Title: The health and health inequalities impact of a place-based community wealth Initiative
Funder: Department of Health and Social Care

Abstract: The UK experiences some of the largest differences in health between places in Europe with people living in poorer areas dying on average 9 years younger and living for 19 more years in poor health than more affluent areas. These differences are largely due to economic differences between places, such as high unemployment and low wages in some places. Many initiatives have been carried out in the past to try and address the economic difficulties faced by disadvantaged places, however they have had limited success._x000D_ _x000D_ A new approach, called a Community Wealth Initiative has been tried in Preston, a city in the North West of England that has historically been relatively disadvantaged. Rather than involving new government funding, this new approach involved all the large public and third sector organisations in Preston, known as anchor institutions (e.g. the local authority, university, NHS, police, the social housing provider etc)._x000D_ _x000D_ These organisations looked at how they spent their budgets, to see if they could buy more services from local suppliers. Where they could not find local suppliers they helped establish new charities and cooperatives. They also improved the conditions of their employees, increasing their wages and encouraged their suppliers to do the same. They looked at their investments, property and land to see how these could be used in ways that increased benefits for the local population – for example renovating empty properties for social housing. _x000D_ _x000D_ All of these actions aimed to boost the local economy and ensure that the most disadvantaged groups were benefiting from these improvements. There are some indications that this approach may be improving the local economy and several other places are now implementing a similar approach. As being out of work, on low income or in poor housing are major causes of poor health, these changes could lead to improvements in health, however, at the moment we do not know if they have done, or which of these changes had the biggest effect. _x000D_ _x000D_ Our research aims to investigate the impact of the Preston Community Wealth Initiative on peoples’ mental health so that other areas can learn from this approach when developing their economic strategies. We will calculate the effect of the Community Wealth Initiative on mental health by comparing changes mental health in Preston with changes in comparison areas that have similar characteristics but have not implemented a Community Wealth Initiative. We will then work with all the organisations and people involved in the Community Wealth Initiative to understand what has helped or hindered this change in Preston. _x000D_ _x000D_ We will use the findings from this research to help other areas across the UK to influence their local economy so that it promotes health and reduces health inequalities.

Lay abstract: Background: The large regional economic disparities in the UK lead to some of the largest regional differences in health of any country in Europe. It is likely that the current COVID19 pandemic will exacerbate these economic and health inequalities. Previous attempts to address this issue have had limited success. _x000D_ Intervention: The Community Wealth Initiative (CWI) aims to address this problem in Preston. It involves a coalition of large employers coordinating action to improve the local economy and reduce inequalities by: (1) changing procurement to support local supply chains; (2) supporting local small enterprises (cooperatives, social enterprises, charities, small businesses); (3) investing pension funds in affordable housing; (4) improving working conditions and (5) renovating empty properties for social housing. This strategy has the potential to improve health, reduce health inequalities and make Preston more resilient to the adverse consequences of the COVID19 pandemic. _x000D_ Objectives: _x000D_ 1) Investigate the impact of the Preston CWI on social, economic and health outcomes, and assess whether the Preston CWI has mitigated the impact of the COVID19 pandemic on these outcomes. _x000D_ 2) Assess additional costs associated with implementing the CWI though changes in procurement practices and whether these costs outweigh the benefits. _x000D_ 3) Increase our understanding of the process of change within Preston initiated by the CWI and the pathways to changes in outcomes. _x000D_ 4) To draw out policy, practice and research implications for future CWIs so that they maximise their health and wellbeing benefits. _x000D_ Methods: We combine two approaches to achieve these objectives. Firstly we estimate the impact of the CWI on our primary outcome – the Small Area Mental Health Index, by using propensity scores to match areas in Preston with a set of comparison areas that have similar characteristics but have not implemented a CWI. We will then apply difference-in-differences analysis to compare changes in this outcome in Preston before and after the intervention with changes in the outcome in comparison areas. We will use similar methods to assess the impact of the CWI on investment, employment, wages and life satisfaction. We will assess whether the intervention mitigated some of the adverse effects of the COVID19 crisis and evaluate additional financial costs from changes in procurement practice. Secondly we use a combination of participatory network analysis, interview, observation and documentary analysis to understand the process of change that has taken place in Preston and what has helped or hindered this._x000D_ Timeline for Delivery: The research will be delivered between April 2021 and Sept 2023. _x000D_ Anticipated impact: The research will indicate the critical components needed for implementing CWI and the likely costs and benefits of these approaches. We will work with local governments across the UK through the Community Wealth Building Centre of Excellence, to implement these findings in developing local economic strategies that are likely to improve health and reduce health inequalities.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: MENTAL HEALTH