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BACKGROUND: Pervasive use of unclean solid fuels is impeding the transition to sustainable household energy by 2030 in many low-income and middle-income countries. The coal to gas or electricity policy in rural north China effectively reduced wintertime air pollution; however, this roadmap was challenged in the nationwide clean heating renovation due to unaffordability and reliable energy supply, rendering it unsustainable. METHODS: This study developed a new, multi-pronged framework for clean cooking and heating in rural China, including both long-term and short-term heating regions, relying primarily on affordable electrification with supplemental biofuel pellets. We performed cost-benefit analysis of this cleaning approach following the cause-effect chain from changes in pollutant emissions, indoor and outdoor air quality, and monetised health outcomes. FINDINGS: (33·1-50·2) in H9, and consequently averting 51 190 (37 480-66 990) premature deaths, with the estimated monetised health benefits being nearly 2·55 (1·43-4·40) times the cost. Meanwhile, clean cooking transition for the whole rural population (scenario C2) would avert 78 740 (56 240-103 390) premature deaths, with the benefit-cost ratio of 7·70 (4·17-14·70). Combining clean cooking and heating would yield more substantial effects across the country. Costs and health benefits exhibit spatial variability and differ across age groups. INTERPRETATION: The proposed pragmatic household clean energy framework would benefit over 1 million rural residents in China who still rely on traditional solid fuels to meet basic energy needs, with the monetised health benefits notably higher than the associated cost. FUNDING: National Natural Science Foundation of China and Ministry of Education of the People's Republic of China.
Shen et al. (Sun,) studied this question.