This article explores the local mixed economy of healthcare in two of England’s largest cities–Leeds and Sheffield–between the late Edwardian period and the outbreak of the Second World War. It examines the level of service provision across the period to identify areas of strength and weakness and considers the extent to which these were determined by local political priorities. It examines indicators of success, such as falling death and infant mortality rates, increased access to treatment in hospitals and clinics and improved outcomes for those treated. Finally, it assesses the degree to which the mixed economy was able to develop a coordinated approach despite limited and ineffective central state direction. In particular, it looks at how local authorities and voluntary providers worked together in areas like Infant and Child Welfare, Maternity provision and general acute treatment to build the healthy city. Overall it suggests that this mixed economy, operating within a policy environment shaped by local urban cultures and needs, was able to deliver extensive health care improvements which belie the conventional pessimistic assessments of the period.