Nature-Based Solutions, Climate, and Health in Chinese Cities: A Secondary Analysis of an English-Language Systematic Review with Implications for Urban Policy and Practice

Abstract

Urban nature-based solutions (NbSs) are increasingly deployed to address climate risks, yet their health co-benefits remain poorly understood. This paper presents a secondary analysis of 90 peer-reviewed, English-language China-specific studies drawn from a registered systematic review covering January 2015 to April 2025. Evidence was analyzed by geographical distribution, NbS category, climate-adaptation pathway, health outcome, and greenness measurement, with complementary comparison against 88 non-China-specific studies. Air-quality pathways and physical-health outcomes predominated, whereas heat received less attention, and only one study examined flood-related health. Thirty studies (33.3%) were located wholly in eastern China, while 9 of the 31 mainland provincial-level jurisdictions lacked dedicated or separately reported evidence. Setting-based greenery dominated the five-category NbS classification. Of 126 association units, 100 (79.4%) were favorable; null or adverse findings were confined to specific exposures or contexts, including allergenic or low-diversity vegetation and reduced visibility. Although the two subsets covered broadly similar topics, China-specific studies relied more heavily on aggregate greenness indices (e.g., NDVI: 73.3% versus 45.5%), less often distinguished vegetation types or strata (14.4% versus 36.4%), and included no studies treating urban trees or community gardens as distinct exposures. These findings support five China-specific policy priorities and adapt four international policy themes to Chinese governance contexts.