Introduction

Health tourism is a modern and rapidly growing concept that requires the attention and active involvement of urban planners and policymakers. By creating investment opportunities in health tourism, cities could foster the development of a sustainable urban economy, which can be achieved through integrated strategic planning and building a distinctive city brand to maintain a competitive advantage based on contextual and local conditions. Despite theoretical and empirical studies, the lack of an integrated approach toward health tourism-oriented urban development remains evident, particularly in Iran. Meanwhile, even though this potential has long been of interest in Iran, health tourism is still in the early stages of development. It also faces numerous challenges on its path to achieving its rightful place. The Fars Province and Shiraz, due to their rich natural resources, skilled medical professionals, unique tourist attractions, and strategic connectivity, possess significant potential for health tourism. The Shiraz International Health City Project, approved by the Council of Ministers in 2007, remains under consideration. This project, located approximately eight kilometers northwest of Shiraz on an area of about 1,000 hectares, lies along the route connecting the metropolitan area of Shiraz to Sepidan County. Hence, this study aims to explore health tourism-oriented urban development to enhance management solutions, focusing specifically on the case of Shiraz Health City.



Methodology

The present research is of an applied type with a qualitative nature to interpret underlying realities. The study’s theoretical foundations and conceptual framework address the notions of health tourism, health destination, wellness city, destination branding, and strategic requirements. In the empirical section, data were collected through semi-structured interviews conducted with experts and managers associated with the Shiraz Health City Project, including individuals from the Shiraz Special Economic Zone Organization, the Shiraz Health City Company, the Tourism Spaces Development Consortium, the Cultural Heritage, Tourism and Handicrafts Organization, and Shiraz University of Medical Sciences. Upon achieving theoretical saturation, the number of participants reached 7 through purposeful snowball sampling. The questions were designed around five key dimensions corresponding to the process phases of the health tourism-oriented urban development, including planning, management, branding, operational implementation, and monitoring and evaluation. Finally, the inferred categories reflecting the status of Shiraz Health City as a case study were extracted and analyzed through content analysis of the interviews.



Results and discussion

Based on the inferred categories derived from the content analysis of the interview, four main factors were identified as the primary reasons for the failure of the Shiraz Health City initiative: lack of cooperation and coordination among the involved institutions; insufficient financial resources; absence of branding and marketing policies; and inadequate monitoring of the project’s execution. Additionally, political challenges, the multiplicity of responsible authorities, and infrastructure provision problems are other significant issues affecting the project. Finally, lengthy bureaucratic procedures, inconsistency between operational actions and the approved plans, inappropriate project scale, land acquisition problems, and the absence of clear guidelines were recognized as obstacles hindering the realization of the Shiraz Health City Project. Nevertheless, the appropriateness of the initial plan, suitable site selection, alignment with higher-level planning documents, job creation potential, and attempts to establish an integrated management were emphasized by interviewees as positive aspects of the project.



Conclusion

Health tourism-oriented urban development involves multi-level planning, an emphasis on sustainability, and collaboration among all stakeholders. This process requires strategic management capable of identifying competitive advantages, entrepreneurship, innovation, and synergy while continuously monitoring potential opportunities and threats. Destination branding is crucial to attracting health tourists by creating a distinctive image and unique service value. It enables effective marketing and the optimal and efficient allocation of resources through participation. Consequently, a wellness city integrates economic, social, and environmental dimensions, enhancing a health-promoting lifestyle by facilitating and strengthening overall well-being rather than focusing solely on disease treatment and medical interventions. It aims to go beyond superficial or placeless developments, fostering supportive urban environments and improving urban health infrastructure. Continuous monitoring and evaluation of activities—through collaboration among voluntary, public, and private sectors and integrating their resources—is essential to ensure service quality, standard compliance, and management efficiency in health tourism destinations. Based on the integrated analysis of interview content, several solutions are proposed for the targeted development and efficient management of the Shiraz Health City Project: defining a realistic and context-sensitive vision, consistent with local capacities and constraints; preparing a health tourism-oriented urban development guideline; specifying the responsibilities of each stakeholder and establishing a strategic network of relationships for participation and partnership; implementing goal-oriented management of financial resources and credit allocation; forming a branding and marketing task force; and conducting continuous monitoring of project progress.