Spatial disparities and dynamic evolution of the coupling coordination among environment, income, healthcare, education, and health systems in China

Health and sustainable development are global priorities, and China has designated the achievement of a “Healthy China” as one of its overarching development goals by 2035. Advancing the integrated development of environment, income, healthcare, education, and health (EIHEH) constitutes an important avenue for achieving the “Healthy China” strategy. Drawing on the coupling coordination degree (CCD) framework, this study measures the CCD of the EIHEH system for Chinese provinces over the period 2011–2023. To further investigate spatial heterogeneity, Dagum Gini coefficient decomposition and spatial kernel density estimation are employed to characterize and decompose regional disparities. The analysis further indicates the dynamic evolution patterns across the analyzed period. The following is a summary of the findings: (1) Toward the end of the observation period, China’s EIHEH system had largely settled into a state of primary coordination, and all four major regions reaching either primary or intermediate coordination. (2) Although the overall gap in CCD has gradually decreased, spatial imbalances still exist. Inter-regional differences remain the main contributor to these disparities. (3) Considering spatial factors and temporal trends, significant spatial correlations were observed in CCD between most provinces and their neighboring provinces. This study offers theoretical insights and policy suggestions to facilitate the realization of the “Healthy China” strategic objective and advance balanced regional development.