During fieldwork in Lianshui, Jiangsu, I learnt that there was a high incidence of oesophageal cancer in some rural areas of the county. Later, research at the Health Bureau and a review of the literature confirmed this. In 2013, oesophageal cancer was the primary cause of death from cancer in Lianshui. The mortality rate was 49.94/100000, accounting for 34.19% of all cancer deaths, and this was approximately three times the national rural mortality rate for oesophageal cancer for that period.

The latest authoritative medical textbooks attribute the risk factors for cancer to two main sources: environmental factors and hereditary factors. Environmental factors mainly fall into three categories: chemical carcinogens, and physical and biological factors. Hereditary factors include cancers that are passed on genetically within families but also hereditary susceptibility to cancer. Purely hereditary cancers account for only a small percentage of the total and due to the interaction between genes and the environment, most human cancers are still caused by the pathogenic effect of environmental factors. The precise causes of oesophageal cancer are as yet undetermined, but a substantial volume of statistical, experimental and intervention medical research shows that the main risk factors for the disease include environmental factors, nutrition, lifestyle, and genetics.

This chapter uses an environmental history perspective to analyse the effects of changes in the water environment on the production activities and lives of villagers in Lianshui County and examine how environmental change contributes to different types of health risks.