Environmental risk factors, especially air and water pollution, are a major source of morbidity and mortality in China. Biomass fuel and coal are burned for cooking and heating in almost all rural and many urban households, resulting in severe indoor air pollution that contributes greatly to the burden of disease. Many communities lack access to safe drinking water and sanitation, and thus the risk of waterborne disease in many regions is high. At the same time, China is rapidly industrialising with associated increases in energy use and industrial waste. Although economic growth from industrialisation has improved health and quality of life indicators, it has also increased the release of chemical toxins into the environment and the rate of environmental disasters, with severe effects on health. Air quality in China's cities is among the worst in the world, and industrial water pollution has become a widespread health hazard. Moreover, emissions of climate-warming greenhouse gases from energy use are rapidly increasing. Global climate change will inevitably intensify China's environmental health troubles, with potentially catastrophic outcomes from major shifts in temperature and precipitation. Facing the overlap of traditional, modern, and emerging environmental dilemmas, China has committed substantial resources to environmental improvement. The country has the opportunity to address its national environmental health challenges and to assume a central role in the international effort to improve the global environment.