Healthy Sustainable Economies

What does a “healthy, sustainable economy” look like. Some ideas


This is a guest post of work done by others


I’ve been thinking about this issue for a while and not quite nailed it. Fortunately people considerably cleverer than me have had a go at…


here are their thoughts: Peter Roderick, Yannish Naik, Gilly Brenner,




There has been a broad recognition of the links between the economy and health, with economic inequalities being linked to health inequalities (Marmot 2010; Wilkinson & Pickett 2011). Health is also an essential input into a productive economy, with poor health costing an estimated £100 billion in productivity (Black n.d.).

There is a body of evidence linking the impact of economic activity on the environment and human health (Schumacher 1973). Increasing concern regarding the health impacts presented by damage to the environment makes a strong case to consider the economy, human health and the environment as inevitably interconnected (Costello et al. 2009). This is also the international direction of travel where significant work has gone into aligning the economy, the environment and human health (Economy 2014; WHO 2011; UNEP 2016).

Financial sustainability has been increasingly highlighted as being cause for concern following the recent international economic crash and the resulting recession (Keen 2012). Strong and sustainable local economies are likely to be more resilient to external shocks, helping communities prosper together if faced with challenging circumstances.

However, there is still a lack of consensus on how to progress this agenda, and conversations around the devolution of power and the need for economic growth that delivers for all members of society provide a significant opportunity for progress (RSA 2016; Sandford 2015).

At a recent development day with the Yorkshire and Humber Directors of Public Health Network we defined a healthy and sustainable economy as “a system of production and consumption that supports healthy and fulfilling lives and sustains society for generations to come”.

This series of briefing papers has been produced for this Network as a guide to creating healthy and sustainable economies at a local level and aims to build on previous work through Due North. The briefing papers are each centred around a key idea which could be used to promote sustainable and healthy economies. They are certainly not exhaustive, as it is impossible to capture the range of innovative thinking in this field. We hope they will give you some ideas to progress this agenda and practical next steps to take this work forward.







  1. Anchor institutions – organisations with significant local influence …
  2. Cooperatives – employee owned and managed firms …
  3. Social enterprise – companies with a social objective as well as a profit motive …
  4. Commissioning for social value – ensuring procurement delivers for local people …
  5. Transitions management – an approach to changing systems…
  6. Moving forward – collaborations and authenticity …
  7. Appendix: Example social value framework…







1       Briefing: Anchor Institutions

Peter Roderick, Public Health SpR, Yorkshire and Humber

What’s the big idea?

‘Anchor institutions’ are increasingly recognised as key components of local economies. As economic units, they have previously received less attention than corporations and companies in analyses of economic growth, but their function is now receiving greater attention in the movement towards local determination of jobs, skills and infrastructure (e.g. the Northern Powerhouse initiative)

According to the UK Commission for Employment and Skills, an anchor institution

‘is one that, alongside its main function, plays a significant and recognised role in a locality by making a strategic contribution to the local economy’ (UKCES, 2015)

Examples this type of organisation are given the inset box. The major characteristic of an anchor institutions is a commitment in the long term to the local area (their ‘anchor’), often meaning that relocation is highly improbable if not impossible (for instance, think of the implausibility of Bradford City FC moving to London, or the Hepworth Gallery moving to Bristol). This means an anchor institution and its local area are arranged in a synergistic relationship which works both ways for both parties (CLES, 2015). The institution has invested a lot of financial, social and human capital in a local area, and in return reaps the benefits of the growth of its local economy through increased custom, revenue and participation. Likewise, the strength of a local economy often is itself underpinned by the financial performance of key institutions, and the cultural and economic capital reaped through their location in the region. As an example, consider the relationship between a university and its town/city:

Through its large size an anchor institution (often but not always a non-profit organisation) has the ability to invest in a local area for mutual benefit, through participation in civic initiatives, through its purchasing power, through its employment decisions and pay, through working with other institutions and the public sector on shared priorities, and through working together on an agreed local economic strategy that meets the long terms goals of both institution and region (see RSA, 2014)

What are the implications for healthy sustainable economies?

At a basic level, anchor intuitions have a large enough footprint to influence the overall direction of their local economies towards higher levels of health and wellbeing and more sustainable practices. Through employment policy, environmental practice, procurement decisions and general participation in civic initiatives, institutions can for instance:

    • Encourage/nudge their staff towards physical activity, healthy eating and tobacco cessation
    • Create mentally healthy workplaces and creating a supportive, ‘stress-busting’ culture

  • Be encouraged to invest in ethical and responsible financial product e.g. avoiding big oil, big food, big tobacco both for global benefit and top enhance local reputation

  • Start to procure locally and invest in supply chains that benefit other local business

  • Cut carbon emissions and, for instance, share heat generation with neighbouring organisations

  • Play an active role in migrant resettlement and post-Brexit community cohesion


At a wider level, anchor institutions and local areas can work strategically to harness their collective economic muscle and build on an area’s local assets to make it a beacon for health and sustainable economic growth. For instance, a recognition of the clustering of energy-sector assets in the North of England (done for instance by the IPPR, see inset box) shows that geographical ‘anchoring’ gives opportunity for collective working between generation companies, the supply and utility chain, research and innovation, and local authorities; this kind of approach has the potential to ensure a healthier and sustainable energy future than the current fragmented market approach. A good example of this is in the North East collaboration Energicoast.

Source: IPPR North

What are the downsides?

  • The more prestigious ‘anchors’ (e.g. universities and growth-sector companies) tend to be based in urban centres. This raises questions about whether they drain resources out of rural communities, given that their power comes through geographical agglomeration. This also raises issues of health inequalities; areas which have historically strong anchor institutions see government investment and the founding of other such bodies, experience strong growth, and thereby get healthy and wealthier than their counterparts.
  • The local roots of Anchor institutions cannot be taken for granted: for example cultural assets may be owned by larger national franchises, companies may divert profits to other financial bases, universities may leak academic spin-offs to other areas, and there may also risks of ‘buy outs’ by venture capitalists or hedge funds.





Where has it worked?

A prominent network of anchor institutions is the Chicago Anchors for a Strong Economy (CASE), ‘a matchmaker between anchors as buyers and local businesses as suppliers’ (JRF 2016). This is both a demand side initiative – anchors analyse their spend to identify opportunities to redirect a portion of it to competitive local businesses – and a supply side initiative – anchors offer business services and support programmes to local suppliers.

What do we need to do to get it going?

  • Invest in training public health specialists on the role of their future employers as local ‘anchors’
  • Work within local authority and hospital trusts to build up use of local supply chains, employment pools, and participate in risk sharing local enhancement projects
  • Task local networks of anchors (e.g. Leaders for Leeds) with the task of moving to healthier and sustainable practices together, so that short term disbenefits are offset collectively.

Further reading

CLES (2015) Creating a good local economy: the role of anchor institutions

Colledge, Barbara (2015) Anchoring the Northern Powerhouse:

IPPR North (2016) Blueprint for a Great North Plan.

JRF (2016) Chicago Anchors for a Strong Economy (CASE).

JRF (2017) Maximising the local impact of anchor institutions: a case study of Leeds City Region.

RSA (2015) City Growth Commission.

UKCES (2015) What is an anchor institution?



Examples of Anchor Institutions:

① Universities

② Arts and cultural institutions

③ Sports organisations

④ Health providers

⑤ Government departments/ALBs

⑥ Local Authorities

⑦ Chambers of Commerce

⑧ Private organisations with local roots

⑨ Voluntary and faith sector assemblies

⑩ Infrastructure/utility providers









2   Briefing: Worker Cooperatives

Yannish Naik, Public Health Specialty Registrar, Yorkshire and Humber

With thanks to Prof. Virginie Perotin, University of Leeds

What’s the big idea?

Worker cooperatives are companies that are owned and managed by employees. It is often thought that they tend to be small and rare – however the experience from John Lewis shows they can be large and there are more in Italy, Spain and France than in the UK.

What are the implications for healthy sustainable economies?

There is a theoretical basis for potential benefits to employees who are involved in the governance of their firms and who may thus have more control over their activities which may carry health benefits. Weak evidence also suggests that areas with large numbers of cooperatives (types of firms owned and managed by employees) may have lower mortality and higher employment. Cooperatives may also be more productive and have better job retention with further potential benefits for health.

What are the downsides?

All employees will need relevant skills in a cooperative to collectively make decisions, take responsibility for the company and ensure it remains viable.

Where has it worked?

The Mondragon Corporation is a group of cooperatives which includes production, finance and retail as well as a social security system and university. It is primarily based in the Spanish Basque country with subsidiaries across the world.

What do we need to do to get it going?

The first step is to raise awareness of cooperatives and their benefits, by providing information and advice to new businesses. Legislation and the availability of constitutions for new cooperatives could also be of benefit. Loan finance will help companies to start up. Working with Coops UK and Cooperatives Yorkshire and the Humber is a key next step.

Further reading/Sources

Perotin, V., What Do We Really Know About Worker Co-operatives.

Erdal, Perotin, Freundlich and Gago




3       Briefing: Social Enterprise

Yannish Naik, Public Health Specialty Registrar, Yorkshire and Humber

What’s the big idea?

Social enterprise is becoming recognised as a type of business that can deliver benefits for the people and the natural environment as well as profits. This is often referred to as the triple bottom line. Social enterprise can be characterised by two main features – creativity in identifying a market and the initiative to take on a challenge.

A number of different models of social enterprise exist – for example a company may employ vulnerable or disadvantaged groups and fulfil a social function by providing these people with stable and fulfilling employment. Or it may deliver value to these people through its work such as by offering opportunities to develop skills or interact in groups. Finally, social enterprises may reinvest their profits into the local community directly.

There is emerging evidence that diverse service provision of healthcare services may lead to higher quality services and social enterprise could also be used in this context though there is little specific evidence to support this as yet.

What are the implications for healthy sustainable economies?

A recent systematic review of the implications of social enterprise and health found a positive impact on the mental health of employees, improved health behaviours and increased social capital and skills. Further evidence is awaited regarding the potential of social enterprise for health (Roy et al, 2014).

What are the downsides?

These are not clear yet. With any new emerging models there may be negative impacts on the health of social entrepreneurs including concerns about burnout and a lack of support (Unltd, 2016). They may also become a mechanism for organisations to divest themselves of services of doubtful long term viability (and hence off load risks such as redundancy costs).

Where has it worked?

There are a numerous examples of social enterprises. From the Scotland Can Do initiative which aims to develop a whole ecosystem of social entrepreneurship to local initiatives such as the Leeds Community Fund Ideas that Change Lives which aims to support local entrepreneurs in the care sector. (See further reading)


What do we need to do to get it going?

  • Provide financial support to new social enterprises
  • Provide business support and advice to potential entrepreneur
  • Offer entrepreneurs the opportunity to network with each other, policy makers and academics
  • Raise awareness among the public regarding social enterprise

(Munoz, 2016)

Further reading

Roy et al (2014) The potential of social enterprise to enhance health and well-being: a model and systematic review. Soc Sci Med

Munoz and Kibler (2016) Institutional Complexity and Social Entrepreneurship: A Fuzzy-Set Approach Journal of Business Research

Scotland Can do

Leeds Community Foundation. Ideas that change lives.

Unltd, 2016. Burning bright or burning out? Exploring social entrepreneurs’ well-being




4     Briefing: Commissioning for Social Value

Gilly Brenner, Public Health SpR, Yorkshire and Humber

What’s the big idea?

‘Commissioning for social value’ comes from the Public Services (Social Value) Act 2012 which requires all public bodies in England and Wales to consider how the services they commission and procure might improve the economic, social and environmental well-being of the area 1. It asks public bodies to consider the ways that they could most benefit society as part of each decision made.

Social value is a way of thinking about how resources are allocated and used; it requires consideration beyond the quality of service and price, to look at what the collective benefit is to a community when a public body chooses to award a contract or deliver a service. It gives an opportunity to maximise the impact that the services we commission and procure can have beyond their main intended purpose, such as to reduce health inequalities and improve health and wellbeing outcomes for our population, through means other than those directly commissioned in our services.

What are the benefits for public health?

In developing a Commissioning for Social Value strategy for Sheffield CCG 2, I chose to set out priorities by embedding social value under the headings for the six Marmot policy objectives 3, so as to direct focus on reducing health inequalities through action on the social determinants of health.  A framework (see overleaf) was developed of various performance measures, which shows the breadth of ways in which social value can improve economic (eg employment), social (eg community interventions) and environmental (eg air pollution/ climate change) well-being in the local area.  These were given only as examples for inspiration, since the opportunities to impact on social value are broad and plentiful and can be delivered in many innovative and diverse ways.

How does it work?

In a procurement context providers are asked to demonstrate, as part of the competitive process (such as in ITT questions), how they will contribute to social value. There should be a reasonable expectation of contributions to social value, particularly those that are relevant and proportional.  For example, low emission vehicles would be considered an important element to a transport contract provider, whereas increasing active transport amongst staff would be more appropriate for organisations with office-based employees.

Providers are required to set out how over the lifetime of the contract they propose to deliver their relevant social value outcomes. In most cases measures would then be set out as part of the specification and included as key performance indicators.  Exactly how these are included / framed is affected by the procurement and commissioning processes and ensuring the appropriate legislative compliance.

What are the downsides?

There are very few downsides, other than the effort required to develop and implement a strategy! Social value is a way of influencing providers to demonstrate better corporate citizenship and to be innovative in the ways they support the local community.  However, it is appropriate that commissioners should also consider their own organisation and the way in which it contributes social value and this may warrant an action plan of its own.

Social Value Framework – see appendix

Where has it worked?

There are a numerous case studies of social value consideration in public sector contracts 4, 5, 6.  Many organisations have gone to significant efforts to engage with providers about social value and in an attempt to enthuse them about the sorts of contributions they could make.

What do we need to do to get it going?

  • Develop a ‘Commissioning for social value’ strategy (feel free to adapt the Sheffield CCG one!)
  • Concentrate on an action plan and governance for getting social value embedded into commissioning and procurement processes and raising awareness amongst potential providers
  • Recruit champions to the social value cause to strive for a better contribution to social value from your own organisation
  • Consider how to monitor the impact of social value from contracts and what contribution it can make

Further reading










5       Briefing: Transitions management

Yannish Naik, Public Health Specialty Registrar, Yorkshire and Humber


What’s the big idea?

Transitions Management is an overarching approach derived from complexity science and sociology which aims to support large scale social and policy change (Grin, J. 2010).

What are the implications for healthy sustainable economies?

Transitions Management has successfully been applied in regional governance projects and as such they are ideal to address the issue of complex economic policy and practice in local authorities in the United Kingdom. These methods have recently been applied to thinking about the economy with the economic crisis being viewed as a major driver of change (Loorbach & Lijnis Huffenreuter 2013).

What are the downsides?

As with all methods of system change there is the possibility that the approach may not lead to the desired result.

Where has it worked?

There is good evidence to support the effectiveness of this approach. For example, in the case of Parkstad Limburg the approach was successfully applied in response to a regional loss of industry. The Five Cities study also found that the approach generated a collective impetus for change and sense of empowerment in sites across Europe including Aberdeen (Roorda & Wittmayer 2014).

What do we need to do to get it going?

The next steps in applying transitions management are to develop skills relating to this approach amongst key stakeholders and leaders and then apply the methods. A transition approach would identify local niches – in this case these would be the particular interventions such as social enterprise that one was seeking to implement.

It would then seek to develop these niches through Strategic Niche Management, an approach which involves the use of networks and creating learning opportunities to develop local visions about the desired future state (Schot & Geels 2008).

In this case, for example, it may be that policy makers from a local authority formed a policy group and recruited a transition group of innovators, developing links between the two groups such that policy innovations arise out of the innovator group and are implemented by the policy group.

Further reading/Sources

Grin, J., et al, 2010. Transitions to Sustainable Development,

Loorbach, D.A. & Lijnis Huffenreuter, R., 2013. Exploring the economic crisis from a transition management perspective. Environmental Innovation and Societal Transitions, 6, pp.35–46. Available at:

Roorda, C. & Wittmayer, J., 2014. Transition management in five European cities – an evaluation. , (June), p.55.

Schot, J. & Geels, F.W., 2008. Strategic niche management and sustainable innovation journeys : theory , findings , research agenda , and policy. , 20(5), pp.537–554.







6      Moving forward

These briefing papers have hopefully given the reader a flavor of some key innovations in economic thinking and inspired them to further exploration. When these ideas were discussed at the regional Yorkshire and Humber network, a number of key actions were highlighted:

  • A public conversation on these topics
  • Defining footprints for interventions – are we talking local authority or regional footprints?
  • The collection of local examples
  • Inclusion of relevant issues in DPH reports and local government indicators
  • Further research into these topic areas and how they could be developed
  • Training and skills for public health professionals and policy makers on macro-economics, regional development and social regeneration
  • Developing work on strategic alignment, mass collaboration, alternative ways of using ecological services, policy measures, employee wellbeing, apprenticeships, green economies
  • Making the most of opportunities including current discussions around inclusive growth and the need for community engagementCollaboration with a broad range of partners including academics (for example through Equal North), the third sector, politicians, Local Enterprise Partnerships, Chambers of Commerce, etc. We will need to be aware of our own narratives and messages, as well as using language and storytelling creatively.
      • Such engagement will need to be brave and authentic in fostering a relationship around issues where we are not experts.

      And… most of all

      • Collaboration with a broad range of partners including academics (for example through Equal North), the third sector, politicians, Local Enterprise Partnerships, Chambers of Commerce, etc.
      • Such engagement will need to be brave and authentic in fostering a relationship around issues where we are not experts.
      • We will need to be aware of our own narratives and messages, as well as using language and storytelling creatively.







      7       Appendix – example social value framework

      Relevant priority area Potential performance measure
      1.    Give every child the best start in life
      Support families to develop children’s skills and access high quality early years’ care Employees able to access salary sacrifice childcare vouchers &/or high quality childcare provision
      Support breastfeeding Breastfeeding friendly environment and policy
      Support early health interventions for children Opportunities sought to raise awareness of importance of childhood vaccinations eg. flag records to routinely ask parents/ carers of 0-5 year old patients/ service-users if they are vaccinated

      Increase understanding of the importance of good dental hygiene and reduced sugar intake for children.

      2.    Enable all people to have control over their lives and maximise their capabilities
      Provide easily accessible support and advice for 16–25 year olds on life skills, training and employment opportunities Increase understanding/ access to locally available training, volunteering and employment opportunities amongst patients/ service-users/ employees aged 16-25 years
      Provide work-based learning, including apprenticeships, for young people and those changing jobs/careers Number of patients/ service-users/ employees finding/ sustaining subsequent meaningful employment/ training/ voluntary roles
      Increase availability of non-vocational lifelong learning across the life course. Number of patients/ service-users/ employees supported to access meaningful learning opportunities
      Support development of social capital in order to foster health communities in which participation is widespread Proportion of patients/ service-users/ employees involved engaging in community/ social activity/ physical activity

      Support given to local community groups

      Service support self-management for patients rather than develop patterns of dependence Increase understanding of health issues, prevention and self-care amongst patients/ service-users/ carers/ employees/ communities eg. peer support programmes etc
      Improve quality of life particularly for people with long term conditions Proportion of patients/ service-users developing their own care plan
      3.    Create fair employment and good work for all
      Support employment of Sheffield residents to reduce experiences of poverty and hardship Number of FTE jobs created / sustained
      Make it easier for people who are disadvantaged in the labour market to obtain and keep work. Number of relevant people supported into training / employment (unemployed/ young/ disabled/ MSK/ LTC/ equality and diversity etc)

      Number of jobs created or adapted that are suitable for lone parents, carers and people with mental and physical health problems

      Support a living wage to reduce low incomes Employees paid living wage throughout the supply chain

      Fair trade and ethical sourcing practices

      Support good working conditions to relieve health problems associated with employment Implementation of guidance on stress management and the effective promotion of well-being and physical and mental health at work

      Consideration of shift work, zero hours contracts, rest breaks and flexitime arrangements on potential for impact on stress-related sickness absence

      Freedom to join a trade union

      4.    Ensure a healthy standard of living for all
      Support a reduction in the effects of debt on physical and mental health Support access to ethical, affordable credit
      Seek to maximise other investment in the local economy and communities Build capacity and competence in the supply chain
      5.    Create and develop healthy and sustainable places and communities
      Improve access to and consumption of healthy food in order to support better mental and physical health and the local food economy Increase in proportion of fresh, healthy, low carbon food supply chain, consumption by patients/ service-users/ employees

      Increase awareness of healthy food choices amongst patients/ service-users/ employees

      Improve neighbourhood environments by increasing provision, access and quality of green space in order to improve mental and physical health Improvement in provision / access to high quality green spaces for patients / communities
      Increase active travel (walking and cycling) in order to increase physical activity, reduce traffic emission related respiratory illness and carbon emissions Decrease number of staff commuting to work in cars with only single occupant/ baseline and % increase in active travel, public transport and car sharing
      Reduce carbon emissions in order to mitigate against climate change and its negative consequences for health and health inequalities Baseline and % reduction in carbon footprint

      Baseline and % reduction in energy use/ carbon emissions/ increased use of renewable energy

      Baseline and % reduction in waste/ increase in % recycled

      Baseline and % reduction in prescribing and pharmaceutical waste

      Improve housing conditions and energy efficiency in order to reduce health conditions associated with poor housing and fuel poverty Improve advice and support for housing issues for patients/ service-users/ employees

      Improve integration of services, so that patients/ service-users can be referred to appropriate support/ services

      Minimise use of hazardous substances in order to protect health Baseline and % reduction of hazardous substances
      Reduce social isolation and associated health risks by including social contact as a valued outcome Number of new volunteer roles created/ supported/ sustained
      Support community participation and action Proportion of patients/ service-users/ employees involved engaging in community/ social activity/ physical activity

      Support given to local community groups

      6.    Strengthen the role and impact of ill-health prevention
      Prioritise prevention and early detection of cancer and cardiovascular disease Patients/ service-users/ employees most at risk encouraged and supported to take up national screening and health check opportunities as appropriate
      Increase upstream prevention activity Staff trained to have ‘healthy conversations’ through Making Every Contact Count
      Encourage everyone to ‘eat well, move more, be smoke free, drink less (alcohol), check yourself, stress less and sleep better’ Increase in number of staff / patients / carers regularly engaging in physical activity etc

      Promotion and engagement with the Public Health England ‘One You’ campaign

      Support smoking cessation and smokefree places Designate premises including grounds as smokefree

      Number of patients/ service-users/ employees supported to stop smoking

      Improve awareness and parity of esteem for mental health Staff trained in Mental Health First Aid

      Increase in number of patients/ service-users/ employees aware of the importance of the five ways to wellbeing

      Increase the public, patient and carer empowerment, literacy and self-care by building these into services Number of patient / carers involved in design of services
      Increase integration of services so patients are better and more easily supported Number of sustained and meaningful relationships with other providers that support integrated care, including clinical, social and economic parameters affecting health
      Reduce emergency admissions and readmissions which have negative impacts on patients and their carers Reduction in attendances for urgent care by patients/ service-users




      Neil McInroy (Chief Executive, CLES), Stephen Morton (ex National Lead for Sustainability and Public Health Benefits, PHE)



      Black, D.C., Working-for-a-Healthier-Tomorrow.

      Costello, A. et al., 2009. Managing the health effects of climate change. Lancet and University College London Institute for Global Health Commission. The Lancet, 373(9676), pp.1693–1733.

      Economy, C., 2014. BETTER GROWTH , BETTER CLIMATE.

      Keen, S., 2012. Debunking economics – revised and expanded edition: the naked emperor dethroned?,

      Marmot, M., 2010. Fair Society , Healthy Lives Fair Society , Healthy Lives.

      RSA, 2016. Inclusive growth for people and places. , (September).

      Sandford, M., 2015. Devolution to local government in England. , (7029). Available at:

      Schumacher, E.F., 1973. Small Is Beautiful: A Study of Economics As If People Mattered,


      WHO, 2011. Public Health & Environment Global Strategy Overview. , pp.1–11.

      Wilkinson, R.G. & Pickett, K.E., 2011. The Spirit Level. The Spirit Level, (November). Available at: spirit level chapter 13&lr&pg=PP1#v=onepage&q=the spirit level chapter 13&f=false.


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