A paper read at the conference held by the Canadian Council for Social Development. It is believed to have been written by Allan Pepper, who delivered it, when he was Chairman of the Trustees. (The first paragraphs, introducing the Pioneer Health Centre Trustees in attendance has been omitted. The last paragraph has also been edited as it is not appropriate today - the full version is in the Wellcome collection.)

Ottawa, November 24th - 27th 1985.

THE PECKHAM EXPERIMENT

This presentation falls into several sections. First, the History, Objectives and Achievements, referring to the project years of 1926 - 50. Next, an update on what has been done, by Pioneer Health Centre, since 1950, including the contemporary situation in North America. And finally a discussion and question period into which my PHC colleagues will enter. I make no apology for going so far back into history, because I am sure you will see much there that is identical with today's situation, the same problems, the same lessons to be learnt.

In 1926 Drs Scott Williamson and Innes Pearse, already experienced in pathology and medical and physiological research, were provided with the opportunity they were looking for. They wanted to study health, its appearance, its characteristics and perhaps its laws. They could not do this unless they had people-in-health to study. Where were they to be found? They were given the opportunity to run a health centre in a small house in Peckham. This they opened to families living in the neighbourhood, offering for a small weekly sum a periodic medical and dental overhaul for everyone, and parents', ante-natal, post-natal and infant welfare clinics. There was also an orthopaedic clinic and a children's afternoon nursery. Beyond this there was a club room and a Social Secretary whose role was that of dispenser of social remedies.

After three years they had shown themselves to be very successful at running a complex clinic, and at observing the patterns of living and of the incidence of disease. They recognised, however, that there was no significant change in the sickness and health levels in that population, no general raising of vitality and responsibility, nothing yet that they could identify as health, as future material for study and research.. One might say that, in terms of what they had done, this first project was a success, for it pioneered this sort of clinical and social service, and provided for the ordinary people of that time a remarkable facility. (Ed. Note. This was happening before the National Health Service.)

They closed it down and rethought their position. The overwhelming evidence was that the disorders, physiological or social, which people had (and the incidence as today was very high) arose from their environment, from one or more factors in that environment. If the disorder was corrected it, or a comparable disorder, would arise because of the same environmental influence. Their conclusion was that to enable people to acquire health they would have to be provided with an environment that was favourable to health. What was such an environment? Perhaps an easy question to deal with theoretically, but (still today) a very difficult one to answer in practical terms, in do-able terms. It is worth following some of their thoughts.

They were confident of two things. One was that as biologists they had to study families, or more impersonally, the mated pair and their offspring. They needed community as context within which growth and development takes place. And they would have to focus on leisure time of the family and community because working time was beyond their reach and access: and leisure time is living time for parents and children. They would also have to provide a place, space, where people, as a community, could spend their leisure. Finally there would have to be something for people to do, some organisation, some sort of structure to give shape to what people might do. Only the last point - organisation and structure - will test your belief. Here is why. They decided that, as far as the member families were concerned, there would be no structure, no disciplinary rules, no time-tables, no fine structuring of events and activities laid down by "management" or by others who might assume a management or leadership role.

As Dr Barlow put it years later, "they knew, as biologist, that structure serves function. They did not know what human function, in health, was; they were searching for it. If they imposed structures on that community, then habituated man would restrict himself to the limits of that structure, and inhibit the emergence of health, the associated action, and the structure that was appropriate". This was the line that Scott Williamson took, and maintained. It was to some extent an act of faith, but it was the faith of a biologist in the human species. It was to be the key to their achievement: not a trick, but a biological principle.

The building, opened in 1935, was 45,000 square feet total, on three floors. Apart from a central swimming pool, a cafeteria adjacent, and a gymnasium, it was open space, with high visibility and easy access. Dimensions and proportions enabled it to feel homely, and not like a railway station. On the top floor were rooms for health examination and consultation, and a laboratory.

The conditions of membership were simple. You had to live within approximately a mile of the Centre, join as a family (although after that you did not have to use it as a family), and pay a weekly small fee and, for the adults, pay a usage fee if using some of the facilities or equipment. The payments were necessary to help the social running costs of the project. In addition to this every family would have an annual health overhaul and consultation, and could choose to have ad hoc individual consultations during, for example, pregnancy or breast feeding. Finally, there were no other rules or regulations of any sort. There was nothing to tell members what to do, when to do it, or how to do it: nor to tell them what not to do. The only authority exercise by the staff was the authority to prevent any other group or person assuming authority. Within the centre the members were to do what they liked, when, where and how they liked, and enjoy the free exercise of their aesthetic, physical and mental faculties.

Of course, this freedom was counter to the experience of the members, and counter to their intuitive expectations. It was also beyond the experience of the staff, and counter to the urge of some. But Scott Williamson stuck to the principle, despite the chaos, damage and complaints from all directions. After some ten months one or two tings went "right". And then quickly everything seemed to go right from then on, right up to the closure in 1950. And by "everything" I mean the growth and development of the babies and the young, the flowering and integration of families, and the development of community, for starters. We must look more closely at the achievements.

First, is the lack of central organisation to control a highly complex and fluid pattern of individual and group activities.

Second, the emergence of a generally high level of initiative and responsibility amongst the members on individual, group and community action.

Third, a very high level of membership and of utilisation of the building, with absolutely no sign of burn-out - in fact, just the reverse.

Fourth, successful growth and development from birth onwards.

Fifth, the disappearance of 'age gaps' and the emergence of positive transactions and respect between age levels and generations.

Sixth, the emergence of parents and parenthood with a refined role.

Seventh, the enhanced ability of members to use information to their own advantage, and to the advantage of their families: and to use the health care facilities when needed.

This summary must be, of course, rather dry and perhaps without much meaning, so I would like to give some illustrations of what actually went on. Of course, there were so many things going on, all the time, and many of them all at the same time, that it is impossible to do any more than select certain things that we all know something about on a day to day, or professional, basis. I would like to read about the children. This is written by Allison Stallibrass in a recent paper. She was on the staff in the early years. Some of you may know her name: she is the author of "The Self Respecting Child".

"….The children were free to wander around the building mixing with their friends' families and their families' friends. This enabled them to penetrate the fascinating world of grown-ups, and, sometimes, to witness the art and grace of human fellowship.

Some two hundred children used the Centre every day, the majority coming on their own straight from school or, on holidays, from home, soon after the Centre opened at 2 pm. Yet it was necessary for one member of the research team only, assisted by a student, to attend to their needs. And it was possible for her to combine this work with the responsibility for booking out of space to groups of adults, and for welcoming new members.

In spite of - or more likely because of - this very minimum of supervision, there was only one broken limb in 4 ½ years, including constant use of the gymnasium for free play on the ropes and other apparatus, often by as many as 30 children at a time. Moreover, to everyone's surprise, not a single case of bullying was ever observed or reported, and, except during the first months of the Centre's life, there was no vandalism. There was no "daring" of each other by the children in the course of their play.

Again most unexpectedly, it became evident that the children had no desire to do better than the next child, nor, even, to compare themselves with others. They never organised races or competitions, or requested anyone to do so for them.. It seemed almost as if, as soon as they entered the building, they became free of conditioning to become competitive that they might have received elsewhere.

It was evident that, for them, all the pleasure lay in acquiring skill to their own satisfaction, or in solving some problem they had set themselves, or in testing their concepts or their ability. When a child had worked - sometimes every day for weeks - at mastering a particular skill, he would revel for a while in his newly acquired power and then move on to the mastery of something else, even if it meant changing his play-fellows. The energy, persistence and purposefulness of the children was most striking.

All through, from the time they could toddle onwards, the children were seen to be learning a skill that is important for the health of any human society - but it is not learned except when circumstances are favourable - that of being a part of a harmoniously active group and, at the same time, one's own unique self. In the play arenas of the centre, it was not hard for a child to pursue his individual purpose and, at the same time, contribute to the diversity and harmony of the whole, exercising an awareness of the total dynamic situation in his vicinity as well as a precise control of his movements in space and time. One might have thought that, in the arena of the general social life of the Centre, it must have been very much harder, because of the varied nature of the activity, most of it as yet outside his experience and beyond his understanding. Yet, after using the Centre purposefully for a few months, the great majority of the children appeared to be doing just this. They moved among the adults in a serene and easy and unobtrusive manner. The adult members found the presence of the children increasingly acceptable: indeed, one member recently recalled that "we began to love all the children, not only our own".

Visitors to the Centre often remarked on the poise and straightforward friendliness with which the children responded to questions. They did not compulsively draw attention to themselves, or show off in order to impress either adults or the "gang", or try to give themselves some feeling of effectiveness by acts of vandalism or other violence. They were content and serene; but they were also alert and aware of what was going on around them because, as Professor Robert W. White has pointed out, "the organism's urge to realise its capacity to interact effectively with its environment is a steady and persistent urge". They were on the lookout for further nourishment for their powers and food for thought, and so they tended to be sensible of the whole of their presently appreciable environment!"

That is the end of this quote from Allison Stallibrass. Comparable experience was gained in other phases of life, some easy to describe, such as the progressive development of the toddler, and others inherently difficult to observe directly, such as family relationships or the dynamics of community integration. The book "The Peckham Experiment" was written with the main purpose of describing these many phases, and the enhanced health and quality seen in them - a quality which arose form the inherent potential of the people who were members.

By 1939 Scott Williamson and Innes Pearse had in abundance the material for which , as biologists and scientists, they were searching. They knew it, and so did a lot of people in the outside world, for already the Centre had claimed the attention of the health professionals, teachers and students. But the war stooped it all. The building was used as a factory, the equipment was put to other use, the families with young children experienced evacuation.

With peace came the reopening of the building and the return of the members. The patterns of spontaneous action were in evidence straight away, as though the Centre had never closed. The post war years, up to 1950, continued with the same energy and quality as before. There was, however, one significant development. The parents established their own school for their own children. It came about in this way. Let me quote Allison Stallibrass again..

"Already, before the war, the idea of a Centre school had been mooted by members. Soon after the post-war re-opening in 1946, forty member families, with children rising five, set about organising one. These parents, some of whom were far from well-to-do, would rather pay for the schooling of their children, than hand them over into the unknown and segregated world of the State Primary School from 9 to 4 every day. They were loathe to deprive them of the use of the Centre during the early afternoons; and they wished to have some say in the kind of teaching they would receive. They wanted their children to learn the skills that require the assistance of a teacher: but they had observed the persistence of the children in learning skills of their own choosing and guessed that children learn best when motivated by their natural curiosity and desire to extend their powers.

They wanted their children to have the opportunity to continue to develop the agility and grace, the genuine sociability and self-reliance that they had begun to acquire in the Centre nurseries. School had to be an extension of, and within, the day-to-day life of the naturally growing children. This, they achieved."

Before and during the war the project had become pretty well known. Now, after the war, it became famous. The Foreign Office sponsored overseas lecture tours, and a film, to show the world the progress made in the UK in the social sciences. The ministers and other politicians paid homage to it, as did members of the Royal family. Its books sold like best sellers, and it attracted thousands of visitors a year from home and abroad. It was so obviously a practical model of community and health facility that half a dozen towns in the UK stated their interest in having 'Peckhams' of their own. These did not materialise; Coventry showed that the finest of plans come to nothing if central authority refuses building permission.

A cloud came over the horizon; in fact, two clouds. One was the problem of financing the project. This had always produced difficulties; but post war costs and inflation made the deficits critical. One might assume, with such success, how could the project fail to raise funds? This is a question asked by many people over the years. It is dealt with by Kenneth Barlow in a paper read to the Society for the Social History of Medicine in 1984. I quote:

"Between 1942 and 1948 there was national concern about the environment into which the post-war generation,, would grow. Not inconsiderable in this concern was the question of health…There were two approaches. One approach was conventional; it was outlined in the Beveridge Report. It stated that health was to be achieved by a comprehensive medical service for every citizen, coupled with a minimum income necessary for subsistence. The other approach lay not through the doctor's surgery, the hospital and at the chemist's shop, but through an exploration of the still uncharted biological basis of environmental health, in the sense now defined. The first approach was accepted and embodied in the Act of 1948; the second approach, to our cost, was rejected.

The Minister, Aneurin Bevan, was challenged from several sides because at that time the repute of Peckham was high. Bevan did what ministers do. He took advice. In particular he took the advice of Bradford Hill of the Medical Research Council, the father of statistics, and of Rock Carling, then one of the Trustees of the Nuffield Foundation. Both of these gentlemen trod in the footsteps of Beveridge; besides, Bradford Hill needed records, and what records were there of positive health?"

Against this backcloth the Pioneer Health Centre could not raise the finances it required to see the project continue well into the future. Neither from the Government, nor from Foundations in England and North America, aware that the project was not in line with the policies of the British Government.

So, still running marvellously, it closed. During this conference frequent reference has been made to "motherhood", a focal point in life. In 1950, in a sense, it was "good-bye motherhood". It was also good-bye childhood, fatherhood, parenthood, adulthood and community. It was as though a light had been turned out.

But the Pioneer Health Centre Ltd did not wind up, although, of course, it had no project. It was occupied from 1950 to 1960 preparing Scott Williamson's main thesis for publication, and with dealing with a steady, not unexpected, flow of professional and lay enquiries. During this time we kept our eyes open for promising health promotion and community projects; we were keen, anxious, to transfer our expertise to people who were heading in the same direction as that taken in Peckham, or who wished to develop schemes based on the same biological principles. By 1957 we had seen that virtually every social and health provision made by government or local authority, or by private institutions, was fragmented in its design and practice, was liable to disintegration, and needed to be held together and re-injected with energy from time to time by external agencies. In the UK and the USA, we learnt, planners of social schemes could even estimate their burn-out times in advance. Although spectacular progress was being made in antibiotics, and in preventative medicine, and in medical technology (and still is today) there was nothing to show in health cultivation or in the study of positive health. So we then chose to look for, and take, opportunities to establish one or more projects based on Peckham principles, i.e. biological principles, and using methodological insights gained in Peckham.

Between that time and today we have been involved, by invitation, to a greater or lesser extent, in six project proposals in the UK and three in North America. They have ranged from rural to urban and inner city locations, and have focussed on, in the first instance, the young family, the elderly, and the full community. Not one of these projects has yet been launched. Why not? The reasons are varied, but they contain the very factors which you are discussing and challenging with such vigour and frankness in this very conference. First, professional antipathy. Second, institutional coolness. Third, political self interest. I must add that to this list must be added financing problems - which can never be isolated from the others; and perhaps, to be fair, some inability on our part to persuade people more effectively, and a definite limit to our resources.

Where a project survives, and has the possibility to come to fruition at some time in the future, there is some person or persons in that locality with the insight and dedication, and sufficient personal clout, to enable them to hang on is whilst the obstacles are being tackled, and keep things alive. Without such people new ideas, proposals which are against the grain of the establishment or vested interest don't live very long.

It is particularly impressive that a very noticeable interest in the Peckham Experiment has been….. expressed in North America. ………we have come to know many people in the health business here who have either known about Peckham since their youth, or who have more recently read the literature, or who have been thinking in similar terms for some time ……. I am given permission to name Professor Joel Elkes of Louisville, recently of McMaster, Professors Rae Grant and Ross Hume Hall of McMaster, and Professor Stuart Hill of McGill……. It is envisaged that a network of interested people will be established, with regular communication ………

The outlook is good.