Assessing the relationship between community resilience and health outcomes: an observational local-authority level study in England

Background Community resilience is a relevant concept in public health, but its empirical relationship with health outcomes remains underexplored. This study examines whether a Community Resilience Index (CRI) is associated with population health outcomes in England, and whether it offers explanatory added value beyond the Index of Multiple Deprivation (IMD).

Methods The CRI comprises 44 indicators reflecting community-level resilience to chronic stressors. Associations between CRI scores and five health outcomes, deaths of despair, cardiovascular disease (CVD) mortality, COVID-19 mortality, excess all-cause mortality during two waves of COVID-19 and self-rated health were assessed at local authority district level. IMD was adjusted to remove health-related indicators. Linear regression models assessed the explanatory power of the CRI and IMD, using likelihood ratio tests to compare model fit. Interaction and stratified analyses explored effect modification by IMD.

Results Higher CRI scores were associated with lower Deaths of Despair and CVD mortality, and higher self-rated health; these associations remained significant after adjusting for IMD. CRI was not significantly associated with COVID-19 outcomes. IMD remained the stronger predictor of health outcomes, but CRI significantly improved model fit. The interaction between CRI and IMD was significant for deaths of despair and self-rated health. Stratified analyses showed the CRI–deaths of despair association was strongest in more deprived areas.

Conclusions Community resilience is associated with health outcomes in England. While not a substitute for deprivation-based measures, resilience indices offer complementary insight into structural and social factors shaping health. Resilience-building efforts may be particularly impactful in areas of greatest disadvantage.