A health-friendly, climate resilient, and carbon-neutral pathway would deliver major benefits to people's health and wellbeing in China, especially for older populations, while simultaneously promoting high-quality development in the long run. This report is the third China Lancet Countdown report, led by the Lancet Countdown Regional Centre based in Tsinghua University. With the contributions of 73 experts from 23 leading institutions, both within China and globally, this report tracks progress through 27 indicators in the following five domains: (1) climate change impacts, exposure, and vulnerability; (2) adaptation, planning, and resilience for health; (3) mitigation actions and health co-benefits; (4) economics and finance; and (5) public and political engagement. From 2021 to 2022, two new indicators have been added, and methods have been improved for many indicators. Specifically, one of the new indicators measures how heat affects the hours that are safe for outdoor exercise, an indicator of particular relevance given the boom in national sports triggered by the summer and winter Olympics. Findings in this report, which coincide with the UN Framework Convention on Climate Change 27th Conference of the Parties (COP27) hosted in Egypt (where much attention is being focused on adaptation for clinically vulnerable populations), expose the urgency for accelerated adaptation and mitigation efforts to minimise the health impacts of the increasing climate change hazards in China.