Spatiotemporal analysis of health poverty in China amid social change: regional inequalities, socioeconomic drivers, and policy implications

This study develops a Health Poverty Index (HPI) that integrates health rights, capabilities, and risks to analyze provincial disparities in China from 2010 to 2020. Utilizing data from the China Family Panel Studies (CFPS) encompassing 76,999 households, we measured the incidence, depth, and spatiotemporal drivers of health poverty through Geographically and Temporally Weighted Regression (GTWR). The results indicate a national decline in HPI from 0.338 to 0.163, with incidence rates falling from 68.5% to 37.9%. However, the reduction in poverty depth was marginal (from 0.494 to 0.429, a marginal reduction of 0.065). Western provinces, such as Guizhou (HPI = 0.503 in 2010), exhibited higher initial HPI but experienced more rapid improvements (“high baseline, rapid decline”), whereas eastern regions like Shanghai saw substantial reductions in incidence but persistent depth, indicative of “asynchronous breadth-depth alleviation.” GTWR analysis identified key drivers: economic growth (measured by per capita GDP) most effectively reduced HPI in southwestern China during 2014–2016, but its impact diminished after 2020 in the northeast due to industrial constraints. Population aging exacerbated HPI in the southwest, while low education heightened risks nationwide, particularly in technology-intensive eastern provinces. Enhanced healthcare resource allocation (e.g., nurse density) significantly mitigated HPI, though efficiency gaps remained in the west. Additionally, reductions in pollution aligned with improved governance after 2016. These findings highlight the necessity for region-specific policies: expanding the healthcare workforce in the west, implementing equity-oriented interventions in the east, and adopting aging-adapted reforms in the northeast to achieve sustainable eradication of health poverty.