Shifting vehicle management to performance-based for better air quality and health.

Excessive NOX emissions from heavy-duty trucks (HDTs) pose a global health threat. Current emission management strategies, which primarily rely on regulatory standards to identify potentially high emitters, fail to effectively address real-world pollution. Using a comprehensive HDT inspection dataset from China (4.8 million HDTs), we identify high emitters and evaluate various management strategies. Validated against real-world measurements, our analysis shows that performance-based policies targeting actual high emitters significantly outperform standard-based strategies in climate, air quality, and health co-benefits. Performance-based approaches yield 76 billion CNY (95 % CI: 56-99) in health benefits from PM2.5 and O3 reductions, plus 65 billion CNY (4-126) in carbon mitigation benefits-more than twice the gains of standard-based policies while far exceeding the added cost of 4.0 billion CNY (-14-22). Subsidizing the replacement of pre-China V vehicles with new type-approval models proves inefficient, whereas electrification substantially improves cost-effectiveness. These findings underscore the need to adopt performance-based strategies and prioritize truck electrification to maximize efficiency and public health benefits.