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China, the world’s largest greenhouse gas emitter in 2022, aims to achieve carbon neutrality by 2060. The power sector will play a major role in this decarbonization process due to its current reliance on coal. Prior studies have quantified air quality co-benefits from decarbonization or investigated pathways to eliminate greenhouse gas emissions from the power sector. However, few have jointly assessed the potential impacts of accelerating decarbonization on electric power systems and public health. Additionally, most analyses have treated air quality improvements as co-benefits of decarbonization, rather than a target during decarbonization. Here, we explore future energy technology pathways in China under accelerated decarbonization scenarios with a power system planning model that integrates carbon, pollutant, and health impacts. We integrate the health effects of power plant emissions into the power system decision-making process, quantifying the public health impacts of decarbonization under each scenario. We find that compared with a reference decarbonization pathway, a stricter cap (20% lower emissions than the reference pathway in each period) on carbon emissions would yield significant co-benefits to public health, leading to a 22% reduction in power sector health impacts. Although extra capital investment is required to achieve this low emission target, the value of climate and health benefits would exceed the additional costs, leading to $824 billion net benefits from 2021 to 2050. Another accelerated decarbonization pathway that achieves zero emissions five years earlier than the reference case would result in lower net benefits due to higher capital costs during earlier decarbonization periods. Treating air pollution impacts as a target in decarbonization can further mitigate both CO₂emissions and negative health effects. Alternative low-cost solutions also show that small variations in system costs can result in significantly different future energy portfolios, suggesting that diverse decarbonization pathways are viable. 

China’s power system is highly regulated and uses an “equal-share” dispatch approach. However, market mechanisms are being introduced to reduce generation costs and improve system reliability. Here, we quantify the climate and human health impacts brought about by this transition, modeling China’s power system operations under economic dispatch. We find that significant reductions in mortality related to air pollution (11%) and CO2 emissions (3%) from the power sector can be attained by economic dispatch, relative to the equal-share approach, through more efficient coal-powered generation. Additional health and climate benefits can be achieved by incorporating emission externalities in electricity generation costs. However, the benefits of the transition to economic dispatch will be unevenly distributed across China and may lead to increased health damage in some regions. Our results show the potential of dispatch decision-making in electricity generation to mitigate the negative impacts of power plant emissions with existing facilities in China.