Spatiotemporal evolution pattern and convergence of healthy city development in China

Abstract Background Urbanization-induced urban diseases threaten public health. The World Health Organization launched the Healthy City Initiative in 1986, and China has incorporated it into the Healthy China 2030 strategy. Currently, China faces significant regional development disparities, and issues regarding the development level of the healthy city in China, as well as its spatiotemporal pattern and convergence, remain to be clarified to promote the equalization of health services. Methods Using panel data of Chinese cities from 2011 to 2022, this study constructs an evaluation system covering 4 dimensions and 25 indicators, and applies the entropy weight method to measure the development level of China’s healthy city development. Methods including exploratory spatial data analysis, spatial correlation analysis, trend surface analysis, kernel density analysis, Dagum Gini coefficient, and kernel density estimation are used to reveal the spatiotemporal pattern of China’s healthy city development. The β-convergence model is employed to conduct the convergence test. Results From 2011 to 2022, the average level of healthy city development increases from 0.149 to 0.269, representing a growth rate of 80.5%. At the regional level, it exhibits a gradient differentiation characteristic described as "the eastern region taking the lead, while the central and western regions showing similar levels below the national average". Spatially, it presents a pattern of "low levels in inland hinterlands and high levels in coastal and border areas". The global Moran’s I index ranges from 0.129 to 0.152 (P < 0.001). The Gini coefficient fluctuates downward from 0.172 to 0.123, with the contribution rate of inter-regional disparities falling within the range of 55% to 60%. The kernel density distribution curves of all regions shift continuously to the right, with the main peak widening first and then narrowing; the degree of internal differentiation in the eastern region is higher than that in the central and western regions. Significant absolute β convergence and conditional β convergence are observed both at the national level and across the three major regions. In terms of convergence speed, the western region has the fastest convergence rate (1.37%) with a half-life of approximately 51 years, the central region has a convergence rate of 1.34% with a half-life of 52 years, and the eastern region has a relatively slower convergence rate (1.00%) with a half-life of 69 years. Regarding the convergence-driving factors, economic development and government intervention in the eastern region, urbanization in the central region, and financial development in the western region promote convergence, while opening-up in the western region inhibits convergence. Conclusions Healthy city development in China shows an overall steady upward trend, but significant regional gradient disparities exist, forming a spatial pattern characterized by high-value agglomerations in coastal and border areas and contiguous low-value clusters in inland hinterlands. Regional disparities generally demonstrate a narrowing trend, with inter-regional disparities being the primary source of overall disparities; the degree of internal differentiation within the eastern region is higher than that of the central and western regions. Convergence exists at both the national level as well as across the eastern, central, and western regions. The eastern region should strengthen economic support and government intervention, the central region should promote the balanced development of healthy cities through urbanization, and the western region should increase financial support and reasonably guide opening-up, so as to drive the convergence of healthy city development. The modular framework constructed in this study, which consists of the evaluation index system, spatiotemporal pattern analysis, and convergence test, features strong universality. Moreover, the research findings can provide scientific guidance for the coordinated development of healthy cities in China and offer a Chinese practical reference for global healthy city construction.