How did decision-making in Big Local impact health and wellbeing?

Communities making decisions about the place where they live has the potential to effect change through different routes. Increased control over one’s life circumstances shapes personal health outcomes in a positive way (Townsend et al., 2020). There is also some evidence that collective control over decisions leads to better health (Townsend et al., 2020). 

This article looks at the effects of increased collective control brought about by the Big Local programme, for those most actively involved. For example, a resident-led partnership in each area decided how the Big Local fund of £1m should be allocated over 10 to 15 years, based on local priorities. This increase in control and self-efficacy should benefit health – particularly for residents who oversaw the programme locally. 

Communities with control over funding may also make better decisions, which could lead to better health outcomes through physical activity, improved environmental health, and more. 

Local Trust has explored what Big Local areas did to improve health in another article.

Big Local showed that participating in collective decision-making can be good for health. A survey showed that partnership members’ mental wellbeing improved between 2016 and 2018 (based on all respondents who responded to the survey in both of those years). There was a 1.46 unit increase in self-reported mental wellbeing, according to the Warwick-Edinburgh Mental Wellbeing Scale, which runs from seven to 35 (Popay et al., 2023).

This trend did not continue into 2020, with scores remaining similar. This could have been due to several reasons, not least the Covid-19 pandemic. Responding to it may have offered a sense of purpose for some Big Local volunteers, but many would have felt stressed, anxious, and lonely – along with many others across England. There was no control group for the survey respondents, and so the cause of the wellbeing scores cannot be established. 

There was also a positive correlation between higher mental wellbeing and:

• respondents agreeing that residents were willing to help each other and that residents could collectively influence decisions 
• the area prioritising funding of environmental activities
• the number of hours that respondents volunteered.

While this does not strongly indicate cause, it is worth noting.

Increased control should be good for health, and Big Local shifted control to residents in different ways (Popay et al., 2020; Ozano et al., 2024). Frameworks categorising different types of power help us to understand how it was increased through Big Local (Popay et al., 2020).

The first step was often developing ​‘power within’: collective capability and confidence to change things for the better. This was demonstrated in achievements such as: listening to what the whole community said and identifying their needs; developing a shared vision for how to use the Big Local funds; and building a collective identity (Ponsford et al., 2020; Wilson et al., 2025). People began to see their own value and ability as a part of this collective endeavour.

Big Local also developed ​‘power with’: building partnerships with other groups, organisations, or institutions to achieve common goals. Often this was a tricky process, involving re-shaping relationships that were previously poor (McCabe et al., 2022) or unequal (Popay et al., 2023). These situations often improved and the dynamic became more balanced, but in some cases, partnership members still felt like they lacked influence well into the programme.

The programme also helped develop ​‘power to’: the capacity to take action or exercise collective control. Initially this was seen in successfully established governance structures, such as resident-led partnerships. Eventually, it showed in the improvements Big Local areas made in local conditions, including social, physical, and environmental (Popay et al., 2020). 

Power ​‘with’, ​‘to’, and ​‘within’ are all positive, generative forms of power, which could lead to better health as they increase control. Yet power can be seen as a finite resource – for one entity to have power, another must lose some. Reflecting this, some studies of Big Local explored forms of power that are limiting, known as ​‘power over’ (Popay et al., 2020). For example, local politicians were sometimes seen to have too much influence on resident-led decision-making.

Power dynamics within a partnership may have also undermined equity. This could occur when a longstanding group was defensive to new members asking questions or bringing new ideas, or where people were left out because they were perceived as too loud or too difficult (McCabe et al., 2021; Ponsford et al., 2020; Lyon et al., 202 1). Sometimes decision-making was concentrated amongst a small group within the partnership (Wilson et al., 2025). 

In some cases, while power dynamics played out subtly, they could nevertheless have a harmful effect, such as unconscious racial bias. Such negative power dynamics could contribute to poorer wellbeing and stress.

In other cases, developing resistance and counter-strategies could be a positive outcome of negative forms of power. For example, in one area residents asserted their boundaries by insisting on funds being used appropriately, refusing to pay an invoice where they believed the providers had not kept to the terms of the agreement (Ponsford et al., 2020).

As well as feeling greater control, active involvement in Big Local could bring about more social connections and a sense of purpose, thereby improving wellbeing. Each partnership worked as a group, meeting regularly to make decisions. While these potential personal wellbeing benefits of volunteering have been relatively under-researched, some research reports did focus on the individual impact for volunteers (Shift and Local Trust, 2023).

This sense of purpose could have also gradually evolved into ​‘learned optimism’ – an expansion in people’s ideas of what is imaginable, possible, and achievable. This in turn could have developed people’s confidence, representing the opposite of giving up or resigning in the face of adversity (Wilson et al., 2025). 

Beyond partnership members’ experiences, much of Big Local activity focused on improving the social environment and reducing social isolation. Areas which progressed the fastest by 2022 showed improvements in mental health at the population level (between 2016–2022).

Local Trust has explored what Big Local areas did to improve health in another article.

There was nuance to the impact on health, and while Local Trust surveys of partnership members showed that working on Big Local was generally positive it was sometimes stressful. In 2024, over half of respondents agreed or strongly agreed that being involved in Big Local was satisfying (60 per cent) and rewarding (56 per cent). However, 32 per cent said it was frustrating and 20 per cent found it stressful (Local Trust, 2024). Between 2016 and 2018, there were positive impacts on mental wellbeing for both men and women. However, the impact was greater for men and people with one or more university degrees (Popay et al., 2023).

Keeping up morale in the Covid-19 pandemic years was challenging, with fewer opportunities for fun and meet-ups but an increased sense of responsibility for many partnership members (McCabe et al., 2021). Reflecting wider trends of declining volunteering (DCMS, 2024), recruiting more volunteers was a common challenge for Big Local partnerships, so those who did give their time often had to do a lot of work. And while the long-term nature of the programme was useful in many ways, it meant partnership members had to maintain commitment and energy over the years, balancing Big Local with major life events (Wilson et al., 2025).

Some partnership members found it difficult to work through divisions in the partnership.

The sense of responsibility brought about by Big Local could be stressful – not least because people had to make decisions about the place where they live, have friends and neighbours, and were potentially raising families. Making decisions about allocating a million pounds was not easy in this context. 

Some experts on place-based initiatives have recommended that residents’ roles should be focused on identifying priorities (Popay et al, 2023). Delivery in line with these priorities should be, in this view, a shared responsibility (presumably with public and voluntary sector agencies). Good quality professional support is undoubtedly key to successful community-led change, not least to prevent volunteer burnout. However, as shown above, different forms of power are developed through extensive (sometimes challenging) experience, as people learn by doing (Ozano et al., 2024). It is debatable whether those who delivered the programme in areas would have been able to develop collective control in the same way without such hands-on experience. 

The Big Local programme could not remove the widespread socio-economic challenges which individuals and communities continued to face (Wilson et al., 2025). These challenges could have negative impacts on long-term health outcomes. What the programme was able to do was develop different forms of resident power through authority over decision-making, and with this, the potential health benefits that come with an increased sense of control over one’s life.