Category Archives: Research

Breaking down language barriers for better medicine on the front line

Access to quality healthcare goes long way in bettering a person’s health, but we often neglect to consider the importance of translation and interpretation as an essential tool for saving and improving lives across language barriers.

Medical translation has many benefits, but perhaps the most important is its ability to advance medical research. Medicine is truly an international field, with researchers all across the globe tackling a wide range of medical issues and sharing their findings with medical professionals across the world.

In each case, the initial research will have been undertaken in the native language of the country in which it was conducted, which is going to have its own particular nuances and specific medical words and phrases unique to that language.

The ability to move between languages not only advances medical research, but truly enhances the sort of medical attention and overall health care provided to individuals. Here, we examine where multilingualism in medicine is key to breaking down barriers for better medicine on the front line.

Hospitals and primary healthcare facilities

Medical translators need a good working knowledge of medical science and treatments to convey information clearly and precisely. As this NPR feature reports, discussions in the hospital room that become lost in translation can have fatal consequences. What’s more, if a patient doesn’t fully understand policies, from insurance to medical history, release forms to billing, accessing medicine can become an administrative nightmare.

The NHS acknowledge that they have a “statutory and moral responsibility to patients” to provide medical translators to all the communities they serve, and aim to offer a strictly confidential service in a wide range of languages. A dedicated administrative team works to supply translators and interpreters in all cases where patients, relatives and carers may have difficulty discussing medical conditions and giving informed consent for procedures.

Luis Asciano is fluent in French and Spanish, and works as a medical interpreter in a clinic in Washington DC. “You are sort of a bridge,” he says. “And it is very important that you do not obscure the context of the conversation.” The role of the interpreter is two-fold: to convey the facts of the situation as accurately as they are able, but to do so empathetically: Medical interpreters must have an ability to convey emotion, tone of voice and assuage patients’ fears too.

However, according to an analysis published in Health Affairs, more than a third of US hospitals in 2013 did not offer patients similar language assistance. In areas with the greatest need, about 25% of facilities failed to provide such services. This despite the fact that over 60 million people in the country do not speak English as a first language. Further, studies reveal that nearly all claims for medical malpractice filed by foreign nationals in the US were the result of poor documentation in the patient’s native language.

The need for specialised translators and interpreters really can be a matter of life and death. A study by the American College of Emergency Physicians in 2012 analysed interpreter errors with clinical consequences, and found that the error rate was significantly lower (12% compared to 22%) for professional interpreters than for ad hoc interpreters. For industry-trained professionals with more than 100 hours of study, errors dropped to 2%.

As leading translation agency Global Voices point out, “Medical and pharmaceutical translation is highly specialised and requires great accuracy and expertise.” To achieve the utmost accuracy, they only work with linguists who have at least 5 years experience performing medical translations and interpretations.

With all of this in mind, then, it becomes apparent that medical translators create a better environment not only for the treatment of patients, but also their sense of ease and comfort when faced with illness or injury.

Crisis Events

Disaster response can be a truly international affair, with medical, support and logistical staff hailing from all corners of the globe. The international staff who comprise the organisation Médecins sans Frontieres work in nearly seventy countries around the world.

Instructions for disaster procedure and relief can be difficult enough to communicate within language borders, let alone across them, which is why translation accuracy is key. The misinterpretation of just one word or phrase can lead to anything from stagnation to outright disaster, highlighting the extreme importance of proper translation in the medical field.

The Translators Without Borders group respond in such crisis events with their Words of Relief Programme, the first crisis relief translation network intended to improve communications with communities during and after humanitarian crisis response efforts by eliminating linguistic barriers that can impede vital relief efforts.

Relying on translators in the field is obviously going to be of great use, but having important medical information, as well as disaster relief information, present in the native language is of great import to the recovery process as well.

In the last year, Translators without Borders have assisted in the translation and dissemination of vital documentation and advice regarding transmission of the Ebola virus and monitored social media and web communications in affected countries in order to detect where support is most needed.

From February 2015 to February 2016, roughly 712 healthcare articles in 54 languages were added to Wikipedia’s medical pages thanks to TWB volunteers. Elsewhere, developers are working to bring a digital translation tool facilitating communication with refugees from the Syrian crisis.

During such disasters, there’s just as much of an emotional and psychological toll wrought on the populace as there is a physical one. Providing support and materials in native languages is truly instrumental in providing those in need with the psychological building blocks necessary for recovering. Breaking down language barriers is therefore instrumental in facilitating medical care around the world, not just in research, but on the front line too.

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Medical science has greatly evolved in recent years. This becomes apparent when you compare the medical discoveries of a few years ago with what we have today.

For instance, some of the most common medical tools that we now take for granted e.g. stethoscopes and microscopes have only been around since the 1800s. The same is true for the x-ray. However, while the two former instruments have remained largely unchanged, with the microscope only increasing in size or magnification, the latter has definitely come a long way. Nowadays we have sophisticated MRI scanners that are capable of taking pictures of the inside of your body in seconds.

These developments aren’t limited to medical tools and instruments. Thanks to medical research, there have been numerous remarkable breakthroughs in medical treatment and care of various diseases. In the 18th century, people suffered greatly from diseases such as smallpox, diphtheria and polio. Through intensive medical research, scientists discovered that these were caused by bacteria, viruses and other microbes. This discovery made it possible to isolate the organisms and develop vaccines to prevent disease occurrence. To date, vaccines have saved millions of lives across the globe and have virtually eliminated diseases that once threatened humankind.

These medical breakthroughs are not outdated. Flip through any medical journal and you are sure to see several studies aimed at finding a cure or a new way to manage any number of diseases and illnesses. You are also likely to come across recent successes. For instance, the first hand transplant in the USA was done recently in 2011 by surgeons at Ronald Reagan UCLA Medical Centre, marking a milestone in medicine.

One area that is receiving a lot of attention these days is stem cell research. Medical researchers and practitioners now believe that stem cell therapy holds the key to remedies for conditions such as Alzheimer’s, Parkinson’s, Multiple Sclerosis and certain forms of cancer, among others. Stem cells are unique in that they can grow and differentiate into different cell types within the body. They have immense healing potential since they can develop into various body tissues or organs and can replace cells that have been damaged by injury or disease.

Stem cells were originally harvested from bone marrow. However, it was recently revealed that stem cells from teeth or the umbilical cord have the widest potential for therapeutic application. Cells that have been harvested from the donor in this way are a perfect match, reducing chances of rejection by the body. For this reason, parents are encouraged to store their children’s milk teeth in a Tooth Cell Bank, to be used for stem cell extraction should the need ever arise.

In summary, you can see that medical science discoveries have helped improve the lives of millions of people in the world. Thanks to these discoveries, we can now provide better care and disease management allowing people to live longer. Those who have chronic illnesses can enjoy better quality lives with more personalized treatment. As technology improves and more medical discoveries are made, maybe you will one day wake up to a world that is free of disease.

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A working party looking into the inclusion of placebos in surgical trials has led to a recommendation for greater use of the controversial method by the Royal College of Surgeons of England.

Although placebo control groups are used in drug trials across the world, placebo-controlled surgical trials are extremely rare, with only 75 such trials published up to October last year.

Often labelled with the misleading term ‘sham surgery’, it has long been argued that because placebo surgery is more invasive than placebo drugs it is difficult to justify its use.

However a new paper resulting from the working party, ‘When should placebo surgery as a control in clinical trials be carried out?’, supports evidence to show they should be increasingly considered as part of surgical studies to produce the very best research evidence and be of the greatest benefit to patients.

The research found that in half of the placebo-controlled surgical trials carried out up to 2013, surgery was no more effective than the placebo, calling into question the surgical procedure for the conditions treated.

Lead author and Deputy Vice-Chancellor (Education and International) at Brunel University London, Professor Andrew George, said: “This is a controversial issue, but the benefit to clinical research of placebo-controlled surgery is just as great as in drug treatment, as long as it follows correct surgical practice.

“The misconception is that this method would replace treatment in a control arm that is known to be effective, but that would not be the case. Placebo surgery should only ever be used when there is uncertainty about the relative benefits of an experimental intervention and placebo, and when any potential harm is minimised and reasonable.

“Most importantly, controlled trials could potentially avoid future harm to patients if they demonstrate that a particular treatment is ineffective and should not be adopted into clinical practice.”

Placebo surgery varies from minor procedures such as making an incision in the skin so that the patient doesn’t know whether they have been treated, to a full surgical procedure.

In all cases ethical guidelines must be followed with patients being made aware of, and giving consent to, being part of a randomised trial.

The paper is published here. The Royal College of Surgeons of England has released a position statement in support of greater use of placebo surgery here.

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PECKHAM, LONDON affiliated to the National Trust for the Promotion and Study of Health

Address inquiries to The Secretary 8k Hyde Park Mansions London, N.W.I. Tel. Paddington 6358.

You should read the book The  Peckham  ExperimentBy Innes H. Pearse And Lucy M. Crocker Published By Geo. Allen & Unwin, Ltd., 5/-.

price 6d.

(1)    WHAT IS HEALTH?

Health is everyone’s birthright; the pity is that so many lose it, the difficulty is to see how it can grow and be developed. In spite of our vast sickness services, national health insurance, school medical inspections, ante-natal and post-natal clinics, welfare centres, tuberculosis and other clinics, the burden of ill-health in the community is heavy. Medical science advances rapidly with new treat­ments, drugs and instruments, but it does not seem to kill disease. So, quite logically, thought has turned to a more radical attack on disease: to protect people from disease and give them immunity.   The preventative school is now at work on its plans. From the vanguard of this school another has emerged: those who believe that there is a negative ring in the words prevention, immunity and security; those who feel that it is a contradiction in terms to speak of protecting health, as though health were a weakling; those who believe that health is an active ‘ Positive ‘ thing, something as infectious as disease, which can also grow and spread. Such people speak of “positive health.”

And there the track ends abruptly. For what is the nature of “positive health”? Out of what is it bred and how does it grow? Clearly bad economic conditions are enemies of this ”positive health,” but a study of those in the higher income groups suggests that they are not the whole story. We have had disease under the microscope. Our lenses grow more powerful. We see the cancer cell, the bacterium, and the body’s scavengers. But the study of the nature of disease does not reveal to us the laws of health; it is health itself which we must study. We must devise a laboratory where we can study health, put it, too, under a lens, look at it, discover; how it behaves, and in what conditions it can grow and spread.

(2)    THE EXPERIMENT: Stage 1

The Peckham Experiment—the first laboratory in the world for the study of human health—began 20 years ago under the direction of two biologists, Doctor Scott Williamson and Doctor Innes Pearse. Research workers themselves, widely experienced in early diagnosis and in the investigation of disease, they had come to the conclusion that no headway would be made in the cultivation of health by further research into the nature of sickness. Intuitively aware that each person is born with an urge to health and a capacity for health that is seldom achieved, they sensed that health has its own pattern of behaviour, a pattern that is quite different from the pattern of disease. It was this pattern that they set out to study, and if you had asked them what they expected the Experiment to prove they would have told you ” that health is more powerful than disease.”

The choice of Peckham as the site of the Experiment was the outcome of a careful search for a suitable area. Peckham has a mixed population. Pre-war wage levels rose from £2 0s. 0d. a week (husband’s income) to £1,500 or more a year. Small income people lived next door to the relatively rich, and a ten-roomed house might contain one family or be divided up to accommodate three. The bulk of Peckham people are sturdy families making their own way through life; they are free from gross poverty or continuous unemployment. Peckham was chosen as providing a cross section of low, middle, and upper middle income groups, and as likely to contain a maximum of people who might be pre­sumed to be healthy.

These biologists started their work in a small house in Peckham, which they called the Pioneer Health Centre. Local families were invited to use it as a club. The member-families were offered through s their club a periodic health overhaul. This gave the doctors their first opportunity to begin to study and assess health, while it gave member-families a chance of gaining for themselves modern know­ledge to maintain such health as they had. The equipment of this small Centre was limited to a con­sulting room, an afternoon nursery for the children and a small club room. Here mothers had a chance of meeting people over a cup of tea in the afternoons, and- in the evenings both parents could enjoy a cup of coffee or a glass of beer, and now and then a whist drive or a concert.

(3)    SOME FIRST CONCLUSIONS

This was a small beginning, from which, at the end of three years’ experimental work, the following facts were established: —

  1. That there were families who welcomed and accepted the overhaul as a practical means of maintaining their health.
  2. That the disorders which come before there is any definite disease can be thus detected long before the individual himself is aware that anything is wrong.
  3. That disorders discovered in this early stage are much easier to deal with than in the later stage at which they are normally taken to the doctor.
  4. Though the disorder, detected early, can usually be easily removed, with the co­operation of the patient, in a very large number of instances the disorder quickly recurs if the individual returns to the environmental conditions from which the disorder has sprung.

The general standard of vitality that they found, even in those who showed no early signs of disorder, was low. There was evidence of wide-spread inertia, of capacities unused, and with no outlet for expression, it was not poverty, nor any of the conditions that arise from poverty, for the families who joined the Centre were not in material want. Was there some inherent lack of vitality inthe families themselves? They had money in their pockets, there was food for them to buy in the shops, yet they were not well nourished. There were swim­ming baths and tennis clubs in the borough, yet not even the young were well exercised. It was a crowded district and they had next door neighbours, yet they were isolated and friendless. They were, so to speak, hungry in the midst of plenty, and for no easily discoverable reason. Their vitality was low for want of things which were there for them to use and they did not use them.

(4)    FURTHER WORK BASED ON FIRST FINDINGS

The periodic overhaul had proved itself as a sieve for sifting out disease and disorder, but it was not, the doctors considered, by itself enough. Conditions seemed needed in which a family could find outlets for self-expression, in which it could recover vitality through a fuller use of its faculties. Doctor Scott Williamson and Doctor Innes Pearse decided to shut down the Centre and plan another. So the Peckham Experiment has now come to be housed in the large, unusual and very beautiful concrete building, new both in structure and in concept, which was built to Doctor Scott Williamson’s design—and to serve his special purpose—not by an Architect but by an En­gineer, Sir E. Owen Williams. Money was raised for the purpose by a Committee, almost all of whom were young people. The money lent and given came—in large and small amounts—from private per­sons. It should be made clear that those who sub­scribed did so in order to support a piece of research, and to make possible a social experiment of far reaching implications.

As well as the capital cost of the building, it was necessary to raise a development fund to pay for maintenance during the period in which membership was reaching the total of 2,000 families for which the experiment was planned. The family subscriptions and money spent in the club by adults (for all the children’s activities were free) was estimated to cover running costs and ultimately to pay a small interest on capital. The War interrupted the experi­ment before membership reached the 2,000 mark, and so it has not yet been possible to demonstrate that such a service can be self-supporting, though there was evidence to indicate that this is a practical possibility.

This new building then, was planned to provide a club for two thousand families, with a swimming bath, gymnasium, cafeteria (licensed to sell beer), a theatre, library, games rooms and nurseries. It was to supply them with a special kind of environment, an environment in which, moving freely, they could find wide and varied oppor­tunities for action. In the Centre they were neither directed nor organised, for health must emerge spontaneously. The ‘ doctors ‘ were there to ob­serve and to assess capacity not to mould people. They were there to study the ways in which health expresses itself. From this study they hoped to- be able to formulate guiding principles for the cultiva­tion of health.

It was a condition of membership that the mem­ber should be not an individual but a family unit, each family paying a subscription of one shilling a week, prewar. For this they had both periodic health overhaul and the use of the Centre’s facilities. The Peckham families were independent, and “kept themselves to themselves ” – ” Oh, no, we don’t know the people next door, we never speak to them.” It was strange how rarely the young mother had any friends in the district, she had lost touch with her old school-friends or those she had made at work before she married. When she felt she needed company she went off to Fulham or Finchley to spend the day with her sister. The father was less cut off. He might drop in the local for a drink with a man met at work or on the train, or perhaps a game of billiards at the club, and on Saturday there might be a football match or an afternoon at the dogs. His wife, after the children came, could seldom go with him: there was no one she could ask to “mind the babies.” When the children grew older, she did not even know the parents of the friends they made at school. There was no widening circle of friends coming into the home. In this isolation the family had lapsed into listless inactivity.

In the environment of the Centre they began to take hold of new opportunities. For instance, dur­ing the first three years after the second Centre opened, 157 married women, most of them middle-aged, had with no urging or persuasion—and very much to their own surprise—learned to swim. Out of 160 children between the ages of 5 and. 16 who joined the Centre in 1937, only forty were swimmers. A year later, 128 of them could swim or were teach­ing themselves to do so. Opportunities which, though provided by the borough, had been ignored, were eagerly taken up in the Centre.

Now, and often led by the children, everyone was making friends. Out of swimming, dancing, the gymnasium, the theatre in which people acted, costumed and sometimes wrote their own plays, out of their own concert parties and orchestras, out of games, crafts and studies, making the teas for the babies in the nursery, and shared interests of many kinds, came new acquaintances and finally friends. Now, there were other families with whom the family was glad to go on holiday, with whom they could exchange impressions and ideas. The release from social loneliness, and with it the increase in physical, mental and emotional energy was tremendous. This shift towards health and vitality was reflected in the findings at the yearly recurring overhaul of the family.

(5)    THE BUILDING AGAIN

Since the Centre was built to the special design of the ‘doctors’ for the study of health, some description of its plan will help in understanding how the bringing together of these activities under one roof, and their careful adaptation to the leisure and needs of families came to make so distinct a change in the health of the family. The Pioneer Health Centre was built in concrete and glass. Its roof and its four walls, with wide bays on the side which caught the afternoon sun, were almost entirely of glass. In the centre of the building was the big swimming bath, the concrete tank of which occupied the depth between ground and first floor, its water level the level of the first floor, the sloping sides of its glass roof, through which swimmers could see the sky, rising above the flat roof of the rest of the building.

Pioneer Health Centre

Plan of Peckham Health Centre

A glass band encircled the bath chamber and round this window was placed the cafeteria, where members could watch the swimmers. They could also look down on to the stage of the theatre, which was at one side of the swimming bath, and into the gymnasium which was on the other side. On the cafeteria floor there was also a large social hall. On the ground floor, as well as the gymnasium and the theatre, were the nurseries, changing rooms; and engine house.

One side of the top floor was the only space shut off from general circulation. This was the consulta­tion block with its laboratory, private consulting rooms, reception rooms and changing rooms. The rest of this floor was made up of large light open spaces for indoor games, for study, for a library, workrooms, wireless room, billiards, table-tennis, darts and whist, etc.

Except where privacy was obviously essential, the partition walls were of glass. Visibility throughout the building of people and of their actions, was necessary for the scientists in this’ the first “health laboratory.” It gave them a special ‘ sight ‘ of their field of observation—the family. This transparency was their new ‘ lens.’ Members were fully aware that whilst they were gaining from the opportunities which the Centre offered them, they were also con­tributing to the scientists’ knowledge of health.

Sometimes one of the men would look at the doctors quizzically and say: ” What are you getting out of this? ” They got the true answer and were satisfied. But for the most part they were busied about in their own concerns and forgot about the ‘doctors.’ Natural, spontaneous and unselfconscious behaviour was a conspicuous quality of life in the Centre (visi­tors often commented on it) and indeed it was essen­tial to the validity of the observations that this should be so.

(6)    THE PEOPLE AGAIN

It will be clear that the design of the building itself invited social contact. It provided an environ­ment for the chance meeting, for gala occasions as well as for acquaintanceship, companionship and for developing friendships, and also for the entertain­ment by families of visiting friends and relations. The activities which were taking place could be seen, and it was the sight of action which was the incentive to action.

Here it is necessary to stress two points. It is usually considered that it is the competent and skilled who are the incentive to action. That is true for those whose interest is already aroused, and who have some confidence and some pretention to skill. It is not true, however, of those who do not par­ticularly want to do anything, who have no con­fidence and no skill. In the Centre it was found that the incentive to these—the great majority—was the sight of persons with less skill, who were even less well endowed with capacity than they. In the Centre there were people of all sorts doing all sorts of things, rather than small groups of experts doing things expertly to a large audience of spectators. In the Centre all eventually became ‘ doers.’

The second point is that because the Centre was a family club, there were people of all ages mixing freely with one another as one does at home. That meant that there was always for the young a group just a little more mature than they—the people into whose company they naturally wanted to move. That in itself acted as a stimulus to them to grow. The adolescent wanted to be admitted to the group of young adults, so he strove to be, not only as skilled as they, but as socially competent as they. The young married couple without a baby, came to want a baby of their own like their slightly older friends, and so on.

These natural stimuli to growth, and development can only emerge where all ages and types move freely in the general body of society. Any segrega­tion into age and sex groups tends to confirm im­maturity, and grading into select groups of experts tends to spectatorship of the mass rather than development.

The directors did not organise, suggest or pro­mote any undertakings nor provide any ‘leaders.’ They discouraged members from forming them­selves into permanent committees to organise their various enterprises. Thus there were no difficult thresholds for the new members to cross, no closed doors, no embarrassing applications, no cliques to intimidate the newcomer.

 There were, of course, difficulties, and there were a few people who behaved badly, but the community was finding its own way of dealing with any disturb­ing element. Members tended to live and to let live. They exercised their individuality in relation to each other, and it was found that individualism released from repression and operating in a mixed society cures itself of egotism. That is the basis of social health. The experiment was proving that in a suit­able environment people will use the opportunities around them. But what was perhaps more astonish­ing was the commonsense way in which they utilised new knowledge. Though communities may not re­spond to set teaching or to propaganda, and will re­sist persuasion, they will respond eagerly and pur­posefully to facts and information when they feel a use for them.

(7)    A1. AT PECKHAM

This spontaneous response of the ordinary man and woman to facts and information given objectively was a very early discovery. It had come out very clearly at the family overhauls in the first Centre, and it throws light on a very serious problem. Out­side the Centre, people do not go to the doctor until very late, sometimes too late, but they went gladly to the Centre because they knew that they would be able to get full information in a form they could understand about “where they are and what they can stretch to”—as they put it. They knew that their overhauls were being- made in order to find out what evidence there was of health and vitality, rather than as a search for what was wrong. So they never felt they were being made into ‘patients.’ Their overhaul was like a ship’s survey at Lloyds— A1 at Peckham. “The ‘doctors’ tell you where you stand,” they said.

There were two appointments for the overhaul: one for the laboratory and the other for the personal overhaul at which the father and boys were examined by a man, the mother and girls by a woman. When all the individuals had been examined the whole family met at a Family Consultation. The children were discussed one by one and then went out, leaving the parents with the two ‘doctors.’ Nothing was withheld in these talks. What was found in every member of the family was frankly reviewed; what it was, what it was not, and what it could be. No treatment was given and no advice, unless asked for. Every question—and there were many—was answered. . Facts which doctors and specialists often consider too technical to discuss were as far as possible explained. The family was left in possession of the facts, free to use them as they thought fit.

The families went away and digested what they had heard; they thought it over and talked it over at home. They came to their own conclusions, and made their own decisions. If the decisions meant coming back and asking for advice or help—if they wanted to get their teeth filled or had made up their minds to have a necessary operation, or to under­take some treatment—then the arrangements they asked for were made with their practitioner or with a suitable hospital or clinic. Every effort was made to make these arrangements to suit their own circum­stances and their pockets, so that no one by looking after himself need expend unnecessary time or money, nor risk losing his job.

These consultations established a relationship between the Centre staff and the member-families from which both gained. Parents fell into the habit of discussing the way in which the family was grow­ing up and the education of the children. The ‘doctors’ had seen the children in action in the Centre, as well as having examined them in the con­sulting room. From the correlation of these two sets of observations, as presented to the family by the doctors, the people often gained a fuller understand­ing of the way in which their children were develop­ing. Husbands and wives discussed parenthood and whether or not to have more children. Most signifi­cant of all, young couples took advantage of the overhaul to achieve their fullest health before the conception of a child.

In the Centre the work of thirty different medical and social agencies was covered in any ordinary week’s administration.  The full list of these activities is given in Chapter XV of “The Peckham Experiment” by Innes Pearse and Lucy Crocker, which has recently been published by Allen & Unwin. This book gives a full description of the new technique for the cultivation of health as it was prac­tised in the Centre,

(8)    GENERAL CONCLUSIONS AND SOME DISCUSSION POINTS

The reader will see that the Peckham Pioneer Health Centre was, in fact, designed for the cultiva­tion of health. It should not be confused with the Polyclinics for the treatment of early and minor diseases, or with the proposed centres for group medical practice, both of which types of institution are often spoken of indiscriminately as health centres.

The study of health involves the study of the springs of human behaviour, the deep-seated im­pulses underlying the actions of individuals and nations. So far, only the fringe has been touched. The findings of the Peckham Experiment are regarded by the experimenters as a pointer, a shaft of light flung into the obscurity of the future. They are, they claim, establishing a new branch of science and a new art, the art of the cultivation of the health of man and of his society.

The experiment has shown that, given favourable circumstances, people will lay hold of oppor­tunities and use knowledge—without persuasion. It has found a ‘catalyst’ in the presence of which the family is able to utilise for their growth and develop­ment the plenty which modern civilisation is discover­ing.

In the sample of society examined at their first overhaul in the Pioneer Health Centre, there were 10 per cent of individuals with nothing wrong, and roughly 20 per cent, who knew they had something wrong when they joined. The great middle group, which the biologists describe as being in ‘well-being’ because they would have spoken of themselves as being well, had some early disorder of which they were unaware or which they were ignoring. In the present state of society, this group inevitably drifts into disease, thus continuously swelling the number of the sick. In the environment of the Pioneer Health Centre, this large group, on the contrary, was tending to move towards health.

In this ‘move-over,’ the lead comes mainly from the young.  The old are more or less set in their ways and, though they may improve, few of them can now realise the potential health that should have been their birthright. But there are times in the human life span at which the individual, as a result of a natural process, may leave behind him the habits of the past. Such phases might be described as biological junctions at which the traveller changes trains and may take another direction. The time of puberty has always been recognised as one of these, but the work of the Centre is indicating that the time of mating, and the time before the birth of a child (for both parents) are others. At such moments, individuals who are in the middle group which these biologists have classified as ‘well-being’ can, even in the early part of middle life, move into the direction that points to health.

In the Centre the influence of the young in the family environment was very marked. Friendships of families grew out of the friendships of children, and the young people were constantly enriching the circle of the family life by bringing back new experi­ences and interests into the home. The young for their part were not segregated amongst those of their own age. They were growing up in a ‘vertical’ society, made of individuals of all ages and all skills.

They were in touch with those who were both more and less knowledgeable and mature than them­selves, and that in itself is a big part of an education in living. Watching the children as they grew and developed in such circumstances and in so integrated a society, there was already evidence that an increas­ing proportion of a new generation could achieve its ‘birthright of health.’

(9)    FINANCE

The cost of building and equipment was £38,000.

Four years were spent in planning, before the pre­sent Centre opened. These plans included financial estimates. The planners were preparing to cater for a ‘vertical’ section of the populace. Incomes would range from the Railway Porters (pre-war) 37/- to 40/- per week to the professional man’s £1,500 per year. The building had thus to be put up for a limited capital cost to be so planned that the lowest possibly weekly family subscription would cover its maintenance. It was estimated that the maximum weekly sum which could be derived from the lowest member family income would be 2/- per week net.

This 2/- was estimated to include: —

  • The fixed subscription of I/- per week for family, Mother, Father and all children.
  • A fixed subscription of 6d. per week for adult wage-earning- sons and daughters of member-families.
  • Small charges made to adults for the use of the Centre’s ‘instruments,’ that is for the use of the swimming bath, gymnasium, theatre, cafeteria, and so forth.

2,000 families, spending 2/- per week, made up as above, would represent an income of £10,000 per annum.

At the same time maintenance costs and services were estimated at a basic minimum of £8,500 per annum, and not to exceed £9,700 p. a., at prewar rates.

(a)  During the four years prior to the war, in which the Centre operated, it became evident that maintenance and service costs could be sustained at between £8,500 and £9,700. This, however, was a very experimental period. And there was every reason to believe that the figure would stabilise at the sum of £8,500 originally estimated.

(b)  The ultimate earning ‘capacity’ of the Centre is more difficult to assess. For one thing the Centre had not yet achieved the membership of 2,000 families for   which it had been planned. Nor had the income derived from each family reached the estimated sum of 2/- per week per family. An analysis, however,
of the ‘curve’ of ‘earnings, which were, of course, carefully recorded, revealed an in­crease which was steadily moving towards the estimated figure.

It will be appreciated that the estimated capacity of each family to represent an income of 2/- per week was as much a subject for experiment and observation as anything else in the Centre. It had not, for instance, been realised in advance that the use of the Centre during the families’ leisure hours would effect considerable saving of heat and light for them at home—especially during the long winter months. Moreover, the families who were now doing things themselves instead of watching other people doing things, were now spending much less than formerly at places like the cinema, the theatre, the dogs and football matches. A third and very in­teresting discovery was that members of the family now spent rather less money in promiscuous ente­tainments, public-houses, etc. So, as time went on, more and more families began to notice and to men­tion that the Centre, in spite of the money spent there, was in fact reducing the family expenditure.

From the foregoing it begins to be evident that the economic value of the Centre to its member-families could be recalculated and assessed at a higher figure than 2/- net per week.

Reviewing all these points carefully, that is, pro­bable reduction of maintenance costs, a full comple­ment of member-families, and a higher assessment of the families’ spending capacity, it seemed reason­able to believe that with careful planning a Centre could earn the necessary income, not only for main­tenance, but also to pay a small interest on capital. In other words, that a Health Centre could be, in fact, as it should be, self-supporting.

The National Trust For The Promotion And Study Of Health

The need for this National Trust arises directly out of the widespread public demand for Health Centres of the Peckham type. Many towns are con­templating Peckham Health Centres as part of their organisation under the new Health Services Bill. Voluntary movements are already afoot for example in Coventry, Winchester, Oxford and in other dis­tricts ways and means of establishing Peckham Health Centre of their own are being considered.

Advice and guidance is sought by these groups and authorities. The training of staffs in the new-methods is essential. Hence some Central Organisa­tion is needed to which these new Health Centres of the Peckham type could be affiliated to guide and stabilise their practice and to correlate all their in­dividual efforts.

When the State assumes full responsibility for caring for the sick and diseased, voluntary benefac­tions will no longer be needed. That being so, no better object for such funds could be found than in the promotion of Health.

The purpose of the Trust is to further these ends through the pursuit’ of Research into the Nature of Health and through the coordination of all efforts to Cultivate Health.

Donations to the Trust can be made to The Secretary, The National Trust for the Promotion and Study of Health, Temporary address, 8K Hyde Park Mansions, London, N.W.1

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