater greenness, reduced chronic disease, longer sleep duration, more frequent exercise, improved visibility, lower income inequality, higher perceived socioeconomic status, greater life satisfaction, and higher household income. Policy exposure was also associated with lower household medical and preventive-health expenditures. These findings suggest that place-based ecological restoration can function as a population health intervention by reshaping environmental exposures, material resources, and psychosocial conditions.