Are cities healthy? A city health diagnose framework from the perspective of living organism

Cities, as organisms, exhibit complicated phenomena of life characteristics. With global urbanisation, sustaining the health status of cities has become an imperative issue. Proper diagnose upon the healthy status of cities requires a set of scientific and rigorous city health diagnose toolkits. With regard to city health diagnosis, extant studies have proposed various indicators. Whilst the diagnosis indicators appear to be fragmented and lack an organism perspective in investigating urban health status. This study thus fulfills the gap of existing literature by treating cities as living organisms and establish a conceptual framework of city living organism, which is composed by five aspects of living characteristics, including metabolism, response, adaptivity, growth, and reproduction. Based on the city organism framework, a set of city somatic index system is proposed, and detailed guidance upon how to use this set of index system to conduct city health diagnose is provided. City health diagnosis in referring to the established conceptual framework and index system can be undertaken at three levels: macro, meso and micro. The validity of the established city health diagnosis framework is tested via a case study of 12 Chinese cities. The city organism framework and city health diagnose index system provide a scientific toolkit for city managers and researchers to systematically investigate city health status and address any underlying urban diseases.