A New Dimension of Health Sustainability Model after Pandemic Crisis Using Structural Equation Model

Since the coronavirus (COVID-19) pandemic, it has been clear that the health dimension (HEDm) has a severe impact on sustainability, which was originally considered from the pillars of society, environment and economy. Hence, the integration of the health dimension into the other three pillars is plausible to define guidelines and criteria for progress monitoring and policy assessment towards a health-sustainable city. The objective of this study aims to present The Health Sustainability Model (HSM), a four-dimensional model for health sustainability (health, economy, environment, and society), using the Del-phi method to determine potential indicators agreed by eighteen experts, including physicians who deeply understand issues on health sustainability, and assess complex dimensions of health in the context of sustainability. The researchers have found that 45 indicators, later grouped into 15 elements and 4 dimensions, have a high level of agreement with Kendall's W (KW) at 0.36. The HSM was then examined by the structural equation model (SEM) with reliability and validity shown as follows: the absolute fit with CMIN/DF = 1.44, RMSEA = 0.033, GFI = 0.96, AGFI = 0.94, RMR = 0.025, and the incremental fit with NFI = 0.94, CFI = 0.98, TLI = 0.97, and IFI = 0.98. Based on the results, the model is valid, in line with the empirical data. For further application, the HSM is expected to support city planners and decision makers by identifying room for improvement in each dimension through the indicators employed in the model. In contrast to existing studies that mainly use qualitative data, by conducting quantitative assessment, the model enables policy makers to objectively evaluate conditions and appropriately design policies to improve residents' well-being.