Study published in Lancet finds health and wellbeing benefits from Preston model

'Our research indicates that an approach focused on community wealth building may be more effective at achieving wellbeing improvements'

A study published in the Lancet has found a number of improvements in terms of mental health and wellbeing from the community wealth building programme put in place by Preston City Council.

Commonly known as the Preston Model, the project diverted the procurement policies of the local authority and other anchor institutions – such as the city’s university and housing providers – to support local businesses, develop new enterprises, encourage better employment conditions such as the living wage, and increase the socially productive use of wealth and assets, such as local government pension funds.

It has made Preston a flagship example of a co-operative new municipalism in the UK and around the world – but opposition parties in the city have been critical, calling on the Labour leadership to prove its effectiveness.

The study, funded by the National Institute for Health Research and carried out by researchers led by Prof Ben Barr of the University of Liverpool, offers the Labour leadership some of the evidence it needs.

The report puts its findings in the context of the UK having “some of the largest spatial health inequalities in Europe, with people in socio-economically disadvantaged areas dying on average nine years younger and living for 19 more years in poor health than more affluent areas.”

Previous place-based efforts to resolve this have had only partial success, the study says, noting that these projects have been criticised for failing to change “underlying economic determinants of health”.

In Preston – one of the 20% most deprived local authorities in England – the need for action was clear, with health measures “considerably worse than the national average” – but according to the new study, community wealth building has brought improvements.

“During the period in which the community wealth building programme was introduced,” the study found, “there were fewer mental health problems than would have been expected compared with other similar areas, as life satisfaction and economic measures improved. This approach potentially provides an effective model for economic regeneration potentially leading to substantial health benefits.”

The study compared trends in mental health outcomes in Preston, relative to matched control areas before (2011–15) and after (2016–19) the introduction of the programme. For evidence, it looked at antidepressant prescription rates, prevalence of depression, and mental health related hospital attendance rates using data provided by National Health Service Digital, the Quality and Outcomes Framework, and the Office for National Statistics. Additional analysis compared local authority measures of life satisfaction, median wages, and employment with synthetic counterfactuals created using Bayesian Structural Time Series.

Researchers also found a 3% decline in the prescribing of antidepressants, a 2% decline in the prevalence of depression, relative to the control areas, and a greater reduction in the prevalence of depression in the most deprived areas of the city.

During the same period, the local population experienced a 9% improvement in life satisfaction, and 11% increase in median wages, relative to expected trends.

“Our findings are consistent with Preston’s community wealth building programme having led to economic improvements that have translated into improvements in mental health and wellbeing,” the researchers added.

“Our study provides evidence that alternative place-based approaches to economic development such as Preston’s community wealth building, centred around economic democracy and social value, could potentially support the joint aims of economic regeneration, health and wellbeing improvements, and reduced regional inequalities.”

Prof Barr says the figures translate to 350 fewer people being diagnosed with depression, and reflect the impact of working conditions and financial security on people’s mental health.

“As we emerge from a pandemic that has disproportionately affected the health and economy of the most disadvantaged places, new and inclusive approaches for economic recovery are needed. Our research provides valuable evidence that such approaches can help improve health as well as benefiting the local economy.”

He added: “Our study indicates that the approach to economic development applied in Preston provides lessons for the UK government,” he added. “Policies to level up the health, wellbeing and economy of disadvantaged places are often based on the principles of attracting inward investment into places such as Preston. However, such approaches have not always led to improved wellbeing and decreased inequality. Our research indicates that an approach focused on community wealth building may be more effective at achieving wellbeing improvements.”

Cllr Matthew Brown

Council leader Matthew Brown welcomed the study and said more work had been done on community wealth building since the report was compiled, including construction of a municipally owned cinema and a £60m investment into the Harris Museum and Art Gallery, with the primary contractors based in Preston. 

Ten worker co-ops are at various stages of incubation, including the transfer of a Travellers’ site to co-op ownership. A community land trust is working to regenerate the former Emmanuel Church site in Plungington by creating 14 quality affordable flats for rent and a vibrant community venue and worship space. The council is also working with the Co-operative Education Centre, a union co-op which is encouraging worker ownership in union branches across the city.

Other worker co-ops have been set up to help female former prisoners back into employment;to retrofit buildings; and organise members of the south Asian community into projects to alleviate food poverty. New businesses include the Mandala Centre for yoga and wellbeing, which is in the process of becoming worker-owned.

“Additionally,” said Brown, “we’ve just announced a project for a community energy co-op that will install solar panels and other net zero infrastructure on a couple of our anchor institutions, with local businesses involved.”

Work is also progressing on a regional mutual bank, he said, and the council is considering possible ideas around social housing and municipal broadband to tackle digital exclusion.

“This push we have for a more democratic, fairer economy is actually being brought to scale now,” added Brown. 

“But we’re really restricted in terms of what local government can do. Even if you have a much larger council, they’re restricted in terms of how they raise finance, acquisitions of land and other things. It’s a really difficult situation in this country.”

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