Does cultural service provision contribute to improving public health levels? Empirical evidence from 283 Chinese cities

Introduction: Understanding the relationship between public cultural service provision and urban public health is crucial for enhancing population wellbeing. This study investigates the association between changes in public cultural service supply and public health outcomes in Chinese cities. Methods: Using panel data from 283 prefecture-level cities in China (2019-2023), we employed generalized spatial two-stage least squares (GS2SLS) models with inverse-distance spatial weights to examine this relationship. To address spatial endogeneity, higher-order spatial lags of public cultural service supply (PSC) and exogenous controls were used as instruments. Robustness was verified through standard weak-instrument and over-identification tests, as well as alternative spatial matrices and instrument sets. Results: < 0.01). The association between PSC and PH is economically significant: across model specifications, the elasticity of lnPSC ranges from 0.36 to 0.76. For instance, in the fixed-effects model, βlnPSC = 0.758 (SE = 0.125; 95% CI: 0.513-1.003), indicating that a 1% increase in PSC is associated with approximately a 0.5% improvement in PH. Discussion: The findings demonstrate that enhancing cultural infrastructure and service quality is correlated with better public-health performance. This underscores the value of integrating cultural and health policies in urban governance. The results are robust to various sensitivity checks, supporting the conclusion that public cultural services play a meaningful role in promoting population health in Chinese cities.