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Cities increasingly rely on assessment tools to understand whether neighbourhoods and urban systems support health and wellbeing. Yet results can depend on which tool is used. We examined fourteen widely used health assessment tools using a structured analytical framework. Our study shows that divergence is not primarily about which indicators are included, but about how tools operate across multiple layers.
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Target audience
Municipal planners, public health directors, urban policy officers, monitoring and evaluation units, and city leaders responsible for selecting and applying healthy city assessment tools.
The problem
Cities increasingly rely on assessment tools to understand whether neighbourhoods and urban systems support health and wellbeing. Yet the same city can receive very different results depending on the tool used. A place that performs well under one framework may perform poorly under another. This creates uncertainty for decision-makers who must choose which system to adopt or reference. Most comparisons focus only on indicators, while deeper differences in structure, meaning, purpose, and institutional backing remain insufficiently examined.
What we did and why
We examined fourteen widely used healthy city and place-based health assessment tools using a structured analytical framework. Rather than comparing indicator lists alone, we analysed how each tool defines measures, organises them into composite results, frames the concept of health, positions its intended purpose, and establishes legitimacy. We undertook this analysis to identify where divergence occurs across tools and to clarify why systems that appear similar at first glance may lead to different policy interpretations.
Our study’s contribution
Our study shows that divergence is not primarily about which indicators are included, but about how tools operate across multiple layers. Differences increase as one moves from technical measurement toward conceptual framing, intended use, and institutional credibility. By identifying eighteen key attributes across five analytical levels, we provide cities with a structured way to understand how assessment tools differ in their assumptions, design logic, and governance positioning.
Impacts for city policy and practice
Our findings support more transparent and confident decision-making in cities. We recommend that planners and public health officials look beyond indicator lists and examine how measures are defined, how results are combined, what concept of health is being assessed, whether the tool matches their policy purpose and spatial scale, and how legitimacy has been established. Making these elements explicit strengthens accountability and improves the responsible use of urban health assessment systems.
Further information
Full research article:
Beyond indicator lists: aligning place-based health assessment tools using a semiotic framework by Jamal Al-Qawasmi & Abubakar Idakwo Yaro
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