Urbanisation and human health in China: Spatial features and a systemic perspective

Background, aims and scope: Current studies have paid little attention to the dynamism in urban spatial expansion and its possible environmental and health effects or to the health effects of rapid urban environmental change at different points along the urbanisation gradient. This study adopts a public health ecology approach to systematically understand the relationship between urbanisation, urban environmental change and human health in China. Method: Remote sensing image analysis, based on night light data at five different time periods in recent decades, was used to determine changes to the overall urban area. Through a review of the evidence on the relationships between environmental health, urbanisation and health, we advance a pathway framework for explaining urban human health ecology. The Spearman rank correlation coefficient was used to measure the correlation between disease prevalence and urbanisation level, adding a further dimension to a systemic understanding of urban health. Results and conclusions: Urban areas have been increasing spatially, but unevenly, in recent decades, with medium and small cities also expanding rapidly in the past decade. Urbanisation and urban expansion result in changes to land use/coverage change, the urban environment and the residents' lifestyle, which result in human health problems. Regions with the highest urbanisation level were more inclined to have a high prevalence of chronic disease in recent decades. An ecological public health approach provides insights into the multiple types of data which need to be routinely collected if human disease is not to become a barrier to social and economic development.