Environmental performance is increasingly important in promoting officials, whose pursuit of promotions and related behavior may affect the health of residents in their jurisdictions. In this study, we spatially matched Chinese river water quality monitoring station data, enterprise pollution emission data, and resident health data and quantified how Chinese officials pursuing promotions based on environmental performance affected resident health using a regression discontinuity design and difference-in-difference with interaction terms design strategy. The results show that the upstream-downstream disparity of environmental governance and pollutant emissions affects the residents' health, medical treatment behavior, and medical expenditure. Furthermore, we identified the causal relationship between official promotion and upstream-downstream disparity and estimated the marginal effect of promotion on residents' health. The study suggests that local officials limit the pollution emissions of enterprises in the upstream river to achieve environmental performance and relax the pollution restrictions of firms in the downstream river to achieve economic performance, such that the health of residents near the river is differentially affected.
