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Patients still make enquiries at busiest hours, despite 24/7 online access

· University of Warwick publishes first independent evaluation of one of the main providers of online consultation platforms

· Targeting services at younger patients and those with general administrative enquiries could be most effective

· “In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes.” Says supervising author.

Patients are using online consultations in the same way they would arrange a consultation via traditional means, a new independent evaluation by the University of Warwick reveals.

Despite this, the study identifies several opportunities to tailor online platforms to specific patient requirements and improve their experience.

Primary care researchers from Warwick Medical School have today (26 March) published the first independent evaluation of one of the main providers of online consultation platforms in NHS general practice. Published in the British Journal of General Practice, it provides independently analysed information on the types of patients that are using online triage systems, how and when patients are using this platform, and what they think of it.

Online triage is a system in which patients describe their problems via an online form and subsequently are telephoned by a GP to conduct a telephone consultation or arrange a face-to-face consultation. Practices aim to respond within one hour of receiving the request.

The researchers examined routine information from 5140 patients at nine general practices using the askmyGP platform over a 10 week period. Highest levels of use were between 8 am and 10 am on weekdays (at their highest on Mondays and Tuesdays) and 8 pm and 10 pm at weekends, mirroring the busiest time for patients contacting their practice via telephone.

Supervising author Dr Helen Atherton, from Warwick Medical School, said: “With online platforms there is an assumption that having a 24/7 ability to make contact with a general practice will cater to those who wish to deal with their health problem at a convenient time, often when the practice is shut, and that being online means they will perhaps share different problems than they would over the telephone or face-to-face.

“In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes. This suggests that patients’ consulting behaviour will not be easily changed by introducing online platforms. Therefore practices should be clear as to exactly why they are introducing these online platforms, and what they want to achieve for themselves and their patients in doing so – the expectation may well not meet reality.”

The NHS Long term plan sets out that over the next five years all patients will have the right to online ‘digital’ GP consultations. The main way these are being delivered is via online consultation platforms. The online platforms claim to offer patients greater convenience and better access and to save time and workload for GPs, however there is currently a lack of independent evidence about their impact on patient care and care delivery.

Patient feedback analysed as part of the study showed that many found the askmyGP system convenient and said that it gave them the opportunity to describe their symptoms fully, whilst others were less satisfied, with their views often depending on how easily they can normally get access to their practice, and on the specific problem they are reporting.

The study found that two thirds of users were female and almost a quarter were aged between 25 and 34, corroborating existing evidence. The commonest reason for using the service was to enquire about medication, followed by administrative requests and reporting specific symptoms, with skin conditions, ear nose and throat queries and musculoskeletal problems leading the list.

The researchers argue that practices should avoid a ‘one size fits all’ approach to implementing online consultations and should tailor them to suit their practice populations and model of access, considering whether it is likely to add value for their patient population.

Dr Atherton adds: “Individual online consultation platforms are uniform in their approach, patients are not. We found that patient satisfaction is context specific – online consultation is not going to be suitable for all patients and with all conditions and that one approach is unlikely to work for everyone.

“Practices could focus on encouraging people to deal with administrative issues using the platform to free up phone lines for other patients. It could be promoted specifically to younger patients, or those who prefer to write about their problems and not to use the telephone. Clear information for patients and a better understanding of their needs is required to capture the potential benefits of this technology.”

· ‘Patient use of an online triage platform; a mixed-methods retrospective exploration in UK primary care’ published in the British Journal of General Practice, DOI: 10.3399/bjgp19X702197

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Lesbian and bisexual women are at increased risk of being overweight or obese compared to heterosexual women, according to new research from the University of East Anglia and UCL.

Gay men however are less likely to be overweight than their straight counterparts, and more at risk of being underweight.

The study, published today in the Journal of Public Health, is the first to investigate the relationship between sexual orientation and body mass index (BMI) using population data in the UK.

The findings support the argument that sexual identity should be considered as a social determinant of health.

The research team pooled data from 12 UK national health surveys involving 93,429 participants and studied the relationship between sexual orientation and BMI.

Lead researcher Dr Joanna Semlyen, from UEA’s Norwich Medical School, said: “We found that women who identify as lesbian or bisexual are at an increased risk of being overweight or obese, compared to heterosexual women. This is worrying because being overweight and obese are known risk factors for a number of conditions including coronary heart disease, stroke, cancer and early death.

“Conversely, gay and bisexual men are more likely than heterosexual men to be underweight, and there is growing evidence that being underweight is linked to a range of health problems too, including excess deaths.

“We also found that gay men are significantly less likely than straight men to be overweight or obese.

“This study demonstrates that there is a relationship between sexual identity and BMI and that this link appears to be different for men and women.

“There are a number of possible explanations for these findings. We know that sexual minority groups are more likely to be exposed to psychosocial stressors, which impacts on their mental health and their health behaviours such as smoking and alcohol use and which may influence their health behaviours such as diet or physical activity.

“These stressors include homophobia and heterosexism, negative experiences that are experienced by the lesbian, bisexual and gay population as a result of their sexual orientation identity and are known to be linked to health.

“Until 2008, sexual orientation wasn’t recorded in health surveys. This means that until recently it has not been possible to determine health inequalities affecting lesbian, gay and bisexual people.

“Continued collection of data on sexual orientation identity within national health surveys allows us to measure the health of sexual minorities.

“We hope that policy makers and clinicians will be able to use this fresh evidence to provide better healthcare and tailored advice and interventions for lesbian, gay and bisexual people. We need longitudinal research to understand the factors underlying the relationship between sexual orientation and BMI, and research to understand more about being underweight, especially in this population.”

‘Sexual orientation identity in relation to unhealthy body mass index (BMI): Individual participant data meta-analysis of 93,429 individuals from 12 UK health surveys’ is published in the Journal of Public Health on Thursday, February 21, 2019.

EDITOR’S NOTES

1/ For more information or to request an interview, please contact the UEA communications office on +44 (0)1603 593496 or email communications@uea.ac.uk.

2/ The paper is available from the following dropbox link: https://www.dropbox.com/sh/fxypgrqt4niuh89/AAAOA0H8AStuNFGOZlW13OQMa?dl=0

3/ The University of East Anglia (UEA) is a UK Top 15 university. Known for its world-leading research and outstanding student experience, it was awarded Gold in the Teaching Excellence Framework. UEA is a leading member of Norwich Research Park, one of Europe’s biggest concentrations of researchers in the fields of environment, health and plant science. www.uea.ac.uk

4/ About UCL (University College London)

UCL was founded in 1826. We were the first English university established after Oxford and Cambridge, the first to open up university education to those previously excluded from it, and the first to provide systematic teaching of law, architecture and medicine.

We are among the world’s top universities, as reflected by performance in a range of international rankings and tables, and are committed to changing the world for the better.

Our community of over 41,500 students from 150 countries and over 12,500 staff pursues academic excellence, breaks boundaries and makes a positive impact on real world problems.

www.ucl.ac.uk | Follow us on Twitter @uclnews | Watch our YouTube channel YouTube.com/UCLTV

Lead researcher Dr Joanna Semlyen is available for interview. We have Globelynx TV and ISDN radio facilities on campus. Let me know if you would like to set something up.

Lisa Horton

UEA communications office
+44 (0)1603 592764 / l.horton@uea.ac.uk

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DELIVERED AT JULIAN HART’S FUNERAL — JUNE 16th 2018

 

Julian and I were chatting once about heaven and hell, as you do. He didn’t believe in either, but supposing he was wrong, he thought he might be allowed into heaven, not as a believer, you understand, but for good behaviour.

Julian always wanted to be a doctor in a mining village, partly because his father had been a colliery doctor in Llanelli; partly it was the romance of mining practice as popularised in AJ Cronin ‘s novel The Citadel; but mainly it was the sort of community to which he wanted to belong.

And belong he did. As Gerald Davies, one of his patients, said in a BBC documentary , Julian wasn’t aloof like the other doctors, the headmaster and the colliery manager. He lived in the village and shared the common experience.

He wrote about it for medical students, “No one is a stranger; they are not only patients but fellow citizens. From many direct and indirect contacts, in schools, shops and gossip, I have come to understand how ignorant I would be if I knew them only as a doctor seeing them when they were ill.”

Julian loved his patients – not romantically, of course. The opposite of love in this context is indifference and Julian was never indifferent. He hated when bad things happened to his patients, especially when they could have been prevented. In his last 28 years at Glyncorrwg, there wasn’t a single death in women from cervical cancer.

In his book A New Kind of Doctor, he described a man, invalided out of the steel industry after a leg fracture, aged 42. With no further use for his big muscular body, he had become obese, had high blood pressure and cholesterol, got gout and was drinking too much. 25 years later, Julian described how, after 310 consultations and 41 hours of work, initially face to face, eventually side by side, the most satisfying and exciting things had been the events that had not happened: no strokes, no heart attacks, no complications of diabetes. He described this as the real stuff of primary medical care.

At a seminar in Glasgow, we asked Julian what happened next. The man had died, of something else, a late-onset cancer I think, but when Julian told us this, there was a tear in his eye. His patient had become his friend.

This was Dr ‘art, without an “H”, as known to his Glyncorrwg patients. None of this explains why Dr Julian Tudor Hart became the most famous general practitioner in the history of the NHS.

In 1961 with large numbers of very sick people, huge visiting lists and a nearby colliery that was still working, the Glyncorrwg practice was extremely busy. His initial base was a wooden hut. It took five years to reach a stable position.

He was the first doctor in the world to measure the blood pressures of all his patients. Famously, Charlie Dixon was the last man to take part, had the highest blood pressure in the village but was still alive 25 years later. Julian became an international authority on blood pressure control in general practice and wrote a book about it which went to three editions and was translated into several languages, with a companion book for patients.

What he did for patients with high blood pressure, he did for other patients, delivering unconditional, personalised continuity of care. After 25 years he showed that premature mortality was almost 30% lower than in a neighbouring village – the only evidence we have of what a general practitioner could achieve in a lifetime of practice.

It’s said that behind every great man there is an astonished woman. Behind Julian, was a great woman. When Deborah Perkin was planning her BBC documentary, the Good Doctor, (which we keep showing to medical students and young doctors), I said to her, there is something you have to understand. There’s two of them. Mary was his partner and anchor every step of the way.

Glyncorrwg was the first general practice in the UK to receive research funding from the Medical Research Council. Mary and Julian had both worked with Archie Cochrane and his team at the MRC Epidemiology Unit in Cardiff where they learned a democratic type of research in which everyone’s contribution was important and the study wasn’t complete until everyone had taken part. And so, in Glyncorrwg, there was the Shit Study, the Pee Study, the Salt Studies and the Rat Poison Study, all with astonishing high response rates.

Julian counted as a scientist anyone who measured or audited what they did and was honest with the results. Brecht’s The Life of Galileo was his favourite play and he often quoted Brecht’s line, “The figures compel us.” Julian didn’t pursue scientific knowledge for its own sake. His research always had the direct purpose of helping to improve people’s lives.

He had a talent for the telling phrase. His Inverse Care Law stated that the availability of good medical care tends to vary inversely with the need for it in the population served, or more simply, People without shoes are clearly the ones who need shoes the most.

When Sir Keith Joseph, a Conservative Secretary for Social Services, announced that
“Increased dental charges would give a financial incentive to patients to look after their teeth,” Julian commented, “The government has not yet raised the tax on coffins to reduce mortality, but Sir Keith is assured of a place in the history of preventive medicine.”

Julian’s friend and fellow GP, John Coope from Bollington in Lancashire, admired Julian’s nose for what mattered in the published literature. In his book The Political Economy of Health, that magpie tendency was on display, the footnotes comprising one third of the book and worth reading on their own. A Google search could never assemble such a mix. Goodness knows what readers made of it in the Chinese translation.

He lectured all over the world – in the US, Australia, Kazakhstan, Italy and Spain in particular. Julian could deliver formal lectures but for brilliance and exhilarating an audience he was at his best in impromptu, unscripted exchange.

When principles were at stake, Julian could argue until the cows came home. In his younger years he took no prisoners. A famous medical professor reflected that he had been called many things, but never a snail.

Dr Miriam Stoppard arrived in the village to interview Julian for her TV programme, determined to cast him in the role of a doctor who made life or death decisions concerning his patient’s access to renal dialysis and transplant. They battled for a whole afternoon, Stoppard trying to get Julian to say things on camera that fitted her script. He defied her, ending every sentence by mentioning how much dialysis and transplant surgery the cost of a single Trident missile could buy. She went away defeated and empty-handed.

I was surprised once at Paddington station to see him with a copy of the London Times. He was no fan of the Murdoch press. On boarding the 125 for South Wales, he laid out the newspaper as a tablecloth and over it spread a messy, aromatic Indian carry-out meal. If businessmen in their smart suits wanted to sit next to us, they were very welcome.

Standing for election to the Council of the Royal College of General Practitioners, Julian topped the poll. What he offered GPs was a credible image of themselves as important members of the medical profession – alongside specialists, not beneath them.

Julian was humble in himself but ambitious for his ideas. He accepted with ambivalence the honours and sentimental treatment that came with age but he never lost his edge, and if we are to celebrate his life it should be by holding to the principles he held dear.

The work of a general practitioner is immeasurably enhanced by working in, with and for a local community, for long enough to make a difference.

Everyone is important, the last person as important as the first, and the work isn’t done until everyone is on board.

Julian was the “worried doctor”, anticipating patients’ problems, not waiting for them to happen, and then avoiding them by joint endeavour.

Drawing on his reading of Marx, he saw health care as a form of production, producing not profits but social value, shared knowledge, confidence, the ability to live better with conditions, achieved not by the doctor alone but by doctors and patients working together. Patients were partners, not customers or consumers.

The NHS should never be a business to make money but a social institution based on mutuality and trust – the ultimate gift economy, getting what you need, giving what you can, a model for how society might run as a whole. In re-building society, co-operation would trump competition, not marginally, but as steam once surpassed horsepower. The Glyncorrwg research studies showed glimpses of that social power.

My daughter Nuala met Julian many times. Losing him as a person, she said, was like the Mackintosh Building at Glasgow School of Art, burning down. We lost someone dear, a big part of our lives, an institution, a one man “School of ‘Art”, full of life, light and creativity.

Julian’s gift to us today is not the example he worked out in the microcosm of a Welsh mining village over 25 years ago; it is the present challenge of how we follow and give practical expression to his values in local communities in the future. In honouring his memory, there is work for all of us do.

 

Professor Graham Watt
MD FRCGP FRSE FMedSci CBE
Emeritus Professor
General Practice and Primary Care
University of Glasgow

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Health inequalities persist and grow in the UK. Differences in morbidity and mortality add to rising public concerns about household poverty and children’s health and development. Current attempts to redefine and find new national lower measures for poverty in the UK when current measures show increases, talk endlessly about getting more information about poor people and their lives and involving them in defining the problems. This blog is about how the language used itself diverts attention from the real underlying issues, such as why, in the rich UK, are personal and public resources so badly distributed by government or the labour market that anyone is left without sufficient to choose an acceptable conventionally inclusive and healthy lifestyle. Whatever the role of freedom of choice in people’s lives, which is a basic premise of our marketised consumerist society, it follows that no one should have too few resources to exercise it as others do.

Today’s problems are constant reminders of what Sir Douglas Black brought to wider public and political awareness as long ago as 1977. His report concluded that “poverty remains the chief cause of disease, and it is a factor which is beyond the immediate control of medicine”. ‘Disease’ here means all forms of ill-health, and the poverty referred to is not only that of the individual household lacking adequate disposable resources (mainly cash incomes) to be free to make its own healthy choices of food and socially-inclusive lifestyle, but also the lack of the collective resources of decent housing, health and care, children’s services, education, public transport, opportunities for adequately paid work and other collective means of enabling and empowering people to take a recognised part in their society over time. These are matters that Sir Donald Acheson’s report on Inequalities in Health reiterated in 1998 and others repeatedly have since then.

Public expenditure on and availability of all of these collective as well as individual resources at the levels needed to prevent deprivations and health inequalities has been considerably reduced by deliberate government ‘austerity’ policy since 2010. It is just possible that the politicians who devised and maintained these anti-statist policies were unaware of the health consequences of their pursuit of austerity; at any rate, if not culpably ignorant and oblivious, they seem to disregard the reports which increasingly make the connections between their policies and the consequent growth in a wide range of social evils including health inequalities. Beyond a little fire-fighting in crisis situations the current political response is too often to focus on or even blame the victims, suggesting for instance that they wouldn’t be so unhealthy if they’d made the right lifestyle choices compatible with their resources. The current government does not acknowledge that the resources are inadequate for such choices.

The obvious problem of inadequate resources and incompatible objectives, such as eating or heating, can’t be answered as long as we focus only on people in poverty and their own reports. The language we use to talk about the problems (the discourse, to use the technical jargon) not only distorts our focus on underlying causes but actually closes off some options for policy action, and this is being deliberately promoted for ideological reasons by some of the people involved. It’s part of the bigger story of attitudinal manipulation widely discussed in political circles, but it’s relevant in many other fields as well, and it affects social scientists as well as other publics. That’s why the current discourse matters when we discuss health problems.

First, a note about the social science technical aspects. The discourse reflects the currently accepted explanatory paradigms, the self-consistent system of concepts and theories which any scientific system uses to structure its approaches in ways which make it seem like ‘common sense’ not needing to be questioned. That’s why to make sense of what’s happening now, we need to review,  brutally briefly, the succession of dominant poverty paradigms since the 19th century. The traditional paradigm was acceptance of class-based social stratification, given its authority by the dominant social order or even by religious beliefs, in which poverty was the way of life of the lowest layer of society, in terms of squalor and exclusion. Dividing poor people into the ‘roughs’ and the ‘respectables’, many well-off people assumed this was a matter of individual choice even if the system was immutable. But the earliest systematic attempts by such pioneers as Seebohm Rowntree showed the poorest people lacked adequate resources even for physical efficiency. He designed an artificially low ‘primary poverty’ budget to show it was inadequate for real life, but even so it was criticised for superfluity.

This generated the second dominant paradigm in this field, poverty defined as and measured by household incomes below artificial minimum subsistence budgets. In the 20th century this generated an academic industry of competing prescriptions for variants of what the lowest level of living for poor ‘othered’ people could be, some allowing for minimal social participation expenditure as well or targeted on ‘healthy living’. Against this, during the 1930s, Sir John Boyd Orr argued that instead of prescribing minimum budgets for the lowest level of living at which people didn’t show nutritional deficiency symptoms, researchers should study empirically at what minimum levels of income households actually achieved optimum levels of nutrition. This generated lively scientific and professional association arguments for years. In the post-war period, the sociologist Professor Peter Townsend argued that if households were to be studied for sufficient spending on adequate nutrition, this applied even more strongly to adequacy of their resources for social participation. He suggested that seriously lacking resources for participation in conventional lifestyles was the conceptual definition of the social phenomenon of poverty, identifying its cause in the structure of resource distribution and pointing to a more appropriate measure of poverty than normative budgets based on the natural science measures of nutrition and health alone.

This third paradigm thus raised the question of whose standards of adequacy of resources and life choices were to be applied to distinguish normally inclusive lives from poverty. Should they be the experts’ prescriptive (normative) views about healthy diets and lives, or the population’s views about inclusive lifestyles (though research experts are needed to discover empirically what they are)? The question of whose and what standards were to be applied, and the levels of various resources needed to enable inclusive lifestyles, became a matter for the poverty research industry, but some policy-oriented researchers (and many politicians) found it hard to accept the shift from expert to ordinary people in defining what an inclusive lifestyle and adequate resources might be. Some of this was caused by manifest confusion between the social science question of what levels and standards of resources were needed for social inclusion, adequacy, as defined by the whole population, and the completely different political question of what governments asserted ‘the taxpayer’ could afford for social security claimants.

A larger problem, one which is rarely admitted openly but colours all such arguments, is the ancient class distinction between living standards Good Enough for Us, We the People, or sufficient for Them, the Poor. Evidence from social surveys and focus groups shows that when they ask about what levels of living are needed for poor people to escape poverty, participants offer more restrictive views than when they are asked about what all of ‘us’ need to live a minimally decent inclusive life in society. If the word ‘poverty’ is used in the question, responses often ‘other’ the victims as ‘them’. Thus although the currently dominant paradigms may succeed in dominating discourse to squeeze out previous ones, the older ones may leave persistent residues in common thought. Today’s focus on poor people’s lives which avoids the social and economic structures within which they occur harks back to the traditional paradigm of class divisions.

This is no accident. It shows that it’s not only traditional social distinctions but ideology, how power should be used politically, which influences the discourse. The chief distinction is between the traditional conservative view that different minimum standards are naturally hierarchical since in that ideology each class has its ranked position and unequal status and the decent minimum may vary accordingly. By contrast, the socialist egalitarians argue that the minimally adequate inclusive lifestyle standards should apply to everybody. This reflects the recognition that conventionally inclusive lifestyles may remain unequal in many respects but everyone within them has sufficient resources to make choices and still be recognised as included or healthy. Inequalities remain but are no longer caused by a serious lack of resources, and are therefore not a poverty problem even if they are some other. For instance, assessing the promotion of ‘go private and get better service’ in the NHS then depends on whether the standard quality of services in this essential collective resource demonstrably meets the ‘good enough for us all’ expectations or whether it reflects a ‘NHS good enough for those who don’t have resources to make choices’ conservative austerity perspective.

The focus of all the public argument right now against this background is the people in poverty as defined by the current paradigm, as people whose “resources are so seriously below those commanded by the average individual or family that they are, in effect, excluded from ordinary living patterns, customs and activities” (Townsend 1979). Why then do some anti-poverty organisations welcome more intensive study of people in poverty — “to fight poverty, we must first understand more about those in its grip” (The Guardian 17.9.18). This focus dominates much media framing of what to do about poverty. Even if the scope is broader, it’s the counterpart of studying malnutrition in terms of why don’t poor people eat greens instead of junk food. In terms of the old analogy of pulling drowning people out of the river downstream, it’s asking why don’t they swim, and planning to teach them better, instead of asking why did they fall in upstream — or even who keeps pushing them in. The article quoted calls on policy makers to use this focus “to help alleviate poverty in Britain”. But why not work to abolish it? The answer must lie on the political right where alleviating poverty is philanthropic and OK, while policy to abolish it is political and ‘lefty’.

A discourse which focuses obsessively on the characteristics and experiences of people in poverty is a bit like first aid. Victims must of course be relieved, even if at that stage no account is taken of causes. But overall in the health field much more attention is rightly focused on prevention even while state funding is restricted. The danger of the discourse focusing only on victims is that it normalises acceptance of ill-health and alleviation (the conservative stance) instead of emphasising attention to its preventive ‘clean water’ of adequate resources. ‘Poverty porn’ attracts many television viewers and normalises ‘othered’ lifestyles whose deprivations and deviances are enforced. It’s a modern version of visiting Bedlam three hundred years ago. Of course ‘those who experience it are best able to describe it’, a perspective long emphasised by for instance community workers and mental health service patients (not forgetting victims of oppressive social security, as illustrated by ‘I, Daniel Blake’). But this is not the same as the shift to claiming that the ‘voices of the poor’ should be the principal source of valid evidence on how to abolish it. This would be like acknowledging that sick patients are the best guides to what their symptoms feel like, and then claiming their reports as scientific analysis of causes. Cholera patients report fever and diarrhoea, not polluted water supplies. A neglected factor in this well-meaning emphasis on victims’ accounts is the implication that people who aren’t suffering can’t understand it, or even that they lack empathy, which is used to discredit critics who look beyond symptoms to causes.

The more the current discourse emphasises focus on people in poverty, the more it distracts from discussion of preventive measures, especially when these are discussed in terms of government policy instead of the foundations of good health. But to avoid policy argument as “not our business” gives covert support to ideological opposition to structurally redistributive policies, not the foundations of social policy for health and social security of resources for everyone. Evasion of those issues is discourse closure on prevention. Preventing poverty and health inequalities sounds good, but when it means trying to change the behaviour of victims without increasing their access to relevant individual and collective resources to adequacy levels, it’s dishonest.

Poverty prevention is not the only subject closed off by discourse focusing primarily on the lives of people in poverty. In this world of inequalities, there doesn’t seem to have been interest in studying how far statistically normal individual variability in health experience overlaps with health inequalities which themselves correlate with variations in levels of individual or household power over resources and the availability of collective resources. No one expects the normal range to be dependent on resources alone, so we need research to establish what its contribution is. The ‘Money Matters’ research by Kerris Cooper and Kitty Stewart (JRF 2013; 2015) showed that (contrary to some conservative lobby groups’ claims) money indisputably does matter and others showed the causative networks by which it does. Regrettably the project failed to proceed to ask, ‘and if money matters, then how much money matters?’ If we are to have effective preventative policies to abolish poverty as well as alleviating it, then we need to know what the evidence suggests that bit of the anti-poverty target is.

There is no theoretical reason (except perhaps in some neo-liberal economic or politically reactionary fantasies) why anyone in UK society should have too little power over resources to be able to make healthy choices without detriment to their conventionally decent socially-inclusive lives. Discourse matters because when it focuses only on poor people’s health it closes off the bigger problem of those structural inequalities which also damage everyone’s social health.

 

 

Author.

John Veit-Wilson is Emeritus Professor of Social Policy of Northumbria University and guest member of Sociology at Newcastle University. He is author of Setting Adequacy Standards: How governments define minimum incomes (Policy Press 1998) and was poverty consultant to the Joseph Rowntree Foundation’s Money Matters research programme. He was a founding member of the Child Poverty Action Group in 1965.

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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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