Consumption-driven health burdens within borders: China's interprovincial transfers

China's clean-air strategies have led to remarkable improvements in air quality and public health, representing a critical environmental achievement. Building on this progress, understanding the spatial distribution of health benefits provides important insights for future policy optimization. Historically, the country's interprovincial economic networks have shaped the geographic distribution of pollution and health burdens, with emissions often occurring in industrial production regions while consumption benefits accrue in economic centers. This study provides a quantitative assessment of how historical economic linkages have influenced environmental health distribution patterns, integrating multi-regional input–output (MRIO) data, emission inventories, population exposure maps, and mortality estimates across 31 provinces over the 2012–2017 period. Using a consumption-based responsibility framework, the analysis quantifies the transfer of PM₂.₅-attributable premature deaths between producing and consuming provinces and examines how these spatial patterns evolved during this transformative period. Results show that approximately 40.0% of PM₂.₅-related premature deaths in 2015 were associated with production serving consumption in other provinces. Coastal economic hubs such as Beijing and Shanghai sourced over 80% of their consumption from other provinces, while inland industrial regions including Hebei, Shandong, and Shanxi experienced mortality rates up to three times higher than implied by their own consumption. Despite a one-third national reduction in PM₂.₅ concentrations, these historical development patterns persisted along east-to-inland economic corridors. By examining historical patterns of economic development and environmental health outcomes, this study offers evidence-based insights for future policy design. Learning from these spatial dynamics and embedding spatial equity considerations into fiscal and business strategies, strengthening interregional coordination mechanisms, and promoting comprehensive supply-chain accountability are essential steps toward aligning clean-air progress with sustainable and just development goals in China's next phase of ecological civilization construction. • In 2015, approximately 40% of PM2.5 premature deaths were driven by consumption outside the province of death. • Shanghai & Beijing externalized >85% of consumption-attributed deaths; Hebei absorbed 149 net—approximately 2× its footprint. • Net exporter/importer rankings stayed mostly stable (2012–2017) despite major overall air-quality gains. • Top 20 transfer corridors account for >50% of flows, enabling targeted bilateral action over system-wide measures.