Over the past three decades, China’s economic income inequality has been mainly reflected in regional differences and the gap between urban and rural areas7,17,20. For example, evident but insufficient empirical research has indicated that for education and medical resources, urban areas are often higher than rural areas, and the more developed coastal areas are also better than the less developed inland areas1,17,31. By using the Gini coefficient as an index, we determined the spatial equality of education and medical facilities in China’s 10 cities (Fig. 1; Appendix, Fig. S1). Our result preliminary illustrates that for most types of education and medical facilities, there are evident differences in equality between urban and rural areas (Fig. 2). In particular, how to solve the regional inequality caused by the urban–rural duality has become a critical problem hindering social development, but the premise is to accurately determine what type of facilities and determine the inequality17,20. We found that for educational and medical facilities, kindergartens and pharmacies demonstrated equality in urban areas but exhibited relative inequality in rural areas (Fig. 2A,I). Moreover, the equality of other types of facilities in the two regions was similar, either relative equality (e.g., primary schools, middle schools, and health service centers) or inequality (e.g., universities, education-training institutions, comprehensive hospitals, and specialized hospitals). However, there remained some differences in the degree of inequality (Fig. 2). To reduce the inequality of facilities between urban and rural areas, the government could emphasize on the “supplementary principle” before the “compensation principle” in mitigating the unequal distribution of public facilities22 (i.e., to solve the inequality of irreplaceable facilities, such as kindergartens, and consider facilities that can be temporarily replaced by other types of facilities, such as pharmacies). Furthermore, for large-size facilities that are unique to urban areas (e.g., universities, comprehensive hospitals, and specialized hospitals), many rural people can only enjoy services by paying travel costs or moving to urban areas2,22. Therefore, enhancing accessibility from rural areas to urban municipalities (such as convenient transportation facilities and lower welfare restrictions) is essential to reduce the equal difference in access to public facilities between urban and rural areas17,51. An irrelevant but interesting phenomenon is that the land surface temperature will increase with the increase of urban intensity in the urban–rural gradient52 (i.e., heat island effect), which indicates that residents in urban areas have to adapt to the adverse factors of corresponding environmental change while enjoying the advantages of public services.
Inequality among cities or regions with larger spatial scope has constantly existed7,21, which has also been confirmed by comprehensive comparative analysis of the Gini coefficients of various facilities in the representative cities with different urbanization rates of China’s four major economic zones in our study (Appendix, Fig. S2; Appendix, Table S1). The results showed that the equality of public facilities performs better in the eastern economic zone than in other regions. In recent years, the Chinese government has vigorously promoted the Western development strategy through the top–down path, and sufficiently focused on the construction of public facilities in underdeveloped regions15,19,31. This undertaking may explain that the facilities supported by the nine-year compulsory education policy and those serving the grassroots level, primary schools, middle schools, health service centers, and pharmacies can reach a relatively equal level in all regions (Appendix, Fig. S2). However, we admit that there are still some types of facilities that are significantly lower than the average in regions, such as kindergartens in the northeast, middle schools in the central region, and health service centers and pharmacies in the western region (0.4 < Gini < 0.5). In general, regions with better educational and medical resources (e.g., eastern region) can often attract more people, particularly wealthy people, to live and work in the region1,42. Conversely, areas lacking public facilities or with a high degree of inequality (e.g., western and northeast regions), population loss, or agglomeration of poor people often occur43, which leads to a non-virtuous cycle and hindering the further development of cities in the region. Therefore, only by improving the “short board” facilities in each region as much as possible can lay a basic guarantee for the improvement of the well-being of vulnerable areas and better realize the coordinated development of public facilities.
In general, spatial pattern of urban facilities depends on top–down planning and bottom–up spatial competition and also closely related to the functional attributes, quantity, and size of facilities8,53. Our results support the equality of educational and medical facilities with similar functions but small-size is significantly higher than that of large-size facilities (Fig. 1; Appendix, Fig. S3). Evidently, there is a considerable demand for the number of small-size facilities (i.e., primary schools, middle schools, and kindergartens; Appendix, Fig. S4), so their distribution is also more widely and evenly extensive26,36. Furthermore, the equality of facilities with evident public nature is generally higher than that of commercial facilities. For example, the size of education-training institution is relatively small, but their equality is poor compared with other educational facilities, second only to universities (Fig. 1A–E; Appendix, Fig. S1). In addition, primary and middle schools belong to nine-year compulsory education in China15. Therefore, as long as school-age children, their school needs will be guaranteed, which explains that their equality is higher than other types of educational facilities (Fig. 1B,C). Similarly, the degree of equality in medical facilities from high to low is health service centers, pharmacies, specialized hospitals, and comprehensive hospitals (Fig. 1F–I). Among them, the Gini coefficients of the first two types of facilities with smaller scale are about to reach relative equality, which is also due to the wide distribution in urban and rural areas and the government’s attention to basic medical facilities40,47. For facilities with large-size, such as universities, comprehensive hospitals, and specialized hospitals, their equality is relatively low (Fig. 1D,F,G; Appendix, Fig. S1), which is often caused by their clustered existence mode under the condition of limited urban land resources, resulting in strong spatial heterogeneity45. Although education-training institutions and pharmacies are small and have certain commercial attributes, the equality of pharmacies is significantly higher than that of education-training institutions (Fig. 1E,I). Note that the facilities dominated by bottom–up market competition (i.e., education-training institution), even if the number is high, its spatial distribution often has a certain degree of agglomeration26,37, so the equality will be low. Spatial inequality of benefit-driven facility distribution is reflected in the types of facilities and also in differences between urban and rural areas, as well as cities in different economic regions.
Equality of facilities assessed based on the Gini coefficient is closely related to the matching degree of population and is also affected by the attribute of urban social development9,13. We quantified HPM between various types of public facilities and socioeconomic factors that mainly affect their equality on the county scales (including districts), which is mainly shown in the form of logarithm and logarithmic linearity (Table 1; Fig. 4). This study is relatively more systematic and comprehensive than previous studies on the pattern and equality of certain types of facilities in cities13,40. We found a significant negative correlation between the regional area and spatial equality of various facilities (Table 1). In this study, regional area refers to the sub-urban scale (municipal districts and counties), and the rural area where the county is located is large but its population and corresponding facility demand are often small (Appendix, Table S1). Moreover, there is strong heterogeneity in the equality of facility distribution. Population and GRP, as important socioeconomic factors, were significantly positively correlated with facility equality (Table 1). In particular, population is a direct variable for calculating the Gini coefficient, and its impact on facility equality is self-evident7,47. Therefore, a reasonable idea is to avoid analyzing variables related to population, if not considering the need to integrate all impact factor analysis. Meanwhile, we found that the households had a significant correlation with the equality of kindergartens and pharmacies, which also reflected that the distribution of public facilities is closely related to the actual demands of residents. Previous studies have confirmed the important driving effect of GRP on the spatial pattern of urban facilities26,36 (e.g., urban–rural gradient). We further found that GRP has significant correlation with education-training institutions and universities on the county scales (Fig. 4). However, apart from the per capita GRP and urbanization rates, we did not find any other significant impact relationship between the equality of public facilities and socioeconomic factors on the city scales (Appendix, Figs. S5, S6). This also indicated that compared with the city scale, the smaller spatial scale (such as the county scale) can more clearly reflect the impact of driving factors on facility distribution54,55. Furthermore, building density had a significant logarithmic relationship with the spatial equality of pharmacies, although it did not show a certain correlation with that of other education and medical facilities (Table 1; Fig. 4). Similar research results indicated that building density may significantly affect the distribution of facilities on a more precise spatial scale, such as street scale15,54. Therefore, the impact of socioeconomic factors on distribution and equality of facility is different on different spatial scales7,25. Accordingly, exploring the driving mechanism of facility equality on multiple spatial scales (e.g., regions, cities, counties, and communities) may help to seek feasible suggestions conducive to urban development.
In our study, the gap in the equality of public facilities between case cities indicated that the coordinated development of education and medical facilities faces challenges under the differences of economic level and policy system (Figs. 1, 3), while case cities with good equality can also provide reference for sustainable development4,43. For example, the distribution of primary schools, middle schools, kindergartens, health service centers, and pharmacies in Shanghai and Hangzhou is nearly absolutely equal (Fig. 3). The reason is that, as an international metropolis42, the units of 17 districts and counties in Shanghai are in a relatively synchronous development state, except for the county of Chongming Island. Similarly, Hangzhou is the core city of the Yangtze River Delta urban agglomeration, and its Zhejiang province is the pilot area of the national “common prosperity” strategy25. However, for Chengdu, which is located in the Western Economic Zone, although the proportion of districts and counties with relatively equality basic education facilities is above 50%, the corresponding basic medical facilities (i.e., health service centers and pharmacies) have the lowest equality in the city (Fig. 3). In addition, our study found that even for cities with geographical and socioeconomic similarities, there was still an unequal relationship in the distribution of facilities and residents’ activities23,24. For instance, although the basic education facilities (i.e., kindergartens, primary schools, and middle schools) were relatively equal overall, some specific cities were still at a low level, such as kindergartens in Harbin and middle schools in Wuhan (Fig. 3). Therefore, for the education and medical facilities, the local government should focus considerably on the types of facilities that are highly unequal but can still be improved15,40, thereby gradually improving the equality of local residents’ access to facility resources. For example, the expanded university campuses can be gradually distributed to the suburbs or small cities around the metropolis, so as to relatively alleviate the equality difference of higher education between regions in the city15,22. However, how to balance regions with relatively backward economic development and a huge gap in the ability to obtain scarce services with cities in the southeast coastal region remain a challenge for regional coordinated development.
At present, some urban transformation is still in progress, which is mainly reflected in the aggregation of rural young labor force to urban areas44,51, and accompanied by an increase in demand for education and health services47. In recent years, the Chinese government has appropriately reduced the restrictions on children of urban migrants to enjoy urban benefits in urban areas17, and liberalized the two-child and three-child policies to adjust the population age structure19, which will have a certain impact on the spatial equality of education and medical infrastructure in urban and rural areas21. On the one hand, although the distribution of basic education facilities in urban and rural areas, such as primary and middle schools, has reached a relatively equal level (Fig. 2; Appendix, Fig. S2), more “rural children” in urban areas may still face the dilemma of being unable to go to school in the future. On the other hand, the increase in the number of newborns is bound to increase the demand for kindergartens and corresponding medical facilities, so the existing supporting facility planning formulated by local governments may be inapplicable to the development needs, particularly in some cities with backward facility equality on a county scale, such as Zhengzhou, Chengdu, and Harbin (Fig. 3). More importantly, the population agglomeration in urban areas leads to a shortage in education and medical facilities, while land resources for urban development are limited15,22. Most villages have basic public facilities (e.g., kindergartens, primary schools, middle schools, and health service centers), but the demand population is gradually losing (especially school-age children) and the corresponding talent resources of educational and medical are decreasing7,17,31. To alleviate the inequality of social resources and realize the equalization of public service facilities, the matching of supply and demand facility resources22, the corresponding national development strategies56, as well as the difficulties faced by local urban development should be comprehensively considered13,17. Social sustainability2,7 (e.g., facilities services, income, and welfare) and environmental sustainability11,52 (e.g., air quality, climate change, and green space) are crucial in building livable and equitable cities that can be maintained in the long term13. Improving social equality means that all residents, particularly for vulnerable groups and low socioeconomic groups, have access to social and natural services43. Therefore, an improved understanding of the inequality of various resources related to human socioeconomic activities is conducive to improving the well-being of residents in developing countries and even developed countries, and further achieving sustainable urban development.
However, there are still some limitations that should be further improved in this study. First, this study defined the main types of educational and medical facilities according to statistical yearbooks and industrial classification standards, but a few facilities were not included36,55 (e.g., private clinics, pet hospitals, higher vocational colleges, and driving schools). For further research, a more detailed and systematic evaluation may be carried out according to the functional type of the facility. Second, we analyzed the equality of facility by taking the individual facilities as mass points (hospitals, universities, and other facilities took independent buildings as the representative of quantity), disregarding the differences in the scale and service radius between facilities2,25, which is mainly limited by data acquisition. For the future work, the parameters related to the facility attributes and accessibility can be considered, and the supply–demand balance of facility services can be measured based on the existing equity framework22 (such as the integrated spatial equity evaluation framework), which is conducive to a more comprehensive and reasonable measurement of the equality of facilities. Third, owing to the limited access to urban electronic map data, 10 case cities are currently used to represent various economic regions in China, which is not considerably comprehensive. With the same limitation, we have not obtained the latest year’s data of facilities (such as 2020). To more systematically reflect the equality of various facilities in China, further research can consider analyzing from the perspective of spatiotemporal dynamics, and appropriately expanding the number of case cities. In addition, there is no unified and clear definition of rural areas in previous studies30,32,33. Hence, we regarded areas outside the boundary of urban areas as rural areas, which may include areas unrelated to human economic activities, and may lead to a certain deviation in analyzing the correlation between area and facility equity. Lastly, our research tends to assess the equality of public facilities from the urban and regional levels, but cannot be extrapolated to the individual level2,44. Therefore, the parameters that can represent the attributes, demands and socioeconomic activities of residents were not considered, such as population characteristics, education level, land or housing prices, and residents’ personal preferences. Further research can consider acquiring and integrating these parameters to explore the driving mechanism of facility equality more deeply, contribute to urban planning and management, and promote the improvement of human well-being.
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