The Effect of Urbanization on Population Health: Evidence From China

Can public hospital reform reduce medical resource mismatches? Evidence from China

BACKGROUND

The mismatch of medical resources is a significant issue in global healthcare, undermining both service accessibility and system efficiency. In China, despite the implementation of the "Healthy China" strategy, persistent mismatches remain due to factors such as industrialization, urbanization, and population aging. This study empirically evaluates the impact of Public Hospital Reform (PHR) on mitigating these mismatches.

METHODS

A Difference-in-Differences (DD) approach is applied to panel data from 300 cities spanning 2010 to 2021, using the phased implementation of PHR as a quasi-natural experiment. This allows for a comparative analysis of changes in resource allocation between cities that adopted the reform and those that did not. Quantile regression assesses the effects of PHR across varying levels of resource mismatch, while mechanism tests investigate how PHR influences mismatches through cost reduction and supply expansion.

RESULTS

PHR is found to reduce medical resource mismatches by 13.9%, primarily driven by cost reductions and increased resource supply. The effects are more pronounced at both lower and higher levels of mismatch, with a limited impact at mid-levels. Furthermore, the reform's effectiveness diminishes as it is extended to more cities, suggesting a potential saturation effect.

CONCLUSIONS

This study demonstrates that PHR significantly alleviates medical resource mismatches in China. The findings underscore the need to focus on cost control and resource supply in future healthcare reforms, providing key insights for policymakers in developing countries facing similar healthcare resource challenges.

Urban sprawl impact assessment on the land surface temperature over the green capital of Gujarat using a geospatial approach

In developing countries, examining land use land cover (LULC) change pattern is crucial to understanding the land surface temperature (LST) effect as urban development lacks coherent policy planning. The variability in LST is often determined by continuously changing LULC patterns. In this study, LULC change effect analysis on LST has been carried out using geometric and radiometric corrected thermal bands of multi-spectral Landsat 7 ETM + and 8 TIRS/OLI satellite imagery over Gandhinagar, Gujarat, in the years 2001 and 2022, respectively. Maximum likelihood classification (MLC) was applied to assess LULC change while an NDVI-based single-channel algorithm was used to retrieve LST using Google Earth Engine (GEE). Results showed a substantial change in built-up (+ 347.08%), barren land (- 50.74%), and vegetation (- 31.66%). With the change in LULC and impervious surfaces, the mean LST has increased by 5.47 ℃. The impact of sparse built-up was seen on vegetation and agriculture as a maximum temperature of > 47 ℃ was noticed in all LULC classes except agriculture, where the temperature reached as high as > 49 ℃ in 2022. Since Gandhinagar is developing a twin-city plan with Ahmedabad, this study could be used as a scientific basis for sustainable urban planning to overcome dynamic LULC change and LST impacts.

Spatial effects of township health centers' health resource allocation efficiency in China

Introduction

China is a large agricultural nation with the majority of the population residing in rural areas. The allocation of health resources in rural areas significantly affects the basic rights to life and health for rural residents. Despite the progress made by the Chinese government in improving rural healthcare, there is still room for improvement. This study aims to assess the spatial spillover effects of rural health resource allocation efficiency in China, particularly focusing on township health centers (THCs), and examine the factors influencing this efficiency to provide recommendations to optimize the allocation of health resources in rural China.

Methods

This study analyzed health resource allocation efficiency in Chinese rural areas from 2012 to 2021 by using the super-efficiency SBM model and the global Malmquist model. Additionally, the spatial auto-correlation of THC health resource allocation efficiency was verified through Moran test, and three spatial econometric models were constructed to further analyze the factors influencing efficiency.

Results

The key findings are: firstly, the average efficiency of health resource allocation in THCs was 0.676, suggesting a generally inefficient allocation of health resources over the decade. Secondly, the average Malmquist productivity index of THCs was 0.968, indicating a downward trend in efficiency with both non-scale and non-technical efficient features. Thirdly, Moran's Index analysis revealed that efficiency has a significant spatial auto-correlation and most provinces' values are located in the spatial agglomeration quadrant. Fourthly, the SDM model identified several factors that impact THC health resource allocation efficiency to varying degrees, including the efficiency of total health resource allocation, population density, PGDP, urban unemployment rate, per capita disposable income, per capita healthcare expenditure ratio, public health budget, and passenger traffic volume.

Discussion

To enhance the efficiency of THC healthcare resource allocation in China, the government should not only manage the investment of health resources to align with the actual demand for health services but also make use of the spatial spillover effect of efficiency. This involves focusing on factors such as total healthcare resource allocation efficiency, population density, etc. to effectively enhance the efficiency of health resource allocation and ensure the health of rural residents.

How does urbanization affect the cognitive function among older adults: A geospatial analysis in China

There has been a plethora of studies on urbanization and older adults, and more recent ones on how older adults adapt to this process with their cognitive competence. Yet it has been unclear about the relationship between them, like how the level and rate of urbanization affect the cognitive function among older adults. This study sourced, formed, and analyzed a set of geospatial big datasets from different sources, such as the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data, and the NPP/VIIRS nighttime light (NTL) data. Results showed a generally negative linear association between the rate of urbanization and cognitive performance among older adults in China. The "U" shaped non-linear relationship between urbanization level and cognitive function, as well as the tipping point, were identified. At the same time, it should be noted that mediators such as education, physical activity, social activity, and community elderly service might be able to mitigate these negative associations. Furthermore, older adults living in eastern regions or urban areas appeared to have better cognitive function than those living in mid-western regions or rural areas in China. The findings also pointed to the importance of focusing on older adults with poor cognitive health status in rapidly urbanizing areas.

Characterization and childhood exposure assessment of toxic heavy metals in household dust under true living conditions from 10 China cities

Health hazards caused by metal exposure in household dust are concerning environmental health problems. Exposure to toxic metals in household dust imposes unclear but solid health risks, especially for children. In this multicenter cross-sectional study, a total of 250 household dust samples were collected from ten stratified cities in China (Panjin, Shijiazhuang, Qingdao, Lanzhou, Luoyang, Ningbo, Xi'an, Wuxi, Mianyang, Shenzhen) between April 2018 and March 2019. Questionnaire was conducted to gather information on individuals' living environment and health status in real-life situations. Multivariate logistic regression and principal component analysis were conducted to identify risk factors and determine the sources of metals in household dust. The median concentration of five metals in household dust from 10 cities ranged from 0.03 to 73.18 μg/g. Among the five heavy metals, only chromium in household dust of Mianyang was observed significantly both higher in the cold season and from the downwind households. Mercury, cadmium, and chromium were higher in the third-tier cities, with levels of 0.08, 0.30 and 97.28 μg/g, respectively. There were two sources with a contribution rate of 38.3 % and 25.8 %, respectively. Potential risk factors for increased metal concentration include long residence time, close to the motorway, decoration within five years, and purchase of new furniture within one year. Under both moderate and high exposure scenarios, chromium showed the highest level of exposure with 6.77 × 10-4 and 2.28 × 10-3 mg·kg-1·d-1, and arsenic imposed the highest lifetime carcinogenic risk at 1.67 × 10-4 and 3.17 × 10-4, respectively. The finding highlighted the priority to minimize childhood exposure of arsenic from household dust.

Unveiling the health consequences of air pollution in the world's most polluted nations

Air pollution poses a persuasive threat to global health, demonstrating widespread detrimental effects on populations worldwide. Exposure to pollutants, notably particulate matter with a diameter of 2.5 µm (PM2.5), has been unequivocally linked to a spectrum of adverse health outcomes. A nuanced understanding of the relationship between them is crucial for implementing effective policies. This study employs a comprehensive investigation, utilizing the extended health production function framework alongside the system generalized method of moments (SGMM) technique, to scrutinize the interplay between air pollution and health outcomes. Focusing on a panel of the top twenty polluted nations from 2000 to 2021, the findings yield substantial insights. Notably, PM2.5 concentration emerges as a significant factor, correlating with a reduction in life expectancy by 3.69 years and an increase in infant mortality rates by 0.294%. Urbanization is found to increase life expectancy by 0.083 years while concurrently decreasing infant mortality rates by 0.00022%. An increase in real per capita gross domestic product corresponds with an improvement in life expectancy by 0.21 years and a decrease in infant mortality rates by 0.00065%. Similarly, an elevated school enrollment rate is associated with a rise in life expectancy by 0.17 years and a decline in infant mortality rates by 0.00032%. However, a higher population growth rate is found to modestly decrease life expectancy by 0.019 years and slightly elevate infant mortality rates by 0.000016%. The analysis reveals that per capita greenhouse gas emissions exert a negative impact, diminishing life expectancy by 0.486 years and elevating infant mortality rates by 0.00061%, while per capita energy consumption marginally reduces life expectancy by 0.026 years and increases infant mortality rates by 0.00004%. Additionally, economic volatility shock presents a notable decrement in life expectancy by 0.041 years and an increase in infant mortality rates by 0.000045%, with inflationary shock further exacerbating adverse health outcomes by lowering life expectancy by 0.70 years and elevating infant mortality rates by 0.00025%. Moreover, the study scrutinizes the role of institutional quality, revealing a constructive impact on health outcomes. Specifically, the institutional quality index is associated with an increase in life expectancy by 0.66% and a decrease in infant mortality rates by 0.0006%. Extending the analysis to examine the nuanced dimensions of institutional quality, the findings discern that economic institutions wield a notably stronger positive influence on health outcomes compared to political and institutional governance indices. Finally, the results underscore the pivotal moderating role of institutional quality in mitigating the deleterious impact of PM2.5 concentration on health outcomes, counterbalancing the influence of external shocks, and improving the relationships between explanatory variables and health outcome indicators. These findings offer critical insights for guiding evidence-based policy implications, with a focus on fostering resilient, sustainable, and health-conscious societies.

Relative and absolute inequalities in cerebrovascular disease mortality rates: exploring the influence of socioeconomic status and urbanization levels in Taiwan

BACKGROUND/OBJECTIVE

Limited evidence exists regarding the socioeconomic inequalities in cerebrovascular disease (CBD) mortality at different urbanization levels. Therefore, this study was conducted to assess the socioeconomic inequalities and urbanization levels in township-based CBD mortality in Taiwan.

METHODS

Socioeconomic variables, including the percentages of low-income households, individuals with a university education and above, and tax payments, were measured at the township level from 2011 to 2020. Urbanization was also determined by the national survey and divided into seven levels. Age-standardized mortality rate (ASMR) of CBD was calculated using a Geographic Information System (GIS) in 358 townships. The effects of socioeconomic variables and urbanization levels on relative and absolute inequalities in township-based CBD mortality rates were examined.

RESULTS

Significant differences in ASMR of CBD were observed across all socioeconomic status indicators over the years. Higher proportions of low-income households were associated with higher ASMR of CBD. Conversely, there were negative correlations between higher proportions of individuals with a university education and above and tax payments with ASMR of CBD. The regression analysis indicated significant impacts of relative and absolute socioeconomic inequalities on ASMR of CBD. Additionally, a moderation effect of socioeconomic variables and urbanization on CBD mortality rates was observed, with rural areas showing sensitivity to these factors.

CONCLUSION

Although ASMR of CBD showed significant decreases over time, socioeconomic inequalities in CBD mortality rates persist. Interventions targeting socioeconomic inequalities in health outcomes, especially in rural areas, are needed to address this issue.

Association of land urbanization and type 2 diabetes mellitus prevalence and mediation of greenness and physical activity in Chinese adults

The prevalence of type 2 diabetes (T2D) is higher in urban than in rural areas. Limited information is available on the association between T2D and Land urbanization (LU) while LU influences not only greenness and Particulate Matter 2.5 (PM2.5) but also inhabitant behavior. We aimed to explore the association between the LU level and T2D prevalence, as well as whether greenness, PM2.5, or conscious physical activity mediated any of the observed associations. This study encompassed 27,633 adult participants from Shandong Province who completed the sixth National Health Service Survey in 2018. Ambient LU exposure was estimated by spatial characteristics, including the existing impervious surface area (ISA), road density (RD), and annual night light (NL). Exposures were estimated using satellite images and OpenStreetMap, with 1000 m used as the main analysis buffer. Two-level logistic regression models were used to investigate the association between the LU metrics and T2D. Additionally, we explored potential mechanisms of the association through mediation analysis. The prevalence of T2D among participants was 5.14%, with average exposures to ISA_1000m of 1.441 km2, RD_1000m of 3.856 km/km2, and NL_1000m of 9.821 nW/cm2/sr. Higher levels of LU exposure were associated with higher T2D ORs [for each interquartile of ISA_1000m, RD_1000m, and NL_1000m, the adjusted OR (95% CI) for the T2D prevalence were 1.29 (1.19-1.4), 1.25 (1.15-1.36), and 1.25 (1.15-1.36), respectively]. This relationship persisted in several sensitivity analyses including use of different buffer sizes. We observed stronger associations among participants younger than 65 years or in men. Greenness mediated a 20.78%-65.36% of the estimated associations, conscious physical activity mediated a 10.35%-15.85%, while PM2.5 mediated insignificantly. These results suggest a deleterious association between higher levels of LU and T2D among adult residents in a developing country. Greenness and conscious physical activity mediate the association.

Study on association factors of intestinal infectious diseases based-Bayesian spatio-temporal model

BACKGROUND

Intestinal infectious diseases (IIDs) are a significant public health issue in China, and the incidence and distribution of IIDs vary greatly by region and are affected by various factors. This study aims to describe the spatio-temporal trends of IIDs in the Chinese mainland and investigate the association between socioeconomic and meteorological factors with IIDs.

METHODS

In this study, IIDs in mainland China from 2006 to 2017 was analyzed using data obtained from the China Center for Disease Control and Prevention. Spatio-temporal mapping techniques was employed to visualize the spatial and temporal distribution of IIDs. Additionally, mean center and standard deviational ellipse analyses were utilized to examine the spatial trends of IIDs. To investigate the potential associations between IIDs and meteorological and socioeconomic variables, spatiotemporal zero-inflated Poisson and negative binomial models was employed within a Bayesian framework.

RESULTS

During the study period, the occurrence of most IIDs has dramatically reduced, with uneven reductions in different diseases. Significant regional differences were found among IIDs and influential factors. Overall, the access rate to harmless sanitary toilets (ARHST) was positively associated with the risk of cholera (RR: 1.73, 95%CI: 1.08-2.83), bacillary dysentery (RR: 1.32, 95%CI: 1.06-1.63), and other intestinal infectious diseases (RR: 1.88, 95%CI: 1.52-2.36), and negatively associated with typhoid fever (RR: 0.66, 95%CI: 0.51-0.92), paratyphoid fever (RR: 0.71, 95%CI: 0.55-0.92). Urbanization is only associated with hepatitis E (RR: 2.48, 95%CI: 1.12-5.72). And GDP was negatively correlated with paratyphoid fever (RR: 0.82, 95%CI: 0.70-0.97), and bacillary dysentery (RR: 0.77, 95%CI: 0.68-0.88), and hepatitis A (RR: 0.84, 95%CI: 0.73-0.97). Humidity showed positive correlation with some IIDs except for amoebic dysentery (RR: 1.64, 95%CI: 1.23-2.17), while wind speed showed a negative correlation with most IIDs. High precipitation was associated with an increased risk of typhoid fever (RR: 1.52, 95%CI: 1.09-2.13), and high temperature was associated with an increased risk of typhoid fever (RR: 2.82, 95%CI: 2.06-3.89), paratyphoid fever (RR: 2.79, 95%CI: 2.02-3.90), and HMFD (RR: 1.34, 95%CI: 1.01-1.77).

CONCLUSIONS

This research systematically and quantitatively studied the effect of socioeconomic and meteorological factors on IIDs, which provided causal clues for future studies and guided government planning.

The impact of healthcare industry convergence on the performance of the public health system: a geospatial modeling study of provincial panel data from China

Objective

This paper examines the impact of healthcare industry convergence on the performance of the public health system in the eastern, central, and western regions of China.

Methods

Public health performance was measured by a composite index of three standards: average life expectancy at birth, perinatal mortality, and maternal mortality. The healthcare industry convergence was measured using a coupling coordination degree method. The spatial lag, spatial error, and spatial Durbin models were used to estimate the effect of healthcare industry convergence on public health system performance and this effect's spatial dependence and heterogeneity across eastern, central, and western China using panel data from 30 Chinese provinces from 2002 to 2019.

Results

The convergence of the healthcare industry significantly promotes regional public health [β =0.576, 95% CI: (0.331,0.821)]. However, the convergence does not have a spatial spillover effect on the public health system at the national level. Additionally, analysis of regional heterogeneity shows that the direct effects of healthcare industry convergence on public health are positive and statistically significant for Eastern China, statistically insignificant for Central China, and positive and statistically significant for Western China. The indirect effects are negative, statistically significant, positive, statistically significant, and statistically insignificant for these three regions, respectively.

Conclusion

Policy efforts should strengthen the convergence between the healthcare industry and relevant industries. It can produce more current healthcare services to improve public health and reduce regional health inequality.

How urbanization affects residents' health risks: evidence from China

Continued urbanization requires a deep understanding of how urbanization affects residents' health risks. This study used regression analysis of Chinese provincial-level panel data from 2004 to 2019 and empirically analyzed the nonlinear effects of urbanization on health risks and regional differences using STIRPAT model. Health risks were assessed by the average number of residents' visits to medical facilities and population mortality. We also examined the moderating effect of income and environmental factors. The results show that (1) urbanization increases the average number of residents' visits and reduces population mortality. The positive effect of urbanization in increasing the average number of visits is reinforced by an increase in income level and environmental pollution, whereas the negative effect of urbanization in reducing population mortality is weakened by environmental pollution. (2) Regarding long-term trends, urbanization has an N-shaped relationship with the average number of residents' visits, and a U-shaped relationship with population mortality; (3) Urbanization has an N-shaped relationship with the average number of residents' visits in the eastern, central, and western regions and an inverted N-shaped relationship with population mortality in the eastern region. Urbanization has significant effects on residents' health risks in areas with high levels of infrastructure. According to the results, suggestions are proposed, such as developing new-type urbanization, improving infrastructure, focusing on green urbanization, and promoting national fitness programs.

The impact of the digital economy on occupational health: A quasi-experiment based on "Broadband China" pilot

The recent years' booming digital economy can not only benefit businesses, but also be an important way to improve people's wellbeing. This paper aimed to identify the relationship between the digital economy based on the "Broadband China" pilot policy and occupational health by applying DID method. The empirical results highlight that occupational health in the pilot cities of "Broadband China" are significantly improved compared with those in non-pilot cities, indicating that the digital economy can significantly improve occupational health. However, this effect varies across regions with different levels of economic development. Compared with developed areas, the digital economy has a more obvious effect on the improvement of occupational health in less developed areas, which indicates that this effect conforms to the law of diminishing marginal effect. Therefore, the digital economy should be continuously promoted to improve occupational health. Governments at all levels should strengthen the network infrastructure to provide a good basic environment for the development of the digital economy. At the same time, governments should introduce more detailed digital economy goals and programs according to the actual situation of their jurisdictions to fully release the economic and social benefits of the digital economy.

The wellbeing of adolescents and the role of greenness: A cross-sectional study among Italian students

Introduction

Adolescence is a critical period of life, and the level of wellbeing acquired during this stage might have an influence on health status in adulthood. The wellbeing of adolescents is associated with both biological and environmental determinants. To date, few studies have evaluated the effect of exposure to urban green spaces (i.e., greenness) on adolescents' wellbeing. Therefore, the aim of this study is to assess the association between exposure to greenness and the wellbeing of adolescents, accounting for the level of urbanization surrounding schools.

Methods

In the frame of the 2018 Italian Health Behaviour in School-aged Children (HBSC), we analyzed cross-sectional data from the Piedmont Region. Exposure to greenness was quantified by the Normalized Difference Vegetation Index (NDVI). Schools were geocoded, and a fixed buffer (radius 1,500 m) centered on each school was then built to enable average NDVI calculations. Adolescents' wellbeing was assessed by self-reported psychological, somatic, and psychosomatic health complaints as follows. Respondents were asked how often, in the last 6 months, they had experienced: (a) headache, (b) stomachache, (c) backache, (d) dizziness, (e) feeling low, (f) irritability or bad temper, (g) feeling nervous, and (h) difficulties getting to sleep using the HBSC Symptom Checklist (HBSC-SCL), an eight-item tool. Multivariable, multilevel logistic regression models tested the association between exposure to NDVI and psychosomatic, somatic, and psychological health complaints, one at a time, using schools as a random intercept.

Results

In total, 2065 subjects (47.6% girls) aged 11 (48.4%) and 13 (51.6%) years were involved. Greenness was found to be inversely associated with reported psychosomatic (OR 0.72, 95% CI: 0.53-0.98) and psychological health complaints (OR 0.67, 95% CI: 0.49-0.92) in boys only, adjusting for age, urbanization level, and socioeconomic status, and stratifying by gender.

Discussion

Our results support the implementation of future policies for urban environmental design supporting the increase of green spaces, as suggested by the United Nations Sustainable Development Goals. Further studies are needed to confirm our findings.

How does urbanization affect public health? New evidence from 175 countries worldwide

Urbanization is an essential indicator of contemporary society and a necessary historic stage in the industrialization of all countries. Thus, we explore the impact of urbanization on public health using the OLS estimation and a two-way fixed effect model based on annual panel data from 175 countries from 2000 to 2018. This paper also addresses potential endogeneity issues and identifies causal relationships using the coefficient stability tests, system GMM, and instrumental variable method. The results demonstrate that urbanization positively affects public health. Furthermore, we find that the impact of urbanization on public health can be mediated through living standards, and nations with higher living standards reduce the effect of urbanization on public health. An increase in the urbanization rate can promote public health by improving residents' living standards. Our results have significant real-world implications for the research of urbanization and the formulation of public health policy.

Gender differences in association of urbanization with psychological stress in Chinese adults: A population-based study

Objective

To investigate the gender-specific associations between exposure to urbanization and psychological stress in China experiencing rapid urbanization.

Methods

Data were obtained from the 2015 China Health and Nutrition Survey. A total of 4,388 men and 5,098 women aged at least 18 years were obtained from 288 communities across 12 provinces and municipalities. Tertiles of the urbanization index, summarizing 12 urbanization dimensions at the community level, were used to define low, medium, and high levels of urbanization. The psychological stress was measured based on the 10-item Perceived Stress Scale. The gender-stratified multilevel analysis (Level-1: Individuals, Level-2: Communities, and Level-3: provinces/municipalities) was used to estimate the association between exposure to urbanization and psychological stress.

Results

After controlling for age, education status, marital status, work status, household income per capita, current smoking, alcohol drinking, sleep duration, BMI, and chronic conditions, the urbanization index was negatively associated with psychological stress in women (P _trend = 0.017) but not men (P _trend = 0.476). More specifically, a one-standard deviation increase in the score of community population density (β = -0.329, P = 0.329), modern markets (β = -0.247, P = 0.044), education (β = -0.448, P = 0.002), and housing (β = -0.380, P = 0.005) was negatively associated with psychological stress only in women, separately.

Conclusion

Our data revealed that living in the most urbanized communities is associated with lower levels of psychological stress for women but not men. Thus, this study can help empower decision-makers to accurately target vulnerable communities and plan effective strategies to address psychological outcomes.

How Does Government Efficiency Affect Health Outcomes? The Empirical Evidence from 156 Countries

This paper uses the unbalanced panel data of 156 countries during the period of 2002 to 2018 to explore the possible impact of government efficiency on health outcomes. Firstly, we used the fixed-effect model to examine the relationship between government efficiency and health outcomes and found that the increase in government efficiency can significantly improve health outcomes. Then, a series of robustness checks were carried out, which confirmed the reliability of the above result. Thirdly, this paper conducted a heterogeneity analysis from the perspective of life cycle. Fourthly, this paper investigated the mechanisms of the impact of government efficiency on health outcomes from the perspectives of economic growth, health innovation, education and corruption control. Finally, this paper studied the moderating effects of the ruling party’s ideology and democracy on the relationship between government efficiency and health outcomes. The findings of this study provide some references for governments to improve health outcomes.

Life Satisfaction of Rural-To-Urban Migrants: Exploring the Influence of Socio-Demographic and Urbanisation Features in China

Objectives: China has experienced an ongoing urbanisation that associated with spatial transformation and personal changes, which are expected to have direct or indirect impacts on migrants’ health and well-being. This study aims to investigate their life satisfaction and the significant influences.

Method: A quantitative research strategy was adopted, with the questionnaire survey towards 877 migrants across Hangzhou and Ningbo cities. Descriptive statistics showed migrants’ life satisfaction, socio-demographic characteristics and urbanisation features. Three logistic regression models examined key factors that influenced life satisfaction.

Results: Over one third of migrants were unsatisfied with their life. They mainly received education lower than high school and had an annual household income less than 60k. Comparatively, migrants, who worked in formal sectors, moved into resettlement communities and adapted to city life, tended to have higher levels of life satisfaction.

Conclusion: There should be an improvement in migrants’ life satisfaction. This could be achieved by building up their educational level and financial capability. Meanwhile, positive actions such as professional training are required to maximise their participation in formal sectors as well as community life.

Conflict or Coordination? Spatiotemporal Coupling of Urban Population-Land Spatial Patterns and Ecological Efficiency

The coordinated relationship between urban population–land spatial patterns (UPLSPs) and ecological efficiency (EE) is conducive not only to the rational utilization of resources and environment and the sustainable development of society, but also to the provision of a living environment that benefits public health. Identifying the coupling relationship of urban development and EE can provide critical information for urban planning. Previous studies have mainly focused on the coupling relationship between urban population and land, urbanization, and ecological development, while ignoring that between UPLSPs and EE. This study integrates several models to construct a novel framework for coupling UPLSPs and EE. Taking Hubei Province as the research area, we calculate the UPLSPs, EE, and their coupling coordination degree for 12 cities from 2000 to 2019. The paper offers several conclusions. (1) the urban population–land spatial matching degree increased, but the overall matching level was not high; the average value of EE showed an “N”-shaped change trajectory, and its overall level was low, with small changes and obvious regional differences. (2) The average value of the coupling coordination degree between UPLSPs and EE was a slow upward trend, with a radial distribution high in the middle and low in the periphery. There was conflict between the spatial patterns and EE, and the former restricted the development of the latter. (3) There were strong correlations between coordination degree and various indicators of UPLSPs and EE. While we should revitalize the stock of construction land and optimize the upgrading of the industrial structure, we also must coordinate human and land resources and the ecological environment, and narrow regional development differences. This study provides a new framework for urban environmental assessment and urban planning decision-making.

Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces

China’s immunization programme is relatively strong, with latest WHO-UNICEF monitoring rates for 2019 showing national vaccination coverage over 90%. However, vaccination coverage is heterogeneous, varying across geographic regions, rural–urban communities, and sub-populations. We conducted a qualitative study from a critical realist perspective, analyzing semi-structured interviews with 26 vaccination providers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. We analyzed data thematically, using deductive and inductive coding. Providers reported vaccination coverage in their areas had increased significantly, but remained lower among migrant and left-behind children. Main coverage determinants were child-related (i.e. gender, number, health status), caregiver-related (i.e. socioeconomic status, role, education level, ethnicity), institution-related (i.e. vaccinator numbers, information system, appointment process), and system-related (i.e. vaccine supply, intersectoral cooperation, vaccine ‘hesitancy’). Potentially effective measures to promote vaccination coverage included using routine maternal and child health-care visits for catch-up vaccination, providing additional health education, conducting follow-up family visits by village doctors, and requiring vaccination verification at school enrollment. This is the first qualitative study to examine potential determinants of low vaccination coverage in these areas of China. Findings can inform policies to strengthen the role of schools, develop the national immunization information system, and promote appointment apps. More consideration is needed to improve service quality and eliminating inequities, such as strengthening health education and service provision for migrant and left-behind children.

The Effect of Urbanization on Health Care Expenditure: Evidence From China

This paper investigates the impact and non-linear effects of urbanization on health care expenditure in China. The results indicate that urbanization in both Eastern and Central regions can significantly increase health care expenditure. But the impact of urbanization is not significant, which is related to the backward economic development level and low urbanization rate in the Western region. Taking population aging into consideration, the results of the panel threshold regression model imply that the positive relationship between urbanization and health care expenditure becomes greater when the level of population aging exceeds 10.72% in the Eastern region and 7.00% in the Western region. Therefore, in the urbanization process, the government should pay attention to the positive effect of urbanization on health care expenditure, provide more financial support for the construction of medical facilities, and expand the coverage of medical services and security for residents, especially for elderly people.

Spatio-Temporal Analysis of Population-Land-Economic Urbanization and Its Impact on Urban Carbon Emissions in Shandong Province, China

New-type urbanization is a dynamic process composed of numerous elements and multiple subsystems. Coordination and coherence of various subsystems are critical for promoting urban-rural integration and regional synergistic development and will have a complicated impact on sustainable development in the trade-off between socioeconomic growth and environmental conservation. This paper theorized the interconnected and mutually influential coupling coordination relationship between population-land-economic urbanization (PLEU) and the mechanism by which this relationship affects urban carbon emissions. The Wavelet Neural Network (WNN), Coupling Coordination Degree model, and econometric model were used to reveal this relationship and mechanism. A total of 17 cities in Shandong Province, China, were used as study subjects for empirical examination. The results show that the level of PLEU in Shandong was significantly improved from 2007 to 2016, but the gap between cities tended to further expand. The 17 cities gradually got rid of the antagonistic disorder issue of the coupling coordination relationship of PLEU from 2007 to 2016, spatially showing the agglomeration characteristics with Qingdao and Jinan as the core, respectively. The influence of the coupling coordination degree of PLEU on urban carbon emissions presents an inverted, U-shaped characteristic, that is, the total urban carbon emissions will first increase and then decrease as the improvement of the coupling coordination relationship of PLEU. China’s new-type urbanization has provided an efficient solution to sustainable development, namely planning and designing at the highest strategic level to establish scientific goals. This new-type urbanization strategy could provide an effective alternative for other emerging countries worldwide, for addressing the challenges to sustainable development.

Epidemiology of Antepartum Stillbirths in Austria-A Population-Based Study between 2008 and 2020

(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22⁺⁰ gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20⁺⁰/40 was 3.10, ≥22⁺⁰/40 3.14, and ≥24⁺⁰/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33⁺⁰ (27⁺²–37⁺⁴) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58–8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83–3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020.

The Impact of Local Economic Growth Target Setting on the Quality of Public Occupational Health: Evidence From Provincial and City Government Work Reports in China

This article uses data from the government work reports of 31 provinces (autonomous regions and municipalities) in China and 21 cities in Guangdong Province of China to perform a fixed effect regression. It was found that economic growth target constraints and economic growth target gaps between countries and provinces, or between provinces and cities have a significant impact on the quality of public occupational health. The non-linear relationship between economic growth target setting and the quality of public occupational health was then discussed in detail, and the reliability of basic conclusions drawn was ensured by robustness and endogeneity tests. The results show that the effect of economic growth target constraints and gaps on the quality of public occupational health shows a “U-shaped” trend at both the provincial and city levels, which initially promotes and, eventually, inhibits. This relationship is closely related to the current economic system reforms, administrative reforms, and social transformation in China. Therefore, in emphasising high-quality economic development, the government should fully consider the actual state of the development of jurisdictions in setting economic goals to improve the quality of public occupational health in an orderly manner.

Effects of Smart City Construction on the Quality of Public Occupational Health: Empirical Evidence From Guangdong Province, China

This article takes the Guangdong Province of China as the research object and uses the difference-in-difference model to evaluate the impact of smart city construction on the quality of public occupational health and intercity differences. The obtained results show that smart city construction significantly improves the quality of public occupational health, and it is still valid after a series of robustness tests. The effect of this policy is stronger in cities that belong to the Pearl River Delta region or sub-provincial level cities. This study indicates that the central government should improve the pilot evaluation system and the performance appraisal mechanism of smart cities from the perspective of top-level design during the process of promoting smart city construction, which aims to correctly guide local governments to promote the construction of smart cities. To achieve the full improvement effect of smart city construction on the quality of public occupational health, local governments should implement smart city strategies in a purposeful and planned way according to the actual situation of the development of the jurisdiction.

The Impact of Digital Economy on Residents' Health: Based on the Perspective of Population Ageing

This paper uses panel data from inland provinces of China to perform a fixed effect regression and finds that the development of the digital economy has a significant promotional effect on the health of residents. Then, the population ageing rate is further used as a threshold variable for a threshold regression, and the relationship between the development of the digital economy and the health of residents from the perspective of ageing is discussed. The empirical results show that the ageing of the population will reduce the role of the digital economy in promoting residents' health. There is a non-linear single threshold effect between the development of the digital economy and residents' health indicators. In areas of China with a better developed digital economy, when the ageing rate exceeds the threshold, the positive impact of the development of the digital economy on population health has increased compared with the population ageing below the threshold. These asymmetric developments are closely related to economic development, historical and cultural factors, and policies formulated by the government. Therefore, as the digital economy continues to advance, the government should also provide health services fairly and efficiently, and formulate effective Internet assistance policies for the elderly so that the development of the digital economy can more comprehensively promote the health of residents of all ages.