Integrating digital twins, BIM, and GIS for urban health equity: Advancing smart and sustainable healthcare planning

• Integrates DT–BIM–GIS-AI to enhance spatial equity and resilience in healthcare planning. • Identifies digital barriers for vulnerable groups in China’s healthcare transition. • Demonstrates technology gains: 25% cost reduction and 84.9% facility siting accuracy. • Proposes inclusive digital health strategies aligned with Healthy China 2030 goals. • Recommends scalable, equity-focused frameworks for smart and sustainable cities. Ensuring equitable healthcare is a critical pillar of sustainable urban development, yet vulnerable populations, such as older adults, persons with disabilities, and low-income groups, risk exclusion from rapid digital transformation, which refers to the integration of advanced technologies such as artificial intelligence (AI), Internet of Things (IoT), and digital twins (DTs) into healthcare systems. This study investigates the integration of DTs, building information modelling (BIM), geographic information systems (GIS), AI, and IoT in healthcare planning, focusing on vulnerable groups in China. Through a systematic review, the analysis reveals three key findings. First, older adults, persons with disabilities, and low-income groups face persistent barriers in geographic access, digital literacy, and service navigation. Second, integrated DTs-BIM-GIS ecosystems demonstrate significant potential for enhancing spatial equity and accessibility outcomes. In the Santander Local DTs case, the use of Age-Friendly Neighborhood Index (AFNI) indicators resulted in a substantial improvement in neighborhood age-friendly accessibility, with the AFNI increasing from 12.15% to 23.03% under the proposed intervention. Third, international smart-city practices provide scalable models for inclusive innovation. The study synthesizes global and Chinese developments to identify gaps in socio-technical integration and equity-driven design. It proposes strategic recommendations, including adopting interoperable DTs-BIM-GIS frameworks, advancing digital inclusion programs, and embedding equity indicators in urban planning. The findings support designing inclusive, data-driven healthcare systems that align with the Healthy China 2030 agenda and global sustainability goals, ensuring vulnerable populations are not left behind.