The health and health inequalities impact of a place-based community wealth Initiative

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.

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. Objectives:

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.

2) Assess additional costs associated with implementing the CWI though changes in procurement practices and whether these costs outweigh the benefits.

3) Increase our understanding of the process of change within Preston initiated by the CWI and the pathways to changes in outcomes.

4) To draw out policy, practice and research implications for future CWIs so that they maximise their health and wellbeing benefits.

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.

Timeline for Delivery: The research will be delivered between April 2021 and Sept 2023.

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.