Exports Widen the Regional Inequality of Health Burdens and Economic Benefits in India.

Both the ever-complex international and subnational supply chains could relocate health burdens and economic benefits across India, leading to the widening of regional inequality. Here, we simultaneously track the unequal distribution of fine particle matter (PM 2.5 ) pollution, health costs, and value-added embodied in inter- and intranational exports for Indian states in 2015 by integrating a nested multiregional input-output (MRIO) table constructed based on EXIOBASE and an Indian regional MRIO table, Emissions Database for Global Atmospheric Research (EDGAR), the Community Multi-Scale Air Quality (CMAQ) model, and a concentration-response function. The results showed that the annual premature deaths associated with PM 2.5 pollution embodied in inter- and intranational exports were 757,356 and 388,003 throughout India, accounting for 39% and 20% of the total premature deaths caused by PM 2.5 pollution, respectively. Richer south and west coastal states received around half of the national Gross Domestic Product (GDP) induced by exports with a quarter of the health burden, while poorer central and east states bear approximately 60% of the health burden with less than a quarter of national GDP. Our findings highlight the role of exports in driving the regional inequality of health burdens and economic benefits. Therefore, tailored strategies (e.g., air pollution compensation, advanced technology transfer, and export structure optimization) could be formulated.