With growing health risks from climate change and a trend of increasing carbon emissions from coal, it is time for China to take action. The rising frequency and severity of extreme weather events in China, such as record-high temperatures, low rainfall, severe droughts, and floods in many regions (along with the compound and ripple effects of these events on human health) have underlined the urgent need for health-centred climate action. The rebound in the country's coal consumption observed in 2022 reflected the great challenge faced by China in terms of its coal phase-down, over-riding the country's gains in reducing greenhouse gas (GHG) emissions. Timely and adequate responses will not only reduce or avoid the impacts of climate-related health hazards but can also protect essential infrastructures from disruptions caused by extreme weather. Health and climate change are inextricably linked, necessitating a high prioritisation of health in adaptation and mitigation efforts. The 2023 China report of the Lancet Countdown continues to track progress on health and climate change in China, while now also attributing the health risks of climate change to human activities and providing examples of feasible and effective climate solutions. This fourth iteration of the China report was spearheaded by the Lancet Countdown regional centre in Asia, based at Tsinghua University in Beijing, China. Progress is monitored across 28 indicators in five domains: from climate change impacts, exposures, and vulnerability (section 1); to the different elements of action, including adaption (section 2) and mitigation, and their health implications (section 3); to economics and finance (section 4); and public and political engagement (section 5). This report was compiled with the contribution of 76 experts from 26 institutions both within and outside of China. The impending global stocktake at the UN Framework Convention on Climate Change 28th Conference of the Parties (COP28), the UN initiative on early warning systems (which ...