Objective  To understand the equilibrium status of public health security in different regions at the county (county-level city, district) level in Zhejiang province, thus providing a basis for targeted policy implementation across the entire province.

Methods On the basis of the public health security evaluation index system, relevant public health security data in 2023 were collected from seven counties (county-level cities, districts) in Zhejiang province. The entropy weight technique for order preference by similarity to ideal solution (TOPSIS) was used to calculate the index values for each county (county-level city, district). The comprehensive closeness degrees for six dimensions including policy guarantee, resource support, healthy environment, surveillance and early warning, emergency response, and vulnerable population were calculated upon the grouping by different socioeconomic levels, different terrains, and different county-level administrative categories. The coefficients of variation were calculated to assess the level of balance in public health security development.

Results The comprehensive closeness degree of public health security in moderately developed areas in Zhejiang was the highest (0.644 0), significantly higher than that in developed areas (0.399 3) and underdeveloped areas (0.344 6). The coefficient of variation for the health environment dimension among the three areas with different socioeconomic levels reached 91.25%. The comprehensive closeness degree of public health security levels in plains was the highest (0.525 0), followed by those in islands (0.353 9) and mountainous areas (0.333 3). The closeness degrees for the emergency response dimension in the latter two areas were both close to the ideal value of 1.000 0. County-level cities had the highest comprehensive closeness degree of public health security (0.666 0), followed by districts (0.435 9) and counties (0.382 2). The coefficients of variation for the health environment and emergency response dimensions among the three areas with different county-level administrative categories were high, reaching 68.77% and 51.93%, respectively.

Conclusions The public health security levels in different counties (county-level cities, districts) of Zhejiang province exhibit a certain degree of non-equilibrium. In moderately developed areas, the overall public health security level is relatively high, with a particular emphasis on the healthy environment. The islands and mountainous areas have significant advantages in emergency response, while their healthy environment and surveillance and early warning capabilities are not as strong as those in plains. In county-level cities, the overall public health security level is relatively high.