Persistent Spatial Health Inequalities in Czechia: A Two-Decade Analysis Using a Holistic Determinants Model

Health inequalities represent a persistent and pressing public health challenge. This study investigates the spatial patterns and temporal dynamics of health inequalities in Czechia over two decades (2001–2021), using a holistic model of health determinants. The analysis is conducted at the LAU 1 regional level and incorporates 57 indicators across seven categories of contextual determinants (A.1–A.7) and a composite index of population health outcomes (B). Composite indicators were developed using the Weighted Sum Approach and spatial relationships were explored using Moran’s Index and Local Indicators of Spatial Association (LISA). Statistical significance of temporal change was tested using the Wilcoxon Signed-Rank Test, and interregional inequality was measured with the Theil Index.Results indicate that while some determinants improved, particularly economic and social conditions (A.1), education (A.2), and individual living status (A.5), others remained stagnant or deteriorated. The composite determinant index (A.1–A.7) improved between 2001 and 2011 but stagnated thereafter. Spatial clustering of low values was repeatedly observed in both urban and rural peripheral regions, with increasing disparities in access to care (A.7) and environmental status (A.4). The findings suggest that health inequalities in Czechia are structurally embedded and remain stable over time, despite policy efforts. Regional disparities reflect a complex interplay of socioeconomic deprivation, institutional capacity, selective migration, and territorial development trajectories. This study highlights the need for more targeted, locally sensitive interventions and improved coordination between health and social policy. The methodological framework is scalable and can be used for ongoing monitoring and international comparison of health inequalities.