Sustainable age-friendly cities and communities in China: a scoping review and narrative assessment of national policies

Background: Climate change, aging populations, and rapid urbanization intersect to pose public health challenges in China, impacting the livelihoods of older adults. This review maps China's national policies shaping Sustainable Age-Friendly Cities and Communities (AFCC), highlights supporting sub-national innovations, and identifies potential policy gaps and opportunities. Methods: We searched 26 national government websites for policy documents published from January 1, 2020, to December 20, 2024, screening 35,809 records and including 125 that met criteria. Findings: National frameworks (National Strategy for Climate Change Adaptation 2035, Healthy China 2030, Healthy Cities) have parallel efforts linking climate resilience and healthy aging. However, policy domains are siloed: age-friendly policies focus on healthcare accessibility, whereas sustainability policies target ecological restoration. Sub-national innovations, such as 15-min life circles, sponge cities for flood, "one old, one young" inter-generational hubs, advance climate adaptation. The large-scale Three-North Shelter Forest Program indirectly benefits older adults respiratory risk by controlling dust and desertification. However, these initiatives run in parallel, with limited shared targets, data systems, and co-financing. Institutional fragmentation and regional disparities in geographic, economic, and administrative capacities impede uniform implementation, risking inefficient spending and missed synergies. Interpretation: Effective action on concurrent aging and climate risks hinges on policy-and-practice integration of AFCC and sustainability agendas. Age-friendly plans should include sustainability and vice versa. China's administrative grid and large-scale ecological programs provide infrastructure for delivery of dual-benefits. Funding: This work is supported by the World Health Organization (WPRO/2024-02/AGE-DHP/22552 4), the National Natural Science Foundation of China (82422064, 82250610230, 42307535, 42577488), the Natural Science Foundation of Beijing (IS23105), and the National Bureau for Disease Control and Prevention (20241660047).