Evaluating Place-Based Health: Coverage and Consistency of Indicators Across Assessment Tools

Place-based health (PBH) assessment tools are increasingly used to evaluate the extent to which urban environments support health and well-being. However, concerns remain regarding their consistency and ability to adequately represent the multidimensional nature of the PBH construct. Despite the growing use of such tools, few studies have systematically examined their indicator structure and coverage. This study evaluates 14 PBH assessment tools to examine their internal structure, indicator usage patterns, and coverage of PBH attributes. A total of 667 indicators were extracted from the examined tools, from which 503 unique indicators were identified and compiled into the Extensive List of Place-Health Indicators (ELPHI), comprising 16 categories and 58 subcategories. ELPHI was then used as a reference framework to conduct a multi-level coverage analysis of the examined tools. The results reveal substantial fragmentation in indicator selection, with 84% of unique indicators appearing in only one tool, indicating limited consensus regarding the attributes considered important for assessing PBH. While most tools demonstrated moderate to high comprehensiveness of coverage at the category level, performance was considerably weaker at the subcategory level. No tool achieved high representativeness of PBH subcategories, with coverage ranging from 10% to 66%. Environmental attributes generally received broader and more representative coverage than socio-economic attributes, which were frequently underrepresented or omitted. In addition, between 34% and 90% of PBH subcategories and between 6% and 75% of PBH categories were not covered by any indicator in individual tools. This study also demonstrates the utility of coverage analysis and ELPHI as a systematic framework for evaluating the content validity, consistency, and structural robustness of PBH assessment tools, and for supporting the development of more balanced and comprehensive assessment frameworks.