Rethinking the changing role of hospitals in urban transformation : the co-evolution of therapeutic landscape and urban restructuring in China

Abstract

Amidst growing urban health challenges, research and policies increasingly focus on the relationship between place and health, particularly within the Healthy City campaign. This has prompted governments around the world to reconfigure hospital distribution efficiently and equitably, while the commodification of healthcare has transformed hospital infrastructure’s role in urban society. In China, new urban spaces and planning practices like the ‘Patients Tribe’ and ‘Medical City’ have emerged, highlighting the complex interplay of urban restructuring and hospital infrastructure within a state-market-society framework. This overhaul raises a significant yet understudied issue in comprehending the current trajectory of healthy city development: the extent to which hospitals leverage and (re)shape the process of urban transformation. To address this, the concept of therapeutic landscapes serves as a valuable theoretical framework. Defined as dynamic assemblages of competing, interacting, and evolving entities within specific socio-spatial contexts. Prior studies on therapeutic landscapes have mainly focused on individual-level diversities or narrowly defined urban landscapes, oversimplifying broader socio-spatial changes. Situated at the intersection of health and urban geography, this study aims to unveil the socio-spatial transformations associated with hospital infrastructure, delineating the spatial distribution patterns of hospitals and the socio-spatial restructuring trajectory, mechanisms, and therapeutic outcomes in adjacent neighborhoods in China. This research uses mixed methods and diverse data sources, including open big data, semi-structured interviews, pre-existing questionnaire datasets, urban planning documents, and other secondary materials. Noting the interaction between hospital and urban structure as a multi-scale process, this research involves three sub-studies at different level. Firstly, a transferrable and nonparametric methodology is utilised to reveal the spatial clustering pattern of hospitals across 36 major Chinese cities. Secondly, through the empirical analysis of three cases in Guangzhou, this study develops a typology to understand the diverse outcomes and mechanisms of hospital-driven neighbourhood-level urban restructuring. Thirdly, based on the relational understanding of therapeutic landscapes, this study scrutinizes the therapeutic experiences of local community during hospital-driven neighbourhood restructuring and examines the co-evolution of neighbourhood restructuring and therapeutic landscape. This study contributes to the literature and practices of healthy cities in several ways. Firstly, the comparative analysis offers a deep understanding of hospital clustering patterns and the underlying mechanisms, highlighting the complex interactions between hospital clustering and multidimensional urban structures. Secondly, it bridges studies of China’s urban transformation with healthcare research, underscoring that hospitals are no longer merely passive infrastructure configured in a top-down approach but critical driving forces in urban space production and consumption. Thirdly, by examining the contested and dynamic therapeutic experiences in hospital-driven urban restructuring, the study enriches the understanding of the therapeutic landscape’s heterogeneity and dynamics. This research also provides valuable policy insights for China’s healthy city agenda, including addressing healthcare inequalities, promoting polycentric urban spatial development, and creating health-supporting urban environments. Given the global health challenges and the evolving role of healthcare in urban transformation, the findings in this research can also offer valuable insights for other economies facing similar issues by highlighting the hospital-city nexus.