Wellbeing through Participation:
The Relevance of the Peckham Experiment in the 21st Century
By Magdalena Zasada
“Peckham was as much (or more) a social experiment as it was a medical experiment.
Its greatest lesson was that the social was necessary to the medical.”
(Young 1985)
In 1926 two doctors set out to study health at the Pioneer Health Centre, Peckham. Their reasoning was unorthodox
and ground-breaking. To date, medical services were concerned predominantly with the study of disease and its cure,
but George Scott Williamson and Innes Pearse wanted to study the multiple dimensions that combine holistically into
health. They wanted to create an environment for local families that would enable physical, psychological, social and
spiritual wellbeing (Scott-Samuel 1990).
The Pioneer Health Centre is not considered here as a scientific experiment studying the nature of health, but as a
social initiative designed to improve a community’s health and wellbeing. Recently many of the issues identified by
Williamson and Pearce have become topical, and similar approaches to health promotion have been suggested,
despite policymakers and practitioners not being familiar with the Peckham Experiment and its successes.
Recognising its contemporary relevance is therefore even more valuable.
The Peckham Experiment – diagnosing and treating the social ailment
The Pioneer Health Centre was established by Williamson and Pearse in a small house in Peckham as a ‘family club’.
It served primarily social purposes, but health-related information was readily available; there were ante-natal and
post-natal clinics, and all members had yearly health checks. The doctors hoped to find out if enhancing their
environment would encourage families to take greater responsibility for looking after their health.
The doctors recruited a seemingly healthy population who had declared wellbeing, though most had some minor
ailments. If it was necessary, individuals were referred to hospital consultants; but over three years it was observed
that “Health and vigour were not necessarily increasing with the greatly increased volume of medical care being
provided” (Pearse 1979 p. 7). Williamson and Pearse realised that there were no appropriate facilities where health
could be cultivated through physical and social activity. Consequently funds were raised for the construction of a
purpose-built centre comprising an Olympic-sized swimming pool, gymnasium, cafeteria, nursery, consulting rooms
and indoor and outdoor ‘social’ spaces to satisfy all age groups. It opened in 1935, and for many became an extension
of their family home and the focus of their social lives.
The holistic approach to wellbeing employed by the Centre staff allowed great insight into the causes and nature of the
‘social deficiencies’ experienced by individuals prior to joining the Centre. Social isolation, leading to disorders in
family life, and therefore particularly affecting the wellbeing of children, was identified through observation and family
consultations as a common concern to all social classes. “With the figures for physical disease and disorder before us,
it is no surprise that we should find corresponding disorder and absence of function in the psychological and social
realm” (Pearse & Crocker 1943 p. 273). Data collected through the annual health checks revealed that in the 20 – 45
year-old age group, women suffered more disease, disorder and deficiency than men (Pearse & Crocker 1943 p. 254225). It was quickly established that women’s social circumstances after marriage often left them with little opportunity
to develop and use their skills and maintain regular social contacts. This was amplified by another problem, the
“prevailing ignorance of the young mother in domestic matters” (Pearse & Crocker 1943 p. 256). It was concluded that
social changes1 meant that as younger women, mothers had been increasingly kept away from any housework whilst
being encouraged to get an education and start a clerical career before marrying. The transition to the role of
housewife and mother, for which they lacked skills and to which they consequently dedicated minimal effort, led to
1
Families were getting smaller, and increasing prosperity made consumer goods, appliances and services available reducing the
burden of usual household chores like cooking, washing or mending clothes.
1
increasing frustration and apathy because of a sense of alienation and little opportunity to engage in meaningful
activities. It was concluded that the families were drawn into a vicious circle:
“In the poverty of present-day social life, even those with healthy appetites are forced in upon themselves, the
family being driven to sustain itself egoistically – instead of altruistically in mutual synthesis with its environment”
(Pearse & Crocker 1943 p. 248-249).
The Peckham staff attributed this to a prevailing lack of opportunities:
“It is not wages that are lacking; nor leaders; nor capacity; certainly not goodwill; but quite simple – and one
would suppose ordinary – personal, family, and social opportunities for knowledge and for action that should be
the birthright of all” (Pearse & Crocker 1943 p. 274).
The doctors were able to identify and address these issues as a result of practicing what is now termed ‘social
medicine’; an approach that is “interested in the health of people in relation to their behaviour in social groups and as
such is concerned with care of the individual patient as a member of a family and of other significant groups in his daily
life”(S. Kark & E. Kark 2006 p. 115). Addressing this ‘social pathology’ of isolation and disengagement was considered
as crucial to the amelioration of minor physical disorders, although to external observers these underlying issues
would have seemed trivial, as their impact was not readily visible.
In their approach to running the Centre, Williamson and Pearse had pre-empted much later developments in health
promotion practice, which in 1986 was defined as “ the process of enabling people to increase control over, and to
improve, their health” (World Health Organisation 1986 p. 1). They adopted what is now termed a community
development approach understanding community to be “the result of a natural functional organisation in society, which
brings its own intrinsic impetus to ordered growth and development” (Pearse & Crocker 1943 p. 292). They believed
that a conducive social environment could make health more ‘contagious’ than disease. Health messages regarding
fitness, nutrition and early-years development were spread in the Centre through spontaneous interaction between
members and staff. For example, there was no need to advertise or campaign for child immunisation: “The Centre has
aroused an “appetite” for parental action and has avoided the necessity for persuasion or coercion” (Pearse & Crocker
1943 p. 286).
This approach necessitated a change in the relationship between ‘medical professionals’ and individuals, and this
allowed for a shift in responsibility. It was no longer the doctors’ role to “fix” their patients’ disorders, rather their
stepping back permitted individuals to embrace the opportunities and facilities available through the Centre and,
almost unknowingly, make appropriate lifestyle changes. It was acknowledged that it was not easy for professionals to
distance themselves from their roles, and some working at the Centre experienced frustration “arising from the
withdrawal of an ‘authority’ deriving from a training which tacitly endows him with power of persuasion over persons”
(Pearse 1979 p. 30). There was, however, a strong belief in the value of autonomy:
“Individuals, from infants to old people, resent or fail to show any interest in anything initially presented to them
through discipline, regulation or instruction which is another aspect of authority” (Ward 1985).
As a result, the Centre had “shown itself to be a potent mechanism for the ‘democratisation’ of knowledge and action”
(Pearse & Crocker 1943 p. 78). It was very quickly proven that people left to their own devices organised themselves
very effectively, and members choosing to do things on their own initiative produced a richer social environment than
would have been achieved by the more traditional, structured approach. It was identified that the lack of engagement
may be an issue of self-belief or, for some older members, “consciousness of disability” (Pearse & Crocker 1943 p.
266). They were often provided with discrete instruction, encouragement and support from friends and family, and this
contributed to a rise in self-assurance. Members acquired new skills through mutual influence, whether it was children
learning how to play badminton or an expectant mother learning how to care for a baby. People naturally took on
‘expert’ roles as they gained experience and confidence.
The Peckham Health Centre’s considerable social stimulus led to greater community cohesion and a sense of
ownership relating to the Centre. Pearse asserted that the post-war re-opening of the Centre was possible largely
because of the involvement and time-contribution of past members to the enormous task of renovation; and that this
provided ample evidence that the Experiment had a lasting effect – 550 of the original 875 families rejoined
2
immediately. She recalls: “Seven years of war had passed, but these member-families walked into their building as
though they left it only the day before” (Pearse 1979 p. 87). It has been suggested that community integration, together
with the creation of social support networks, were the most important achievements of the Experiment (Scott-Samuel
1990).
Recurring complaints
Over 60 years have passed since the Peckham Health Centre closed; however, the key issues identified there as
barriers to improving health have not disappeared. I would argue that in the last few decades, British society has made
significant progress in the organisation and delivery of medical care; it has failed, however, to appropriately address
the social issues underlying poor health. As in the pre-war period, the focus remains on the ‘health service’;
understood as institutions providing effective medical treatment of precisely diagnosed ‘disorders’.
Public
deliberations have been concerned with issues of budget holding, organisational structure, necessary efficiency
savings, quality of hospital care, and competing interests in the commissioning process.
Social circumstances have now been further confirmed as triggers or aggravating factors of many common
‘medicalised’ health conditions, as was perceived by the Peckham doctors. Enhancing people’s social environment
and addressing, or sometimes implicitly challenging, cultural norms, social perceptions and habits was demonstrated
to be effective in the Pioneer Health Centre and it is now an established way of ‘cultivating health’. Health psychology
has proven health behaviours to be both actor-driven and socially-imposed through culture, institutions and the
surrounding environment (Ogden 2000); and a high proportion of premature deaths is still caused by ‘diseases of
lifestyle’ (Department of Health 2010).The Marmot Review (Marmot 2010) demonstrated that wellbeing in England is
significantly influenced by ‘social determinants of health’, with individuals who are already disadvantaged by age,
disability, ethnic background or neighbourhood deprivation being most affected by social isolation (see also: Barnes
1999; Bennett et al. 2009). There is considerable evidence that social support positively affects morbidity and mortality
(Uchino 2006), whilst promoting mental wellbeing (Golden et al. 2009). Nevertheless the impact of social factors on
health is still overlooked by health professionals and underdeveloped in health promotion.
The policy response to these issues in the UK is being presented as a ‘new’ vision of community-based health
promotion: “We need a new approach that empowers individuals to make healthy choices and gives communities the
tools to address their own, particular needs” (Department of Health 2010 p. 2). It is in fact quite obvious that this
proposal is the exact approach endorsed by Williamson and Pearse over 80 years ago. Nevertheless, finding the
appropriate ways for this policy to be implemented remains a key challenge today.
It is assumed that engagement in local programmes can overcome the barriers that exclude certain groups and
individuals. ‘Choice’ (Greener 2009) and ‘empowerment’ (Bridgen 2004) have been popular in policy discourse for
many years; however, those whose needs remain unmet often have limited confidence and restricted opportunities to
become actively involved in community initiatives. It is argued that statutory agencies are often not best positioned to
manage these initiatives because of their authoritative status:
“The legacy of paternalism will not easily be challenged by the newfound commitment to empowerment,
especially if this is, in itself, perceived by some as a top-down policy priority” (Alcock 2004 p. 92).
It has been suggested, however, that community organisations are better predisposed to fulfil this role:
“The third sector is well placed to access communities and identify assets that would extend community
networks, engaging and supporting individuals and developing community infrastructure through self-help,
unpaid work and voluntary endeavour” (Marmot 2010 p. 160).
Their independence also means that they can maintain a dynamic organisational culture that encourages creativity,
innovation and spontaneous action. With this in mind I have undertaken a research project exploring how the health
promotion methods of pre-war Peckham are applied in communities today.
The community cure reinvented
There is no contemporary initiative directly comparable to the Peckham Health Centre. I am therefore carrying out
case studies of health-focused community development charities working in disadvantaged neighbourhoods to find out
3
how they are addressing the social issues underlying poor health outcomes. These organisations are neighbourhoodbased and have extensive local knowledge, giving them unparalleled insight into social circumstances and making
them well placed to bring together disparate groups: generations, ethnic minorities, and social classes. I have
interviewed their trustees, managers, community workers and volunteers, as well as observing their activities, to gain
maximum insight into their work and the challenges they face. As a result of these studies, some interesting parallels
can be drawn with Williamson and Pearse’s work.
Firstly, not being limited by a ‘service specification’ allows community organisations to adopt a holistic approach, and
being able to support people in maintaining wellbeing prior to the discovery of any issues requiring medical attention.
This was identified by several of my respondents as an area that is currently not being attended to through Primary
Care:
But I think it is also to do with the medical model and only wanting to treat people when there is a disease, a
syndrome, a symptom, rather than looking at how do we enable people to maintain their health so that they don’t
turn into a patient, they’re still a person. And I don’t think that is due to a prejudice of people within the NHS, (…)
it comes down to a GP model where you don’t see your GP unless there is something wrong. [Trustee]
A community-focused approach also fully acknowledges the importance of participation and engagement in
maintaining health, so activities have sharing and mutual learning at their core, as was the case at Peckham. When I
watched individuals who only a short time before were living on the margins of society participate in a cooking class, it
was remarkable how eager they were to share their knowledge and skills. They later told me how participating in
consecutive sessions has not only boosted their confidence in the kitchen and provided a positive experience of
teamwork, but also greatly improved their overall self-esteem.
The community workers who I interviewed told me about people presenting symptoms of mild depression (who would
have otherwise been routinely prescribed medication by their GPs) recovering, simply as a result of being helped to
find their way out of isolation. They attributed their success to recognizing the value of simple activities that can help
individuals regain a feeling of control over their lives:
It’s actually about the enjoyment of being creative; I don’t think we’re allowed to be creative anymore. (…) if we
can’t enable people to be creative, be it through their cooking, be it through their walking, then we’ve lost
something. (…) empowerment, it’s just allowing that aspect to be engaged with something, and that enables
them to feel that they can do something for themselves, that makes something within themselves feel good
which then progresses. [Manager]
The second key issue brought out by my research is the empowering effect of the community workers not exercising
authority over the people they work with. It was suggested that coming from a charity they were more likely to foster
confidence and engagement as they were not directly associated with statutory agencies that have a strong presence
in deprived areas. Lay involvement in health promotion has been shown to be beneficial because of their more
informal relationships – this has been endorsed by public health academics (South et al. 2011), and was expressed by
my respondents:
The people we employ to engage with the community, they don’t come with eight hundred degrees, although
they are very well qualified, they are from and out of the community, they are down to earth, they talk to you on a
level, they can come out with all sorts, they’re just normal, ordinary people, they don’t come in wearing white
coats [Trustee]
The approach of doing things ‘with’ – not ‘to’ – the people concerned, for example through involvement in deliberative
processes, has proven to have broad social benefits (see for example: Our Life 2011). Firstly, it accurately identifies
people’s barriers to making healthier choices. This means that relatively simple measures can be taken locally to
create a more supportive environment; for example, an affordable community gym has been set up with separate
facilities for female users to overcome cultural barriers. Crucially, the opportunity to take initiative and acquire new
skills has been found to increase self-confidence and self-reliance (Our Life 2011), allowing local initiative to flourish.
In my research I encountered a food co-operative selling high quality produce at cost price. This was established with
minimal organisational support, and no previous retail experience, by a group of residents from a deprived estate; it
4
was inspired by a citizens’ jury carried out three years ago. In this time they have trained at least a dozen new
volunteers and are now expanding to provide a mobile service for more remote communities.
The organisations I am studying provide many other valuable opportunities for participation, collaboration and
individual growth in the neighbourhoods they serve. I would argue that they have managed to facilitate social
integration and build support networks in a manner that Williamson and Pearse would probably have whole-heartedly
approved of.
Conclusion
Despite the success of the Peckham Experiment, and substantial evidence demonstrating the effectiveness of existing
community organisations, such initiatives have a low-profile in health policy debates. Many of my respondents claim
this is because of their role being neglected by policymakers and practitioners, and because of the prevalent
perception of ‘professional’ healthcare agencies as having sole authority on health-related issues remaining widely
unchallenged:
The fear of people thinking you’re stepping on their toes, lots and lots of professional snobbery (…) what I know
about is how to take it [health] to communities and getting people involved. (…) I’m not going to go off to give
people treatment [Manager]
The ‘cultivation of health’ in diverse and socially excluded communities remains a key challenge today. There are
some limitations to the Peckham model that would make it inadequate for direct implementation; there is no mention,
for example, of the Peckham doctors addressing the issues of drugs, tobacco and alcohol misuse – today widely
recognised as contributors to morbidity and premature death rates. Furthermore, it needs to be acknowledged that
society has changed since the 1940’s – communities are less settled and significantly more ethnically diverse, family
roles and structures have undergone transformation, health and caring roles are more professionalised, and statefunded community initiatives are heavily regulated. Nevertheless, the Peckham Experiment’s participatory model of
facilitating people in taking control of their own health can still provide ample inspiration for health promotion initiatives.
The Peckham Health Centre can be considered a trailblazer for contemporary organisations applying the community
development approach to improving health and wellbeing.
REFERENCES
Alcock, P., 2004. Participation or pathology: contradictory tensions in area-based policy. Social Policy and Society,
3(2): 87-96.
Barnes, M., 1999. Users as citizens: collective action and the local governance of welfare. Social Policy and
Administration, 33(1): 73-90.
Bennett, F., Nazroo, J. & Popay, J., 2009. Report of Task Group 9: Social Inclusion and Social Mobility, Institute of
Health Equity. Available at: http://www.instituteofhealthequity.org/projects/social-inclusion-and-social-mobilitytask-group-report [Accessed December 15, 2011]
Bridgen, P., 2004. Evaluating the empowering potential of community-based health schemes: The case of community
health policies in the UK since 1997. Community Development Journal, 39(3): 289-302.
Department of Health, 2010. Healthy Lives, Healthy People: Our strategy for public health in England. Available at:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127424.pdf [Accessed
September 24, 2011]
Golden, J., Conroy, R.M. & Lawlor, B. A, 2009. Social support network structure in older people: underlying
dimensions and association with psychological and physical health. Psychology, health & medicine, 14(3): 280-90.
5
Greener, I., 2009. Towards a history of choice in UK health policy. Sociology of health & illness, 31(3): 309-24.
Kark, S. & Kark, E., 2006. A practice of social medicine. Social Medicine, 1(2): 115-138.
Marmot,
M.,
2010.
Fair
Society,
Healthy
Lives.
The
Marmot
Review.
Available
at:
http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review [Accessed September
23, 2011]
Ogden, J., 2000. Health Psychology: A Textbook. Buckingham: Open University Press.
Our Life, 2011. Talking Food: Taking Action - case study. Available at: http://www.ourlife.org.uk/silo/files/case-study-talking-food-taking-action.pdf [Accessed September 23, 2011].
Pearse, I., 1979. The Quality of Life, Edinburgh: Scottish Academic Press.
Pearse, I. & Crocker, L., 1943. The Peckham Experiment. A study in the living structure of society., London: Allen and
Unwin.
Scott-Samuel, A., 1990. Total Participation, Total Health. Reinventing the Peckham Health Centre for the 1990s,
Edinburgh: Scottish Academic Press.
South, J., Branney, P. & Kinsella, K., 2011. Citizens bridging the gap? Interpretations of volunteering roles in two
public health projects. Voluntary Sector Review, 2(3): 297-315.
Uchino, B.N., 2006. Social support and health: a review of physiological processes potentially underlying links to
disease outcomes. Journal of Behavioral Medicine, 29(4): 377-87.
Ward,
C.,
1985.
Peckham
Revived?
New
Society,
20(27).
Available
http://marylangmanprize.org.uk/component/content/article/3-reviews/17--peckham-revived-by-colin-ward.
[Accessed December 15, 2011]
at:
World Health Organisation, 1986. The Ottawa Charter for Health Promotion. First International Conference on Health
Promotion, Ottawa, Available at: http://www.who.int/hrp/NPH/docs/ottawa_charter_hp.pdf [Accessed February 1,
2012]
Young, M., 1985. The Peckham Experiment. Available at:
http://marylangmanprize.org.uk/component/content/article/3-reviews/16-the-peckham-experiment-by-michaelyoung. [Accessed December 15, 2011]
6