The rapid economic growth of China in the last twenty years has caused a commensurate rise in atmospheric pollution which has had an impact on both the environment and public health. Since 2013, SO2, CO2 and nitrogen oxide levels have reached a level that may cause climate change and have adverse effects on the health of the local residents. Past environmental efficiency analyses have rarely examined economic development, air pollution and health as interacting systems; therefore, this study used a new two-stage DEA model, the Modified Undesirable EBM Two Stage DEA (Epsilon-Based Measure) to explore the environmental, economic and health efficiencies in thirty-one major cities in China. The results were as follows: while all cities needed to improve their GDP, the environmental efficiencies were continuing to rise in most cities. The health efficiency index indicated that disease efficiency had increased in most cities but declined in one third; therefore, it is necessary to strengthen treatment. The respiratory disease treatment efficiency in most cities was rising, and the room for improvement had significantly reduced. There were improvements in the mortality rate in 15 cities; however, the mortality rate treatment efficiency declined in 11 cities.

China has become the second-largest economy in the world; however, the price of its rapid economic development has been a rise in serious environmental pollution, with air quality being a major public issue in many regions. However, few previous energy and environmental sustainability studies have included the Air Quality Index (AOI) and in particular CO2 and PM2.5 emissions in their calculations and few have included regional differences, as these are difficult to describe using radial and non-radial methods. In this paper, DEA (Data Envelopment Analysis) is used to assess the energy and economic efficiencies of Chinese provinces and cities, in which the environmental pollution source variable is CO2, and the main methods applied are radial (CCR or BCC) and non-radial SBM (Slacks Based Measures). Different from past studies, this study used both a Meta Undesirable EBM (Epsilon-Based measure) method to overcome the radial and non-radial errors and geographical differences and AQI environmental pollution indicators to accurately assess the economic, energy, and environmental efficiencies. It was found that: (1) Guangzhou and Shanghai had the best four-year efficiencies, (2) the energy efficiency differences in each city were large and there was a significant need for improvements, (3) the GDP efficiencies in each city were high, indicating that all cities had strong economic development, (4) the CO2 efficiencies indicated that around half the cities had had sustained improvements, (5) the AQI efficiencies in each city were low and there was a significant need for improvement, and (6) the technological differences between the cities were large, with the efficiencies in the high-income cities being much higher than in the low-income cities.

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Past research on energy and environmental issues in China has generally focused on energy and environmental efficiencies with no models having included the public health associations or the role of the media. Therefore, to fill this research gap, this paper used a modified Undesirable Dynamic Network model to analyze the efficiency of China’s energy, environment, health and media communications, from which it was found that the urban production efficiency stage was better than the health treatment stage, and that the energy efficiencies across the Chinese regions varied significantly, with only Beijing, Guangzhou, Lhasa and Nanning being found to have high efficiencies. Large urban gaps and low efficiencies were found for health expenditure, with the best performances being found in Fuzhou, Guangzhou, Haikou, Hefei, Nanning, and Urumqi. The regions with the best media communication efficiencies were Fuzhou, Guangzhou, Haikou, Hefei, Lhasa, Nanning and Urumqi, and the cities with the best respiratory disease efficiencies were Fuzhou, Guangzhou, Haikou, Lhasa, Nanning, Wuhan, Urumqi, Xian, and Yinchuan. Overall, significant efficiency improvements were needed in health expenditure and in particular in respiratory diseases as there were major differences across the country.