Equity analysis of public health human resource allocation: evidence from China 2015–2024

To evaluate regional equity in the allocation of public health human resources across China from 2015 to 2024, and to formulate targeted evidence-based strategies for the balanced and high-quality development of the national public health workforce. Descriptive analysis, the Human Resource Agglomeration Degree (HRAD), Population Agglomeration Degree (PAD), and rank sum ratio (RSR) method were used to analyze the equity of public health human resource allocation in China from 2015 to 2024. The total public health technical workforce expanded steadily from 639,200 personnel in 2015 to 806,800 in 2024. Eastern China maintained HRAD and PAD values above 3, with an HRAD/PAD ratio approaching 1, demonstrating well-balanced population and geographic matching. Central China recorded HRAD above 1 and PAD between 0.5 and 2.0, with most years showing an HRAD/PAD ratio greater than 1. Western China had persistently low HRAD below 1 and PAD below 0.5, revealing long-standing disadvantages in resource endowment. The RSR grading results show that the comprehensive equity of national resource allocation improved continuously year by year over the decade: rated poor during 2015–2016, medium during 2017–2018, good during 2019–2022, and excellent in 2023–2024, marking the highest allocation level within the study period. Overall equity saw a clear upward trend rather than stagnation or decline, with a stable east–central–west hierarchical gap throughout the period. While the national public health workforce grew continuously between 2015 and 2024, prominent stepped regional inequities persisted: Eastern regions held dominant resource advantages, Central regions occupied a transitional intermediate position, and Western regions faced chronic resource shortages. The overall comprehensive allocation performance improved markedly across the 10-year period. Accordingly, four targeted recommendations are proposed directly based on empirical findings: implement differentiated talent subsidy and paired assistance policies for Western China to narrow interregional gaps; shift workforce development from quantity expansion to structural optimisation by reinforcing recruitment for urgently needed specialties such as disease prevention and maternal and child health; improve flexible cross-regional talent mobility mechanisms to break rigid resource segmentation; and build a regular dynamic assessment system to sustain long-term equitable allocation of public health human resources.