Background <p>Establishing a comprehensive national public health emergency management system is essential for ensuring population health. However, pronounced disparities in economic development and healthcare resources among China’s provinces have led to heterogeneous public health emergency response capabilities, highlighting the need for an evaluation framework that incorporates region-specific features.</p> Methods <p>Based on the ternary space theory, an indicator system was constructed across physical, social, and information dimensions. Provincial panel data from 2013 to 2021 were analyzed using game theory-based combination weighting and TOPSIS methods. SHAP analysis was employed to identify key influencing factors.</p> Results <p>Emergency response capacity improved overall but exhibited significant spatial variation, with eastern regions outperforming western areas, and a structural imbalance whereby pre-preparation in most provinces lagged behind response and recovery capacities. Regional economic development and transportation infrastructure density were identified as the most critical determinants.</p> Conclusions <p>The findings emphasize the necessity of optimizing resource allocation, enhancing medical agglomeration in underserved regions, and strengthening transportation networks to mitigate regional disparities and improve national public health resilience.</p>