To investigate the coupling coordination between provincial-level social service capacity and public health governance in China, and to reveal regional disparities and dynamic evolutionary patterns, this study draws on panel data from 31 provinces over the period 2014–2023. The entropy weight method and coupling coordination degree model are employed to measure the level of synergistic development, Dagum Gini coefficient decomposition is applied to disaggregate regional disparities, and Kernel density estimation combined with Markov chain analysis is used to examine dynamic evolution. Moran's Index is further introduced to test for spatial agglomeration. The results show that the national coupling coordination degree has risen from mild imbalance to basic coordination, exhibiting a spatial pattern of "high in the east and center, low in the west." Inter-regional disparity is the dominant source of overall inequality, with its contribution reaching 60.766% in 2023; the hypervariable density contribution surged from 5.754% to 14.565%, indicating intensified cross-regional overlap. Spatial agglomeration strength has continuously increased, and coordination levels are primarily characterized by gradual upward transitions, with high-level neighboring regions exerting a significant positive pull effect. On this basis, the study recommends deepening the dual-system coordination and linkage mechanism, implementing targeted and differentiated policies tailored to the distinct conditions of eastern, central, and western regions, building cross-regional collaborative networks, and activating endogenous momentum for coordinated regional development, so as to advance high-quality coordinated development of social services and public health governance.