The Development Of Healthy City In Hubei Province:Based On Spatial Perspective

BackgroundUrbanization is an inevitable outcome of social and economic development and also a trend in the global.However,the acceleration of urbanization has brought a series of urban and population health problems,which pose a serious challenge to the equalization and accessibility of health resources and public services.No healthy city,no healthy people.As an important starting point of"Healthy China"strategy,"Healthy City"plan is the main way to realize"health care for all"and health promotion.As a strategic highland in central China,Hubei province is striving to build a"Hubei model"of healthy China.It is the right time to understand the progress and precise positioning of healthy city construction.ObjectiveIn the study of visualization analysis,we aimed to make an accurate and comprehensive analysis of Healthy City literature in China,to grasp the research focus and frontier trends in this field,and to make sense of the research status of Hubei province.In the study of construction and evaluation of Healthy City in Hubei province,we aimed to master the degree of development and to find the effect and deficiency.Through the Geographic Information System(GIS)technology,we aimed to understand the spatial distribution regularities in the construction of healthy cities,explore the spatial distribution characteristics,determine whether the construction of healthy cities was affected by neighboring areas,and understand the possible influencing factors.MethodsIn the study of visualization analysis,we used the software CiteSpace5.8.R3 to analyze the co-occurrence of multiple authors,scientific research institutions,keywords with strong citation bursts,keywords clustering,and so on.The 46 evaluation indicators of Healthy City in Hubei province were established based on the 42 indicators from Establishment and Evaluation of National Healthy Cities(2018 edition).Two or three rounds of correspondence were conducted using the Delphi method to determine expert weights for each indicator,and by calculating the Kendall Coefficient and the Coefficient of Variation to clarify the consistency of expert opinions.After dimensionless processing was conducted,the comprehensive index evaluation method was used to calculate the healthy city index of each city,including the aspects of the environment,society,service,population,and culture.Two independent sample t-tests and two independent sample non-parametric tests were applied to compare the difference between national hygienic cities and provincial hygienic cities.The difference with target values was also compared.Then,a geospatial distance matrix was constructed with the software ArcGIS 10.7.The global spatial autocorrelation analysis was conducted to confirm the existence of spatial aggregation.Spatial aggregation types were identified by local spatial autocorrelation analysis and visualized by the LISA agglomeration map.A Getis-Ord Gi*analysis was carried out to identify hot spots and cold spots.And last,we applied the ordinary least square method to establish a classical regression model testing for influencing factors of healthy cities.Based on it,a spatial lag model or spatial error model was selected to test spillover effects of healthy cities according to the results of Lagrange Multiplier test or robust Lagrange Multiplier test.The comparison among"Wuhan 1+8"Metropolitan,"Xiang-Shi-Sui-Shen"urban agglomeration,and"Yi-Jing-Jing-En"urban agglomeration was conducted,meanwhile,quantile regression was used to deal with the stability of models.The R~2,Akaike’s Information Criterion,and Schwarz Criterion were used to evaluate the fitting degree of the model.According to the results of spatial econometric regression models,we estimated the healthy city index for each city and then used the Markov chain to calculate transition probabilities.P<0.05 was considered statistically significant.Results(1)A total of 369 articles were involved in this bibliometric analysis.The first research on Healthy City in China was published in 1991,and the number of publications generally showed an upward trend.Shanghai was the region with the largest number of publications,and Hubei ranked eighth.The academic level and the quality of published journals had a way to getting to the first-class standard.The top five keywords with high frequency and centrality were"healthy city","health promotion","urbanization","healthy community",and"health".It formed 11 cluster modules,with the cluster module value Q of 0.670 and the average contour value S of0.946,showing a credible result.The early emerging burst keywords were"public health"and"health care",and the top three with the highest intensity were"healthy China","health",and"evaluation".(2)In the construction of Healthy City Index System in Hubei province,the second round of expert consultation showed that the Kendall coefficient and variance of all indicators were acceptable,the expert’s authority coefficient was larger than 0.7,and the positive coefficient was 100%.The healthy city index system included five dimensions,namely healthy environment,healthy society,healthy service,healthy population,and healthy culture,covering 46 three-level indicators.It was found that the comprehensive score of Yichang(112.212),Dangyang(101.237),and Shiyan(94.532)ranked in the top three,whereas Guangshui(32.496),Zaoyang(28.195),and Yicheng(5.317)were the last three.In terms of each dimension:①Eleven national hygienic cities showed a higher health environment index than the standard value,and the top three were Shiyan(40.373),Xiantao(34.053),and Huanggang(33.511),whereas 2provincial hygienic cities whose index was higher than the standard value,namely Yicheng(22.881)and Wuxue(22.502).National hygienic cities’health environment index was significantly higher than provincial hygienic cities.②The average value of the health society index of national hygienic cities was 17.081,and only Yichang held an index of 30.647 higher than the standard value.The average health society index of provincial hygienic cities was 14.624,and only Danjiangkou held an index of 26.619higher than the standard value.There was no significant difference between national and provincial cities(P=0.255).③The average value of the health service index of national hygienic cities was 14.038,and only Yichang held an index of 30.647 higher than the standard value.The average value of the health service index of provincial hygienic cities was 13.670,and Yicheng held the highest score of 17.844.There was no statistical difference between national and provincial cities(P=0.785).④Seven national hygienic cities showed a higher health population index than the standard value,and the top three were Dangyang(29.428),Xiantao(22.783),and Wuhan(21.556),whereas 2 provincial hygienic cities whose index was higher than the standard value,namely Hanchuan(25.412)and Honghu(20.705).National hygienic cities’health population index was significantly higher than provincial hygienic cities.⑤The average value of the health culture index of provincial hygienic cities was 9.124,and Yichang held the highest score of 15.108.The average value of the health culture index of provincial hygienic cities was 7.533,and Honghu held the highest score of 12.942.There was no significant difference between national and provincial cities(P=0.280).(3)In the analysis of spatial distribution characteristics of a health city,the global Moran’I of a healthy environment,society,service,population,culture,and the comprehensive index was separately 0.797,0.876,0.603,0.773,0.965,and 0.906 with significance.The results of Anselin Local Moran’s I showed that environment,society,service,population,culture,and the comprehensive index developed high-high clusters and low-low clusters.According to the LISA map and Getis-Ord Gi*analysis,the southern part of Hubei province displayed better in the construction of healthy cities,but high-quality and low-quality regions were dispersed.(4)The spatial spillover effect existed in a healthy environment,healthy society,healthy service,and healthy culture,and the elastic coefficient was respectively 0.967,0.980,0.981,and 0.639.The goodness of fit of the models was good,and most R~2s were around 0.9.The spatial spillover effect was also significant in"Wuhan 1+8"Metropolitan,"Xiang-Shi-Sui-Shen"urban agglomeration,and"Yi-Jing-Jing-En"urban agglomeration.Gross regional product and local financial expenditure were two major factors affecting the development of healthy cities.Besides,averaged disposable income affected the healthy environment,healthy society,and health services index,population density affected the health services index,education expenditure affected the healthy society index,and urban hierarchy affected the healthy environment and healthy population.As predicted by the Markov chain,from 2017 to 2019,the average healthy environment index would increase by 0.063,and Xianning,as well as other 2cities,would transfer to higher development areas in 2019.The average healthy society index would decrease by 2.106,but Anlu,as well as other 3 cities,would transfer to higher development areas in 2019.The average healthy service index would increase by 0.989,Xiangyang,as well as other 8 cities,would transfer to higher development areas in 2019.The average healthy culture index would increase by 1.476,and Zhongxiang and Xianning would transfer to higher development areas in 2019.ConclusionsThe research on Healthy City in China is still in the rising stage of development,especially in Hubei province.In 2017,Hubei province made remarkable achievements in healthy environment and population,but the unbalanced development between and within regions is an urgent problem to be solved.Meanwhile,the healthy city construction in Hubei province had an obvious spatial aggregation effect,which was manifested as high-high clusters and low-low clusters.The spatial aggregation was roughly consistent with the distribution of"Wuhan 1+8"Metropolitan,"Xiang-Shi-Sui-Shen"urban agglomeration,and"Yi-Jing-Jing-En"urban agglomeration.Because of the strong spatial dependence,the construction of healthy cities in Hubei province should consider geographical spatial factors in the future.Considering the differences among the three urban agglomerations,it is suggested to carry out more systematic and in-depth researches and coordinate development between different regions.