Comprehensive evaluation and influencing factors of healthy cities in China's urban agglomerations

Research on urban health constitutes an important issue in the field of health geography and also a strong propeller of the Healthy China Initiative. As the main form that realizes new-type urbanization, urban agglomerations should become the primal sites for the construction of a "Healthy China". The evaluation of healthy cities' development in urban agglomerations has both theoretical and practical values. Based on the concept of urban health and its evaluation models, this paper developed an evaluation framework for healthy cities that involved multiple data sources. With 19 urban agglomerations in China as the research subjects, we used CRITIC weighting and geographical detectors to examine the geographies of healthy cities and their influencing factors in 2010 and 2020. The results were fourfold. Firstly, the urban health level of China significantly increased from 2010 to 2020, and the comprehensive health index developed towards a positive skewed distribution, along with a shift from "low in the hinterland - high in the coastal areas" to a "multipolar" pattern led by the coastal and southwest urban agglomerations. Secondly, among various dimensions of urban health, the healthy environment index became improved with narrowed regional differences; while the health services index was still polarized; health collaboration was upgraded with a strengthened intercity health network; the healthy population index slightly declined and converged to the middle. Thirdly, urban health in China has initially demonstrated the characteristics of a H-H pattern in the Yangtze River Delta and Chengdu-Chongqing regions, as well as L-L clusters in the northern urban agglomerations, the narrowed regional differences, and increasing coordination within each urban agglomeration. Fourthly, the geographical detector found that economy, urbanization and the human capital were significant external factors that affected urban health development. The explanatory power of technological innovation and opening to the outside world were also increasing. The development of healthy cities is yet to be transformed into regional health integration.