From Duty to Dividend?

How Local Well-being Law Could Unlock Prevention Funding and Social Impact

“Prevention is better than cure” is more than a public health cliché, it’s an economic imperative. The Lancet’s recent studies on Community Wealth Building and public health have made it clear: investing upstream in the social determinants of health yields exponential returns downstream. But for local authorities, the challenge isn’t just knowing this, it’s having the legal, financial, and operational mandate to act on it.

That’s why the idea to embed a statutory wellbeing duty alongside the health improvement duty for district, unitary, and strategic authorities, complete with a “well-by” date, measurement framework, and national oversight, is more than legislative housekeeping. It’s a structural shift in how we define public value.

From Power to Obligation: Why a Duty Matters

By requiring councils to improve health and well-being and reduce inequalities in every decision they make, the proposed amendment to the NHS Act 2006 reframes well-being as a core outcome, not a discretionary add-on. This matters because it creates a legal anchor for prevention. It means that early intervention whether in housing, transport, education, or employment isn’t just good practice. It’s a statutory responsibility.

Measurement as Mandate: The “Well-by” Clause

The proposed National Well-being Measurement Programme would require annual surveys, local improvement plans, and national reporting. This isn’t just about data, it’s about accountability. It gives authorities the tools to:

• Identify where inequalities are deepest
• Set measurable targets for change
• Track progress over time
• Justify investment in upstream interventions

In short, it turns well-being from a vague aspiration into a quantifiable public duty.

Unlocking Social Outcomes Funding

Here’s where things get exciting. With a statutory duty and robust measurement in place, local authorities could begin to access social outcomes funding including:

• Social Impact Bonds tied to well-being improvements
• Prevention-focused pooled budgets across health, housing, and education
• Community Wealth Building (CWB) strategies that reinvest local economic gains into health equity

CWB isn’t just about procurement or anchor institutions it’s about retaining and reinvesting value locally. If authorities are legally required to improve well-being, then CWB becomes a delivery mechanism, not just a policy preference. Imagine a local authority using its well-being survey to identify high rates of youth anxiety, then commissioning a community-led mental health programme funded through a social outcomes contract, with repayment linked to measurable improvements in emotional well-being. That’s the future this legislation could unlock.

The Lancet’s Case for Public Health Systems

The Lancet’s work has shown that multi-sectoral public health systems, those that integrate housing, education, transport, and employment, are the most effective at reducing inequalities. But they require:

• Legal clarity on who is responsible
• Data infrastructure to measure impact
• Funding models that reward prevention

This proposed duty delivers all three. It gives local authorities the mandate, the metrics, and the mechanism to lead public health from the ground up.

From Local Duty to National Dividend

Embedding health and well-being duties in law isn’t just about local government. It’s about national resilience. It’s about shifting the fiscal centre of gravity from reactive services to proactive systems. And it’s about recognising that the places people live — not just the services they use — shape their life chances.

So let’s stop treating well-being as a soft outcome. Let’s legislate for it, measure it, fund it, and hold ourselves accountable for it.

Because when councils are empowered — and required — to act on well-being, prevention stops being a policy ambition and starts being a public dividend.

📜 Draft Amendment: Health and Well-being Duties of Local and Strategic Authorities

After section 2B of the National Health Service Act 2006 insert—

2BA Health improvement, health inequalities and well-being duties of local and strategic authorities

1. Application of this section This section applies to— (a) district councils in England; (b) unitary authorities in England; (c) county councils in England; (d) combined authorities and county combined authorities; (e) the Greater London Authority; and (f) any other strategic authority prescribed by regulations made by the Secretary of State.
2. General duty When considering whether or how to exercise any of its functions, an authority to which this section applies must have regard to the need to— (a) improve the health and well-being of persons in its area; (b) reduce health inequalities and well-being inequalities between persons living in its area; and (c) mitigate any detriment to health or well-being, or any increase in such inequalities, which would otherwise be occasioned by the exercise of its functions.
3. Meaning of health inequalities In this section “health inequalities” means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.
4. Meaning of well-being inequalities In this section “well-being inequalities” means inequalities in respect of— (a) emotional well-being; (b) evaluative well-being; (c) sense of meaning and purpose; which are wholly or partly a result of differences in the drivers of well-being.
5. General health determinants “General health determinants” include— (a) standards of housing, transport services or public safety; (b) employment prospects, earning capacity and any other matters that affect levels of prosperity; (c) the degree of ease or difficulty with which persons have access to public services; (d) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle that are or may be harmful to health; and (e) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.
6. National Well-being Measurement Programme (1) The Secretary of State must establish and maintain a National Well-being Measurement Programme. (2) The Programme must— (a) conduct an annual online national survey of the well-being of persons in each authority’s area; (b) provide central analysis of data and support for the administration of the survey; (c) make provision for citizen consent to participation in the survey, ensuring that participation is voluntary and that results are handled confidentially; (d) regularly publish the results of the survey and provide relevant data to participating authorities and other public bodies for the purposes of improving well-being; (e) set and publish national and local targets for the improvement of children’s well-being, informed by the results of the survey; and (f) report annually on progress against those targets, including actions taken to address areas of concern.
7. Well-by date requirement (1) Each authority must, within X months of the coming into force of this section, publish a Health and Well-being Improvement Plan setting out— (a) baseline measures of health and well-being in its area; (b) targets for improvement over a period not exceeding 5 years; and (c) the actions it proposes to take to achieve those targets. (2) Each authority must review and update its Plan at least once every 3 years. (3) The Secretary of State must lay before Parliament an annual report summarising national progress against the targets set under subsection (6)(2)(e).
8. Guidance The Secretary of State may issue guidance to authorities on the discharge of their duties under this section, and authorities must have regard to such guidance.