Impact of the China Healthy Cities Initiative on Urban Environment


The China Healthy Cities initiative, a nationwide public health campaign, has been implemented for 25 years. As “Healthy China 2030” becomes the key national strategy for improving population health, this initiative is an important component. However, the effects of the initiative have not been well studied. This paper aims to explore its impact on urban environment using a multiple time series design. We adopted a stratified and systematic sampling method to choose 15 China healthy cities across the country. For the selected healthy cities, 1:1 matched non-healthy cities were selected as the comparison group. We collected longitudinal data from 5 years before cities achieved the healthy city title up to 2012. We used hierarchical models to calculate difference-in-differences estimates for examining the impact of the initiative. We found that the China Healthy Cities initiative was associated with increases in the proportion of urban domestic sewage treated (32 percentage points), the proportion of urban domestic garbage treated (30 percentage points), and the proportion of qualified farmers’ markets (40 percentage points), all of which are statistically significant (P < 0.05). No significant change was found for increases in green coverage of urban built-up area (5 percentage points), green space per capita (2 square meter), and days with Air Quality Index/Air Pollution Index ≤ 100 (25 days). In conclusion, the China Healthy Cities initiative was associated with significant improved urban environment in terms of infrastructure construction, yet had little impact on green space and air quality.

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We thank all the coordinators in the cities studied and the local governments for their invaluable support. We also thank our research assistants for their great work during data collection and field studies. Special thanks to Jingjin Yu, Yong Zhang, Xiaomeng Hu, Mingzhu Yu, Yang Mei, Hongliang Qi, and Chunzhu Luo, for their coordination and technical supports. We also appreciate the efforts from Zheng Chen, Yuansong Huang, Wen Wu, and Zheng Xin, who assisted us in design and data collection. We also thank Dr. Robert E. Weiss and Dr. Xiao Chen from the University of California, Los Angeles, for their statistical support.

Author’s Contributions

QM and GC designed the study. All authors contributed to the data collection and revisions of the manuscript. DY analyzed the data and drafted the manuscript. QM coordinated the study. All authors have read and approved the final manuscript.

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Corresponding author

Correspondence to Qingyue Meng.

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Funding Information

This study was supported by the Disease Prevention and Control Bureau, National Health and Family Planning Commission of the People’s Republic of China with grant number NHFPC 2012-006.

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Yue, D., Ruan, S., Xu, J. et al. Impact of the China Healthy Cities Initiative on Urban Environment. J Urban Health 94, 149–157 (2017).

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  • China Healthy Cities
  • Urban environment
  • Inter-sector collaboration