Although China has one of the most densely populated coastal areas on Earth and is home to some of the world’s busiest ports, it is not protected by an International Maritime Organization-designated Emission Control Area (ECA). An ECA is a special area in which a country or group of countries can enforce more stringent ship emission standards to improve air quality and protect human health. To justify an ECA designation, countries must demonstrate both that shipping is a significant source of emissions that have negative health impacts and that the cost of reducing emissions from ships is comparable to land-based controls. As research estimates that at least 22,000 Chinese die prematurely each year as a consequence of ship-related air pollution, this paper analyzes the costs and benefits of a potential Chinese ECA in the Greater Pearl River Delta (GPRD) region.