Beyond indicator lists: aligning place-based health assessment tools using a semiotic framework

Place-based health assessment/rating tools have expanded rapidly, yet structured divergence persists in their architecture, meaning, and application. This study applies a semiotics-based framework to examine fourteen widely used tools as layered socio-technical systems. Through systematic review and structured content analysis, eighteen attributes were identified and mapped across five semiotic levels: empiric, syntactic, semantic, pragmatic, and social. Divergence is unevenly distributed. At the empirical level, variation is limited, as all tools (100%) provide operational definitions, although calculation logics differ, including continuous normalization (36%) and benchmark-based scoring (36%). The syntactic level shows moderate divergence, with 64% operating as frameworks. Greater variation appears at the semantic and pragmatic levels, where disciplinary orientations span urban planning (43%) and public health (36%), constructs range from healthy city development (50%) to population health (29%), and monitoring represents 57% of stated purposes. The highest divergence occurs at the social level, where only 7% report formal reliability assessment. These findings indicate that cross-level misalignment, rather than indicator diversity alone, constrains comparability. A semiotic compliance framework is proposed to reduce misalignment while preserving contextual variation.