Abstract

Background
Regional economic disparities in the United Kingdom lead to large differences in health. Previous attempts to address this issue have had limited success. Community Wealth Building is an economic strategy that aims to address these inequalities by redirecting wealth back into the local economy and increasing community control over the economy. The City of Preston initiated a Community Wealth Building strategy in 2012. We investigate the health impact of this approach in Preston up to 2019, a period during which their strategy largely focused on progressive procurement and the adoption of the Living Wage by employers within Preston.

Methods
We estimate the impact of Community Wealth Building in Preston on mental health problems as measured by the Small Area Mental Health Index and its constituent components (antidepressants, depression diagnoses and mental health-related hospital attendances), self-reported life satisfaction, wages, employment and the number of non-profit enterprises. We use matching and difference-in-differences analysis to compare changes in outcomes in Preston before and after the intervention with changes in the outcomes in comparison areas. We use data on invoices and contracts issued by local authorities to compare procurement by Preston City Council with other similar local authorities, assessing the impact of local procurement on employment, wages and the cost of contracts. Finally, we use a combination of interviews and workshops to understand the process of change that has taken place in Preston and what has helped or hindered this.

Results
We found that, in Preston, the introduction of Community Wealth Building was associated with a reduction in mental health problems (−0.11 reduction in Small Area Mental Health Index, 95% confidence interval −0.16 to −0.06) alongside improvements in life satisfaction (0.06, 95% confidence interval 0.01 to 1.3), wages (£38 per week, 95% confidence interval £6.8 to £62.1), employment (4.1%, 95% confidence interval 2.3% to 5.8%) and a growth in non-profit enterprises (additional 20 enterprises 95% confidence interval 6 to 50). These economic improvements tended to be greatest among more disadvantaged groups, reducing inequalities. Preston City Council was much more likely to procure services from local suppliers compared to other similar local authorities, and this practice is likely to have contributed to these economic benefits. We found no evidence that procuring locally increased costs. Stakeholders in Preston highlighted that economic pathways to health impact were the most developed particularly in relation to procurement policy, while the community pathways to impact were less developed. Lack of widespread public involvement and engagement with smaller Voluntary, Community, Faith and Social Enterprise organisations in Preston had arguably limited the potential impact of Community Wealth Building in Preston. Despite this, appreciation for the approach and its aims remains strong.

Conclusion
Community Wealth Building in Preston has led to economic gains that disproportionately benefited less advantaged groups, and this led to improvements in mental health and well-being. This seems to have been largely driven by changes in procurement practices of anchor institutions alongside policies to improve working conditions – such as the Living Wage. Future development should aim to shift the balance toward bottom-up civic engagement, which will help enhance sustainability of the approach.

Funding
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR130808.