China's Healthy City Pilot Policy Improves Physical and Mental Health Outcomes for Middle-Aged and Older Adults: A Quasi-Natural Experiment Based on CHARLS

BackgroundRapid urbanization in China has raised significant public health concerns, particularly regarding residents' physical and mental well-being. Effective interventions are urgently needed to address these issues.ObjectiveThis study evaluates the impact of China's Healthy City Pilot Policy (HCPP), introduced in 2016, on improving residents' health outcomes and examines demographic differences and mechanisms driving these effects.MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, a difference-in-differences (DID) approach was employed, along with propensity score matching (PSM-DID), placebo tests, and sensitivity analyses for robust results.ResultsThe HCPP significantly enhanced residents' health in pilot cities, leading to better self-rated health, lower medical expenses, higher life satisfaction, and reduced depression. These benefits were most pronounced among the elderly, women, less-educated individuals, and residents of rural and central-western regions. Key mechanisms included increased physical exercise, social activities, and improved air quality.ConclusionThe HCPP positively impacts urban health, especially for vulnerable groups, highlighting the urgent need to integrate health considerations into urban planning and providing valuable insights for future policy development.