Does Healthy City Development Improve Individual Health Human Capital? Evidence from a City-Level Health Index and the 2023 China Social Survey

Urban health-oriented governance has become increasingly central to improving population health and supporting sustainable economic development. This study examines whether healthy city development enhances workers’ health human capital and explores the underlying mechanisms. We construct a multidimensional Healthy City Development Index using an entropy-weighted TOPSIS approach for Chinese provincial capital cities and match it with nationally representative microdata from the 2023 China Social Survey (CSS). Workers’ health human capital is proxied by a composite index derived from physical and mental health indicators using principal component analysis. Baseline regressions show that higher levels of healthy city development are significantly associated with improved health human capital. The results remain robust to alternative outcome measures, model specifications, and sample restrictions. Mechanism analyses indicate that improved public service accessibility and healthier individual behaviors serve as important transmission channels. Heterogeneity tests reveal stronger effects among workers in eastern regions and higher-income groups, suggesting unequal returns to urban health governance. To address potential endogeneity, we employ an instrumental-variable strategy using dialect diversity and historical post office density, and the findings remain qualitatively unchanged. These results provide micro-level evidence on the health returns to urban governance and offer policy implications for narrowing emerging health disparities.