Understanding how best to use limited land without compromising food security, health, and beneficial ecosystem functions is a critical challenge of our time. Ecosystem service assessments increasingly inform land-use decisions but seldom include the effects of land use on air quality, the largest environmental health risk. Here, we estimate and value the air quality health effects of potential land-use policies and projected trends in the United States, alongside carbon sequestration and economic returns to land, until 2051. We show that air quality health effects are of first-order importance in land-use decisions, often larger in value than carbon sequestration and economic returns combined. When air quality is properly accounted for, policies that appeared beneficial are shown to be detrimental and vice versa. Land-use-driven air quality impacts are largely from agricultural emissions and biogenic forest emissions, although incentives for reduced deforestation remain beneficial overall. Without evaluating air quality, we are unable to determine whether land-use decisions make us better or worse off.
Keywords: air quality; ecosystem services; health; land use; valuation.