Spatial diagnosis and differentiated governance of provincial public health resilience in china from a dual-constraint perspective

Public health resilience is critical for responding to health crises, yet systematic assessments that simultaneously consider system capacities and external constraints remain limited. This study aims to construct a comprehensive public health resilience assessment framework integrating the “prevention–protection–emergency” capability chain with economic and environmental dual constraints. Using China as a case study, we diagnose provincial-level resilience levels, spatial differentiation, and core shortcomings, with the goal of revealing underlying mechanisms and providing evidence for balanced regional development and precision governance. Using panel data from 31 provinces in China covering the period 2020–2022, we developed a dual-dimensional “capacity-constraint” assessment framework. Standardized and synthesized indicators were used to calculate provincial public health resilience indices. Spatial autocorrelation analysis, panel regression with fixed effects, Bootstrap mediation tests, and pressure-response threshold modeling were employed to examine spatial patterns, influencing factors, environmental pressure thresholds, and the “economy–resources–resilience” transmission pathway. China’s public health resilience exhibits a distinct “east-strong, west-weak” spatial pattern. Nonlinear threshold effects are identified at two critical values (32.42 and 34.87), beyond which the resilience response pattern undergoes two structural shifts, dividing provinces into low-, medium-, and high-capability regimes (Bootstrap p < 0.01 for both thresholds). Panel regression confirms the transmission pathway of “economic level → resource allocation → resilience index,” with the indirect effect through resource allocation accounting for 45% of the total effect (Bootstrap 95% CI for the indirect effect: [0.18, 0.34]). Based on the “capacity–economy” matrix, four types of regional imbalance are identified. Enhancing public health resilience is a systemic task requiring context-specific strategies. The proposed dual-dimensional assessment framework and quantitative diagnostic methods can precisely identify regional weaknesses and offer tools for differentiated interventions. China"s experience provides valuable governance references for other countries facing similar challenges of balancing health system capacity development with economic and environmental constraints.