This study uses satellite data to detect agricultural straw burning and estimates its impact on air pollution and health in China. We find that straw burning increases particulate matter pollution and causes people to die from cardiorespiratory diseases. We estimate that a 10 ​μg/m3 increase in PM2.5 increases mortality by 3.25%. Middle-aged and old people in rural areas are particularly sensitive to straw burning pollution. Exploratory analysis of China’s programs to subsidize straw recycling suggests that extending these programs to all the straw burning regions would bring about a health benefit that is an order of magnitude larger than the cost. •Satellite data are used to detect straw fires.•Straw burning significantly increases air pollution and cardiorespiratory mortality.•A 10 ​μg/m3 increase in PM2.5 increases monthly mortality by 3.25%.•Middle-aged and old people are particularly vulnerable to straw burning pollution.•Subsidizing straw recycling can bring about significant health benefits.