Public concern about these issues is also mounting. Pollution-related health problems are increasingly the cause of complaints, lawsuits and mass protests.⁴ Between 2006 and 2010, the petitioners’ department of the Ministry of Environmental Protection (MEP) received more than 300,000 environmental complaints. The MEP reports that 56 of the 232 relatively large environmental incidents occurring between 2007 and 2011 involved cases in which environmental pollution caused damage to health, as did 19 of the 37 ‘mass incidents’. As the MEP remarks, these incidents ‘caused a serious threat to the health of the masses and to social stability, and had a very negative impact (elie de yingxiang 恶劣的影响)，both domestically and abroad’.⁵

While the need for stronger environmental protection is recognized, research shows that this policy stream lacks authority, administrative rank and financial and human resources.⁷ As Hildebrandt⁸ has pointed out, for social organizations to exist in China there must be a demand for them and the state’s limited capacity to deliver environmental protection is a clear example of this demand. In recent years, China’s environmental authorities have therefore adopted a proactive approach that allows civil society actors to participate in the overarching environmental governance project.⁹

This edited volume explores the ways in which civil society actors contribute to policy innovation in China with a focus on their role as policy entrepreneurs.¹⁰ In this chapter, we look at the ways in which ENGOs are working on the impact of pollution on health, the extent to which they are engaging in policy innovation and the factors that shape their ability to do so. Our research shows that very few ENGOs are in fact able to act as ‘policy entrepreneurs’, in the sense that it is used in the literature, and that this role is restricted to international NGOs and a very small number of Beijing-based Chinese organizations. However, we also argue that this limited definition underestimates the important role that local ENGOs play in creating demand for policy innovation and in promoting more effective policy implementation. This suggests that instead of regarding policy entrepreneurship or policy innovation as the most valuable roles that ENGOs can play, it is important to understand the different contributions that different types of ENGOs can make in addressing environmental impacts on health and to design appropriate programmes to strengthen their capacity to work in this complex area.

In this chapter, we also emphasize how the specific challenges of this policy domain interact with the generic problems facing ENGOs in China. A substantial literature exists on the factors that facilitate or impede NGO work in China. However, most of this research either highlights generic capacity problems or analyses the political opportunity structures associated with different policy domains, largely as the result of their level of political sensitivity. The focus is therefore on state–NGO relations.¹¹ A major concern of this analysis has been to debate the degree of autonomy that NGOs have from the state and the range of activity that the state tolerates.¹² However, the effectiveness of NGOs depends not only on underlying state–civil society relations in China and the sensitivity of particular issues, but also on the nature of the policy domain and particularly on the level of scientific complexity and the structure of the policy networks involved. In the case of the environmental impacts on health, both of these are very complex, creating particular challenges for policy¹³ and constraining the role that ENGOs can play as policy entrepreneurs. This problem has also been noted in studies¹⁴ of the US environmental health movement, as we discuss in the conclusion.

Our study finds that, because of these factors, most ENGOs are confined to creating demand for policy innovation and more effective policy implementation and are unable to participate in the design of policy solutions. Even in this work, a lack of scientific knowledge, insufficient financial means and limited networks hamper their effectiveness. These are problems that ENGOs will need to overcome if they are to make more of a contribution to addressing environmental impacts on health.

The scientific capacity, location, finances and network resources of ENGOs tend to determine the type of activity in which they engage. Grassroots ENGOs generally focus on drawing attention to and mitigating environmentally induced health problems in their local communities. National ENGOs operating from Beijing and international NGOS with offices in Beijing are the only organizations with the capacity to attempt to participate in policy innovation at a national level. This is a natural division of labour. Grassroots ENGOs have in-depth knowledge about local problems and their networks in the local community make it possible for them to design and implement projects appropriate to local conditions. While some grassroots ENGOs have developed a scientific capacity within their organization, national and international ENGOs have higher levels of scientific capacity and more access to channels for engaging in policy advocacy activities.

However, the work of grassroots ENGOs is as important as that of national and international ones. Because of the significant investment of time and resources required to develop the capacity to work on these issues at a policy level, it may be unreasonable or undesirable for many ENGOs in China to do so. However, we should not underestimate their importance in creating demand for policy and acting as watchdogs. Furthermore, as many practitioners have noted, given that policy implementation is a challenge in itself in China, it is questionable whether attempting to change national policies is the most effective use of ENGOs’ limited resources. For these reasons, we feel that a broader governance framing, rather than one that emphasizes traditional understandings of policy innovation, is more appropriate to understanding the role of ENGOs in this issue area. At the same time, there are some clear needs to strengthen the capacity of grassroots ENGOs to work on environmental health.

The findings presented in this chapter draw on three sets of data. The first are comprehensive qualitative case studies of 27 ENGOs that focus on pollution and that are based in 15 different provinces in China.¹⁵ Kathinka Furst conducted open ended qualitative interviews between June 2012 and January 2013 as part of her doctoral dissertation research. All interviews were recorded with the respondents’ consent and later transcribed. The ENGOs are of different sizes, have different organizational lifespans and vary in the types of activities in which they engage to reduce and prevent industrial pollution and its related impacts on health. Second, we draw on data collected from an electronic survey supported by the Social Science Research Council’s (SSRC) China Environment and Health Initiative. This survey includes information from 14 ENGOs located in 12 different provinces.¹⁶ Finally, reflections from practitioners in the field, as well as the authors’ observations from working with ENGOs through the SSRC’s China Environment and Health Initiative and the Forum on Health, Environment and Development (FORHEAD),¹⁷ also informed our analysis.

This understanding of policy innovation focuses our attention on the very beginning of the policy process. However, this is a very limited part of the policy system and an even smaller part of the governance picture and this narrow definition inevitably affects our evaluation of what ENGOs are doing or might do about a given issue. We argue that a broader governance framework is more useful in understanding how Chinese ENGOs work on environment and health, but given the claim of many ENGOs that their work influences policy, and the requirement by many funding organizations that it should, we begin by examining their potential for doing this.

Innovat...