Category Archives: Health

Austerity, Health, Working

Why Austerity Kills

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I think COVID-19 has made all of us realise just how deadly austerity is, but The Body Economic by David Stuckler and Sanjay Basu should be required reading for its death-dealing potential outside of pandemic conditions.

Please, can we not go backwards after this.

I am often nervous about anything that draws parallels too strongly between society and body, policy and medicine. But I think they do it really well here.

Austerity is medicine intended to reduce symptoms of debts and deficits, and to cure recessions. It cuts governmnet spending on healthcare coverage, assistance to the unemployed and housing support. At the start of the trial, its potential side-effects were not well understood (ix).

There is a wealth of work on the social determinants of health such as Marmot‘s review — there is nothing so new here but yet it can’t be repeated enough it seems.

Good health doesn’t start in hospitals and clinics; it starts in our homes and our neighbourhoods, in the food we eat, the air we breathe, and the safety of our streets. Indeed, a top predictor of your life expectancy is your zip code. (xi)

They study the impact of the economy on health and find that it is not recession but austerity that impacts it most negatively. ‘Recessions can hurt,’ they write, ‘but austerity kills (xx)’. Even the IMF has recognized this, reversing previous policy, writing that ‘austerity slows down economies, worsens unemployment, and hampers investor confidence.’ Yet how little has changed.

This book consists of chapter after chapter of evidence pulled from around the world (I love this scope around the world…) where divergent paths can be seen and tested to some degree, starting with the Great Depression in the US. States implemented the New Deal very differently, states taking fullest advantage of government supports and providing social services showing mortality rates far below those states which did not. They move on the the post-communist mortality crisis–which I am humbled to say I had never heard of. The authors show that the huge rise in mortality in men — the awful, heartrending rise in mortality — took place wherever in the former Soviet Union they pushed Shock Therapy, ‘a radical package of market reforms’ designed to push the transition to capitalism as quickly as possible. Primarily Harvard economists were behind this: Andrei Shleifer, Stanley Fischer, Lawrence Summers and Jeffrey Sachs. Russia, Kazakhstan, Kyrgyzstan followed this advice. Stiglitz was on the other side of this argument, pushing for gradual reform, Belarus, Poland and the Czech Republic followed this path.

The austerity imposed through shock therapy did not just cause a spike in mortality, it also significantly slowed economic recovery — even by its own justification (if there could be such a thing causing so many deaths), it failed. Milton Friedman himself admitted Stiglitz was right.

Another chapter on East Asia, again showcasing the deaths caused by IMF imposed austerity in Thailand, South Korea and Indonesia, as compared to Malaysia where austerity was resisted. Heartbreaking again.

On to the ‘Great Recession’, the approach taken by Iceland prosecuting bankers rather than imposing austerity. Quicker economic recovery, fewer deaths. Compare this to Greece. Compare this to the US, where they write:

A 2009 study found that people who lack medical insurance were 40 percent more likely to die prematurely than those who had it. During the great Recession, before the PPACA came into effect, there were approximately 35,000 avoidable deaths due to the lack of healthcare insurance (99).

People were dying, and at the same time

Profits of health insurance companies soared…In 2009 the top five US health insurance companies reported $12.2 billion in profits, a staggering increase of 56% over the figures for 2008. In 2009, a year that saw 2.9 million people lose coverage, insurance companies’ profits rose by 56 percent (101).

I haven’t read Kenneth Arrow, Nobel prize-winning economist, but he wrote in a 1963 paper that markets ‘often fail to deliver affordable, high-quality healthcare‘ (101). What they do instead, is make some people a whole lot of money.

Stuckler and Basu move on to Italy, the protests of the vidove bianche, or white widows of the increasing numbers of men committing suicide after losing employment. This opens a chapter on suicide and its connections to work, the ever increasing numbers of primarily men killing themselves after the imposition of austerity around the world. The way that governments, as they have done here in the UK, averaging out the numbers of deaths erase the spikes that demand attention.

From work to housing… They look at the unprecedented rise of the West Nile Virus during droughts, ultimately it was discovered that this had been caused by the foreclosure of homes and the breeding of mosquitoes in neglected pools. As an aside, West Nile Virus is a pretty terrifying disease.

This is not the only cost to health from the housing and foreclosure crisis. Housing is a precondition for good health — to be without it is to be among the most vulnerable groups.

People without homes tend to die forty years earlier than those with a roof over their heads. They often suffer from a raft of health problems and lack adequate access to healthcare. In addition, the homeless are at high risk of contracting infectious diseases like TB, which can then spread to the rest of the population. Poor health and homelessness are so closely linked that it is difficult to ascertain which came first, but the public health outcome is the same: a huge increase in the risk of death and avoidable suffering (127).

They describe people skipping medicines to be able to pay mortgages, a rise in hospitalisation leading to increased medical debt leading to increased likelihood of foreclosure. They write that the rise in foreclosures in communities strongly correlated to a rates of emergency room visits.

Heartbreaking.

Ultimately austerity has failed because it is unsupported by sound logic or data. It is an economic ideology. It stems from the belief that small government and free markets are always better than state interventions. It is a socially constructed myth–a convenient belief among politicians taken advantage of by those who have a vested interest in shrinking the role of the state, in privatizing social welfare systems for personal gain. It does great harm–punishing the most vulnerable, rather than those who caused this recession (140).

Well said. These are their recommendations:

To break the cycle of radical austerity programs, we need a New New Deal…To work, it must follow three key principles:

1. “First, do no harm” is the ancient higher law of the healing professions. Because social and economic policies have collateral effects on health and sickness, the doctors’ mantra should become a requirement for all such policies.

2. Help people return to work: In hard times, having a stable job is often the best medicine. Unemployment and the fear of unemployment are among the most significant drivers of poor health that people face in an economic crisis (143).

3. Invest in Public Health (144)

Stuckler, David and Sanjay Basu (2013) The Body Economic: Why Austerity Klls. Recessions, Budget Battles, and the Politics of Life and Death. NY: Basic Books.

Health, History

Storytelling in a time of plague: Boccaccio’s Decameron

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In the face of its onrush, all the wisdom and ingenuity of man were unavailing…numerous instructions were issued for safeguarding the people’s health, but all to no avail. (4)

Boccaccio describes the Black plague then, the swellings in the groin or armpit, the spread of swelling, the blotches and bruises. From the time of the first sign of swelling you knew you would die.

I can’t imagine it. All that we know now of science and medicine and so this bubble we find ourselves in and the ambulances to take people away and the clean white antiseptic of hospitals and experts and antibiotics and you can still die and it is still terrifying…but not like then.

Against these maladies, it seemed that all the advice of physicians and all the power of medicine were profitless and unavailing (5)

But what made this pestilence even more severe was that wherever those suffering from it mixed with people who were all unaffected, it would rush upon those with the speed of a fire racing through dry or oily substances…

It did not just do so through direct touch, but through clothes and other objects handled by others. Some became more sober and abstemious and god-fearing, others hedonistic, satisfying all cravings. Laws broke down. Servants died or fled, breaking down some of the distinctions between people, women were no longer able to gather and mourn the dead. The bodies were left lying outside of the door of the home for collection to be buried in mass graves.

…it is reliably thought that over a hundred thousand human lives were extinguished within the walls of the city of Florence…Yet before this lethal catastrophe fell upon the city, it is doubtful whether anyone would have guessed it contained so many inhabitants.

Ah, how great a number of splendid palaces, fine houses, and noble dwellings, once filled with retainers, with lords and with ladies, were left bereft of all who had lived there… (13)

Thus the circumstances that lead seven young ladies to gather at a church. Pampinea says:

Here we linger for no other purpose, or so it seems to me, than to count the number of corpses being taken to burial, or to hear whether the friars of the church, very few of whom are left, chant and their offices at the appropriate hours, or to exhibit the quality and quantity of our sorrows, by means of the clothes we are wearing, to all those whom we meet in this place. And if we go outside, we shall see the dead and the sick being carried hither and thither, or we shall see people, once condemned to exile by the courts for their misdeeds, careering wildly about the streets in open defiance of the law, well knowing that those appointed to enforce it are either dead or dying; or else we shall find ourselves at the mercy of the scum of our city who, having scented our blood, call themselves sextons and go prancing and bustling all over the place, singing bawdy songs that add insult to our injuries. Moreover, all we ever hear is “So-and-so’s dead” and “So-and-so’s dying”; and if there were anyone left to mourn, the whole place would be filled with sounds of weeping and wailing.

And if we return to our homes, what happens? I know not whether your own experience is similar to mine, but my house was once full of servants, and now that there is no one left apart from my maid and myself, I am filled with foreboding and feel as if every hair of my head is standing on end. Wherever I go in the house, wherever I pause to rest, I seem to be haunted by the shades of the departed, whose faces no longer appear as I remember them but with strange and horribly twisted expressions that frighten me out of my senses. (13-14)

Our coronavirus is not quite like this. It is strange to know that it is all around us, to watch the numbers of the dead climb, to mourn. To hear accounts of places like New York where a friend of mine describes constant sirens, fear, a life more at risk for Asian features as attacks spread. To see the strange attacks here in the UK on G5 masts, this mad conspiracy theory but yet its components not mad at all in marking out the collusion of government and industry for profit without caring about human cost. I can’t look too hard at what is happening around us to be honest.

We have been in a bubble, my partner and I, still allowed to go outside though as of yesterday lockdown extended three more weeks. It will be more, how could it not be more?

And today my grief sits hot and unbearable in my chest, it is not the covid but the cancer, taking my aunt and there is nothing to do. No way to go. Impossible to travel to be present to say goodbye to grieve with family. I am not the first by any stretch to note the horror of this epidemic is the way it keeps us apart from one another, though if we are lucky we can drive by family homes, speak to them from the drive, press our hands against their windows. But not when they are an ocean away.

To travel such distance, always a privilege. It requires money or credit cards, the right to travel with a legal status and passport that permit exit, entrance, return. This should belong to all of us. The cost of its absence immeasurable.

I take refuge, as my family always does, in some level of dark humour. This is from the introduction to the Decameron:

…the sombre and frightening prelude which medieval rhetoricians regarded as an essential component of the genre of comedy to which the Decameron, like Dante’s great poem, was intended to belong. Both works, in fact, despite their obvious differences in form and subject-matter, respect the definition of comedy formulated for instance by Uguccione da Pisa in his Derivationes: ‘a principio horribilis et fetidus, in fine prosperis desiderablis et gratus’ (foul and horrible at the beginning, in the end felicitous, desirable and pleasing’). (xlii)

You don’t even need a translation for that. I rather love this idea of comedy, always have, but it seems even more necessary now. It makes me think of Stewart Lee, though he rarely gets around to the felicitous, desirable and pleasing. I love him for it.

Building Social Spaces, City & Country, City Unseen, Health, Housing, Networks

Young and Willmott on Leaving the Slums for the Estate

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I know they are listed as Young and Willmott but that simply is impossible to roll off the tongue, I shall try and probably once again fail to write it this way in part two on Family and Kinship in East London (1957). From the densely woven networks of family described in part 1, held together in crowded rooms and turnings by living with parents or next door to them, by every day visits, shared meals, shared chores, shared lives, to spacious new council homes built on 44 acres near Epping Forest. This is how everything changed, and as Young and Willmott write, what better way to understand the importance of residence?

From Bethnal Green to Greenleigh (Debden)

Less than twenty miles away from Bethnal Green, the automatic doors of the tube train open on to the new land of Greenleigh. On one side of the railway are cows at pasture. On the other, the new housing estate. Instead of the shops of Bethnal Green there is the shopping centre at the Parade; instead of the street barrows piled high with fruit, fish, and dresses, instead of the cries of the costermongers from Spitalfields to Old Ford, there are orderly self-service stores in the marble halls of the great combines. In place of the gaunt buildings rising above narrow streets of narrow houses, there are up-to-date semi-detached residences. Bethnal Green encases the history of three hundred years. Cottages built for the descendants of Huguenot refugees, with their wide weavers’ windows and peeling plaster, stand next to Victorian red-brick on one side and massive blocks of Edwardian charity on the other. Greenleigh belongs firmly to the aesthetics of this mid-century. Built since the war to a single plan, it is all of one piece. Though the Council has mixed different types of houses, row upon row look practically identical, each beside a concrete road, each enclosed by a fence, each with its little patch of flower garden at front and larger patch of vegetable garden at back, each with expansive front windows covered over with net curtains; all built, owned, and guarded by a single responsible landlord.

Instead of the hundred fussy, fading little pubs of the borough, there are just the neon lights and armchairs of the Merchant Venturer and the Yeoman Arms. Instead of the barrel organ in Bethnal Green Road there is an electrically amplified musical box in a mechanical ice-cream van. In place of tiny workshops squeezed into a thousand back-yards rise the first few glass and concrete factories which will soon give work to Greenleigh’s children. Instead of the sociable squash of people and houses, workshops and lorries, there are the drawn-out roads and spacious open ground of the usual low-density estate. Instead of the flat land of East London, the gentle hills of Essex.

‘When I first came,’ said Mrs Sandeman, ‘I cried for weeks, it was so lonely. It was a shock to see such a deep hill going up to the shops.’ (121-122)

That gives such a beautiful sense of the differences, albeit a very particular view of them. But the scale is quite incredible.

Between 1931 and 1955 nearly 11,000 families containing over 40,000 people were rehoused from Bethnal Green on L.C.C. estates, many of them outside the county.’ (124)

People did, many of them, choose to come of course. Part of the study was to understand just why. The reasons were many, but not, for the most part, weaker attachments to their family.

lf the migrants did not have weaker kinship attachments than other people, why did they come? The main reason is {quite simple. The attraction is the house. Our couples left two or three damp rooms built in the last century for the ‘industrious classes ‘, and were suddenly transported to a spacious modern home. Instead of the tap in the backyard, there was a bathroom with hot and cold water. Instead of the gas stove on the landing, a real kitchen with a sink and a larder. Instead of the narrow living room with stained wallpaper and shaky floorboards, a newly painted lounge heated by a modern solid-fuel grate. And instead of the street for their children to play in, fields and trees and open country. The contrast is all the sharper because the new residents had, in the main, come from Bethnal Green’s worst houses. (126)

But the council in general had much more to do with it:

But, in general, the L.C.C.’s view of who needed it most decided who went. Our informants were mostly at the top of the L.C.C.’s housing list – they were living in the most overcrowded or the most unhealthy houses in the borough – and that is why they were selected. (127)

One of the tenants told them — ‘If we could take the house with us, we’d go back like a shot.’ (127)

For many, as with so many families, it was about the generations to come, not the generations they had left behind.

‘Everything seems quieter here, more calmer,’ said Mrs Vince. ‘The fresh air hits you when you come out of the station.’ Many people value the air and fields even more for their children than for themselves. Greenleigh is generally thought ‘better for the kiddies’.

So even where they left their kin with regret, the people were not deserting family so much as acting for it, on behalf of the younger rather than the older generation. (128)

But many did not stay.

Many migrants in fact decided that they had made the wrong decision, and left the estate, most of them to return to the East End. Altogether, from the opening of the Greenleigh estate until March, 1956, 26 percent of the tenants who had come there moved away again. (129)

The Family at Greenleigh

So what changed? Any friendly community feeling did not survive the scale of changing community. Everyone found the neighbors snobbish, stand-offish. Talked about the terrible loneliness. Some got part-time jobs just to survive it — one of those said ‘If I didn’t go to work I’d get melancholic.’ Her verdict on Greenleigh — ‘It’s like being in a box to die out here.’ (133)

The study found a great sense of loss, particularly women missing mothers. Most of the men continued to work in Bethnal Green as there were no jobs out near the estate, so suddenly they become the ones maintaining family ties. What made me most sad — it wasn’t distance or time that kept women from their wider families, but the cost of transport. In times of trouble they had no support, there was no one to lend money to tide people over, help when sick or pregnant, help with kids. Visiting was not a thing that was done.

Their study of Bethnal Green showed just how much happened in public spaces, not private ones, and these were precisely the spaces missing in the new estates.

One reason people have so little to do with neighbors is the absence of places to meet them. In Bethnal Green there is one pub for every 400 people, and one shop for every 44 (or one for every 14 households). At Greenleigh there is one pub for 5,000 people, and one shop for 300.

They had no cinemas, so could not congregate there either. This combination of distance and television changed things. Young & Willmott write:

The growth of television compensates for the absence of amenities outside the home, and serves to support the family in its isolation. (143)

Rents were also higher there on the council estate, often by 3 times. That in addition to fares meant people were trapped there.

Keeping Themselves to Themselves

Willmott and Young found people in Greenleigh eager to talk about their neighbours, how unfriendly they found them, and they always compared back to their community in Bethnal Green.

At Greenleigh they neither share long residence with their fellow tenants nor as a rule have kin to serve as bridges between the family and the wider community. These two vital interlocked conditions of friendship are missing, and their absence goes far to explain the attitude we have illustrated. (150)

They believed this to be partly due to the fact that everyone moving in at the same time, and there was no existing community for them to integrate into. While Willmott and Young describe their expectations that things would have improved over the few years between interviews, nothing really had changed. They blame a lack of density — a bit of catch phrase these days.

One reason it is taking so long is that the estate is so strung out — the number of people per acre at Greenleigh being only one-fifth what it is in Bethnal Green — and low density does not encourage sociability. (153)

The new big homes reinforced a feeling of what people lack, rather than all that they had. They were spending more on filling homes with objects, rather than entertainment and going out as they had before.

There is also a facsinating aside on time and space — in Bethnal Green people tended to be very informal, did ‘not need a highly-developed time sense…because it does not matter greatly whether her goes round to Mum’s at 10 o’clock or at 11. If Mum is not there someone will explain where she has gone‘ (157). This was not at all true of Greenleigh. Much of the difference lay in how close things were in Bethnal Green, with everything walking distance. In Greenleigh, life required a car and a telephone to ‘overcome geography and organize a more scattered life into a manageable whole (158)’.

The impact of this was quite profound, particularly on mental health, and particularly for women. This should not have been stuck in a footnote really:

Footnote 1, p 158: The chief psychiatrist at a local hospital told us that the loneliness of the women on this and other housing estates was the immediate, precipitating cause of so many of them coming to his department for treatment.

This lack of relationships, of knowing people, meant both a growing formality, as well as increased reliance on visual clues for judging strangers.

In a community of long-standing, status, in so far as it is determined by job and income and education, is more or less irrelevant to a person’s worth. He is judged instead, if he is judged at all, more in the round, as a person … How different is Greenleigh…Where nearly everyone is a stranger, there is no means of uncovering personality. (161-162)

They continue

Their relationships are window-to-window, not face-to-face. Their need for respect is just as strong as it ever was, but instead of  being able to find satisfaction in actual, living relationships, through the personal respect that accompanies almost any steady himan interaction, they have to turn to the other kind of respect which is awarded, by some strange sort of common understanding, for the quantity and quality of possessions which which the person surrounds himself (163-164)

They also note the lack of forward planning in the planning process for the estate itself…it has been developed as a community where people cannot age. When people’s children are grown where will they live? Nowhere for them to move close by, almost certain that enough existing units will not become vacant over the normal course of things, and it was council policy to prioritise outside people from the list rather than children. Willmott and Young note the protest that this raised among residents, a local association writing of the LCC in 1955 ‘We are in opposition to the view that people are simply units to be moved around the face of the earth in line with the impersonal schemes of some “Big Brother”...’

W&Y continue

The method by which the council has eased the housing shortage in the middle of the century is bound to create a further shortage in its last quarter. (168)

They weren’t wrong.

Movement between classes

They wanted to check and make sure that this growing sense of the importance of geography was not in fact more a function of social mobility, which leads to a rather interesting way to better understand class. Again, Willmott and Young trace sense of loss and disintegration of a sense of community it primarily back to the geography of the built environment — as people tend to seek out larger houses, they must look elsewhere. The authors write:

The East does not provide ‘middle-class’ people with ‘middle-class’ places to live, and such migration may therefore be more common than it would be in districts with more of a mixture of classes. (172)

In conclusion, though, of all of it.

…very few people wish to leave the East End. (186)

While the houses were better, Willmott and Young look at the networks of support, and find they are absent on the new estates. They have the best description of  the daughters’ new plight,  engaged in the ‘arduous…puzzling…monotonous‘ work of child rearing, while older people were cut off from remaining useful and part of the family. Willmott and Young are highly critical.

It seems that when the balance of a three-generation family is disturbed, the task of caring for dependents at both ends of life, always one of the great and indispensable functions of any society, becomes less manageable. (196)

So one key recommendation is to support these connections rather than tear them apart. Central to that there follows the need to maintain communities intact, and save as many of the existing houses as possible, updating the fabric, giving people new bathrooms, lavatories and kitchens.

I cannot help but agree with them, and wish this had been policy for the past few decades so as to build on the strengths of working class communities, rather than the opposite.

Young, Michael and Willmott, Peter ([1957] 1979) Family and Kinship in East London. Manchester: Penguin Books.

Building Social Spaces, City Unseen, Health, Housing, Networks

The Importance of Residence: Willmott and Young on Bethnal Green

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Michael Young and Peter Willmott’s Family and Kinship in East London is an incredible book, and I am just sorry I didn’t get round to reading it while working in East London though it has been on my list to read for what feels like forever. There are a number of critiques of the book, based primarily on the ‘rosy’ views of working class life. Looking backwards it is hard to tell of course, but it seemed to me it captures much of what continues to be good about working class life…and there is enough here to show that such closeness of community is many-sided and not to everyone’s taste. I thought back to Morrison’s writings on East London, which accentuated the narrowness of life, the gossip in those Mean Streets. I don’t know that either is wrong or right, they can sit together in the richness of how people experience life. For myself, it is always the generousness of my class that has impressed me. Anyway.

This is quite a stupendous piece of research. Amazingly I found a pdf of some of the original survey instruments (original link here, another copy of the docs here)… very cool. But what I love most is they seemed to have actually listened to people, rather than categorising them, and in their work to have explored the intersections of family, home and neighbourhood in quite brilliant ways.

This book is about the effect of one of the newest upon one of the oldest of our social institutions. The new is the housing estate, hundreds of which have been built since the war. In the last century people moved into the cities; in this they have been moving steadily out again, towards the countryside from which their ancestors came. (11)

They write too, that ‘We were least prepared for what we found in the borough’. Because what did they expect? The familiar tale of the ‘good old days’ now gone.  They believed old patterns of wide extended families and support networks had disappeared over the course of industrialization and modernisation undergone in East London, but instead:

We were surprised to discover that the wider family, far from having disappeared, was still very much alive in the middle of London. This finding seemed to us of more interest than anything we had been led to expect, all the more so when it transpired that the absence of relatives seemed to be as significant on the estate as their presence in the borough.

and the last line, a rather fascinating methodological note

We decided, although we hit on it more or less accidentally, to make our main subject the wider family. (12)

This is perhaps why I didn’t prioritise this book, being less interested in constructions of family and more in community and home. But I was terribly wrong about that. In addition to tackling the myth f the destruction of familial networks, they take on others. Bethnal Green’ 54,000 residents in 1955 were almost all working class, but only 8% of population found to be Jewish, ‘contrary to popular opinion‘. So on to what they did find.

Kinship in Bethnal Green

The begin with a review of earlier studies — Charles Booth among others, who described barefoot children, undernourished babies, young moths sick and hungry. The majority of these blamed poverty, blamed the poor, and above all men for spending money on things they shouldn’t, particularly nights down the pub etc. This is the image of the brutal working class man, tales of drunkenness and forced sex, bruises, pregnancies.

Even though we may think the accounts overdrawn, and distrust the representativeness of the families they describe, we cannot ignore the historical evidence, all the more so since the notion still survives that the working-class man is a sort of absentee husband, sharing with his wife neither responsibility nor affection…(19)

But you look at the evidence drawn from their interviews, it is the falling death rate that seems the biggest factor in families remaining families — 29% of those born before 1890 came from homes broken up before they turned 15 by the death of a parent, as compared to 2% from divorce or separation. That is a crazy figure. It was still 19% for those born between 1921 and 1933, compared to 1% divorce and separation.

It had never occurred to me before to think seriously of how young people died, to understand what that meant for the living. To remember how soon this all began changing.

Still — things were improving — despite people living longer, more housing was being made available. In 1931 there were 3 households to every 2 dwellings. 1941, 4 households to every 5 dwellings. More space, less hard wear of space. More comfortable spaces you might want to spend time in as opposed to down the pub. It never occurred to me to think of that much either.

Nor labour patterns and rights, but of course those were also definitive.

The spread of the five-day week has created the ‘week-end’, a new term and a new experience for the working man. (24)

You can see, of course, why I should love this book, bringing all these structural factors together to understand just what life lived within their constraints might mean. It is also full of those details you only get with qualitative work. Like the descriptions of the rise of cinema and wireless — a lovely section on the impact it has had on naming children! No longer names that have always been in the family. Aspirations were changing in other ways — work for example. Primarily for sons, but I love the snark in this reply:

I’d like him to take up chemistry. It’s completely unproductive and therefore well paid. (29)

Young and Willmott continue:

A sizeable minority of men in Bethnal Green take a very different view from white-collar people about the status of manual work, placing jobs such as company director and chartered accountant towards the bottom of the scale and manual jobs, like agricultural laborer, coal miner, and bricklayer, towards the top. These men regard business managers with disfavour because ‘They’re not doing anything. They get their money for walking around’ … Agricultural laborers, on the other hand, they value highly because ‘you can’t do without grub’; coal-miners because ‘without coal, industry stops’; and bricklayers because ‘you’ve got to have houses’. But even some of the men that take this view are anxious that their children should get as good a technical education as possible. (29)

That is one of the best statements of how the world should work I have ever read.

Where People Live

Housing was always an issue given its scarcity, and there follows a long, and brilliantly detailed exploration of how and where people live. After marriage, if the new couple have no home of their own yet, they most often live with the wife’s parents — mother and daughter have a long term bond, can manage in the house together by custom. Willmott and Young write:

Their tenancy is the most valuable property-right many working-class people posses: where the property is privately owned, the rent is low and controlled by law. (33-34)

People inherited tenancies from their parents, sometime going back three generations. This was one of the positive aspects of remaining at home after marriage, but as Young and WiIlmott make clear, most people ‘don’t want to live with them, they want to live near them‘ (35). They include a brilliant quote from Sheldon’s, ‘The Medicine of Old Age’ about similar community in Wolverhampton:

The fact that no less than four per cent of the sample had children living actually next door is astonishing; and there is no doubt that this proportion would have been higher but for the general housing difficulties since 1939, for the opinion was frequently expressed by both generations that this is the best mode of life for the old people, since it enables them to preserve their independence and the married children to lead a separate life, while at the same time ensuring that help is at hand when needed. (36)

This study showed twice as many women as men living in same house with their parents, and twice as many in the same street or block. They talk about the matrilocality of the English working class, and spatially at least this is well born out. (37) They include brilliant little pieces of description of the neighbourhoods they are visiting, and the feel of life there, like their visit to:

a four-roomed house in Minton Street in the middle of the borough. The other houses (but not the two pubs, obviously newer) were all built in the 1870s, of brick which has become a uniform smoke-eaten grey. They are nearly all alike in plan; on the first floor two bedrooms, and on the ground floor a living room, a kitchen, and a small scullery opening on to a yard which has a lavatory at the end of it and patch of earth down one side. Many of the yards are packed with clothes hanging on the line, prams, sheds, boxes of geraniums and pansies, hutches for rabbits and guinea-pigs, lofts for pigeons, and pens for fowls. the only difference between the houses is the colour of the curtains and doorsteps which the wives redden or whiten when they wash down the pavement in front of their doors in the morning. Dilapidated but cosy, damp but friendly, in the eyes of most Bethnal Greeners these cottages are the place, much more so than the huge blocks of tenement buildings standing guard, like dark fortresses, over the little houses . On the warm summer evening of the interview, children were playing hop-scotch or ‘he’ in the roadway while their parents, when not watching the television, were at their open windows. Some of the older people were sitting in upright chairs on the pavement, just in front of the doors, or in the passages leading through to the sculleries, chatting with each other and watching the children at play. (38)

The mother is usually the one who helps get her daughter her own place after marriage — she is the one with connections through the rent collector and through friends. She knows who has died or who is moving out, if she is a good tenant the rent collector can assume her daughter will be too. This means empty apartments go to those from the local area due to this web of connections. Some charitable trusts who owned housing in the area had it as official policy that family gets first chance at flats opening up, in others while not official, that was generally the way things worked. Willmott & Young note too, some of the other arrangements that can be made to reduce animosity over flats where they are scarce, such as letting part to a family who also needs it etc.

This was very different from how the council operated, which is rather fascinating. Willmott &Young noted that at the time of writing the council owned a third of dwelling in the borough and that was increasing. The council worked off of lists not personal connection, and early version of today’s points and priority need. Preference was given to ‘slum’ dwellers and those with high need, and it is easy to see the argument for this, but also you can see what might be lost. In 1957, it was still true that

Bethnal Green suffers from a serious housing shortage. In time, we can hope, it will be much less acute… (42)

Mothers and Daughters

From the above, it is clear just important relationships are. Willmott and Young note the amount of time daughters spend with their mothers, and mothers with their daughters, how it makes no sense to talk about the household as such, particularly given how many meals people share. Again they quote Sheldon on Wolverhampton:

‘In at least 40 per cent of cases they must be regarded as part of a family group, the ramifications of which bear little or no relation to architectural limitations. (48)

I rather love how the family overflows and engulfs the limits of brick walls in that sentence.

There is a multitude of ways listed in which mothers and daughters help each other, but I found this sentence about work quite fascinating:

Part-time work is plentiful in Bethnal Green, both in the small local factories and in the tens of thousands of offices which have to be cleaned in the nearby City, and women are therefore less in need of help from relatives than they would be in many other places. (54)

This would change, I suppose, but it seems to me I have not read much at all that really looks at these employment patterns and the independence such work must have provided. While also being rather shit work.

Husbands and mothers

Another amazing description:

Once arrived in the Hanbury’s front room, most of the guests stood about rather stiffly, holding glasses of beer and sniffing the pickled onions. The Buxtons, that is the bridegroom’s family, were grouped by the window, looking disdainfully at the chipped china dogs on the mantelpiece, the worn linoleum on the floor and the pictures of country scenes which did not quite conceal the damp patches on the wall-paper. (62)

Things liven up though.

You’ll be happy to know that the study found sons to regularly check in on their mothers, it tended to be once a week, and it was often them dropping by on their own. Nice.

The Kinship Network

These are broad, reinforced by regular meetings, but often the mother/oldest sister at their centre, and they tend to dissipate after their death.

The Family in the Economy

More on the many jobs available — it is hard indeed not to think of them as better days:

You do not have to live in Bethnal Green, you only have to take a bus down the main street to notice that this is a place of many industries. You pass tailors’ workshops, furniture makers, Kearley & Tonge’s food warehouse, and near to Allen & Hanbury’s big factory. The borough has by itself a more diversified economy than some countries. But the borough has no frontiers: it belongs to the economy which stretches down both banks of the Thames. At its heart is the largest port in the world, which lines the rives for nearly twenty miles from London Bridge to Tilbury, and supports on every side a web of interconnected industries… (89)

More on immigration, some things don’t change.

Because the East End is a port, and near to the Continent, it is the place where for centuries foreigners have landed to escape from war and persecution in Europe. (89)

Immigration’s connection to employment, though becoming more tenuous

The Huguenots most famously, notes still hand-loom weavers in 1939 and the closure of the last Huguenot silk firm in 1955. Furniture, however, once a spin-off of this trade, still strong though showing signs of winding down…

Several chapters on they have another great story about the Huguenots, where a local resident showed them a document written about the time of the Revolution, some kind of petition to the Governors of the French hospital in Hackney (!) to employ, and treat, his granddaughter. Amazing. But I digress.

Despite this winding down of the furniture trade (though that was still existing in pieces when I worked there), they can still write:

East London is less vulnerable because it has many industries to lean on, and while it cannot avoid being harmed by a general contraction in trade. (91-92)

And they note that those in Bethnal Green able to take the job of their choice. It’s political leanings are no surprise:

Every constituency in East London returns a Labour member to Parliament and every council is controlled by the Labour Party, Bethnal Green regularly electing a complete slate of Labour Councillors almost as a matter of course, The people share their politics; they speak the same language with the same accents; they work with their hands; they have, in short, the same kind of life. These deep-lying bonds between members of a class are also bonds between members of the family. (94)

See? Good old days. Hard to imagine this as Labour now.

One change for the better? Things aren’t quite as openly racist as they used to be:

But for most people the Council is not the prize it was. Security does not now matter enough to offset the low pay. Mr Sanderson, a dustman, explained how far his job had sunk…

Things have got so bad that they recently started about a dozen black men. They’re got the rough and rebel from everywhere. One of the black men was sweeping roads with a cardboard box with eyeholes over his head. The foreman asked him what he was doing that for and he said “Well guv’nor, it’s cold.” If it’s a bad winter, they’ll pack up, go home, and make rum.” (96)

The docks a different story (though probably not in the matter of casual racism), ‘It is a matter of pride to belong to a docker’s family‘. (97) I love this story, though I can’t honestly tell if its racist or not:

There were many well-established families — in a nearby dock, one of these was…known as the ‘Flying Eighteen’, a group of brothers and uncles with legendary sensitivity to the ‘jungle drum beats which let them know a ship was coming up the Thames’. (98)

They always got there first. This closeness of community and family surely has its downside. The study looked at how unions and industries gave preference to members’ sons — Transport and General Workers’ Union, Billingsgate for fish, Covent Garden and Spitalfields for fruit and veg, and Smithfields for meat.  Printing, bookbinding and paper workers the same.

Kinship and Community

Willmott and Young meet some of these challenges head on, at least in terms of the wider white working class:

Since family life is so embracing in Bethnal Green, one might perhaps expect it would be all-embracing… Far from the family excluding ties to outsiders, it acts as an important means of promoting them… The kindred are, if we understand their functions aright, a bridge between the individual and the community… (104)

They give this amazing, cinematic description of Mrs ‘Landon’ doing her half-hour morning’s shopping and telling the name and background of everyone they pass. By her own record of who she saw in a week in the street that she considered herself to ‘know’, there were 63 in total, and 38 were the relatives of someone else she knew. It is in the street, the shop, the pub that people meet each other, NOT in the home, which remains private. But I think much more happened then in public that would now be considered things best kept private.

Again we have another  brilliant description of urban space:

The streets are known as ‘turnings’, and adjoining ones as ‘back-doubles’, Surrounded by their human associations, the words had a glow to them, ‘In our turning we‘, they would say, ‘do this, that, or the other.’ ‘I’ve lived in this turning for fifty years’, said one old man proudly, ‘and here I intend to stay’. The residents of the turning, who usually make up a sort of ‘village’ of 100 or 200 people, have their own places to meet, where few outsiders ever come — practically every turning has its one or two pubs, its two or three shops, and its ‘bookie’s runner’. They organize their own parties…some turnings have little war memorials… (109)

They mention a woman had lived in the same courtyard all of her 62 years, spoke of newcomers with only 18 years residence, shocked to hear the council thought of her court as a slum. Imagine.

Another quote from J.H. Robb Working Class Anti-Semite…I don’t quite know what that is about, will have to look it up, but the quote is a good one:

There is a further localism within the borough. People are apt to look for their friends and their club within a close range. The social settlements draw nearly all their members from within a third of  a mile, while tradition dictates which way borderline streets face for their social life. The main streets are very real social barriers… (110)

So in looking at what holds community together, they write:

The interaction between length of residence and kinship is therefore the crux of our interpretation. Neither is by itself a sufficient explanation. (115)

But above all it is place.

In ending this chapter…If we are to pick out one conclusion, it is the importance of residence.

Marriage, changes of life, all of it

A special cast is given to all these adjustments and readjustments by the fact that they are played out within a limited physical space.  (117)

What better way, they say, to study the importance of residence than to look at what happens to this thick web of connections when there is a change? So on to part two — the new council estate at ‘Greenleigh’, now the truth can come out of the name — the Debden Estate. Why did I think it was the Becontree Estate? Dear oh dear, but it matters not. That will be saved for part 2.

Young, Michael and Willmott, Peter ([1957] 1979) Family and Kinship in East London. Manchester: Penguin Books.

Health, Intersections, Networks

Antonovsky on Salutogenesis in Health, Stress, Coping

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We’ve been doing so much work around social prescribing with Salford CVS, and salutogenesis is all over that literature. A concept developed by Aaron Antonovsky (1923-1994) for where the medical focus should lie: on how people become well, not on why they are sick. There’s some really good stuff in this sadly out-of-print book that I had to order on loan from the British Library.

It opens autobiographically — an intellectual history of Antonovsky’s work and the questions driving that work. I agree that this is the real question we need to be answering:

What are the stressors in the lives of poor people that underlie the brute fact that, with regard to everything related to health, illness, and patienthood, the poor are screwed? (3)

Given that, and all that follows, I can’t say it doesn’t trouble me greatly that Antonovsky moved from NY (and his work around studies of poverty and labour) to Israel, where it does not seem as though he undertook a study of mass Palestinian displacement into refugee camps or poverty or access to health care. Of course for him, understanding the echoes of the Holocaust in survivor’s health is clearly a driving question in his research, and this is where the example that he felt was foundational to his later theorising emerged from: In studying those camp survivors, he found that as a whole the group was unable to adapt as well as other groups to menopause. However, there were women within that group that adapted as well as anyone — so the question became to turn research around and ask why those women had adapted, and why they did so well despite their experiences? This led to what Antonovsky later came to call salutogenesis. Why people are ‘healthy’ not why they are sick. He makes the point that honestly, given how shit the world is, we should all be sick all of the time, so the real question becomes what is stopping that from happening?

It’s interesting, though, that the central concept of the book isn’t really this term salutogenesis, but what leads to it and ultimately what is at the foundation of health — what Antonovsky calls a ‘sense of coherence’:

a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected. (10)

This is what determines how well you deal with the daily bombardment of illness and disease. He also emphasizes that this is NOT the same as a feeling that ‘I am in control’. But more on that later.

I sit with this though. If this is true, then how thoroughly do we have to remake this world for health? Far beyond the policies I have seen Antonovsky quoted as a supporting reference for. For me, this becomes a new framework not only for the loss of my dad and many other people I have loved and lost to poverty and its many ills, but also for the millions of people now in hopelessness, precarity and movement across the planet.

Chapter One: Studying Health Instead of Disease

The problem of salutogenesis is one of the most mysterious, intriguing, and meaningful challenges for philosophy and the biological and social sciences… Pathogenesis–the origins of disease X, disease Y, disease Z–has preoccupied us … here, as in all of science, how one poses the question is crucial to the direction one takes in looking for the answers, (12)

We have looked for the origins of disease X, Y and Z and found them. He talks about the exogenous and endogenous bugs, the sets of agents that cause disease: ‘viruses, mutant cells, pollutants, or agents of physical trauma such as guns, knives, and motor vehicles, that pose a constant threat of damage…’ wait for it though, here it really comes:

And finally, there are those bugs variously called psychosocial stressors, presses, strains: alienation, rapid social change, identity crises, ends-means gaps, discrimination, anxiety, frustration. (14)

These are not, of course, considered working within a pathogenic model.

Our dominant ideological paradigm, which shapes our society’s clinical practice and scientific research, focuses on and responds to a particular disease or clinical entity. (15)

Near the end of the chapter, he gives three reasons why ‘the focus on pathogenesis is likely to handicap us in grappling with both the scientific problem of understanding why illness is far from deviant and the human problem of somewhat reducing pain… (my bullets, his words in what follows)

  1. the pathogenic approach pressures us to focus on the disease, on the illness, on the alteration of body fluids or structures, and to disregard the sickness… it blinds us to the subjective interpretation of the state of affairs of the person who is ill (36).
  2. thinking in pathogenic terms is most comfortable with the “magic-bullet” approach–one disease, one cure–which explains the resistance of many to the concept of multiple causation. … the assumption is that we are cleverer than the bugs and can eradicate them one by one (37)
  3. pathogenesis by definition is a model that postulates a state of disease that is qualitatively and dichotomously different from a state of nondisease…

And I’m going to separate this last bit of the paragraph out, because it better explains salutogenesis:

such dichotomization blinds us to a conceptualization made possible by a salutogenic model, namely, a multidimensional health-illness continuum between two poles that are useful only as heuristic devices and are never found in reality: absolute health and absolute illness. (38)

Chapter 2: Measuring Health on a Continuum

This returns to all the problems of thinking of health and illness as a dichotomy when the real question for Antanovsky is ‘Given the ubiquity of bugs, why does anyone ever stay alive and reasonably healthy?’ (39)

On epidemiology — I know it shouldn’t surprise me that the field of medicine is siloed within as much as without, and epidemiology is only one of those silos, and yet it does–he writes:

epidemiology is one of the major scientific disciplines that have developed in the service of the health care institution. There is no doubt in my mind that the epidemiological conceptualization of the health-illness phenomenon, the model or paradigm used by epidemiologists, is powerful and, for some purposes, far more powerful that the clinical model we have been discussing.

And continues, with bullets that are again my own

  1. epidemiologists are aware of the iceberg phenomenon. They assume, with adequate evidence, that for every case of a disease that has been brought to clinical attention…there are additional cases below the surface… (45)
  2. …they are kept in check by methodological sophistication and compulsiveness… [for clinicians] intuition, art and clinical skills are necessarily acceptable in arriving at a conclusion. The epidemiologist has the luxury of rejecting such subjectivism. (46)
  3. the sine qua non of the epidemiologist’s professional activity is to go beyond description and enter the field of analysis, to deal with causation. As such, it rounds out, complements, the field of laboratory and clinical research. But its core and strength are its understanding of causation as based on teh study of group rather than individual differences. (46)

Thus he gives the public health model higher marks than the clinical model (and I just read a splendid book about social epidemiology, but more on that later), yet it still suffers from this dichotomy of health and illness.

I was curious to find Antonovsky critiquing the WHO definition of health, not its utopian aspects but the way that it can’t be operationalized. He argues that this renders it harmless, and he might be right. He prefers Dubos’ definition of health (I am looking forward to reading Dubos) ‘a modus vivendi enabling imperfect men to achieve a rewarding and not too painful existence while they cope with an imperfect world (1968, p67).

Awesome definition, but I can see that not everyone would be inspired by that. Nor is this mapping of the continuum to inspirational either perhaps, but I found it useful:

As Antonovsky writes:

by defining health as coextensive with the many other dimensions of well-being, one makes the concept of health meaningless and impossible to study … Health wellbeing must be studied separately (68)

Chapter 3: Stressors, Tension, and Stress

Stressors are omnipresent in human existence … Poor tension management leads to the stress syndrome and movement toward dis-ease on the continuum. Good tension management pushes toward health ease. (71)

Everyone alive would agree with that statement. The list of stressors he gives:

accidents and the survivors; the untoward experiences of others in our social networks; the horrors of history in which we are involved; intrapsychic, unconscious conflicts and anxieties; the fear of aggression, mutilation, and destruction; the events of history brought into our living rooms; the changes of the narrower world in which we live; phase-specific psychosocial crises; other normative life-crises–role entries and exits, inadequate socialization, underload and overload; the inherent conflicts in all social relations; and the gap between culturally inculcated goals and socially structured means. (89-90)

Quite a list.

Chapter 4: Tension Management and Resources for Resistance

In moving towards an understanding of the foundations of salutogenesis, Antonovsky develops the concept of the Generalized Resistance Resource, or GRRs as those things that help keep us towards the healthy side of the continuum.

Antonovsky p 103

The principal individual characteristics include rationality, flexibility, farsightedness, but I’m most interested in what he calls Interpersonal-Relational GRRs, more generally known as social supports. These sit in opposition to social isolation — or what in those days seemed to have been termed ‘social isolates’ or ‘social destructs’. Goddamn, imagine being thought of as a social destruct. But we are finally working our way to understanding what Antonovsky means by coherence, ‘the GRR of deep, immediate, personal roots.’ (114) I haven’t read Malinowski since undergrad, but he’s cited here:

Malinowski says that culture gives each of us our place in the world…. In Chapter Three I defined a stressor as a demand made on one for which one does not have tan automatic and readily available response capacity. From this point of view, what culture does, in giving us our place in the world, is to give us an extraordinarily wide range of answers to demands. The demands and answers are routinized: from the psychological point of view, they are internalized; from the sociological point of view, they are institutionalized. (117)

A really fascinating way to think of culture in the abstract, but I can’t help but also think of the left’s too-often sneering attitudes to ‘identity politics’ and culture and struggle, and see how really this all ties in together. And just to repeat once again”

Ready answers provided by one’s culture and its social structure are probably the most powerful GRR of all. (119)

Chapter 5: Perceiving the World as Coherent

This is the central point of the book really, and the key idea for Antonovsky:

The sense of coherence is a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable, and that there is a high probability that things will work out as well as can reasonably be expected. (123)

He doesn’t once, that I remember, quote Voltaire. It’s extraordinary. He continues:

A sense of coherence, as I trust has become clear, does not at all imply that one is in control. It does involve one as a participant in the processes shaping one’s destiny as well as one’s daily experience.

The crucial issue is not whether power to determine such outcomes lies in our own hands or elsewhere. What is important is that the location of power where it is legitimately supposed to be. This may be within oneself; it may be in the hands of the head of the family, patriarchs, leaders, formal authorities, the party, history, or a deity. The element of legitimacy assures one that issues will, in the long run, be resolved by such authority in one’s own interests. Thus a strong sense of coherence is not at all endangered by not being in control oneself. (128)

It’s all about power over your fate — and in fact by this argument participation in struggle could be as powerful and positive a health determinant as being lucky enough to be born in the upper classes. Of course, Antonovsky also describes the way that certain kinds of faith stand in as much good stead. There is so much to think about here.

He gives case histories of Norman Cousins and Freud himself as examples — you have to like that. In thinking about the conditions under which a strong sense of coherence emerges, Antonovsky notes that one line of research might be investigating  how in the case studies given, the ‘one common substantive theme … is the continuous experience of participation in shaping one’s fate‘ (152).

Chapter 6: Relation of the Sense of Coherence to Health

A long chapter that states that as the sense of coherence has not been operationalized and therefore not tested, he is simply bringing together evidence for a ‘prima facie case for the plausibility of the hypothesis‘ (161). I think he manages.

Chapter 7: the Salutogenic Model of Health

And now back to salutogenesis, along with a helpful summary:

In Chapter One, I posed the problem of salutogenesis. Chapter Two proposed a solution to the problem of the measurement of health status consonant with the salutogenic orientation. At that point, the core of the question was put as the need to explain the location of a person near the ease end of the health ease/ dis-ease continuum. Chapter Three considered–and rejected–the hypothesis that the answer could be stressor avoidance. In Chapter Four, an initial alternative answer was presented: the availability of generalized resistance resources. The initial question was also broadened to consider maintenance or improvement of one’s position on the breakdown continuum, irrespective of location at any given time. Analysis of the nature of generalized resistance resources, of why they are hypothesized to facilitate tension management and avoid stress, led to the formulation of the central construct of the book, the sense of coherence, considered at length in Chapter Five. The final building block in which I call the salutogenic model appears in Chapter Six, which presents the evidence for linking the sense of coherence and health status. (182-183)

An amazing chart here to summarise the model. I give it to you:

Antonovsky -- The Salutogenic ModelAntonovsky -- The Salutogenic ModelAnd of course, as I’ve probably failed to make clear, salutogenesis really needs to be the focus of our current age, not instead of pathogenesis but after pathogenic success.

There is, indeed, good reason for the pathogenic model to have dominated thinking about disease for most of human history. The three-pronged power of stressors…which included perhaps above all nutritional deprivation and the most primitive level of sanitation, was sufficient to overcome even substantial resistance resources. When, however, the standard of living…reaches a rough level of adequacy, differences in health level no longer are overwhelmingly determined by biochemical and physical stressors (193).

Chapter 8: Implications for an Improved Health Care System

This isn’t easy, this is no ‘guide to the perplexed‘ — Antonovsky says that twice. But he has a few suggestions. One is to think of the doctor as a GRR — each encounter between doctor and patient a way to support a patient’s sense of coherence. This is particularly important as each encounter will generally involve ‘anxiety, uncertainty, unpredictability and dependence‘ for the patient. Above all this is key after a traumatic situation, when someone finds themselves, as Antonovsky writes, as generally ‘shattered‘. However routine encounters also important. For the most part, those encounters which allow the physician to see and to treat someone as a whole with a sense of their broader self and context are the best.

Near the end of the book, Antonovsky asks: ‘Can the medical profession and the individual physician engage in activities beyond the patient-doctor encounter that affect the sense of coherence?’ Yes of course, and there are four ways this might happen: ‘making health care available to all, promoting a preventive health orientation, buttressing faith in the physician, and reaching out to persons at high risk of damage to the sense of coherence‘. (217)

One of my favourite sentences:

A society, then, that has institutionalized a health care system that expresses consensus that health care is an inalienable right of all its citizens and is to be made available to all on the universalistic ground of being  a resident of that society is a society that has taken a step forward in strengthening the sense of coherence of its members. (217)

Those blocked from this due to poverty or race or rural living distant from health care necessarily lack this sense.

Penultimate paragraph from the epilogue:

If we wish to see the present and future soberly in our world, we must use words like capitalism and totalitarianism.  The social structures in which most of humanity lives and the daily experiences to which we are exposed in these structure are far from conducive to a strong sense of coherence…Societies with a marketing mentality and fetishism of commodities, with terror and arbitrary recasting of history, with grinding poverty and starvation cannot foster a view of the world as one that provides information and music except for the fortunate few.

It would take another book and an extensive research effort to subject to serious analysis the concrete social structures and social positions that in our world foster a strong sense of coherence. Improvement in health status is contingent on such analysis and on a program of social action that could follow. This analysis is one of the crucial tasks of social epidemiological research (227).

He hopes this book is one of the tools that makes this possible, and I believe it is.

[Antonovsky, Aaron (1985) Health, Stress, and Coping. San Francisco and London: Josey-Bass Publishers.]

Health

Bavaria’s Turn-of-the-Century Golden Rules of Health

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One thing I do love about Germany — and the Czech Republic and  Poland (I think I did three posts on apothecaries after visiting Krakow?) — are the way that apothecaries are still everywhere. I know we have pharmacists, but it’s just not the same, is it? But there are also the old signs, the nods back to the glory days with dark, battered wooden shelves full of gleaming bottles and herbs drying from the ceiling, powdered minerals and bits of dried bat and crocodile. Though I do love bats, and prefer them alive. A number also harken back to the superior medical knowledge of the moors — and so I am simultaneously appreciative of that and horrified by the racism inherent in the old figures.

Still, we only saw one of them in Nuremberg. This was by far my favourite:

Nuremberg

I loved most the rules for health from the turn of the last century:

Nuremberg

I have copied them all for you from the website: Counsellor Eckart’s golden rules of health for a prudent lifestyle — but let me highlight my favourite:

Do not dress according to fashion, but rather in tune with the weather. Keep your feet and lower body warm. In snowy, freezing weather, thin tights and shoes are a crime against your health.

I have been thinking that to myself all winter looking at our freezing youth with their strange fashionable dislike of socks.

They are incredibly Victorian, and feel they could have as likely appeared in England or the East Coast of the US. Fresh air, cold water, not too much comfort, not too much good food, and you can imagine no whinging about all of that. I’ve been thinking about health a lot lately, and this kind of framework for how we imagine good living still seems to lurk a great deal in the background.

The golden rules of health from Carl Ludwig Ernst Eckart (1830 – 1911)

Do not burn the candle at both ends: sleep before midnight is of more worth than after sunrise.

Rest your body and nerves. This does not happen when partaking of entertainment or on the dance floor, but rather in God’s free, natural world. Keep the Sunday as a holy day, as it has been designated for our rest.

Pay attention to your daily bowel movement! It is better to eat too little than too much, and to leave the stomach time to digest. A lot of meat and strong spices make the blood heavy and hot; live on a simple and mixed diet and do not reject our natural beverage: fresh water.

Do not load up your stomach in the evening with foods which are hard to digest, and which cause restless sleep and troubled dreams. Leave yourself time to eat, so that your nutrition can be processed more efficiently.

Do not cover yourself with heavy, full bedclothes; your mattress should rather be too hard than too soft.

Do not dress according to fashion, but rather in tune with the weather. Keep your feet and lower body warm. In snowy, freezing weather, thin tights and shoes are a crime against your health.

Fresh air has never hurt anyone; therefore ventilate your rooms well and leave a window open at night. Breathe in deeply, but shut your mouth when walking in the street in windy, dusty conditions; breathing through your nose will suffice.

Get your children used to the frequent use of water. Cold water improves resilience. Keeping your mouth and teeth clean will help to prevent infections.

Always remember that our health is our most precious possession, and do not first start to live prudently when it is too late.

City & Country, Health, Housing

Sprawl, Health, and creating better cities through Smart Growth

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Urban Sprawl and Public HealthPart 2 on Urban Sprawl and Public Health looks at potential interventions and theories that can help reduce the impact of sprawl (read part 1 here). For authors Howard Frumkin, Lawrence Frank, and Richard Jackson, hope lies in the new strategies being put forth under the terms Smart Growth and New Urbanism, arguing for Smart Growth at least as a public health strategy. I have a lot of issues with New Urbanism and Smart Growth as they are so often removed from issues of equity and spatial justice, but it’s interesting to think of how to rebuild and rework our cities as part of a plan around improving health.

They trace a lineage of people working on the connections between health and cities — Dr. John Henry Rauch (1828-1894) in Chicago arguing for land use policies to improve public health, cemeteries at a remove from dense neighborhoods being one of them. Frederick Law Olmstead, and garden cities. Edwin Chadwick working sanitary regulations, housing standards, public water and sewage systems in the UK, Thomas McKeown at Birmingham, who

showed that many of the health advances of the nineteenth and twentieth centuries resulted not from better medical care, but from ‘upstream’ improvements such as better urban infrastructure–better housing, neighborhoods, water, food, and transport. (203)

They also name psychiatrist Leonard Duhl, who has looked at connecting mental health with urban design and community involvement. His ideas have been broadened by physician Trevor Hancock. In 1987, the World Health Organization jumped on the bandwagon, initiating a Healthy Cities Network, which I confess I had never heard of.

There are of course many who could be added to this list, and in the UK at least you have the Marmot Review among others, trying to move health care providers to think more broadly about wellness and how it connects to social and environmental factors.

So…to return to the strategies they promote, we start with Smart Growth. The Environmental Protection Agency itself formed the Smart Growth Network in 1996 together with a number of other nonprofits and governmental organizations. The Networks’ ten Smart growth principles (the whole document ‘Getting to Smart Growth: 100 Policies for Implementation’ can be found here):

1. Mix land uses
2. Take advantage of compact building design
3. Create a range of housing opportunities and choices
4. Create walkable neighborhoods
5. Foster distinctive, attractive communities with a strong sense of place
6. Preserve open space, farmland, natural beauty, and critical environmental areas
7. Strengthen and direct development towards existing communities
8. Provide a variety of transportation choices
9. Make development decisions predictable, fair and cost effective
10. Encourage community and stakeholder collaboration in development decisions

The book goes on to give a more elaborate set of principles in full…they’re interesting, so I do the same — the full text can be found here:

Community principles

  1. All planning should be in the form of complete and integrated communities containing housing, shops, work places, schools, parks and civic facilities essential to the daily life of the residents.

  2. Community size should be designed so that housing, jobs, daily needs and other activities are within easy walking distance of each other.

  3. As many activities as possible should be located within easy walking distance of transit stops.

  4. A community should contain a diversity of housing types to enable citizens from a wide range of economic levels and age groups to live within its boundaries.

  5. Businesses within the community should provide a range of job types for the community’s residents.

  6. The location and character of the community should be consistent with a larger transit network.

  7. The community should have a center focus that combines commercial, civic, cultural and recreational uses.

  8. The community should contain an ample supply of specialized open space in the form of squares, greens and parks whose frequent use is encouraged through placement and design.

  9. Public spaces should be designed to encourage the attention and presence of people at all hours of the day and night.

  10. Each community or cluster of communities should have a well defined edge, such as agricultural greenbelts or wildlife corridors, permanently protected from development.

  11. Streets, pedestrian paths and bike paths should contribute to a system of fully connected and interesting routes to all destinations. Their design should encourage pedestrian and bicycle use by being small and spatially defined by buildings, trees and lighting; and by discouraging high-speed traffic.

  12. Wherever possible, the natural terrain, drainage, and vegetation of the community should be preserved with superior examples contained within parks or greenbelts.

  13. The community design should help conserve resources and minimize waste.

  14. Communities should provide for the efficient use of water through the use of natural drainage, drought tolerant landscaping and recycling.

  15. The street orientation, the placement of buildings and the use of shading should contribute to the energy efficiency of the community.

Regional Principles

  1. The regional land use planning structure should be integrated within a larger transportation network built around transit rather than freeways.

  2. Regions should be bounded by and provide a continuous system of greenbelt/wildlife corridors to be determined by natural conditions.

  3. Regional institutions and services (government, stadiums, museums, etc.) should be located in the urban core.

  4. Materials and methods of construction should be specific to the region, exhibiting continuity of history and culture and compatibility with the climate to encourage the development of local character and community identity.

Implementation Principles

  1. The general plan should be updated to incorporate the above principles.

  2. Rather than allowing developer-initiated, piecemeal development, local governments should take charge of the planning process. General plans should designate where new growth, infill or redevelopment will be allowed to occur.

  3. Prior to any development, a specific plan should be prepared based on the planning principles. With the adoption of specific plans, complying projects could proceed with minimal delay.

  4. Plans should be developed through an open process and participants in the process should be provided visual models of all planning proposals.

Of course, in years of community work around development, I have never seen anything actually work like this.

The authors look at how this compares/ overlaps with New Urbanism and its principles (see the Congress for the New Urbanism for more…):

walkable neighborhoods, a range of housing choices, a mix of land uses, participatory planning, revitalization of urban neighborhoods (206)

They talk about some of the critiques. They come from wildly different directions…

  1. the public doesn’t want it
  2. it limits consumer choice — it’s a form of coercive social engineering
  3. can exacerbate traffic congestion by creating greater density
  4. smart growth projects are isolated enclaves, not integrated
  5. encourage gentrification (213)

Then go on to look at a public health approach to Smart Growth. It’s a very different perspective though concerned with all of the same things. They begin with constructing a community health assessment — paralleling the medical assessment. One method they believe has great promise is the Health impact Assessment, as a way to measure the health benefits from a Smart Growth approach. Nor is it surprising that many of the potential indicators would be the same as for sustainability — transit ridership, percentage of population living within ten minutes of a park, incidence of asthma, extent of recycling. (217) A few useful checklists exist already that could serve, one is the Built Environment Site Survey Checklist in London (this is news to me, this BESSC).(218)

I like how numerous things are coming together — concerns for the health of individuals and communities and neighbourhoods, issues of sustainability and the health of the land and environment. I think, again, there’s a lot more to think about in terms of equity. People’s own power in the process is always the first thing to go — if it ever was on the table. The cold hard facts of development and politics are not amenable to such things, so progress has been made where it helps certain kinds of development become more marketable. But criticism to come…

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City & Country, City Unseen, Environment & Justice, Health

Urban Sprawl and Public Health

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Urban Sprawl and Public HealthUrban Sprawl and Public Health —  a great book! It was amazing to see urban planning and public health brought together in this way — a solid primer on both for each, along with a plea for professionals to start working together to fix this. Because sprawl is killing us.

I myself would throw in a soupçon of sociologists and geographers and community organizers to the health and planning mix as well, because what was missing? More analysis on the nature of development and how the drive for profit drives this urban form, more analysis on the struggle of everyday people to fight for and against some of these dynamics, and the ways in which race and land have long been linked (but there is more of this second aspect than in many another book). Still, despite these critiques, I confess that few things get me going the way that talking about the city and health in the same book do.

Health & Sprawl facts:

In the last 15 years, the US has developed 25% of all the land developed in the past 225 years of its official existence. (xii)

Between 1960 and 2000, average American’s yearly driving more than doubled — 4,000 to nearly 10,000 miles per years. “rush hour” spread over seven, not 4 and a half, average driver’s time spent stuck in traffic each year: 6 to 36 hours in Dallas, 1 to 28 hours in Minneapolis, 6 to 34 in Atlanta. (xiii)

On Sprawl

Sprawl — a term from William H. Whyte! Did I know that? He wrote an article for Fortune in January 1958, titled ‘Urban Sprawl’. There are a variety of definitions and measurements of sprawl, here they follow those that incorporate both land use and transportation as intrinsic. They focus on four main aspects — density, land use mix, automobile dependence and connectivity (or how destinations are linked through transportation systems (7). (5)

I particularly like how much they use illustrations, this is a good one:

"Source:
Source: Drawing by Duany Plater Zybek as shown in F. Spielberg, ‘The Traditional neighborhood Development: How will traffic Engineers Respond?’ ITE Journal 1989 (59) 17-18

I also liked the ‘transect’ — a look at the continuum between sprawl and compact neighbourhoods (16)

Transect 03-03-03" width="1572" height="530" class="size-full wp-image-7010" /> Source: Image courtesy of Duany Plater-Zybec and Company (2003) Transect 03-03-03
Source: Image courtesy of Duany Plater-Zybec and Company (2003) Transect 03-03-03

Chapter 2 looks at the origins of sprawl, and it is based almost in its entirety on Kenneth Jackson’s Crabgrass Frontier. So it summarizes the multiple factors that have lead to spraw, and it is a very long list. He heads it with the pull of the suburbs and the (European) cultural values Jackson believed underlay that pull — domesticity, privacy and isolation (28). In addition you have land ownership as a mark of wealth and status, alongside (partly driving perhaps, but I’m a cynic that this drove development rather than sales) a love of land itself and antipathy toward cities. (29) The Garden City movement feeds into this, embodied by Frederick Law Olmstead, along with the new technologies and construction methods and lots of cheap land (no mention of conquest here of course). There is a little here on the willingness of cities to spend taxes on providing infrastructure like roads and sewers — directly subsidising this kind of development as opposed to improving older neighbourhoods or public housing. The rise of the automobile and destruction of public transportation. The rise of zoning. The HOLC and the FHA, federal policy and money going towards new housing for whites (I do wish, though, that they had read Freund).

Still, I like the simplicity of their conclusions though:

Sprawl, as we know it today, appears deceptively chaotic. In fact, it is a highly ordered and predictable form of development. An edifice of public and private instruments erected over the past three-quaters of a century reinforces and extends sprawl. (42)

There is a little on financing here, and that real estate financing now works on an expectation of profits within 5-7 years — more built-in obsoleteness. I wish they had connected this to Harvey’s ‘spatial fix’ but that’s complex I guess. This is my field though, and this is a good summary.

Urban Health

Urban health is not my field, though I have a good deal of practical organising experience on the subject.

Frumkin et al compare the evolution of urban health with public health through ‘epidemiologic transition’ — and these titles really do inspire the SF writer side of my brain: The Age of Pestilence and Famine, The Age of Receding Pandemics, and where we are now: The Age of Degenerative and Man-Made Diseases. In cities, infectious diseases once dominated, but sanitary infrastructure ended that to a great extent. But industrialisation introduced pollution, and mental health and violence are not forgotten here, with growth in poverty, social dislocation and crime. (45)

From a public health perspective, the critical problems that grew as cities did were: garbage, commercial activity (tanning and other nasty things), sewage, water, air, and housing. (46)

An interesting aside:

In New York, Assemblyman Aaron Burr [founding father and profiteer] obtained a charter for the Manhattan Company, a private firm that was to hold a monopoly on piped water for the next quarter of a century. (51)

Privatised water is nothing new. Nor are the images from Jacob Riis in How the Other Half Lives. My family for example, hanging out with the other half in Pittsburgh, probably looked much like this, though they were never in this particular alley.

Bandit roost (59 Mulberry Street in New York City), Jacob Riis 1888
Bandit roost (59 Mulberry Street in New York City), Jacob Riis 1888

 The Results: A Plethora of Infections

Their heading, not mine. I had not read of the yellow fever epidemics that swept through Washington D.C. — as President Washington fled in 1793 leaving over 5,000 dead, or over ten percent of the city’s population. (55)

The book quotes a citizen group in Philly writing:

if the fever shall become an annual visitant, our cities must be abandoned, commerce will desert our coasts, and we, the citizens of this great metropolis, shall all of us, suffer much distress, and a great proportion of us be reduced to absolute ruin. (56)

it continues

Cholera, Typhoid…Cities in these early days were ‘incubators of infectious disease’ (57)

Now this is Pittsburgh just as my great-grandparents were arriving:

1890s, Pittsburgh, Pennsylvania, USA --- Smokestacks from factory in Pittsburgh, Pennsylvania, belch black smoke into the atmosphere, 1890s. --- Image by © Bettmann/CORBIS
1890s, Pittsburgh, Pennsylvania, USA — Smokestacks from factory in Pittsburgh, Pennsylvania, belch black smoke into the atmosphere, 1890s. — Image by © Bettmann/CORBIS

But slowly this would change…

During the nineteenth and twentieth centuries, as sanitary challenges were met and as industrial pollution was managed, the toxicity of cities–the factors that most threatened residents’ health and well-being and even helped drive migration out of the cities–came overwhelmingly to revolve around social circumstances. (61)

The heading for this section is ‘The Social Pathology of City Life’. (61)

during the nineteenth and twentieth centuries, as sanitary challenges were met and as industrial pollution was managed, the toxicity of cities–the factors that most threatened residents’ health and well-being and even helped drive migration out of the cities–came overwhelmingly to revolve around social circumstances. (61)

The urban crisis — it is interesting, perhaps a little troubling how the social is here linked with the epidemiological, but I am often troubled by the public health gaze at poverty. Foucault was too, so I’m in good company. The book here  notes the riots of the Red Summer of 1919 — yet it doesn’t distinguish these horrifying white killing sprees where literally hundreds of people were murdered with ‘riots’, what inhabitants themselves described as ‘uprisings’ in protest of police brutality and living condition in Watts in 1965, LA again in 1992 and etc (62).

It is interesting to consider the ‘urban health penalty’, however:

a complex of environmental conditions such as deteriorating housing, inadequate access to nutritional food, and scant medical care, and health consequences such as untreated hypertension, cardiocasvualr disease, intentionala dn unintentional injuries, and infectious diseases. (63)

Interesting to read of a 1990 article in New England Journal of Medicine showing that men in Harlem had lower life expectencies than in Bangladesh.* They write:

A literature of urban health arose, focusing on these conditions and how to provide health care to the victims. (63)

From here on to the nitty gritty.

Air Quality:

I like this chart:

IMG_5598

‘As the model illustrates, land use patterns affect each category of athropogenic emmissions–their location, their quantity, their dispersion in the air, and how people are exposed. (66)

And a summary of what air quality means for health:

Air pollution threatens human health in four principal ways. The two most important are by increasing mortality and by threatening respiratory health. In addition, air pollution can damage cardiovascular function and increase cancer risk. There is evidence for some other health effects as well. (80)

Physical Activity:

The ‘epidemic’ of obesity must be well known to anyone doing community work, or even who just reads the paper.

Being overweight is itself a well-established risk factor for a number of diseases. people who are overweight die at as much as 2.5 times the rate of non-obese people, and an estimated 300,000 Americans die preventable deaths each year as the result of being obese. (96)

So sprawl obviously has some share of this, creating environments where no one walks. Where it is dangerous to walk even if you wanted to, and there were somewhere to go. What features of the environment help people become more active?

Frank, Engelke and Schmid** identify three dimensions of the built environment…. land use patterns, design characteristics and transportation systems. (99)

Pikora et al*** expand on this, primarily in area of design — functional factors, safety factors, aesthetic factors and destination factors. So — a mix of different land uses, availability of sidewalks and footpaths, enjoyable scenery, the presence of other people in the space being physically active, safety.

Fucking rocket science, this is.

Injuries and Deaths from Traffic

Holy Jesus, this will make you never want to get in a car again. Over 40,000 people a year die by automobile. (110)

Water Quantity and Quality

So, you got your microbial contamination of water, your chemical contamination. You have your water scarcity. Sprawl affects all of these — thus the section titled ‘The Hydrology of Sprawl’. The rain falls, it percolates through foliage, roots and soil — cleansing itself as it does — to recharge groundwater and the water table. About half of us drink water from surface sources, and the other half from groundwater. My family drank from groundwater once, now we’re on a list, because it was contaminated. But that’s a longer story.

Forested areas are best at capturing and cleaning water, paved streets and rooftops, as you can imagine, fail completely. It all becomes chemical and pollutant-rich run-off. They give a view of what development’s effect is on this process:

Schematic view of water balance before and after development -- Center for Watershed Protection
Schematic view of water balance before and after development — Center for Watershed Protection

The stormwater runoff from suburban development contributes to microbial contamination as it ‘includes large loads of waste from pets and wildlife and nutrients from such sources as fertilizers’. Heavy runoff also carries sediment, these can protect dangerous bacteria like giardia as they sit in filters and drains. And then you have your further suburbs using wells and their own septic systems. The final way is unexpected — the continued growth of suburbs means the focus is on building new infrastructure, not repairing and cleaning out the old, which desperately need it. So our own pipes and things are poisoning us.

The chemical contamination is more obvious I think, all the toxic things we uses every day as well as those deposited by cars and exuded by factories all get swept into the water supply as well.

Mental Health

this is good to see here, I think it is left off of such analyses far too often. They remind us that sprawl is partly caused by a desire to get away from the city, into nature, into all that is good for mental health. Yet this is only one aspect of the suburbs — possibly offset by highways, sameness, box stores, speed, large scales, and just the amount of time people spend driving.

There is a whole of information on just how bad for us driving is. How it increases stress, makes us angrier. Studies on road rage. All of these things could, most likely do, contribute to morbidity.

Social Capital

This comes from community. They define such a sense of community as a

“feeling that members have of belonging, a feeling that members matter to one another and to the group, and a shared faith that members’ needs will be met through their commitment to be together.”**** There are four aspects of this sense of community: membership, influence, integration and fulfillment of needs, and shared emotional connection. (161)

They look at the many ways community psychologists, human ecologists, and sociologists have talked about community and social capital, but much of it is based on Robert Putnam’s Bowling Alone, so I won’t go on too much more here except for the ways it affects health. I’ll be dealing with Putnam too. Everyone quotes him.

Research has focused on two broad aspects of the social environment: structural features and social support. Structurally, people look at the density of relationships and extent of social networks. Social support is described as the the amount of emotional support (and other kinds?) in times of need (166. In a nutshell: People with strong social networks live longer. Lots of studies confirm it (you can see the Marmot Review on the UK). (166) The same correlations hold true for social capital.

Sprawl, on the other hand, tends to to diminish both networks and capital in several ways:

  1. Cars have much to do with this, the amount of time people spend driving restricts free time for civic engagement.
  2. sprawl ‘reduces opportunities for spontaneous, informal social interactions’ (173)
  3. ‘sprawl privatizes the public realm’, people who spend all their time at home don’t value public space, green space, suburban voters almost always vote to limit government programs with social goals or for public transportation
  4. sprawl divides people into homogenous communities.
  5. sprawl disrupts continuity of life as people age — can’t move into smaller house in the same neighbourhood (173)
  6. 1998 report from the Transit cooperative Research program found that ‘sprawl weakens households’ connection both to their immediate neighbors and to the larger metropolitan community. (174)

But it turns out that some sprawl better than others — the built environment and design can affects this, so there is some hope. But this first post is on all that is wrong, the second on what can be made right…

Health Concerns of Special Populations

I do like that there is focused attention on how sprawl impacts different groups, acknowledging that the costs of it are not even. There is a long list…Given that women are usually doing most of daily chores and chauffeuring of kids, the burden falls disproportionately upon them.

Children breath more rapidly, have narrower airways — thus pollution has much more impact on them than on adults. The lack of physical activity affects them more — and yet when they are physically active in polluted areas, it is more dangerous for them. Part of childhood is exploration of the world and the self away from parents — yet we have built spaces where that is not safe, impacting the mental health and development of kids. They are isolated, and don’t have the wealth of networks and adults watching out for them that a health community might have.

The elderly, too, are severely impacted. Communities that aren’t walkable require cars — so people drive long past the time they should not. Elders are isolated, unable to exercise, unable to have meaningful connections that improve their health and quality of life. This is often also true for those who are disabled. How dare we create cities without sidewalks.

Then, of course, there are the poor and people of colour. A reprise here for HOLC and FHA regulations, the racism that confined people into inner cities (I don’t think they quite realise how prevalent this continues to be). The steady concentration of poverty and its related health impacts in areas of higher pollution. The disparities of race in class so visible in health and morbidity statistics.

The connections are multiple and strongly evidenced. Enraging really. I like that they don’t stop there, but include a final chapter on possibilities for changing our cities and our future. That will follow in the next post.

*McCord C., Freeman, H. Excess mortality in Harlem. New England Journal of Medicine 1990; 322: 173-179.

**Frank, Engelke and Schmid (2003) Health and Community Design: How Urban Form Impacts Physical Activity, Washington D.C.: Island Press.

*** Pikora, T et al (2003) Developing a framework for assessment of the environmental determinants of walking and cycling. Social Science and Medicine 56: 1693-1703

**** McMilland and Chavis
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Environment & Justice, Gardens, Health, Smallholding, Sustainability

Masanobu Fukuoka: Sowing Seeds in the Desert

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Masanobu Fukuoka - Sowing Seeds in the DesertMasanobu Fukuoka…I have now read his first book, One Straw Revolution, and his last, Sowing Seeds in the Desert. There is such a distance between eastern and western ways of knowing and thinking, I like how provocative it is to explore the spaces between them. I like how this book sets them in dialogue. Reading Fukuoka reminds me of seeing the Dalai Lama talk at the LSE — they seem so idealistic, they speak using familiar words but in such different ways, seem so removed and unworldly and thus so easily taken advantage of by a capitalist system that thrives on co-opting everything and turning it into profit. Yet really, seems to me their points are needle sharp in deflating the engorged balloons of western, capitalist ways of knowing and valuing. If you listen.

It also, of course, resonates so much with indigenous systems, with permaculture, with struggles for biodiversity and tradition as against monoculture and many another relationship between generations and the land they are connected to.

From the editor Larry Korn, who also helped bring the first book into the world:

The most conspicuous of the cultural difficulties is that the Japanese way of telling a story or developing a complex argument is different from the approach that is generally taken in English. In Japanese, the author typically begins with the theme or the point he wishes to make, then he offers an anecdote or an argument that helps to take that story or bolster the point before returning to the theme, which is restated. Then the author goes on another loop, again returning to the theme. One might say that these side stories or arguments form the petals of a flower with the theme as its center. (xxx)

In Western writing, however, the linear is preferred. The character arc. The beginning ramping up to a climax and then a tidy conclusion. Even in our non-fiction.

There has never been a generation like the present where people’s hearts are so badly wounded. This is true of every are of society–politics, economics, education, and culture. It is reflected in the degradation of the environment, which comes about through the material path humanity has chosen. Now we have the ugly sight of industry, government, and the military joining forces in the struggle for ultimate power. (14)

I don’t know that this linear thinking can be blamed for our current world, but it is part of the larger pattern I think. Curious that old certainties about cause and effect, our capacity to know everything, so many simplifications are being increasingly challenged by new thinking in biology — and this sounds remarkably like the kind of thing Brian Greene writes about in terms of new directions in physics:

Time does not simply flow mechanically in a straight line in a fixed direction. We could think of time as flowing up and down, right and left, forward and backward. As time develops and expands, multifaceted and three-dimensional, the past is concealed within the instant of the present, and within this instant of time is concealed the eternity of the future. (26)

All made of the same things, connected at the base like a chain of islands whose tops are above the ocean

In the past, present, and future, the true disposition of nature is toward abundance for human beings and for all species. Therefore the question should not be “Why are there too many people?” but rather, “Who has created the scarcity into which they are born?” And then, finally, “How can we heal the earth so it can support future generations?” (42)

On the equality and interconnectedness of all things…

Plants, people, butterflies, and dragonflies appear to be separate, individual living things, yet each is an equal and important participant in nature. They share the same mind and life spirit. They form a single living organism. to speak of creatures as beneficial insects, harmful insects, pathogenic bacteria, or troublesome birds is like saying the right hand is good and the left hand is bad. Nature is an endless cycle, in which all things participate in the same dance of life and death, living together and dying together. (43)

It is in using massive interventions to destroy parts of the cycle, with very little understanding of it and driven by motives of profit, that we have arrived at the point of destruction. This lack of holistic understandings is endemic, seen in many a western method for solving things.

When the specialized Western medicinal approach is used, the question of what gives life and health to the whole body and mind is put off. In other words, modern Western medicines puts the human body ahead of the human spirit. This separation is a starting point for emotional anxiety among people today. (44)

Fukuoka keeps them together:

Gradually I came to realize that the process of saving the desert of the human heart and revegetating the actual desert is actually the same thing. (47)

This is all talking about land and spirit and some of us (not me, especially not any more) will be rolling their eyes. But this understanding of the capitalist economy, the ‘Money-sucking Octopus Economy’ (50) as he calls it, is interesting,  it definitely breaks things up in a different way than I am used to. At the heart of the octopus? politicians and the military-industrial-government complex. The legs?

  1. maintenance of the transportation network
  2. control of agencies administering transportation
  3. supervision of communications
  4. establishment of an economic information network
  5. education and administrative advising
  6. control of financial institutions
  7. control of information
  8. control of citizens’ personal computers and registration (53)

I like this list, it’s funny that control of land and resources is not on it.

There is nothing I don’t agree with about consumption and our economic model though:

I have often said that value does not lie in material goods themselves, but when people create the conditions that make them seem necessary, their value increases. The capitalist system is based on the notion of ever-increasing production and consumption of material goods, and therefore, in the modern economy, people’s value or worth comes to be determined by their possessions. But if people create conditions and environments that do not make those things necessary, the things, no matter what they are, become valueless. Cars, for example, are not considered to be of value by people who are not in a hurry.

Economies that aim at production and consumption of unnecessary products are themselves meaningless. (51)

Yet that is our economic model of development. And it is all about control and the marketing of products — whether luxury goods or Monsanto’s technologies:

When I went to apply for a visa from the Somalian government, I was flabbergasted when they told me that any kind of instruction that agitates the farmers and encourages them to become self-sufficient would not be welcome. If such activity went too far, they said, it would be considered treason. (76)

Colonial agricultural policies…Big money into big damns, big irrigation, drawing water from aquifers leading to salinization of land, cash crops, ending nomadic cultures resulting in massive stress on one area of the land and damage to a culture and a people, national parks that its former indigenous residents must leave, and suddenly go all the way around in their movements. The are sudden insights, like the ways that the irrigation of water in high dikes controls the people who surround it, cuts them off from free movement and free access to water. And it puts blame where blame is due:

I started with the recognition that the causes of desertification in most areas are misguided human knowledge and action. If we eliminated them, I believed that nature would certainly heal itself. (87)

It examines the real costs of our current agricultural practices of GMOs, monocropping and etc — Fukuoka writes ‘Agricultural “Production” is Actually Deduction’ (88):

If you really count all the inputs of cost to the environment, mining and fossil fuel extraction, construction of machinery, damage from cash crops etc, we have the most inefficient agricultural systems possible…

It is not just in Africa that these problems exist.

About half of the land in the United States is, or is becoming, desert. I felt that the expanding American desert was at least as great a problem as the deserts of Africa, but most Americans seemed totally unaware that their country is becoming more arid. (123)

We don’t talk about those kinds of things, but it threatens the communities, like New Mexico’s acequia farmers, most likely to offer hope and the capacities to sustainably grow food in increasingly arid condition.

I do like that he toured the US saying this kind of thing:

Everywhere I went I preached the abolition of lawn culture, saying that it was an imitation green created for human beings at the expense of nature and was nothing more than a remnant of the arrogant aristocratic culture of Europe. (129)

This philosophy is a very particular way, very Japanese way of embracing the world, of changing it.

When people are released from the idea that they are the ones who have created things and have abandoned human knowledge, nature will return to its true form. The rebirth of nature is not simply a return to the primitive, it is a return to the timeless. My method of natural farming aims at liberating the human heart… (140)

I loved this final quote, partially a reminder that even if we are not the ones who love land and roots as farmers, we still can live in sustainable ways. But mostly it is good to encounter — to know — that radically different ways of being are still possible in this world:

I still remember the words of an Ethiopian tribesman who at first rejected my ideas of natural farming. “Are you asking me to become a farmer?” he asked. “To be attached to the soil and to accumulate things are the acts of a degraded person.” (52)

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Health

Exploring the role of the apothecary within paintings

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You had your Greeks and Romans writing about health and concocting new medicines, but I confess until Krakow’s Museum of Pharmacy I had not heard of Christ, the Heavenly Apothecary.  It was quite a thing:

Museum of Pharmacy, Krakow

Yet also a rather rare and not-much-discussed thing, as I discovered to my cost trying to puzzle out the not-very-crisp photographs of these paintings which I blithely assumed I could easily find on the internet. Here it states this idea of Christ as Apothecary was first introduced into Western Art in 1610 by, I believe, Michael Herr of Wurttemberg, and 140(ish) examples are known to exist in the form of stained glass, frescoes, paintings in shrines and monasteries and more. I also found a rather lovely early article on the subject by E. Kremers from 1910, called appropriately ‘Christ the Apothecary’, at that time there were only about ten known about.

Not until reviewing my pictures did I realise quite how awesome the paintings were in the museum, and how rich in meaning and how hard it would be to find more information on the web. I was a bit overwhelmed, I think, by stoppered bottles and beautiful wood and stuffed bats and dried mummies. So I have a few shots, too few, and the descriptions are sadly hit and miss. What I wouldn’t have given for a book in English! These were two of my favourites:

Museum of Pharmacy, Krakow

These are Saints Cosmas and Damian, twin brothers who trained as physicians in Arabia, worked in Turkey and were martyred in Syria. Here (unlike elsewhere) they are portrayed as Black.

Museum of Pharmacy, Krakow

I failed signally to document the artist or title of the picture above. Below, however, are two graphite retorts for dry distillation (high temperature, no air). This were contemporary with Michał Sędziwój (Michael Sendivogius), famed Polish alchemist who published treatises on alchemy distributed across Europe. Such experiments provided the basis for many new medicines. This is a painting by Jan Matejko showing Sędziwój  carrying out experiments for King Segismund III — pulling out a nugget of gold from the fire no less — he had his own room in Wawel Castle, which momentarily made me more inclined to go see it (later, the line for tickets disinclined me).

Museum of Pharmacy, Krakow

Below is a picture from a memoir (Memoir! Amazing! but I can find nothing about this) of apothecary Eglinger (1608-1675) of Basel, using a heavy mortar and pestle, it’s use made easier through the rigging up of a bow string. That woman is possibly the goddess of fortune pouring things through the horn of plenty into his concoctions. It could maybe also be his wife I’m thinking, but I’ve no basis for that.

Museum of Pharmacy, Krakow

This next one is awesome, from a series of illustrations by Jan Van der Straet called Nova Reperta, or New Inventions, which I believe I will come back to one day because it is quite extraordinary. He published this in about 1580, and it shows in action many of the things visible throughout the museum — alembics, the pestle and mortar, presses and forges and all sorts.

Museum of Pharmacy, Krakow

This is one of my other favourites as its title is ‘The Death of Credit’. The character on the far right is an apothecary, sadly I would only be inventing things if I told you quite what this picture meant or who painted it or when.

Museum of Pharmacy

Again, for the picture below I have neither title nor artist, but this is a good painting of the days when apothecaries pulled out teeth. I would not wish those days back again.

Museum of Pharmacy

Yet another picture in which I have failed to capture the title or artist, but look, it is a very old apothecary with people in hats I associate with the Renaissance behind the counter and shelves full of bottles…

Museum of Pharmacy, Krakow

Apothecaries are also found sitting sedately on embossed metal:

Museum of Pharmacy, Krakow

Their craft immortalised in stained glass:

Museum of Pharmacy, Krakow

And in statues

Museum of Pharmacy, Krakow

I have signally failed to educate myself or you about the precise nature of these paintings or what precisely can be learned from them, however.

For more on apothecaries:

More posts on Poland:

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