The health of the people is an important indicator of national prosperity and strength. The "Healthy China 2019-2030" initiative emphasizes the need to firmly establish the concept of "health and hygiene", with the government, the public, and individuals working together to promote a lifestyle, ecological environment, and social environment conducive to good health. Building upon this, this study explores the fundamental aspects of a healthy city from a geographical perspective and develops a comprehensive evaluation system that integrates a "five-dimensional" framework for the construction of a healthy city. The research focuses on 341 prefecture-level units in China and investigates the spatiotemporal heterogeneity and formation mechanisms of healthy city construction in the country. The findings indicate the following: (1) The overall level of healthy city construction in China is on the rise. The average comprehensive health index for the years 2010, 2015, and 2020 was 0.367, 0.402, and 0.438, respectively, exhibiting a layout characteristic of higher development level along the coastal regions and lower development level in the inland areas, as well as higher level in the eastern part compared to the western part. Various prefecture-level units exhibit regional disparities across five dimensions, including medical services, economic foundations, cultural development, social services, and ecological environment, resulting in diverse spatial patterns. (2) Healthy city construction in China demonstrates significant overall spatial autocorrelation, revealing a spatial distribution pattern characterized by warmer development in the eastern and coastal regions and cooler development in the western and inland regions. The overall regional disparities in healthy city construction follow a trend of initial increase followed by a decrease, indicating a gradual shift towards coordinated regional development. (3) The natural environment, human activities, construction foundations, and development capabilities serve as fundamental, intrinsic driving, and external promoting factors, respectively, influencing the spatial patterns of healthy city construction. Factors such as per capita GDP, average elevation, population density, and transportation accessibility have a substantial impact on the spatial patterns of healthy city construction. This study, from a geographical perspective with a focus on the "human-land relationship", elucidates the five-dimensional framework of healthy city construction and provides a clear path for healthy city development in China. It offers a scientific foundation for the comprehensive promotion of healthy city construction and supports the implementation of the Healthy China strategy.