Self-perceived health is an important factor for assessing urban residents’ satisfaction and quality of life ^[1][2][1,2]. Scholars have focused on social demographic variables, indoor environment characteristics, lifestyle, and health awareness to account for urban residents’ satisfactions ^{[3][4][5][6][7]}[3,4,5,6,7]. For demographic conditions, gender and age are the two most recognized factors. There are different determinants of self-perceived physical and mental health for women and men, and it has been found that older people often have worse perceived health (^[3][8][9][3,8,9]. In addition, employment, income, and education also play important roles ^[10][11][10,11]. For lifestyle and health awareness, drinking, smoking, and the lack of physical activities often negatively impact health perception ^[10][12][13][10,12,13]. Regarding the indoor environment, badly adjusted indoor temperature, humidity, and ventilation can worsen the perception of health. Finally, health perception is also negatively influenced by different conditions of neighborhood characteristics, especially regarding urbanity, as well as different types of housing ^{[8][14][15][16]}[8,14,15,16].

Scant research has focused on the relationship between lifestyle and health perception in the Chinese context, especially in the western part of China, where rapid urbanization is still in progress. At the same time, evidence has proved that the changing built environment exhibited robust impact on urban residents’ health conditions in various neighborhood typologies [17].

2. Social Demography, Lifestyle and Health Awareness, and Indoor Environment Factors

Demographic factors, such as gender, age, and education, are among the most frequently suggested determinants of perceived health (^[18][19][18,19]. For example, scholars showed that women were more likely to consider a broader range of items, such as psychological factors, non-medical negative life events, or non-threatening life diseases, into their self-rated health responses than men ^[3][20][3,20]. Others argued that while the self-rated health of older age groups unsurprisingly decreased, this association was often not attributable to age, but to other factors, such as physical condition or socio-economic environment ^[12][21][12,21]. Similarly, researchers also suggested that people with less education and lower income also tended to be less positive about their health condition than others [22]. In the Chinese context, rural-to-urban migrants experience better health perception than rural residents [23]. Additionally, a national study showed that people who engage in work, have higher household income, socio-economic status, and social class, have no depression, and have good social ties often report good health [18]. Another national study also argued that income and education had great influence on self-rated health, while occupation was not a significant contributor, except for women in lower grade management and professional jobs [19]. Among Chinese elderly, previous studies showed that age, number of diseases, family and neighborhood relations, and rentage were significant predictors of self-perceived physical health. Lifestyle factors are also frequently investigated. Smoking and a lack of physical activity in both the built and natural environment settings might correspond to negative perception of health (^[7][13][7,13]). However, Ou et al. [24] reported that people who perceive themselves as unhealthy engaged in more physical activities than others. Dhingra et al. [25] found that higher perceived healthcare needs increased with health insurance coverage in Massachusetts, United States. The indoor environment significantly influences both actual health outcomes and self-reported health status. Illnesses such as the sick-building syndromes, which includes non-specific complaints that may or may not result in a concerning health problem come from poor ventilation systems or poorly-adjusted temperature and humidity, and can result in greater stress and annoyance, thereby leading to less positive health status ratings [4]. Research in China showed that indoor air pollution from interior decoration, indoor dampness, and poor ventilation conditions were all causes for sick-building syndrome [26]. Controls over temperature, ventilation, and noise provide the occupants greater comfort.

3. Neighborhood Characteristics and Sub-Group Analysis

The neighborhood environment includes important factors for perceived health quality. The relationship between subjective neighborhood and health perception can be partially explained by loneliness, depression, and stress [27]. Different types of housing, associated with various conditions in indoor environment and community structure, also affect self-evaluated health differently. Studies in Switzerland [14] Scotland [28], and Japan [29] all suggested that people who did not live in private housing (such as social rented or private rented housing) had significantly lower self-reported health than people who lived in their own home. In the Chinese context, relatively little attention has been paid to study the relative associations of self-rated health to different groups of individual and neighborhood environments, with the exception of a few [24]. Globally, sub-group analysis has been widely used in many research undertakings looking at different patterns of perceived-health determinants. Such analyses have led to findings such as the one showing that an association between income and health perception was stronger in urban environments [15]. Sub-group analysis can often give more room for results and discussions, and can help tailor policies that improve the perception of health for specific groups of subjects. To obtain such information on self-perceived health, surveys are often applied to assess the respondents’ perceptions of health by using a three-to-five points scale, rating from poor to excellent [30]. This type of self-rated assessment has been proven to be as good as or better than more specific health questions, such as those investigating functional abilities, chronic diseases, or prescriptive medication. Furthermore, self-perceived health can be predictive of a patient’s chronic disease, functional decline, or even mortality [14]. While this type of health assessment can become a good predictor for overall health status of the whole population, it may be influenced by other factors, such as demography, living environment, social network participation, and psychological state; therefore, separate evaluation for different groups is necessary and requires cautious attention ^[14][31][14,31]. Investigating the relationship between self-reported health and the outside factors is crucial for providing adequate responses to a patient’s own understanding of their suffering and healing processes, thus promoting well-informed public decisions.

4. Determinants of Resident’s Health Perception in the Chinese Context

In China, there is relatively little research focusing on the relationship between lifestyle and health perception, except for some investigations on the effect of smoking [32] and physical activities [24]. Moreover, most of the studies focus on large coastal cities, such as Beijing and Shanghai. Regarding the neighborhood built environment, also in the Chinese context, Liu et al. [33] suggested that the built environment had stronger ties to self-rated health than the natural environment, yet these relationships were relatively weak in comparison to the results from both Japanese and South Korean contexts. Seniors with living arrangement concordance, whether institutionalized or community-resided, reported better health, while people living in public subsidized housing were more likely to report poor health [17]. On the other hand, research has frequently investigated the socio-economic-political conditions of different types of Chinese housing. Traditional housing in China, such as Beijing’s courtyard houses (hutong) and Shanghai’s lane houses (lilong), are frequently discussed in literature, yet cities like Chengdu do not seem to have their own typical vernacular housing. One example is the Kuan Zhai Xiangzi—the old city where Qing dynasty’s bureaucrats lived and worked, which was recently renovated to become a tourism site, yet still allows working-class families to stay and foster the community [34]. During the construction boom and urban regeneration in the 1990s, many traditional housing establishments in Chengdu and elsewhere were transformed into new housing with higher density and larger dwellings [35]. Work-unit (danwei) is the planned concept of welfare-oriented rental housing in China, and is representative of China’s nationalized urban housing process. It has many socio-economic-political and spatial implications for Chinese urban transformation (Bjorklund, 1986), yet is currently diminishing [36]. Many of the original residents have moved out, and the ones entering are mostly rural household registration, or hukou in Chinese; holders who want to find a cheap temporary location [37], thus reducing the social cohesion of work-unit neighborhoods significantly [8]. Many of these middle-income socialist workers are then transferred from the work-unit to proprietors of gated-communities [38], which emerged under the localization of governance and privatization of housing in China late 1980s [39]. This “gateness” existence enhances the residence’s sense of safety and security, but does not necessarily provide a sense of community [40]. Finally, relocated housing was born out of the rapid expansion of cities, which led to urban land development and land use transformation. These housing units, often free and sometimes low-cost yet involuntary for relocated families, sometimes create tension and conflict over the process of residential relocation [41].