The Mental Health And Wellbeing Impact of A Community Wealth Building Programme – A Difference-In-Differences Study

Abstract

Background
Wide differences in health exist between places in the UK, underscored by economic inequalities. Preston, a relatively deprived city in England, implemented a new approach to economic development, known as Community Wealth Building. Public and non-profit organisations modified their procurement policies to support the development of local supply chains, improve employment conditions, and increase socially productive use of wealth and assets. We evaluate the impact of this programme on population mental health and wellbeing.

Methods
Difference-in-differences techniques compared trends in mental health outcomes in Preston, relative to matched control areas before (2011-2015) and after (2016-2019) the introduction of Community Wealth Building. Additional analysis compared local authority measures of life satisfaction, median wages, and employment to synthetic counterfactuals created using Bayesian structural time-series.

Findings
The introduction of Community Wealth Building was associated with reductions in antidepressant prescribing (1.3 ADQs/person [95%CI, 0.72–1.78]) and depression prevalence (2.4 per 1000 population [95%CI, 0.42–4.46]), relative to the control areas. The local population also experienced a 9% improvement in life satisfaction (95%Cr I, 0%–20%) and 11% increase in median wages (95%Cr I, 2%–19%), relative to expected trends. Associations with employment and mental health related hospital attendance outcomes, did not reach statistical significance.

Interpretation
During the period in which Community Wealth Building was introduced there were fewer mental health problems than would have been expected compared to other similar areas, as life satisfaction and economic measures improved. This approach potentially provides an effective model for economic regeneration leading to substantial health benefits.