The purpose of this study was to investigate the relationship between community-level exposure to changes in economic conditions and the incidence and prevalence of mental disorders and cardiovascular disease in 29 resource-based communities (with a focus on mining communities) in British Columbia (BC) during a period of time marked by an economic downturn (1991–2002) The investigation relied on Labour Force Survey (LFS) and Statistics Canada Census data, and health records from the British Columbia Ministry of Health (MoH). Age and sex adjusted prevalence and incidence rates were calculated for each community from 1991 to 2002 and the development of an economic change indicator defined using Census data and industry/government documents allowed for yearly assessment of community-level exposure to economic conditions. The relationship between exposure to economic change and rates of acute and chronic cardiovascular disease and mental disorders across the 29 study communities was investigated using a generalized linear model (stratified by type of community, and adjusted for the effect of the community). Findings indicate an impact on the prevalence rates for acute cardiovascular disease (CVD) during periods of economic decline (rate increased by 13.1 cases per 1,000 population, p < 0.0001 as compared with stable periods) and bust conditions (rate increased by 30.1 cases per 1,000 population, p < 0.0001 as compared with stable conditions) and mental disorders (rate increased by 13.2 cases per 1,000 population, p = 0.0001) in mining communities during declining economic conditions as compared to steady periods of mining employment. This is not observed in other resource-based communities. The paper concludes by highlighting implications for the mining industry to consider as they begin to recognize and commit to mining community health.