Neoliberal reforms have economically transformed China, increased income inequality and changed the nature of the built environment. This chapter first develops a conceptual framework for examining patterns of intra-urban change and their effects on health behaviour and health outcomes. Using this framework two major themes are addressed: the growth of income inequality and its association with health outcomes and smoking and ways in which the pattern of urban development has affected the social distribution of smoking and increased health inequalities. While the evidence is fragmentary, there is some suggestion that social differences in urban smoking are beginning to conform to those expected from Yang X.Y., Barnett R. (2021) Income Inequality, Urban Development and Smoking. In: Barnett R., Yang T., Yang X.Y. (eds) Smoking Environments in China. Global Perspectives on Health Geography. Springer, Cham. https://doi.org/10.1007/978-3-030-76143-1_6the western diffusion model.