This book would be incomplete without mention of the economics of a Health Centre. In this respect the Peckham Experiment, as its popular name implies, was no type-mechanism for all health centres. It was a frank experiment, and as such was built, equipped, and to a large degree maintained by the voluntary subscriptions of those anxious to see an attempt-made to put into practice the principles it stood for. Moreover it was the first of its kind anywhere in the world—and as such had to weather the storm of strangeness amidst the populace for whom it was set up. How great is the effect of this factor of unfamiliarity in popu­larising any new invention can be judged from the history of the launching of many commercial concerns and products, the subsequent universal popularity of which cannot be questioned. Two examples will serve to illustrate this point—the failure of the first attempts to establish Woolworth stores, and the time—15 years—it took to popularise the use of anything so universally desirable as silk stockings.

This must lead us to suppose that acceptance of anything so new as a health centre must be a matter of time, however great its advantages may prove to those who understand its principles and to those who come within its doors and stay to experience its use. Already we have seen that in the case of family-membership in our chosen area there were many other factors—such for example as the absence of social aptitude, or the amount of moving that occurred in the district—that militated against stability of membership. As long as there are no Centres to integrate local society the first of these difficulties must persist, and until there are Centres in all districts so that a family which moves can be transferred complete with dossier to the Centre in the district to which it has migrated, the second must remain a serious source of loss. So even the collection and retention of members became for the first Centre a matter of experi­ment, putting off the date of the achievement of its full membership. The Pioneer Health Centre was designed and built to cater for 2,000 member families (roughly 7,500 individuals). Experience has taught us that it was in every way well suited to fulfil this expectation. With the 1,200 people often within its doors on a Saturday night, there was still ample room for more, even before there had been time and oppor­tunity to develop the extra-mural activities bound to emerge in any inte­grated society : e.g. camp, farm and special club activities.

Membership entailed the payment of a weekly subscription per family to include parents and all children of school age (1/- a week). -A further sum was derivable from the adolescents and other adult individuals of a member-family, each of whom paid a further individual subscription (6d. a week). The proportion of these in the Centre was roughly one to every two member-families. Thus the income to accrue from full membership subscriptions forms a calculable one—roughly £6,000 a year.

Whereas all apparatus and equipment of the Centre was at the free disposal of children of school age and under, all adults paid a small sum for what they did in the Centre: e.g. billiards, the Keep Fit class, the Debating Society, use of the sewing machine, etc., as well as for all home remedies, substitutes for deficiencies (iron, vitamins, etc.), and emergency dressings supplied in the medical department and for all food bought in the cafeteria. This forms a further souce of income, varying with the number of families and with the efficiency of the organisation, but calculated with a full membership to bring in a net sum of not less than the family membership subscriptions, namely, 1/- per week per family. These two sums together give an estimated income of over £10,000 per annum.

On the debit side, experience has shown us that running costs, excluding all research expenditure, amount to a sum approximating to £8,500 a year, and that it should be possible to keep them within £10,000 if payment of interest on capital (say, of £50,000) is included. It must be recalled that owing to the self-service basis of the organisation, the cost of running the Centre remains at much the same level whether it is catering for a membership of 500 or 2,000 families—the maximum charge, apart from the periodic overhaul, being that of lighting and heating the building, From our experience we must therefore infer that although the raising of the capital outlay for the establishment of a Centre may not come within the capacity of any local community, once built its self-maintenance is a matter of practical politics. It is important to state that in our opinion self-maintenance of a Health Centre is not only a possibility, but is an essential for the maintenance of any institution where health is the object. The family’s power to handle affairs, including the responsibility of adjusting a financial balance, is no less an expression of function—of the wholeness of apprehension of environmental circumstances—than any other capability. Moreover the balancing of a budget is one that the family with its limited means is very well competent to carry out, for it is no easy task to house, feed, clothe, educate, insure and maintain four or five people on the relatively slender weekly wage that is available for the purpose in the majority of working class homes.

Nevertheless the balancing of his budget is an experience from which, in the existing circumstances of life, the working man’s family is cut out from all but his immediate domestic sphere. Even the slow steady increase in the level of wages does not alter this, for as wages rise, the tendency is for the State largely to determine for him on what that increase must be outlaid.

Management and knowledge of the family’s social and local affairs in a place like the Centre is the next step in an education long overdue. The importance of some such expanding field of social activity coincident with a rising standard of wages is obvious for the development of health in the Nation.

In the case of sickness we are faced with a quite different proposition. The very essence of sickness is withdrawal from the environment—diminished power of the organism’s spontaneous response to its circum­stances. The burden of the doctor’s work is, thus, to assume responsibility for the sufferer—to tell him what to do, how and when to do it—­until lie is again able to resume this responsibility for himself.

There is also yet another aspect of sickness. It is a liability and threat to society. It becomes therefore at once reasonable that the State itself should assume responsibility for the care of the invalid and for their speedy return to the ranks of the valid.

With the valid citizen it is different. The very definition of health implies an ability to work in mutual synthesis with the environment. The liberty to do so is the first right of the citizen. Without responsible excursion in its local society no Nation can hope to build tip the capability for responsible and knowledgeable action required in a true Democracy.

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