A two-stage concept mapping for emerging concepts: an analysis of the Smart Healthy City

Rapid urbanization and technological advancement pose complex challenges to urban health governance, particularly amid demographic aging, environmental pressures, and widening health inequalities. While Smart Healthy Cities (SHCs) offer a promising paradigm to address these issues, current models lack a comprehensive, theoretically grounded framework for implementation. This study defines the SHC concept and examines its relevance for building inclusive, age-friendly urban environments. An innovative two-stage concept mapping methodology was employed, integrating qualitative insights from expert-focused group interviews with quantitative analysis using multidimensional scaling and hierarchical cluster analysis. A diverse panel of experts from public health, urban planning, digital innovation, and governance participated in the process. Four key dimensions of SHCs were identified: Healthy Environment Cities (emphasizing physical infrastructure), Smart Networking Cities (focusing on digital connectivity), Socially Sustainable Cities (advancing inclusive policies), and Health Empowering Cities (supporting individual capabilities and preventive health). These dimensions were found to contribute differentially to three core SHC objectives: health equity, smart connectivity, and system-level resilience. Priority concepts included improved healthcare access, intergenerational technology integration, and lifespan-oriented disease prevention. Pattern matching and go-zone analyses revealed a notable discrepancy: social sustainability, while conceptually important, was under-prioritized in implementation. The framework incorporates six theoretical perspectives—socio-ecological theory, smart city theory, health equity, systems thinking, the capabilities approach, and participatory urban planning—offering a multidimensional and systems-informed model. By conceptualizing cities as complex adaptive systems, this framework aligns digital innovation with equity and resilience goals. It provides urban planners and policymakers with a roadmap to develop inclusive, sustainable, and health-promoting cities. The study also contributes to Smart Healthy Age-Friendly Environment (SHAFE) discourse by expanding its application beyond aging populations to all urban residents.