Governance and Innovation in Building Smart Healthy Cities: Multi-city evidence from China

As digital infrastructure increasingly reshapes urban governance, Chinese cities are exploring diverse pathways to integrate health systems with smart city technologies. This study selected four typical cities in China, Hangzhou, Shenzhen, Chengdu and Shijiazhuang, which are constructing smart healthy cities through distinct governance models. Using case studies, interviews, and policy analysis, three emergent types of digital health governance are identified: platform-led integrated systems, institution-anchored service ecosystems, and government-enabled multi-stakeholder collaborations. Hangzhou exemplifies a platform-centered model, leveraging city-wide digital infrastructure for cross-sectoral coordination. Shenzhen demonstrates a hospital-led strategy that enhances clinical efficiency through integrated digital platforms. Chengdu adopts a government-facilitated, equity-oriented approach linking industrial innovation and community-based services. Shijiazhuang illustrates a technocratic model prioritizing standardized digital rollout in second-tier contexts. Despite differences in institutional design, population profile, and digital maturity, all cities aim to enhance service accessibility, data interoperability, and system responsiveness. Rather than converging on a single model, cities navigate context-specific trajectories shaped by local governance capacity, policy priorities, and demographic demands. The study argues for an adaptive, modular approach to policy transfer, focusing not on wholesale replication but on identifying transferable components such as data standards, inter-agency platforms, and inclusive digital tools. This multi-case analysis contributes to the understanding of digital health integration in urban settings and provides conceptual and practical insights for shaping smart health city development in China and comparable international contexts.