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 The analysis reveals significant spatial dependence in public health (PH), with a spatial lag coefficient of ρ = 1.12 (SE = 0.32; 95% CI: 0.49–1.75;