Tag Archives: health

The Spirit Level — Can we just get on with greater equality already?

The Spirit LevelThe Spirit Level marshals all the evidence — for those who needed such evidence — that inequality has a huge negative impact on everyone in a society, the rich as well as the poor. But especially the poor.  There is of course, a minimum level of security and income which human beings require. Many do not enjoy such a level. But for those who do, it still isn’t enough to guarantee a full and happy life:

Economic growth, for so long the great engine of progress, has, in the rich counties, largely finished its work. Not only have measures of wellbeing and happiness ceased to rise with economic growth but, as affluent societies have grown richer, there have been long-term rises in rates of anxiety, depression and numerous other social problems. (5-6)

This is good book full of evidence that it is the degree of equality in a  country which leads to longer, happier lives and a stronger society.

Poverty itself is a bit of a slippery concept if you think too hard, I liked this quote from Marshall Sahlins:

Poverty is not a certain small amount of goods, nor is it just a relation between means and ends; above all it is a relation between people. Poverty is a social status . . . It has grown . . . as an invidious distinction between class . . . (Stone Age Economics, quoted p 15)

Poverty as a relationship — it makes sense that this relationship is what matters above the bare minimum required for life.

Their graphs are simple, direct — only as good as their data of course, but that is well documented…This one is from p 20 and p 174, so good they showed it twice!


The best indicator for the whole gamut of health and social problems in rich countries is not poverty, but the difference between rich and poor. Reduce inequality, and you should see marked improvements in all of them.

How Inequality Gets Under the Skin

I read this over the summer, but it’s weird going back over my notes after Trump’s victory, especially reading things like this:

The growing rates of anxiety in the U.S. are very depressing indeed, yet they correlate to more aggressive declarations of self worth.

The answer turns out to be a picture of increasing anxieties about how we are seen and what others think of us which has, in turn, produced a kind of self-promoting, insecure egotism which is easily mistaken for high self esteem (36).

I’m always a little skeptical how we ascertain how society is changing us more broadly, but this rings true. Still, it is hard to analyze the water in which you’ve grown up in. They connect these kinds of psychological anxieties with inequality, and then tend to almost conflate the two in trying to explain the correlation between inequality and many of the social ills and illnesses examined as the multiple indicators of health and wellbeing.

Part 2 — The Costs of Inequality:

So for the great list of indicators:

  • Mental health and drug use
p 67. reproduced at http://thestandard.org.nz/wp-content/uploads/2010/09/spirit-level-5-620x465.jpg
p 67. reproduced at http://thestandard.org.nz/wp-content/uploads/2010/09/spirit-level-5-620×465.jpg

One of the things they cite is Oliver James on the

‘affluenza’ virus…is a “set of values which increase out vulnerability to emotional distress”, which he believes is more common in affluent societies. It entails placing a high value on acquiring money and possessions, looking good in the eyes of others and wanting to be famous. (69)

Interesting, depressing, you can see how hard this would be to live up to.

  • Physical Health and life expectancy

They cite more than 40 papers on the links between health and social capital have now been published. (See M.K. Islam, J. Merlo, I Kawachi, M. Lindstrom and U.G. Gerdtham, ‘Social Capital and health: does egalitarianism matter? A literature review’, International Journal for Equity in Health (2006) 5:3.)

Increasing social capital and reducing inequality improve health across the society, just throwing more money at it doesn’t. Probably because most of that money doesn’t actually go towards health, as in the US, but towards corporate profits, but that’s another story I suppose. Looking at this chart and realising that of all these countries the US is the one that doesn’t actually provide universal healthcare despite the obscene of money going into healthcare makes some sense of the outcomes, and makes you feel sick at the same time. Sadly, there’s no cure for that other than some serious structural changes. Like all of this really.


  • Obesity: Wider income gaps, wider waists — correlates to inequality.
  • Educational performance — correlates to inequality.
  • Teenage births: recycling deprivation — correlates to inequality.
  • Violence: gaining respect — correlates to inequality.

They note that inequality is ‘structural’ violence, and statistically it matches up with…inequality. Again, they connect this inequality with the anxieties that emerge from our unequal society:

…increased inequality ups the stakes in the competition for status: status matters even more. The impact of inequality on violence is even better established and accepted than the other effects of inequality. (134)

  • Imprisonment and punishment — inequality

I’ve read lots about the crazy amounts of incarceration in the US, The New Jim Crow is miles and away better than this summary. But one fun fact

In California in 2004, there were 360 people serving life sentences for shoplifting. (147)

Jesus wept. And of course, there is this on p 148:


I have to note that in many of these charts I couldn’t initially find the US because it is so often alone up at the top…This chart makes me sick too.

Another brief note they make, there is so much to dig into here but it’s interesting:

In societies with greater inequality, where the social distances between people are greater, where attitudes of ‘us and them’ are more entrenched and where lack of trust and fear of crime are rife, public and policy makers alike are more willing to imprison people and adopt punitive attitudes… (155)

  • Social mobility: unequal opportunities — inequality

This is so geared towards statistics and policies, digging through data more than into experience, but every now and then they drop into higher theory, like Bourdieu writing about ‘the actions by which the elite maintain their distinction symbolic violence…’ (164) I had forgotten he wrote about this, this book underlined for me the very strong connection between inequality and violence, inequality as violence, and how that underpins everything else.

Part 3 — a better society

I appreciated that they ended The Spirit Level with some thoughts bringing everything back together, and from there thinking through what change is possible. There was some interesting things on the racial divides in the US, and again and again this book underlines that while the poor suffer from inequality most, really it is everyone who suffers. Maybe that will have some impact? Though it doesn’t seem to have had yet…

in the USA, state income equality is closely related to the proportion of African-Americasn in the state’s population. The states with wider income differences tende to be those with larger African American populations. The same states also tend to have worse outcomes…among both the black and the white population. The ethnic divide increases prejudice and so widens income differences. the result is that both communities suffer…

So the answer to the question as to whether what appear to be the effects of inequality may actually be the result of ethnic divisions is that the two involve most of the same processes and should not be seen a alternative explanations. The prejudice which often attaches to ethnic divisions may increase inequality and its effects. Where ethnic differences have become strongly associated with social status divisions, ethnic divisions may provide almost as good an indicator of the scale of social status differentiation as income inequality. (179)

It is interesting to look at how the numbers brought Pickett and Wilkinson to these findings that are more often found elsewhere. Again and again the message — inequality hurts the poorest most, but it negatively impacts everyone. Reducing inequality benefits everyone. Evidence also suggests it should make rich countries care more about reducing the terrible inequalities between countries — little sign of that despite how desperately — perhaps even more desperately — that is needing recognition, but the more arguments made the better. This is just a building block in working towards ensuring equality remains on the agenda.


There’s a whole section on ‘can this be done?’, can we create more equal societies, but honestly. They themselves make the point that some countries have done it already.

Another truth;

systems of material or economic relations are systems of social relations. (199)

So what is their solution? They look to worker owned business, cooperatives, give example of Tower Colliery, where miners successfully took over pit operation, combining redundancy money to buy the pit in 1995, for 15 years until seam was mined out. They also, in the bigger picture, argue for what they call a steadd health: does egalitarianism d by economist Herman Daly. (220) I’ll have to look more into this and always prefer to start with the source, so to just finish up with some of their final findings.

Evaluations of even some of the most important services, such as police and medical care, suggest that they are not among the most powerful determinants of crime levels or standards of population health. Other services, such as social work or drug rehabilitation, exist to treat — or process — their various client groups, rather than to diminish the prevalence of social problems. (233)

even more damning, this is my personal favourite sentence:

Rather than reducing inequality itself, the initiatives aimed at tackling health or social problems are nearly always attempts to break the links between socio-economic disadvantage and the problems it produces. The unstated hope is that people — particularly the poor — can carry on in the same circumstances, but will somehow no longer succumb to mental illness, teenage pregnancy, educational failure, obesity or drugs. (234)

So really this is an economic and a political problem, they write

The historical evidence confirms the primacy of political will. (238)

Behind this lack of political will? Multiple reasons of course, one being the decline of the trade unions — their decline in power has itself made possible a great deal of this growing inequality. There’s also the fact that many corporations have bigger economies than many a nation state. They quote the UN Conference on Trade and Development (UNCTAD):

Twenty-nine of the world’s 100 largest economic entities are transnational corporations (TNCs)… On the 200 TNCs with the highest assets abroad in 2000, Exxon is the biggest in terms of value added ($63 billion). It ranks 45th on the new list, making it comparable in economic size to the economies of Chile or Pakistan. Nigeria comes in just between DaimlerChrylser and General Electric, while Philip Morris is on a par with Tunisia, Slovakia and Guatemala. (244)

Small wonder they walk with such big sticks. Small wonder higher levels of equality should be so hard to achieve, despite the improvements it makes to everyone’s quality of life.





Sprawl, Health, and creating better cities through Smart Growth

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…




Urban Sprawl and Public Health

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: 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:


‘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




Exploring the role of the apothecary within paintings

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:






Mummies, lizards, stones: the wondrous ingredients of old medicines

Again, the line between alchemist and apothecary was once very fine, and the things once used to create medicine were wondrous indeed. Many also suspicious, invented, disgusting. And far too many argued as aphrodisiacs.

Of course there were herbs, wondrous herbs. The smell in the attic of Krakow’s wondrous Pharmacy Museum was amazingly pungent and sweet.

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Dragon’s Blood, sadly only a combination of powdered plants with astringent qualities:

Museum of Pharmacy, Krakow

Mandrake, not a screaming homunculus pulled from the earth, but a funny shaped root:

Museum of Pharmacy, Krakow

Herbs, roots, flowers, leaves, seeds were not the only things used in medicines, however. Clay and other minerals dug from the earth such as lazurite, orpiment, sulphus, chalcanthite, and talc were also used. Here is cinnabar for treating wounds and ‘women’s problems’, and today used for acne — I love these intensely coloured powders.

Museum of Pharmacy, Krakow

Hematite powered and used to cleanse wounds and to treat blood diseases. Copper sulfate good for scars, and for its antibacterial properties.

Museum of Pharmacy, Krakow

Skinks! Dried and ground they became a ‘panacea’ for many things, and the old aphrodisiac standby…

Museum of Pharmacy, Krakow

Powders of scorpions, snakes and lizards — powdered cockroaches, crab’s stones, powdered oysters, sea sponges, musk, earthworm oil and leeches were also of course in use:

Museum of Pharmacy, Krakow

Castor, or the powdered glands of beavers — look at that picture! A stimulant, antispasmodic, good for hysteria from sexual causes…

Museum of Pharmacy, Krakow

Spermacetti, or sperm whale oil…

Museum of Pharmacy, Krakow

‘Unicorn horn’, powdered, good as a universal antidote and of course, an aphrodisiac. Really, narwhal of course, or anything approaching powdered horn…

Museum of Pharmacy, Krakow

Powdered horn, and ivory looks just like it, tusks of walrus and hippopotamus…once believed a universal cure and aphrodisiac:

Museum of Pharmacy, Krakow

Bezoars! found in the stomachs of ruminants, they look very cool but are really just hollow spheres made up of fur and undigested plant remains. But I still love imagining them as universal cures…

Museum of Pharmacy, Krakow

Spanish flies, whose smell alerts you to their presence, who blood causes painless blisters. Crushed they were used as a diuretic, but more famously as an aphrodisiac and older form of viagra — but you had to be very very careful you didn’t get it wrong…

Museum of Pharmacy, Krakow

Human scalp made into a panacea — also collected and used were human fat, ox bile, bull’s blood, and calf’s stomach.

Museum of Pharmacy, Krakow

Powdered mummy:

Museum of Pharmacy, Krakow

Dried lizards, coral and pearls:

Museum of Pharmacy, Krakow

Pharmacists were also apparently the principal makers and purveyors of candles and sealing wax until the 18th century, as wax was another key ingredient in ointments and plasters. I loved this way of making them:

Museum of Pharmacy, Krakow

And of everything, perhaps this was the most incredible…Multiple use laxative pills of antimony. Crikey. You had to swallow — retrieve — clean — repeat.

Museum of Pharmacy, Krakow

Suddenly I realised it is not just the rows of bottles and jars, the mysterious names in Latin, but also the colours, smells, madness of what they held within them. The dreams they represent of cures for everything, of magic in the form of a powder or oil or pill. The intellectual endeavour they also represent, to explore the world and uncover what within it can ease our way through life and improve the days and years we are given. I owe so much to medicine as we know it, and its origins are here in these bottles and in this lore drawing on centuries of experimentation and learning.

For more on apothecaries:

More posts on Poland:







Glass, Wood, Animals, Books: The wonders of old pharmacies

Only a thin line separated alchemy from old pharmacies once. Apothecaries (who only later became the mystery-stripped ‘pharmacies’ or even worse ‘drug stores’) once contained wondrous collections of barrels, bottles, alembics, retorts, crucibles, pestles and mortars, animals whose bodies and bones were crushed and used in medicines. Of the medieval collections in Krakow’s Pharmacy Museum, the notes quote Shakespeare:

I do remember an apothecary—
And hereabouts he dwells—which late I noted
In tattered weeds, with overwhelming brows,
Culling of simples. Meager were his looks,
Sharp misery had worn him to the bones,
And in his needy shop a tortoise hung,
An alligator stuffed, and other skins
Of ill-shaped fishes; and about his shelves
A beggarly account of empty boxes,
Green earthen pots, bladders and musty seeds,
Remnants of packthread and old cakes of roses,
Were thinly scattered to make up a show.
–Romeo & Juliet, Act 5, Scene 1
This is Krakow’s museum in a nutshell. From the medieval section:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Cabinets of poisons clearly marked to avoid accident:

Museum of Pharmacy, KrakowMuseum of Pharmacy, Krakow

Great vaulted cellars, full of more wondrous things, above all the medicinal wine, either steeped in herbs or to be later mixed with dried herbal powders:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

We found this hidden round a corner. I don’t even know what this is.

Museum of Pharmacy, Krakow

Old water distillers, coloured glass vials, presses, alembics:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow


Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

As time moved on, techniques became refined, the furniture in polished inlaid wood of the Baroque or the Biedermeier style, the glass neatly labelled:

Museum of Pharmacy, Krakow

Rows and rows of canisters in glass and porcelain sitting above wonderful drawers of uniform shape, all rescued from old apothecaries across the city and brought here:

Museum of Pharmacy, Krakow

Hirudines! Aka leeches. A collection of more mortars and pestles, pictures of leading pharmacists of Krakow and their documents now of historical relevance rather than professional necessity:

Museum of Pharmacy, Krakow

Enormous mortars and pestles. And oh, my love for bottles and small labelled drawers full of strange powders and herbs and medicines overfloweth:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Old books are here also, with velveted covers:

Museum of Pharmacy, Krakow

Wooden boxes of superb craftsmanship filled with strange bottles and implements for the storing and mixing of musk:

Museum of Pharmacy, Krakow

Stoppered bottles of vibrant colour that make my heart beat faster:

Museum of Pharmacy, Krakow

Clear glass of strange shape and design:

Museum of Pharmacy, Krakow

Strange scissors of a shape perfectly crafted to an unknown task, old herbals, locked and keyed and made into beautiful works of art:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

A map of plants and the ‘world’ as it was once believed to be:

Museum of Pharmacy, Krakow


Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Tiny glass vials and velveted boxes of syringes used and reused.

Museum of Pharmacy, Krakow

Cork-crushers and medicine makers

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Herbs and storage

All found in the attic, where warmer and dryer air might do their work:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

This is one of my favourite places in this city, and I will be writing more because this only scratches the surface of the apothecarial wonder.

Also, please let us resurrect the term apothecary and use it more in everyday life.

I shall end with another quote from the museum, this from Gabriel Garcia Marquez, One Hundred Years of Solitude:

The rudimentary laboratory—in addition to a profusion of pots, funnels, retorts, filters, and sieves—was made up of a primitive water pipe, a glass beaker with a long, thin neck, a reproduction of the philosopher’s egg, and a still the gypsies themselves had built in accordance with modern descriptions of the three-armed alembic of Mary the Jew. Along with those items, Melquíades left samples of the seven metals that corresponded to the seven planets, the formulas of Moses and Zosimus for doubling the quantity of gold, and a set of notes and sketches concerning the processes of the Great Teaching that would permit those who could interpret them to undertake the manufacture of the philosopher’s stone. Seduced by the simplicity of the formulas to double the quantity of gold, José Arcadio Buendía paid court to Úrsula for several weeks so that she would let him dig up her colonial coins and increase them by as many times as it was possible to subdivide mercury. Úrsula gave in, as always, to her husband’s unyielding obstinacy. Then José Arcadio Buendía threw three doubloons into a pan and fused them with copper filings, orpiment, brimstone, and lead. He put it all to boil in a pot of castor oil until he got a thick and pestilential syrup which was more like common caramel than valuable gold. In risky and desperate processes of distillation, melted with the seven planetary metals, mixed with hermetic mercury and vitriol of Cyprus, and put back to cook in hog fat for lack of any radish oil, Úrsula’s precious inheritance was reduced to a large piece of burnt hog cracklings that was firmly stuck to the bottom of the pot.




Root Shock pt 2 — Struggle and the Aesthetics of Equity

Root Shock - Mindy Thompson FullilovePsychiatrist Mindy Fullilove’s Root Shock doesn’t just explore the costs of displacement to the consciousness of the individual and the collective, but also looks at struggle on multiple levels. First, though, lets just revisit her framing of the issue:

When all the fancy rhetoric about “blight” is stripped away, American urban renewal was a response to the question, “The poor are always with us, but do we have to see them every day?” The problem the planners tackled was not how to undo poverty, but how to hide the poor. Urban renewal was designed to segment the city that barriers of highways and monumental buildings protected the rich from the sight of the poor, and enclosed the wealthy center away from the poor margin.(197)

I also like this fundamental insight:

In the peculiar calculus of American racism…white people must occupy whole parts, like a whole row of bus seats or a whole neighborhood. As soon as any black people enter, the whole is spoiled, and the white people must either eject the black people…or move away themselves. (225)

The most basic means of struggle against such a calculus is that as an individual or group, in the form of political direct action. She talks about what fighting back means to people, quotes testimony from trials:

Gladys Moore on the Montgomery Bus Boycott: “Well, after so many things happened. Wasn’t no man started it. We all started it overnight. (emphasis added) (40)

Jo Ann Robinson, in her memoirs: “The one day of protest against the white man’s traditional policy of white supremacy had created a new person in the Negro. The new spirit, the new feeling did something to the blacks individually and collectively, and each liked the feeling. There was no turning back! There was only one way out–the buses must be changed!” (41)

She also talks about the healing process that occurs through collective struggle, which is nice to hear from a medical professional:

As a public health psychiatrist, I believe that healing a group’s psyche occurs through a collective process that requires organizing ways in which people come together to learn facts, share ideas, raise questions, and search for solutions. (180)

Near the end of the book she lays out a series of workshops done with community members. The first used an idea she called ‘The Community burn Index’, used to measure the damage to the neighbourhood lot by lot, charted through a community mapping exercise where small groups walked street by street telling stories and really seeing their streets and homes. I quite loved what this revealed:

I learned something about the difference between interiority and exteriority when it comes to what we see. People who are insiders to a place stop seeing it. It is a hand part of human consciousness that many things–including the scenery we look at every day–slip our of awareness in to the vast pool of rote activities and knowledge.

People who are outsiders to a place see it as a landscape. they are inhibited from seeing what they’re really seeing, but in their case it’s not because it’s new. Rather, we have another handy mental device for decoding places we’ve never been to before, and that is stereotyping… Oddly enough, neither the inside nor the outsider has the foggiest idea what he is look at. (185)

It is coming together to really look, to see things in the moment as they are, to tell stories, to talk to each other, that they helped each other really see what was there, what was no longer there.

That’s powerful, no?

They repeated this exercise with people from all over Pittsburgh, trying to build connections not just between residents and their built environment, but between people from other neighbourhoods and this particular neighbourhood so long cut off from the city. Through the eyes of a French planner and architect, they realise that this is a neighbourhood that once had multiple entries and exits and paths down the hill to the river, and all of them had gone, sealing them off from the rest of the city.

It is through discussions with this same architect, Michel Cantal-Dupart, that Fullilove proposes a new framework for analysing and resolving issues created by development. She calls it the aesthetics of equity, and it holds some interesting ideas I think. In summary:

Principle One: Respect the Common Life the Way you Would an Individual Life (199)

There is always a common life, whether or not you can see it right away. My own aside — people in power never see it.

Principle Two: Treasure the Buildings History Has Given Us (199)

If only planners had ever done that…instead we work with what they have left us, and I think this is key:

The solution to the “many centers” problem lies in improving the connections among them. The passerby must be able to figure out how to move among the jumble of squares. We need images that compel transition, promote flow, and permit movement from one place to another. We need a permeable city, safe not because of its walls, but because of the engagement of its citizens, each and every one a guardian of the public piece/peace. (204)

Here Fullilove edges towards all the wonderful literature studying how buildings and planning create environments that foster and build community.

Principle Three: Break the Cycle of Disinvestment (204)

I suppose here is where my study of political economy makes me a little skeptical that this could happen without one hell of a fight that is more transformative than anything we’ve seen before. But I write too much about that elsewhere. Still, it is fundamental to these dynamics, and needs to be understood just as much as everything else here.

Principle Four: Freedom of Movement (205)

Hell yes. This has never really existed in the U.S. for non-whites. But there’s a funny section here on the massive gardens of André Le Nôtre built for French aristocrats and the Sun King himself. I feel strongly about such gardens that use perspective to show power and wealth and the subjection of nature, so it’s interesting to be challenged here with a sentence that says 

Perspective creates both the intimacy of “here” and the wonder of “there”. It allows rest and dwelling, but it also encourgaes exploration and travel… Perspective is, at heart, a democratic tool, because it is a linking tool. (208)

I think Gordon Cullen explores this quite beautifully in the townscape in ways that show just how much about power and wealth those damn gardens really are. But point taken in the abstract. I think Cantal has some odd views being passed along here, as Haussman is praised a little further along for his vistas and opening up of the city, and that just makes me a little sad without acknowledging the massive displacement, the purpose of making the poor easier to control and send them to the peripheries.

Still, I quite like these four principles. Just as I do the idea that people should be able to take city spaces and make it their own.

I also like the thought she ends with:

We are somewhere on the dwelling/journey spiral. We have all been forced from home but non of us has yet reached safety. We might choose to continue to proceed in blindness. But we might also recognize that we can use the journey to create the arrival of our dreams in the community of all of us.

Let us listen to the bell; it tolls for us. It’s time to go home. (239)





Root Shock pt 1 — Urban Renewal and Public Health

Root Shock - Mindy Thompson FulliloveThis is one of the few books that really tries to come to grips with the deep psychological trauma caused by mass displacement — what it calls Root Shock. It does so through the prism of urban renewal and reminds us of the scale of it. The program ran  from 1949 to 1973, and during this time the U.S. government bulldozed 2,500 neighborhoods in 993 cities, dispossessing an estimated million people. They were supposed to be slum clearances, they were supposed to create space for new housing. Few of these clearances did, and we are still coming to grips with what was lost. But there is a bitter truth behind the switch from ‘urban’ to ‘Negro’ removal — it is the Black community that lost the most and that continues to be most impacted by it all.

What was it, then, that was lost?

…the collective loss. It was the loss of a massive web of connections–a way of being–that had been destroyed by urban renewal; it was as if thousands of people who seemed to be with me in sunlight, were at some deeper level of their being wandering lost in a dense fog, unable to find one another for the rest of their lives. It was a chorus of voices that rose in my head, with the cry, “We have lost one another.” (4)

I like this understanding of it. I also quite love that despite a clinician trying to deepen our understanding of the psychological impacts, she maintains a larger understanding of just what is happening.

This process taught me a new respect for the story of upheaval. It is hard to hear, because it is a story filled with a  large, multivoiced pain. it is not a pain that should be pigeonholed in a diagnostic category, but rather understood as a communication about human endurance in the face of bitter defeat. (5)

And you know I love the spatial awareness that has to be part of this, because it is a physical loss of building, home, neighbourhood, as much as a loss of connection.

Buildings and neighborhoods and nations are insinuated into us by life; we are not, as we like to think, independent of them. (10-11)

So how does Fullilove define Root Shock?

Root shock is the traumatic stress reaction to the destruction of all or part of one’s emotional ecosystem. It has important parallels to the physiological shock experience by a person who, as a result of injury, suddenly loses massive amounts of fluids. Such a blow threatens the whole body’s ability to function…. Just as the body has a system to maintain its internal balance, so, too, the individual has a way to maintain the external balance between himself and the world. This way of moving in the environment…. (11)

It is not something that is experienced right away and then disappears.

The experience of root shock–like the aftermath of a severe burn–does not end with emergency treatment, but will stay with the individual for a lifetime. In fact, the injury from root shock may be even more enduring than a burn, as it can affect generations and generations of people.

Root shock, at the level of the individual, is a profound emotional upheaval that destroys the working model of the world that had existed in the individual’s head. (14)

This book is interladen with quotes and stories from people Fullilove worked with, she cares like I do to let people speak for themselves about their experience. She quotes Carlos Peterson, on the bulldozing of his neighbourhood:

‘My impression was that we were like a bunch of nomads always fleeing, that was the feeling I had.” (13)

There is Sala Uddin, who remembered urban renewal first with approval — the new homes they were getting, then:

Critiquing his own earlier enthusiasm, he pointed out to me, “We didn’t know what impact the amputation of the lower half of our body would have on the rest of our body until you look back twenty years later, and the rest of your body is really ill because of that amputation.

The sense of fragmentation is a new experience that we can now sense, that we didn’t sense then. We were all in the same location before. Now we are scattered literally to the four corners of the city, and we are not only politically weak, we are not a political entity. We are also culturally weak. And I think that has something to do with the easiness of hurting each other. How easy it is to hurt each other, because we are not that close anymore. We are not family anymore. (175)

Because she is able to listen, she is able to describe the ways that people are connected both to buildings, but also to each other. I love how from multiple angles, the human connections to the earth, to the built environment and to each other always emerge as key to lives well-lived, whether looking at permaculture or public space or psychology:

This lesson of interconnectedness is as hard to learn as differential calculus or quantum mechanics. the principle is simple: we–that is to say, all people–live in an emotional ecosystem that attaches us yo the environment, not just as our individual selves, but as being caught in a single, universal net of consciousness anchored in small niches we call neighborhoods or hamlets or villages. Because of the interconnectedness of the net, if your place is destroyed today, I will feel it hereafter. (17)

This brings a new look at Jane Jacob‘s street ballet, where

you are observing the degree to which people can adapt to different settings, and not just adapt, but attach, connect. They are connecting not to the negatives or even the positives of the setting, but to their own mastery of the local players and their play. (19)

I am quite intrigued by this idea:

Instead, the geography created by dispersal-in-segregation created a group of islands of black life. “Archipelago” is the official geographic term for a group of islands. Black America is an archipelago state, a many-island nation within the American nation. The Creation of the archipelago nation had two consequences for African Americans. The first is that the ghettos became centers of black life; the second is that the walls of the ghetto, like other symbols of segregation, became objects of hatred. In this ambivalent, love/hate relationship, it was impossible to chose to dwell. Yet people did choose to make life as vibrant and happy as they possibly could. (27)

This feels particularly true of earlier periods when the colour lines were hard and fast and patrolled by white mobs and white gangs and the use of violence. When green books were necessary when travelling to know where to stay, what to eat safe from the oceans of white hatred (too far? Not in terms of the hatred, but maybe in terms of metaphor…) When the ghetto walls were high and strong and each brick legally protected, which is part of the story and the trauma of urban renewal’s root shock. For so long people faced the choice: to fight to improve the ghetto or the fight to leave it. Regardless, she captures something of what the ghetto cost the city as a whole:

Segregation in a city inhibits the free interaction among citizens and invariably leads to a brutality and inequality, which themselves are antithetical to urbanity. When segregation disappears, freedom of movement becomes possible. that does not necessarily mean that people will want to leave the place where they have lived. The ghetto ceases to be a ghetto, it is true, but it does not stop being a neighborhood of history. Postsegregation, the African-American ghetto would have been a sight for imaginative re-creation , much like the ghetto in Rome. (45)

She writes later on:

The divided city is a subjugated city. (164)

The tragedy always was this inisght, again from Jane Jacobs  (as summarised by Fullilove):

A slum would endure if residents left as quickly as they could. A neighborhood could transform itself, if people wanted to stay. It was the investment of time, money  and love that would make the difference. (44)

That was almost never allowed to happen. Instead neighbourhoods were bulldozed — and again there is the comparison to rubble left by war, similar to Dybek, to Gbadamosi:

Indeed, in looking at American urban renewal projects I am reminded more of wide-area bombing–the largely abandoned World War II tactic of bombing major parts of cities as we did in Wurzeburg, Germany and Hiroshima, Japan–than of elegant city design. (70)

It was done in the most destructive way possible:

Even though the basis for compensation was gradually extended, the payments continued to be linked to individual property rights. Collective assets — the social capital created by a long-standing  community–were not considered in the assessment of property values. (79)

There is not enough on why I think, which limits the section thinking through what we can do to stop it. But there is this quote from Reginal Shereef, who studies the effects of urban renewal on African Americans in Roanoke:

“But the reality of urban renewal was that cities wanted to improve their tax base. And that is my interest. I have always looked at the intersections between public policy and economics. And what happened in Roanoke was neighborhoods was torn down so that commercial developers could develop prperties and sell it to private interests…” (98)

Part 2 looks at some of the positive ways to think of community, ways that we can work to preserve and improve our neighourhoods. But I’ll end this with one of the lovelier expressions of what home means to people, this from resident Dolores Rubillo:

“People know, you know where you are–” and, leaning in to me added, “you are safe in the dark.” (127)




Memories from Beryl Knotts: Meals on Wheels begins and more

[My interview with Beryl Knotts inspired me immensely, especially after so much reading on the East End and writing about Fr John Groser and his work there, so I thought I would repost this blog I did for St Katharine’s]

Beryl Knotts first interviewed for a position at the Royal Foundation of St Katharine in November of 1953. It all happened quite by accident too — having left school at sixteen to take care of her mother, Beryl first trained and worked for three years as a secretary in two posts in London and Woking. For her third job, she went to inquire at the Tavistock Appointments Bureau, but unwittingly went into the “graduate” section by mistake! Although she had no degree, the woman behind the desk took the time to help her anyway, and recommended she apply for a secretarial job at the national office of the Training and Personnel Department of the YWCA in Baker Street. Thus she began a lifetime committed to social work, as, in due course, the YWCA staff recommended her to move to the work of the Stepney Old People’s Welfare Association then developing at St Katharine’s to get hands-on experience in community work.

20150714_153339She had never been to the East End before, and remembers the fog and the Dickensian feeling of the place, with St Katharine’s an oasis of warmth and light in the middle of a bombed out city. Cable Street was narrow and grimy then, taking a different route past St Katharine’s than it does now. I’ve found an old map from Fr. John Groser’s history of St Katharine’s distributed at the time. It shows the old buildings that once stood here, and also marks the memory of our local train station as Stepney East.

Beryl worked for the most part with Dorothy Halsall, one of the two sisters living and working here as part of the St Katharine’s community. The other was Ethel Upton. There were also two brothers at the time, Brother Bernard from the ministry in Peckham, and Brother De Jong, a layman. Jean Denford was Fr. John Groser’s Secretary, and also an assistant to Dorothy Halsall.

Apart from the main buildings there was a big yard, and alongside it a cottage where for a while Tom lived, a Canadian worker-priest who had committed his life to serving his vocation through work in the factories. He married Sherry and they lived there together, Sherry becoming a model of generosity for Beryl (and now for myself, this is an ideal I love but hard to reach in this day and age I think). Sherry would always begin cooking the evening meal for say four, but as people dropped by they were always invited to stay until it often became eight or more. No matter how many came they would manage to provide them a meal, though the soup might be a bit watery. What food there was would always be stretched to include everyone.

After commuting from Woking for six months, Beryl moved to Bethnal Green — in those days, the wonderful St Margaret’s Settlement provided not just community services but also rooms for 25 young people, half of them students and half of them working in the East End. As part of their life there, they had to do some social work in the local area. Beryl had the most delightful story of the first time she was sent to visit an elderly lady in a second floor flat. Beryl Knotts knocked and this lady (who had clearly met several social researchers in the area before!) answered with ‘Come in love, and I’ll answer all yer questions’ (even though Beryl was just a ‘visitor’!). This lady always gave her great big mugs of very strong hot tea, and her generous but practiced and humorous answer showed perhaps something of how it was to be in an over-researched area of social deprivation as the East End tended to be in those post-war years.

Even so, both the deep commitment to the work and the warm fellowship that arose between the young people living at St Margaret’s and serving the community emerged clearly through our conversation. So much so that I felt its loss deeply, and wish I might have been part of something like that. Beryl has still kept the sparkling sense of fun.

So the Stepney Old People’s Welfare Association. After the war, the housing in this area that hadn’t been bombed flat was often dangerously weakened, and had been in very poor condition even before the bombing started. For this reason, most of the young families were moved out further east towards Dagenham, leaving a disproportionately large proportion of the older age group suddenly alone and in bad housing, bereft of both the useful roles they might once have held in taking care of children or helping with the home, as well as the support and companionship of their families.

She remembers them very poor, very tough, and very strong. Above all her stories are humorous ones, life made better with laughter rather than tears, and hard times always lightened with a joke.

Across the span of sixty years some of these memories ring very clear. There was Alfie, an old docker whom she met in her very first week at St Katharine’s. His wife had just died, and he didn’t know what to do. Dorothy Halsall helped arrange a pubic health funeral for her, and in those days even such funerals involved a carriage and horses and plumes, the procession that stopped in every location that had been important to the person whose life was being celebrated and death being mourned. Alfie had wanted to buy her some flowers and found an old purse in which his wife had hidden away some £5 worth of savings.

He used all of it to buy daffodils, her favourites. The carriage was absolutely filled with daffodils when it stopped at the Hall at St Katharine’s, where she had found so much enjoyment.

The next week Alfie came in and asked them, ‘do you know a woman who would come and live with me?’

The old hall that once stood here sounds absolutely wonderful. They ran lots of clubs from it as well as elsewhere in the borough, including lunch clubs. Beryl remembered every Monday afternoon it was opened up for the elderly to come and play cards or dominoes, and have their tea and biscuits.

We have too few pictures in the archives, but I have found a couple proofs from the Old People’s Welfare Association Christmas Party of 1957. Although Beryl had left St Katharine’s by the end of 1956, most of the people would have been the same:


Old People's Welfare Society Christmas 1957

Meals on wheels also got its start here at St Katharine’s, believed to be the first one in the country. They had a specially fitted van that would pick up food from a restaurant in Limehouse and deliver it through a rota of staff and volunteers to the elderly who were housebound Monday through Friday for which they paid three shillings and four pence a week (ten pence a day). These were always hot and fresh meals, meat and veg and lots of gravy, plus a pudding, on china plates that were returned the next day.

They came to realise that there were also a smaller number of Jewish elderly who needed the same services, but of course offered a special challenge because of requiring kosher meals and kosher service. Dorothy contacted the LCC for help, and they put her in touch with the Women’s Royal Voluntary Service. Somewhat to the amusement of the St Katharine’s staff, they sent an ex-service lady to discuss the programme. Beryl remembers her as someone who, although out of uniform, gave the decided impression that she was still wearing it! She linked them up with Jewish Board of Guardians, who were able to provide a rota of Jewish volunteers with private cars who would fetch the meals from a kosher restaurant in the area, and then deliver them each day to probably around twelve to fifteen homes.

Miraculously, Beryl didn’t think there had ever been any accidents with those meals, though the food was not nearly so secure as in the van they had for the main delivery. There was only one day where they didn’t have a Jewish volunteer able to come. She rang up the taxi rank at Whitechapel to find a Jewish driver, and with his help they were still able to provide the meals.

Beryl would also often take people’s pensions to them when they could not go for themselves to collect them, and Jean Denford would visit the housebound regularly who were referred (perhaps from the Clubs or local agencies) as having special needs. Beryl remembers the older people were always so very happy to see Jean, and just how dreadfully they missed their families.

It seems a very hard thing to have separated them from their families, hard on both sides and a great lesson to be learned there about how important those ties are to people’s wellbeing. This is especially poignant as we face much the same situation again for very different reasons, as the housing crisis is pushing younger families further and further away into London’s outskirts, leaving their elderly parents lonely and isolated in older neighbourhoods like Stepney, Wapping, Shadwell and Limehouse.

Another big issue they provided for here at St Katharine’s was the care of elderly people’s feet. In this very poor and ageing community people often couldn’t manage to take care of their own feet. Most of the people living here, and in the East End more broadly, had always worn second-hand shoes, had seldom had proper nutrition or medical care, and thus had multiple issues with their feet that often threatened their independence and mobility.

Once a week then, St Katharine’s brought in a chiropodist to provide free services — the only requirement for his patients was that everyone first went to the public baths just across the street.

Only last week I was in a meeting of health workers and local champions in Stepney, discussing the realities that with decreased funding available, older people are once again finding it impossible to access care for their feet such as supportive shoes, massage, nail-cutting services and the other things they need to help them stay independent and walk comfortably. Once more, charities serving the elderly as St Katharine’s once did are being asked to find ways to subsidise chiropody services.

Of all the ways that St Katharine’s could honor and revive all that it has done in that past, it is disappointing that we should have to consider anew providing such a service.

There are also, however, collective and the creative ways we could take as inspiration for moving forward that do not invoke a past many hoped we would have left long behind.

Father Groser quite loved acting, so they would put on plays — Beryl remembers once they hosted a performance of ‘Much Ado About Nothing’ in the open air garden. And of course his son Michael was a wonderful sculptor, another son, Tony, was an actor, and his daughter Gillian very musical, so life here had a very creative feel.

Like many people in our community, Beryl remembers the garden parties held here, and the old people’s parties (though you’d never call them that nowadays, she noted). The elderly often put together musical entertainments in the big hall, with sing-along numbers. There was even someone who would dance the can-can in union jack knickers. Mr Donovan was the M.C. with only one eye and no teeth. He was a proud member of the Queen’s Bays (the 2nd Dragoon Guards) and always wore the badge on his lapel. During the Queen Mother’s visit in November of 1955 (she wore a lovely pale mauve velvet coat, pearls and hat) — as the Bays’ Colonel-in-Chief she quickly recognized the badge and Mr. Donovan was absolutely over the moon, and told the tale for weeks afterwards!

St Katharine’s also followed many of the same patterns from year to year, a massive clean every March/April, where absolutely everything would be taken down, shaken out, and thoroughly cleaned — down to all the curtains taken down and washed and rehung even the great old curtains from the stage in the hall. St Katharine’s day on 25th November was also a very big event, with a service and a special meal cooked by Mrs. Pomfret — old Pom as everyone who worked there used to call her. The kitchen and dining rooms today are of course completely different different to what they once were, though more or less in the same place.

Beryl had found her old diaries, they sat in front of us small and worn, and she had noted down some of the many entries she had made so long ago to jog her memory about all that once happened here. It was marvelous of her to prepare so. There were a number of outings: one was to see the Queen’s homecoming at Westminster Pier after her world tour, there were others to Beaconsfield, Ramsgate, Knebworth Gardens, Southend for jellied eels. They sang all the way home from that one.

One summer evening they had what they called a ‘frail party’, with special transportation arranged by Jean Denford and volunteers from the Soroptimists Club (to which Dorothy Halsall belonged) to help a group of housebound elderly escape their own four walls for an evening. They had parties for the mum’s club, St Katharine’s club, a film night where they showed Isle of Summers.

They had an evening lecture called ‘The Social Consequences of the Present Housing Policy’ given by Arthur Blenkinsop, MP from Hull. Fr John Groser sometimes invited public school boys to debate with the dockers and the point of it was for the boys to hear about life from the dockers’ point of view.

We had a most wonderful session of reminiscing, Beryl and I, on a sofa at Friend’s Meeting House beside Euston Station, as she was only down for the day from Oxford. She only briefly let fall how in 1956 she went on to get her social work qualifications at Edinburgh University and LSE — inspired by, and perhaps also with some gentle pushing from Dorothy Halsall. She would have been quite happy, she said, to continue longer in the East End. With so much discussion of how St Katharine’s used to be, we had little time to talk more about her time in Brazil, and all she did upon her return to England and her work around the world, but I hope that we will meet again to talk more about that.

It was an inspiration to speak with her. It always is to meet people who embody a wonderful curiosity about the world alongside generosity and compassion. Especially those who have devoted their lives to making this world a better place. It is only as I was typing up my copious notes that I thought to look for her online, and found a short bio which she has forgiven me for including:

Beryl KnottsBeryl was brought up in a Congregational family and had early experience with the Surrey Congregational Youth Council. She trained and worked as a social worker in the UK and from 1966 to 1969 served as a UNA volunteer in Brazil. This led to 10 years international social work experience in Peru, Nigeria, South Sudan and Geneva, followed by 11 years with Oxfam, latterly in international human resources, until retirement in 1991. She was a URC Racial Justice Advocate, an avowed ecumenist and was a local Church Secretary from 1997 until 2011.

I had a lovely and inspiring time hearing all of her stories, and hope to hear more…