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.

Understanding and mitigating PM_2.5 and ozone (O₃) pollution remains challenging due to the nonlinear atmospheric chemistry and spatially heterogeneous nature of pollutant emissions. Traditional forward modeling approaches suffer from high computational cost and limited diagnostic resolution to precisely attribute emissions sources at fine spatial, temporal, and chemical scales. Adjoint modeling has emerged as an efficient alternative, enabling high-resolution, multi-pollutant source attribution in a single integrated framework; however, its application to simultaneous PM_2.5–O₃ pollution episodes is limited, particularly in densely populated regions experiencing complex co-pollutant interactions. Here we apply a newly developed multiphase adjoint of the Community Multiscale Air Quality (CMAQ) model to quantify the emission sensitivities of PM_2.5 and O₃ concentrations during pollution episodes in major urban agglomerations. Our results indicate that local emissions predominantly drive PM_2.5 concentrations, contributing up to 79 μg m⁻³. In contrast, O₃ episodes are largely initiated by regional transport (3.8–7.3 ppbv), surpassing local emission contributions during episode onset. The sensitivity analyses reveal distinct spatial emission signatures and pollutant-specific influences from critical precursors, including volatile organic compounds (VOCs; up to 15.9 ppbv O₃, 11.4 μg m⁻³ PM_2.5), nitrogen oxides (NO_x; 16.6 ppbv O₃, 13.8 μg m⁻³ PM_2.5), and ammonia (NH₃; up to 8.7 μg m⁻³ PM_2.5). This study demonstrates the diagnostic strength and predictive capabilities of adjoint modeling in unraveling complex source–receptor relationships. By offering detailed, pollutant-specific emission sensitivity information, our approach provides a robust foundation for precision-driven emission control strategies and improved cross-regional policy coordination, substantially advancing air quality management frameworks.

Chinese cooking features several unique processes, e.g., stir-frying and pan-frying, which represent important sources of household air pollution. However, factors affecting household air pollution and the vertical variations of indoor pollutants during Chinese cooking are less clear. Here, using low-cost sensors with high time resolutions, we measured concentrations of five gas species and particulate matter (PM) in three different sizes at multiple heights in a kitchen during eighteen different Chinese cooking events. We found indoor gas species were elevated by 21%–106% during cooking, compared to the background, and PMs were elevated by 44%–159%. Vertically, the pollutants concentrations were highly variable during cooking periods. Gas species generally showed a monotonic increase with height, while PMs changed more diversely depending on the cooking activity's intensity. Intense cooking, e.g., stir-frying, pan-frying, or cooking on high heat, tended to shoot PMs to the upper layers, while moderate ones left PMs within the breathing zone. Individuals with different heights would be subject to different levels of household air pollution exposure during cooking. The high vertical variability challenges the current indoor standard that presumes a uniform pollution level within the breathing zone and thus has important implications for public health and policy making.