What did Big Local areas do to improve health?

The ​‘social determinants of health’ are non-medical factors that influence health outcomes. They are the circumstances within which people are born, grow up, live, work and age, as influenced by economic, political and geographical factors (WHO, 2019). Examples include levels of poverty, quality of housing, access to green space, and quality of social relationships. 

Social determinants of health relate strongly to place-based inequalities. Compared to the England average, disadvantaged areas have historically had poorer access to resources which help improve health, so have experienced worse health outcomes. In the 2010s (and beyond) areas experiencing disadvantage had higher rates of long-term illness compared to the England average and rates of lung cancer, diabetes, and mental health issues were also disproportionately high (OCSI, 2019; Marmot et al., 2020). In the 2010s, the most disadvantaged areas faced the highest cuts to local council budgets (Marmot et al., 2020). By definition, doubly disadvantaged or ​‘left behind’ neighbourhoods have lacked places to meet and an active civil society, as well as experiencing health inequalities and poverty (OCSI, 2019). 

By addressing the factors contributing to health inequalities (like poverty, economic decline, and social isolation), Big Local could be seen as a preventative health programme without being necessarily labelled or understood by its beneficiaries as such.

This article explores how Big Local activity addressed the social determinants of health, and the outcomes of this work. Their activity focused on place-based issues which were suitable to tackle at a hyperlocal level. Yet the causes of poor health are underpinned by global and national trends, and reversing the disadvantage faced by some neighbourhoods requires long-term investment at scale. However, some Big Local areas were able to put in place activities and resources that could help improve health over the long term and use their power to locally influence systemic determinants of health. 

A note on terminology and the sources used: Marmot et al. (2020) refer to ​‘deprived’ areas; the OCSI research (2019) discusses ​‘left behind’ areas which experience multiple deprivation and a lack of connectivity. Here, we use the term ​‘disadvantaged’, but with the caveat that no single term is perfect, nor does this term reflect the range of strengths as well as challenges that any one area possesses. 

Local Trust explores the ways in which Big Local areas worked to influence health service delivery in an upcoming article.

Big Local partnerships sought to build stronger relationships within communities and facilitate people coming together, helping to improve mental health. One study identified this as the most common way in which residents themselves spoke about how they were improving health and wellbeing (Popay et al., 2023). The level of expenditure on community hubs and other spaces to meet also reflects this – more than 10 years since the start of the programme, 105 areas had collectively spent £17.8m at that point (Fisher, 2025). These spaces were generally multipurpose and helped develop the social environment in many ways, including providing a space for mental health or wellbeing-focused groups to meet.

This shows that some of this work included support for those with existing mental health problems who may not have had access to support elsewhere – potentially preventing symptoms worsening. This represented a community-based approach to healthcare.

Local Trust will explore social prescribing in Big Local in an upcoming article.

Big Local funding was also allocated by residents directly to social groups: for example, funding a crèche helped a group of lone mothers to meet regularly and support each other. In some cases, the level of funding was quite small but acted as a catalyst for voluntary, peer-led action to support wellbeing. 

Social activities and events were often framed and designed around improving wellbeing. Sometimes these were intended to reach those more likely to experience social isolation, like older people. In other cases, they were universal and generally contributed to maintaining good mental health.

Local Trust has also explored how Big Local areas created opportunities to volunteer, and the personal benefits of this, in another article.

At a population level, there was promising evidence of Big Local’s positive impact on mental health. Areas progressing fastest in Big Local – those who had spent over 80 per cent of Big Local funds by 2019/20 – saw improved mental health at the population level between 2011 and 2019. This was indicated by a reduction in the Small Area Mental Health Index: a reduction here indicates an improvement in mental health (Daras and Barr, 2020). The effect was even stronger for those areas which had prioritised social activities (Popay et al., 2023).

Big Local areas created opportunities for residents to exercise, join sports teams, coach children’s games, and to get outside and enjoy a pleasant environment. More than 10 years into the programme, in 51 out of 150 areas funds had been invested in open spaces and parks, and in 105 areas funds had been invested in the environment – totalling over £12m (Fisher, 2025). Funds for children and young people also included a lot of activities focused on physical activity and outdoor space. Activities within these categories included playgrounds, exercise facilities, skate parks, and sports facilities. 

Promoting and funding ways to exercise ranged from children’s sports teams to health walks targeted at older people. Facilitating activity was about more than getting people physically fit; it was also part of the drive to create a place where people spent more time together and were less socially isolated. In some cases, activity targeted at teenagers and young adults was framed as a way to keep them ​‘out of trouble’. That said, it was also recognised that young people didn’t always have enough options for things to do – especially in light of cuts to council budgets. Resources in this category included skate parks, multi-use game areas, and access to BMXing (Popay et al, 2023). 

It was common for funding to be used to make an area feel more appealing. ​‘Place stigma’ (or an area having a poor reputation) has been increasingly acknowledged to influence health (Ponsford et al., 2018). Challenging this stigma was important for many Big Local residents. This sometimes involved making an area feel safer, more sociable, and more pleasant to live in – through festivals and creative events, or through physical improvements (like community clean-ups and hanging baskets) (Communities in Control, 2019). Investments in environment included green space improvement and beautification projects. Even small-scale examples could have had knock-on effects of encouraging people to get out more.

Some of the most robust evidence of Big Local’s impact at the population level was reduced rates of crime and antisocial behaviour. Crime affects health in numerous ways: physically and psychologically and by way of its harmful effect on local economies. Fear of crime is also higher in poorer communities (Marmot et al, 2020). There is evidence that Big Local led to a small reduction in burglaries at the area population level, from 2011 to 2019 (Popay et al., 2023). We don’t know why it led to this – it could be due to activities that diverted people away from crime, or improved neighbourhood-level awareness. However, we do know that areas with more investment in environmental activities had a particularly high reduction in crime (especially in burglary rates and, less so, in antisocial behaviour).

A healthy standard of living is one of the most important determinants of health. Access to good work and sufficient income are vital to reduce health inequalities. Through Big Local, people were supported to increase or stabilise their income via Citizens Advice sessions, credit unions, and support claiming benefits. At least 75 areas worked on poverty reduction initiatives, and at least 92 initiated employability, training, and other work-related schemes (Fisher, 2025). These initiatives could have had a large impact on individuals, even whilst they could not prevent wider economic conditions that shape population-level living standards.

Work to address food poverty and insecurity was also common, especially following the Covid-19 pandemic and the cost of living crisis of the early 2020s. Big Local partnerships provided breakfast and lunch clubs, cooking and nutrition classes, food donated from supermarkets, and holiday clubs with free food for children.

A study of Big Local’s impact on health (Popay et al., 2023) did not study the impact on physical health, noting that outcomes in this area would emerge in the much longer term than the data collection period. Clearly, the provision of good quality food to families is worthwhile, although future programmes could study whether such initiatives successfully reach the people most in need, and the effects of different approaches.

Some key health determinants were not as substantially addressed in the Big Local programme.

Housing’s relationship to health is multifaceted and fundamental: poor housing conditions like damp, cold, mould, unaffordability, noise, and overcrowding contribute to poor physical and mental health (Marmot et al., 2020). According to August 2025 internal spend data, twelve Big Local areas used their funds to address housing need. This included purchasing or building properties to add to the stock of good-quality housing in an area. However, this was complex work and led to challenges such as keeping the properties within community control or local opposition to building. 

One notable achievement was in PEACH Big Local. Rather than buying assets, PEACH advocated for the improvement of local social housing provision. Many households were experiencing health and safety issues such as leaks, mould, and asbestos. PEACH’s approach, driven by community organising, succeeded in bringing the local estate’s management back under council control, and secured a rent reduction and a rent arrears amnesty. 

Some Big Local areas allocated funds to early childhood (0–5) provision – a vital part of preventative approaches with the biggest potential to change the life course (Marmot et al., 2020). This included funding playschemes for toddlers, pre-school play parks, expanding local nursery provision, and, in a few cases, bespoke support for families facing challenging circumstances. For example, DY10 Big Local worked with Home-Start Wyre Forest to support families with young children through home visits, with residents trained as volunteers to provide support. 

Yet across Big Local, much of the activity for young people was aimed at older children of school age. This may have been due to several reasons, like the high costs of substantial early-years support programmes (such as a staffed children’s centre) which would have likely been too expensive for Big Local areas. 

Despite the focus on older children, by contributing to the wider determinants of health at a place level, Big Local would have still benefited very young children. For example, having access to well-maintained green spaces or having parents or guardians with a strong social network, would be beneficial from birth (Marmot et al., 2020; The Academy of Medical Sciences, 2024). Therefore, Big Local activity was likely to improve health across generations.