Countermeasures to promote sustainable construction and coordinated development of healthy cities: a case study of Dandong City

In order to promote sustainable construction and coordinated development of healthy cities in small and medium-sized cities, as well as to improve people’s happiness, this paper takes the border city of Dandong as an example. It constructs 5 primary indexes and 28 secondary indexes, including healthy environment, healthy culture, health service, healthy society, and healthy tourism real estate. Among them, the index for healthy tourism real estate includes five secondary indicators: tourism income, number of tourists, real estate transaction volume, average selling price of commercial housing, and renovation of old residential areas. This paper analyzes the overall goal of healthy city construction in Dandong using the analytic hierarchy process (AHP). The relative priorities of the five first-level indicators considered are: healthy environment; healthy society; health service; healthy tourism real estate; and healthy culture. This indicates that a focus on creating a healthy environment is more important in evaluating a city’s health. According to data analysis, Dandong has met national standards for creating a healthy environment and promoting a vibrant cultural scene. In addition to this achievement, the number of practicing (assistant) doctors per 1000 people in health services reached national standards in 2018, and people’s living standards have gradually improved. Combining the advantages of local tourist destinations with the promotion of healthy development in the tourist industry, and balanced growth in real estate development as contributed to the creation of a positive social environment conducive to good health.


Introduction
A healthy city is one that integrates a healthy urban environment, economy, and social system to ensure the efficient functioning of the urban system and meet the health and well-being needs of its residents.The concept of a healthy city represents a promising approach to addressing "urban diseases".
Dandong, a historic border city situated in the southeast of Liaoning Province on the northwest bank of the Yalu River, is renowned for its heroic past.As China's largest border city, it holds distinctions as a National Garden City, National Health City, excellent tourism destination, and one of China's top ten livable small and medium-sized cities.
Drawing from experiences with healthy city initiatives in other Chinese cities and considering factors influencing citizens' health needs, an evaluation index system has been developed for Dandong's healthy city development.This system encompasses basic evaluation indicators as well as characteristic evaluation indicators tailored to Dandong's unique development characteristics and regional health goals.It offers valuable insights for advancing the construction and development of small and medium-sized healthy cities.

Basic evaluation index of Dandong healthy city construction (Dandong Statistical Yearbook 2011-2021; Dandong Yearbook 2011-2021)
Basic evaluation indicators consist of four primary indicators: a healthy environment, a healthy culture, a healthy condition, and a healthy society.These primary indicators encompass several secondary indicators, with this paper selecting 23 secondary indicators (Wang 2019).The data for the secondary indices were sourced from the Dandong Statistical Yearbook and Dandong Yearbook.

Optimal environmental conditions
To establish a healthy city with a conducive living environment, well-developed infrastructure, favorable ecological surroundings, efficient urban management, and distinctive cultural significance (Wu et al. 2024).The health-oriented environment encompasses the social, built, and resource aspects with a focus on people's well-being.Eight secondary indicators have been devised to include urban population density and industrial structural changes, water quality compliance rate, ambient air quality compliance rate, per capita green park area, green coverage rate of built-up areas, number of parks per 100,000 people, proportion of public toilets meeting three-class standards or above, and daily garbage cleaning rate (Pineo et al. 2018).
In 2020, Dandong administers 3 municipal districts (Zhenxing District, Yuanbao District, and Zhen'an District), 1 autonomous county (Kuandian Manchu Autonomous County), and 2 county-level cities (Donggang City and Fengcheng City).The land area and population density of Dandong are detailed in Table 1.
As depicted in Table 1, Kuandian Manchu Autonomous County has the largest land area, followed by Fengcheng City, Donggang City, and the Municipal District.Within the Municipal District, Zhongzhen'an District surpasses Zhenxing District and Yuanbao District in terms of land area.In regards to population density, the Municipal District has the highest density, followed by Donggang City, Fengcheng City, and Kuandian Manchu Autonomous County.Within the Municipal District, revitalized District exceeds Yuanbao District and Zhen'an District in terms of population density.Tables 2 and 3 illustrate that since 2010, there has been a gradual increase in the proportion of primary industry in Dandong from 13.9% to 19.7%.Conversely, there has been a year-on-year decrease in the proportion of secondary industry from 52.7% to 24.3%, while the proportion of tertiary industry has steadily risen from 33.6% to 56.0%.After 2015, tertiary industry surpassed secondary industry to become Dandong City's leading sector.
In 2020, the water quality of the Yalu River (Dandong section) is classified as Class II, indicating excellent water quality.The water quality of the Yalu River water source, Wulongbei water source, Dalinzi water source, Donggang Tiejia reservoir water source, Fengcheng Huajiabaozi water source, and Kuandian Manchu Autonomous County Laodao water source all meet a standard of 100%.
As depicted in Fig. 1, the proportion of Dandong's ambient air quality meeting the standard increased from 84.6% in 2014 to 95.6% in 2020.Furthermore, the overall air quality index ranking also ascended to first place in the province.
Figure 2 illustrates the increase in per capita green area of parks in Dandong from 8.35 square meters to 13 square meters between 2010 and 2017, indicating a gradual growth trend.Subsequently, from 2017 to 2020, the per capita green area of parks in Dandong has demonstrated a stable trend, surpassing even the national average of 11.12 square meters in garden cities.
As depicted in Fig. 3, the green coverage rate of built-up areas in Dandong averaged 38% from 2010 to 2016.It decreased slightly to 36% in both 2017 and 2018.However, there was an increase in the green coverage rate in the following years, reaching 39% in 2019 and further increasing to 40% in 2020.These figures meet the requirements set by the "Urban Landscaping Evaluation Standard" (GB/T50563-2010), which specifies a green coverage rate of I) 40%, II) 36%, III) 34%, and IV) 34%.Additionally, there are on average approximately 0.47 parks per every100,000 people.
Figure 4 illustrates the proportion of Grade III or above public toilets in Dandong increased year by year, rising from 12.6% in 2010 to 89.7% in 2015.However, there was a decreasing trend from 2016 to 2019, with an increase to 75% in 2020.The daily garbage  ,838,610 4,571,460 5,085,256 4,493,628 4,593,456 4,029,449 Added value of the tertiary industry 2, 449,414 3,118,194 3,668,367 3,923,313 4,185,681    cleaning rate reached 100% in both 2019 and 2020, and the sanitary qualification rate of public toilets also achieved a perfect score of 100%.

Promotion of a healthy culture
Health culture encompasses the lifestyles and values that promote both physical and mental well-being.The health culture index primarily reflects the health literacy, health behavior, and overall health atmosphere of a given region.Four secondary indicators have been formulated, including the number of public libraries and cultural centers, the quantity of books collected by public libraries at the end of the year, the volume of book circulation, and the percentage of individuals who regularly engage in physical exercise.
In 2018, the Dandong Library and Dandong Children's Library were merged, resulting in a total floor area of 5028 square meters and a collection of 1,038,000 volumes.By the end of 2020, there will be seven public libraries in Dandong along with eight public cultural centers, including one mass art museum and one Korean Culture Art Museum.Additionally, there will be eighty-four township street culture stations.The city also plans to promote the construction of seventy-eight administrative village cultural squares by 2020.Furthermore, ten county-level libraries and six county-level cultural centers have been completed.
Life is characterized by movement, and scientific knowledge is essential to support this movement.Engaging in scientific sports can help prevent diseases and promote overall health.The percentage of city residents regularly participating in physical exercise has remained relatively stable over the years, with 48% in 2013, 48.2% in 2014 and 2015, 48% in 2016, and 48.2% from 2017 to 2019.By the year 2020, this figure had increased to 48.5%.This surpasses the targets set by the Healthy China Action Plan (2019-2030), which aims for at least a participation rate of above 37 percent by 2022 and above 40 percent by 2030.
It demonstrates that Dandong has made significant progress in promoting the physical and mental well-being of its residents year by year, surpassing the targets set out in the Healthy China Action (2019Action ( -2030)).

Healthcare service
Health services are essential for ensuring the well-being of a city.Their primary goal is to uphold and enhance the physical and mental health of its residents.The provision of medical and healthcare services is a crucial component, encompassing resources such as general practitioners and hospital beds.
Four secondary indicators have been formulated, including the number of medical institutions, the number of beds in medical institutions per 1000 people, the number of practicing (assistant) physicians per 1000 people, and the number of registered nurses per 1000 people.
As can be seen from Figs. 5, 6, 7, 8, the number of medical institutions in Dandong increased from 460 in 2010 to 1687 in 2020, an increase of 266.7%;The number of beds in medical and health institutions in Dandong increased from 12,717 in 2010 to 18,490 in 2020, an increase of 45.4%.The number of beds in medical institutions for 1000 people shows an increasing trend year by year, from 5.25 in 2010 to 7.98 in 2020, an increase of 52%; The number of practicing (assistant) physicians in Dandong has increased from 778 in 2010 to 6250 in 2020, an increase of nearly seven times.The number of practicing (assistant) physicians in the 1000 population has increased year by year from 0.32 in It indicates that Dandong is experiencing a positive growth trend in the provision of services aimed at maintaining and enhancing the physical and mental well-being of its residents.

A healthy society
A thriving society is the most beautiful and desirable, characterized by the integration of individuals from diverse social strata and fostering a conducive environment for harmonious development among people, nature, and society.Social indicators of well-being encompass aspects such as social security, physical fitness activities, occupational safety measures, elderly care services, and other related initiatives.
Seven secondary indicators have been developed, including the per capita disposable income of urban permanent residents, the per capita disposable income of rural permanent residents, the registered urban unemployment rate, the overall passing rate of citizens' physical fitness testing standards, the per capita area of sports venues in the city, the number of sports instructors per 1000 people, and the availability of football fields for every 10,000 people.
Figure 9 illustrates the per capita disposable income of permanent urban (rural) residents in Dandong City from 2010 to 2020.The data shows an increase from 14,535 yuan (8340.3yuan) to 32,346 yuan (18,439 yuan), indicating a consistent annual growth trend.This suggests that the living standards of the people in Dandong City have been steadily improving year by year.
As depicted in Fig. 10, the control rate of urban registered unemployment rate in Dandong City from 2012 to 2020 indicates a consistently low level, always remaining within the provincial target.This is accompanied by a steady increase in employment opportunities and the maintenance of urban security and stability.
Health is a fundamental aspect of human life, constituting a basic right inherent to all individuals from birth.It serves as a cornerstone for economic development, social progress, and national prosperity.The maintenance of good health enables people to approach daily life and heavy work with optimism and ample energy.However, the continuous improvement in living standards has led to an increasing trend in the height and weight of citizens.Notably, the rate of increase in weight surpasses that of height, resulting in a gradual rise in obesity levels among adults, particularly those in middle age.This trend poses certain negative implications for overall bodily health.
As a small border city along the coast and river, Dandong has a slower pace of work compared to larger cities and economically developed southeast coastal cities.This allows for relatively abundant exercise time, which can have certain beneficial effects on maintaining overall body health.However, it is still important to promote a healthy lifestyle among the public and organize a wide range of national fitness campaigns.
In 2020, the sports work in Dandong adhered to the new development concept and focused on high-quality development.It deeply implemented the national fitness strategy with the goal of "building a strong sports city and creating a healthy Dandong," while continuously meeting the sports needs of the people.The percentage of city residents regularly participating in physical exercise was 48.5%, and the overall pass rate for citizens in meeting "National Physical Fitness Test Standards" was 97.5%.By 2022 and 2030, it is expected that no less than 90.86% of urban residents and 92.17% of rural residents will exceed the requirements of the Healthy China Action (2019-2030) to meet National Physical Fitness Testing standards.Additionally, there was an excellent rate of 6.7% for students meeting "National Physical Health Standard.
In 2015, the per capita sports venue area of the city was 1.8 square meters.By 2017, this had increased to 1.9 square meters, representing a growth of 5.6% over the twoyear period.The per capita sports field area of the city in 2020 is now at 1.97 square meters, showing a further increase of 3.9% compared to 2017 figures and surpassing the target of achieving a minimum of 1.9 square meters per capita sports field area by 2022 as outlined in the Healthy China Action (2019Action ( -2030)).It is evident that there has been a gradual rise in the per capita sports field area within the city over time.
In 2020, the city had a sports social organization rate of 0.31 per 10,000 people and a sports instructor rate of 3.2 per 1000 people, exceeding the target of 1.9 sports instructors per 1000 people set by the Healthy China Action (2019-2030) for the year 2022.The development rate of sports venues reached 100%, with ownership of 0.55 football fields per 10,000 people.Furthermore, efforts to enhance the construction of urban and rural mass sports public service system are ongoing and continuously improving.

Evaluation indicators for the characteristics of Dandong's healthy city construction
Dandong boasts abundant tourism resources, encompassing 10% of the city's land area and offering a diverse range of natural attractions including rivers, lakes, seas, mountains, springs, forests, and islands.The city is home to a total of 30 national A-level tourist destinations.In light of Dandong's status as not only a tourist destination but also a desirable place to live, the characteristic evaluation index for the city's health-focused urban development includes healthy tourism real estate.This is further broken down into five secondary indexes: tourism income, number of tourists, real estate transaction volume, average selling price of commercial housing, and revitalization efforts in old residential areas.

Number and income of tourists
As depicted in Figs.11 and 12, the number of domestic and foreign tourists visiting Dandong has steadily increased from 22.807 million in 2010 to 56.082 million in 2019, marking a remarkable growth of 145.9%.The tourism revenue of Dandong City also experienced significant growth, rising from 21.91 billion yuan in 2010 to 45.24 billion yuan in 2014, representing an increase of 106.5%.Although there was a slight decline to 31.24 billion yuan in 2015, the revenue has since rebounded and continued to increase annually, reaching a total of 52.7 billion yuan in 2019-an impressive surge of 140.5% compared to the figures recorded in 2010.
In 2020, the impact of the epidemic led to a decrease in tourist numbers, with only 17.46 million tourists welcomed, representing a 68.9 percent decrease from the previous year.Additionally, tourism revenue was significantly affected, dropping by 78.9% to 11.1 billion yuan compared to the previous year.Dandong has responded to this challenge by implementing special measures focused on "hard work, strong implementation, and execution" as a means of overcoming the impact of the epidemic.The city continues to prioritize the global tourism strategy and remains committed to seeking progress while maintaining stability.Furthermore, there is an emphasis on promoting and publicizing Dandong's brand image as "Shanhai Jiangtian, Lingxiu Dandong".

Transaction volume and average selling price of commercial housing in the real estate market (Liu 2019a)
As shown in Table 4, the sales volume of new commercial houses increased annually from 2010 to 2013.However, the ratio of transaction area for existing housing transactions compared to the sales volume of new commercial houses exhibited a declining trend over the same period.This suggests that buyers predominantly opted for new commercial houses.
In 2014, the transaction value of new commercial housing sales decreased by 57.9% compared with 2013.From 2014 to 2018, the sales volume of new commercial housing increased year by year, and the transaction value of new commercial housing sales in 2019 decreased by only 6.7% compared with 2018.In comparison to the sales volume of new commercial housing, the ratio of transaction area showed an upward trend until reaching 86.86% in 2019, indicating that buyers gradually tended to balance between the purchase of new commercial housing and the stock of housing.
In order to accelerate the revitalization of the stock, promote the destocking of real estate, establish a real estate destocking work system, and formulate a destocking work plan.In 2020, the price index of new commercial housing in Dandong urban area will remain at a medium level among 70 large and medium-sized cities in the country.The cycle for reducing commodity housing inventory is basically within a reasonable range.As depicted in Fig. 13, the average sales price of commercial housing in Dandong exhibited a consistent upward trend over the years, increasing from 3167.7 yuan/m 2 in 2009 to 4810 yuan/m 2 in 2015.There was a slight decrease in the average selling price of commercial housing in 2016 and 2017, with the average price remaining relatively stable compared to that of 2015.However, in 2018, against the backdrop of a stabilizing situation on the peninsula and North Korea's efforts towards full economic development, the average selling price of commercial housing in Dandong City rose to 5310.4 yuan/m 2 .This increase continued into 2019 with a slight rise similar to that of the previous year.By 2020, the average sales price had further increased to reach 5895.5 yuan/m 2 .Overall, from 2009 to 2020, there has been a consistent and positive upward trend observed in the average sales price of commercial housing in Dandong City.
As shown in Table 5 and Fig. 14, the average sales price of commercial housing in each county (city) district of Dandong City from 2017 to 2020 follows the order of city district > city average > county (city) district.
In 2017, the average sales price of commercial housing in each county (city) of Dandong City is as follows: Yuanbao District > Zhen'an District > Zhenxing District > The citywide average > Fengcheng City > Donggang City > Kuandian Manchu Autonomous County;  In 2018, the average sales price of commercial housing in each county (city) of Dandong City is as follows: Zhenxing District > Zhen'an District > Yuanbao District > the citywide average > Donggang City > Fengcheng City > Kuandian Manchu Autonomous County; In 2019, the average sales price of commercial housing in each county (city) of Dandong City is as follows: Zhenxing District > Zhen'an District > Cooperation Zone > Yuanbao District > The citywide average > Donggang City > Fengcheng City > Kuandian Manchu Autonomous County; In 2020, the average sales price of commercial housing in each county (city) of Dandong City is as follows: Zhen'an District > Zhenxing District > Cooperation Zone > Yuanbao District > Average of the whole city > Kuandian Manchu Autonomous County > Donggang City > Fengcheng City; Overall, despite the late start of real estate development in Zhen'an District within the municipal district, its advantageous geographical location and excellent surrounding environment, coupled with the enhancement of supporting facilities, have led to a narrowing of differences.In fact, it has even risen to first place in terms of average sales price of commercial housing within the municipal district in 2020.The situation in Kuandian Manchu Autonomous County mirrors that of Zhen'an District, as it is also projected to rank first in average sales price of commercial housing among each county (city) district in 2020.Furthermore, there is a gradual narrowing of the gap between average sales prices of commercial housing in counties (cities) districts and municipal districts.It can be observed that real estate development across different regions within Dandong city is not balanced and is gradually moving towards a more sustainable and healthy trajectory.

Revitalization of aging residential neighborhoods
In 2019, a total of 35 planned renovation projects were completed by the end of 2018.These projects involved the renovation of 207 residential buildings with a combined floor area of 730,300 square meters.The total investment for these renovations amounted to 138 million yuan, benefiting nearly 10,800 households.
In 2020, the renovation of 66 planned projects commenced at the end of September 2019.These projects encompassed a total of 424 residential buildings, covering a construction area of 1,518,700 square meters and requiring a total investment of 388 million yuan.The renovations benefited 23,100 households.Notably, Taihe Garden Community in Yuanbao District was recognized as the provincial demonstration community for old community transformation in 2020.It marked the first instance in Dandong City where nine elevators were simultaneously installed and put into operation as part of an old community transformation project.This achievement was showcased as part of the results from the old community transformation at the 20th China International Urban Construction Expo column.These developments demonstrate that Dandong has made significant progress in revitalizing its aging residential areas.The Analytic Hierarchy Process (AHP) was developed by T.L. Saaty, a professor and operations research scholar at the University of Pittsburgh in the United States, during the 1970s.It follows the principle of decomposition before synthesis and system, utilizing qualitative information to formalize decision-making processes.AHP is a straightforward and comprehensive method for both qualitative and quantitative analysis.This approach finds widespread application in various fields including economics, energy policy, resource allocation, human resource management, educational development, medical and health sectors, as well as environmental engineering.

Construct the hierarchical structure model
After conducting a study and analysis of the evaluation of a healthy city in this particular area, the factors influencing the evaluation are categorized into various levels based on the hierarchical analysis model, as illustrated in Table 6.

Develop a judgment matrix
After gathering opinions, the discrimination matrix for pairwise comparison between first-level indicators and targets is presented as shown in Eq. (1) (1) Five sets of comparative discriminant matrices for two indexes versus one are provided in Eqs. ( 2)-( 6) respectively.
(2)  This suggests that in assessing a city's healthiness, the most crucial factor is its healthy environment, followed by a focus on promoting a healthy society and providing quality health services.The evaluation indices for local characteristics and health culture rank lower in importance.In qualitative analysis, traditional assessment indicators such as healthy environment, healthy society, and health services continue to serve as the primary basis for evaluating the healthiness of cities.However, there tends to be less emphasis placed on evaluating local characteristics and health culture.For small and medium-sized cities in particular, it is important to pay attention to their unique local characteristics and highlight regional features in order to foster development within these areas while integrating them into efforts aimed at building healthier cities.

Recommendations for mitigating measures
(1) Based on the characteristics of Dandong, a border city known for its gardens and tourism, as well as the top ten livable small and medium-sized cities in China, this paper proposes an evaluation index for the construction of healthy cities.The paper conducts an assessment and analysis of the development of healthy cities by combining these basic evaluation indices.This research can serve as a reference for other small and medium-sized cities, both domestically and internationally, to evaluate and develop healthy cities based on their local characteristics.
(2) This paper focuses on the sustainable construction and coordinated development of Dandong healthy city.It analyzes the topic from two perspectives: basic evaluation index and characteristic evaluation index, which include 5 primary indicators of healthy environment, healthy culture, health service, healthy society, and healthy tourism real estate, as well as 28 secondary indicators.The development of Dandong healthy city is continuously improving in terms of health culture, health services, and a healthy society.
The application of the analytic hierarchy process to analyze the development of Dandong as a healthy city involves an organic combination of qualitative and quantitative methods.This includes transforming qualitative indicators, such as a healthy environment, into quantitative indicators.The systematic decomposition of complex problems makes it easy to understand and accept, allowing for the determination of the weight and priority of evaluation indicators.This approach holds great significance and application value for the multidimensional evaluation of a healthy city.
(3) On the basis of urban construction and development, the concept and indicators of health are integrated to enable the creation of healthy cities to be carried out simultaneously with city construction and development.In light of the advancement in modern urban development, evaluation indices also encompass enhancements to the urban energy system, establishment of a comprehensive water supply and drainage system, expansion of public transportation and municipal infrastructure, improvements to information and communication systems, enhancement of the urban ecological support system, establishment of an urban disaster prevention system, etc., which will be the focus of future research.

Fig.
Fig. Compliance rate of ambient air quality in Dandong from 2014 to 2020

Fig. 4
Fig. 4 Proportion of public toilets above Grade 3 in Dandong from 2010 to 2020

Fig. 5 Fig. 6
Fig. 5 Quantity of medical facilities in Dandong from 2010 to 2020

Fig. 7
Fig. 7 Number of practicing (assistant) physicians among 1000 people in Dandong City from 2010 to 2020

Fig. 9
Fig. 9 Per capita disposable income of urban and rural permanent residents in Dandong City from 2010 to 2020

Fig. 11
Fig. 11 Number of tourists in Dandong from 2010 to 2020

Fig. 13
Fig. 13 Average selling price of commercial housing in Dandong City, 2009-2020

Fig. 14
Fig. 14 Average sales prices of commercial housing in Dandong City and its counties (cities) districts, from 2017 to 2020 the evaluation of healthy cities (Wang et al. 2022; Long and Fang 2019; Pan et al. 2022; Liu 2019b; Ma and Suo 2019; Tang and Zhao 2020; Chen et al. 2021; Jiang et al. 2022; Liu et al. 2021)

Table 1
Land area and population density of Dandong City in 2020

Table 2
Gross regional product and added value of three industries in Dandong City from 2010 to 2020 (Unit: Ten Thousand Yuan)

Table 3
Changes in the industrial structure of Dandong during 2010-2020 (Unit: %)

Table 4
Transaction volume of Dandong real estate market from 2010 to 2019

Table 5
Average sales price of commercial housing in counties (cities) of Dandong City from 2017 to 2020 (Unit: Yuan/m 2 )

Table 6
Evaluation index system for Dandong healthy city

Table 7
Calculation results of scheme matrix