Healthy outlook of young pioneers

Few know that in the 1930s it was home to a visionary experiment in improving the health of the nation. Fewer still that the experiment is about to be revived, this time in a small corner of Fife – the former mining village of Kelty.

Peckham was the home of the Pioneer Health Centre, established by two remarkable doctors as a radical experiment in promoting health rather than treating illness. In its heyday, the centre had 700 families on its books, all within “pram-pushing distance” of its specially designed building.

The Pioneer Health Centre is revered today in public health circles – at least in those (rare) parts of the system that have not succumbed either to the medical model or to the fantasy that we can simply be “nudged” – or if that fails, taxed – into health.

Sadly, the centre proved too innovative even in its own day to survive the creation of the National Health Service. It was forced to close in 1950.

The experiment deserves a revival. And there is a special opportunity in Scotland. For we have in our midst one of the few remaining pioneers with experience of the original centre: Henrietta Trotter worked there as a “student observer” after the war. Her son Christopher now chairs the Pioneer Health Foundation set up to keep the flame alive after the centre closed. Both live in Fife.

The story of the original centre is told in a short film, Rekindling the Spirit of Peckham. It was the brainchild of doctors Scott Williamson and Innes Pearse, who had become frustrated dealing only in illness and wondered what they could do to promote health.

In 1926, they took a house in Peckham, which at that time was a mixed community of working and middle-class families, determined to investigate health in the local population. In two years, they studied over 100 local families and ran regular health checks in more than 400 people.

They discovered three fundamental insights – all thoroughly at odds with dominant practice at the time (and sadly all the more so today).

First, they found that “health is more, not less infectious or contagious than sickness, given appropriate circumstances in society for contact”. In other words, healthy people have healthy friends and spread health among their wider community.

Second, and related to this, they found that it is not possible to be truly healthy as an individual. Health is a property of relationship. They determined at the time that the smallest possible unit for health was the family, a biological mother and father and their children.

Third, it became clear that “intervention” in families’ lives to improve their health was ineffective. Health was contagious and desirable – people could be trusted to discover it for themselves if given the opportunity. But they would not catch it by being told what to do or how to live.

Excited by their discovery, Williamson and Pearse determined to put these principles into practice. In 1935, they opened the world’s first true “health centre” – in an inspirational new building, flooded with natural light.

Only families could become members of the centre, no individuals. They paid one shilling (5p) a week for a full range of facilities for every generation – a nursery, crèche, gymnasium, swimming pool, gardens, dance hall, restaurant, bar, club rooms of all varieties.

True to their principles, Williamson and Pearse imposed no order and provided no “services”, convinced that people are well able to self-organise for health. They set up an enabling infrastructure and then allowed members to organise whatever activity they fancied – on the sole condition that nobody who wanted to participate could be excluded.

The centre also had its own urban farm, largely because of the poor levels of children’s nutrition. It became an early model for the organic farming movement.

Every family entering membership had to submit to a “health overhaul” – a thorough medical check for the whole family, including blood and urine tests (there was a laboratory on site) and full physical examination. The results of the “overhaul” were reported to the family as a whole, rather than just the individuals.

The doctors offered diagnosis, but no treatment – not even the suggestion of treatment. The family could decide for itself whether Dad needed to give up smoking, take more exercise, see his GP etc. The health centre made no such suggestion, just provided the enabling conditions for the family to follow its own desire for health.

In its heyday, there were 1,000 people using the centre every day. They demanded that it be reopened after the war, and it was. But the NHS, with its commitment to universal access to medical treatment free at the point of delivery, was at odds with the Peckham principles and finally killed it.

The centre was not just an idea but an entire philosophy ahead of its time. So much of what Peckham pioneered is now being “discovered” afresh. Sir Harry Burns, Scotland’s Chief Medical Officer, has for example spoken powerfully of the value of “asset-based” programmes and “co-production”. Peckham didn’t use these words: the concepts were self-evident and second nature.

The central Peckham insight – the need to find how to invest in health rather than treatment – has never been more urgent as the soaring NHS budget continues to defy decades of effort to bring it under control. Hence our work in Kelty. Clentry Nursery was one of the first purpose-built nurseries in Fife, opened the year after Peckham closed. It is set in extensive grounds, including a recently planted orchard, with views over Benarty Hill. It is a wonderful setting to develop the Peckham principles afresh, and staff, parents, local agencies, IFF and the Pioneer Health Foundation are all keen to do so.

Clentry is at present confined to providing education and care for three- to five-year-olds. As a first step, we aim to expand its membership “downwards” to children from newborns to three-year-olds and outwards to include pregnant mothers themselves.

Over time, we will create a Peckham-like space for families, providing the conditions for them to develop activities of their own choosing that build on their interests, skills and aspirations. Food will be an important element in the project – growing, cooking and eating together.

Rekindling the spirit of Peckham in Kelty will have to take into account the changing nature of today’s family unit. But by embracing the whole of the extended family – grandparents included – and providing opportunities for everyone to explore and share, we aim to lift the health orbit of the participants to a new level.

Like the original Peckham experiment, this work must find its way against the grain of the dominant culture. Age-based eligibility criteria for services, which are delivered by agencies rather than self-organised. Professional silos and separate programmes for breast-feeding, tackling obesity, poor parenting. The clamour – and the funding – is always either for more such programmes or for more-efficient (cheaper) means of delivery.

Investing in health in this climate, health as a quality of relationship, and as something that people can – and must – develop for and in themselves, is as difficult as ever. But we are convinced that Peckham’s time has come again. Watch this space.

lGraham Leicester is director of International Futures Forum. For more information visit: www.internationalfuturesforum.com