Anders Nordström

Background: The COVID-19 pandemic has revealed how conventional top-down, expert-driven indicators often fail to align with local community realities, marginalising their perspectives, concerns, knowledge, and narratives. However, the limitations of pandemic-related and global health security indicators are not unique but reflect recurring patterns across major social metrics. In response, an alternative paradigm advocates for grassroots-inclusive approaches to developing indicators. Our objective is to assess how and why grassroots-inclusive approaches complement top-down approaches to developing indicators, and to synthesise their theoretical and practical contributions to public health. Methods: We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We systematically searched six databases (MEDLINE, Embase, CINAHL, Web of Science, Scopus, and PsycINFO), as well as Google Scholar, to identify relevant articles published from their inception to September 1, 2024. We included peer-reviewed articles, opinion pieces, and book chapters, narratively synthesising their findings. Results: This review included 43 studies from various disciplines. Across these studies, communities co-produced indicators through participatory workshops, interviews, and consensus exercises in areas such as environmental sustainability, disaster resilience, public health, well-being, and local development. The reported strengths included greater local relevance, community ownership, and accountability, alongside challenges in sustaining participation, integrating into top-down systems, and addressing data gaps. Notably, no study applied grassroots-inclusive indicators to health security or pandemic preparedness. Conclusion: Despite retrieving and analysing articles from various disciplines, no study has specifically applied grassroots-inclusive indicators to health security or pandemic preparedness. However, the evidence clearly shows that it is both feasible and practical to integrate expert and non-expert perspectives when developing indicators.

Addressing global health challenges requires complex coordination and collaboration between actors, often through the process of Global Health Diplomacy (GHD). Although considerable scholarship argues the importance of improving this process to build better health policies and systems, few studies have investigated the 'health diplomats' directly leading this work. In this study, we seek to better understand GHD from a practitioners' view by exploring perceptions of knowledge acquisition, capacity building, and network development amongst those who coordinate and orchestrate global policy solutions. Taking an inductive qualitative approach, we conduct interviews of 54 experienced GHD professionals working across government, civil society, and private industry in 23 countries and identify key themes that outline challenges and opportunities for capacity building in GHD. Findings indicate a nascent global community bound by shared identity and motivations, but also hurdles regarding the transfer of tacit knowledge, network integration, and the improvement of institutional leadership. These findings highlight the boundaries by which knowledge and capacity are difficult for health diplomats to acquire or transfer, which help explain limitations to achieving better outcomes for global health. Further, this study may assist scholars and practi‑ tioners' work by considering GHD as a purposeful community of practice.