It’s time for bold new experiments to tackle poor health – including a Basic Income

2024 is an election year. With war breaking out around the world, the effects of Covid-19 still being felt, the NHS on its knees and the health of the population deteriorating, the time has come for some brave thinking. What about piloting new ideas through bold experiments?

100 years ago, in the aftermath of the first world war and the 1918-20 flu pandemic, many people were already thinking about these issues. Among them were two doctors, Innes Hope Pearse and George Scott Williamson, who were particularly concerned with the health of the nation. They asked a simple but profound question: what is health?

To answer it, they opened the Pioneer Health Centre in Peckham, south London in 1926, and invited families within ‘pram pushing’ distance to join a club with the purpose of studying and promoting their health. This was the pilot project for what became known as the Peckham Experiment.

The pilot was successful but the premises were too small, so in 1935 they moved to a specifically designed building nearby with a swimming pool, gymnasium, theatre, childrens’ nursery, cafeteria and space for activities. Families paid a weekly subscription and could use the building for leisure activities. In return, they agreed to undergo an annual ‘overhaul’ to determine the state of their health, and the results were relayed to them in a family consultation.

Peckham principles

During the experiment, Hope Pearse and Scott Williamson proposed a set of principles for what ‘health’ means:

• This was a study of health, not of disease – the two should never be confused.
• Health is the study of the person within their environment or context. Physical, psychological, social and spiritual factors are cultivated within a healthy environment. Indeed the social and relational factors may be the most important for health.
• The unit of health is the family or household, not the individual. At the time, the definition of family was “the mated pair with or without children”. This would need to be updated for the 21st century, but should be multigenerational and indeed intergenerational.
• Individuals are parts of families who in turn make up communities.

• The design of the building was important. It promoted a light, flexible and open space so people could see what others were doing. This encouraged people who were perhaps shy or uncertain, but could see others enjoying a particular activity.
• Creating a healthy environment was a prerequisite for health. People chose whatever they wanted to do without being told. Non-directional self-help and an anti-authoritarian approach are essential for health.
• User control, open discussion and addressing power dynamics were necessary for health.
• The process of nurturing, cultivating and growing health was important. Health was seen to be contagious.
• Growing nutritious food was key to the experiment. They had a dairy herd at a nearby farm and grew their own fruit and vegetables. The Soil Association and the organic food movement were born in the building.

The Peckham Experiment ended in 1950, mostly because of a lack of funds and a change in focus to the creation of the NHS in 1948. This was another great postwar experiment, which didn’t just look at how to care for ill people with disease but also pursued health as a shared goal through public provision. This dovetailed with the aims and values of the Peckham Experiment – both were fundamentally social.

A Basic Income for all

The idea of a Universal Basic Income (UBI) is yet another social experiment we have yet to fulfil. UBI is fundamentally about ‘health’ in its broadest sense – it fulfils the Peckham principles. A UBI frees people from the need to work more than one job to make a living. It alleviates financial worry and creates time for thinking, reflecting and doing. It allows people to pursue their own path to health and wellbeing.

As employment patterns change and people have more leisure time, a UBI would help us discover activities we may enjoy, like art, music, sport, growing, volunteering or alternative forms of work and employment. But we need somewhere to pursue these activities.

Place-based facilities – welcoming spaces where people can meet to pursue their interests – are fundamental. We used to meet in pubs and clubs, but these are closing by the day. Social media has replaced them as a place to ‘meet up‘, but there is no evidence that this benefits our health. Meeting in person is much more beneficial. We need to create such places in every neighbourhood. The ‘pram pushing’ distance of the Peckham Experiment has been updated for our day with the concept of the ‘15-minute city’ – the idea that all of the amenities we need in day-to-day life should be within 15 minutes’ walk or cycle.

For such places to succeed we need a UBI, and for UBI to succeed we need such places.

The Peckham doctors were not keen on the idea of the NHS. The model was different in many ways, and focused on preventing sickness rather than promoting health. In the 21st century, we need all three:

1. An NHS which is democratic, free and universal, dealing with sickness, disease and its treatment – care and cure.
2. Peckham-style centres in every 15-minute neighbourhood and community. These would be devolved, locally-run and democratically controlled, enabling people to pursue their interests and passions and ultimately their own health and wellbeing.
3. A Universal Basic Income to knit all of this together.

We need some new thinking. And although none of the ideas above are new, linking them together may help us build a healthier society. For the NHS to successfully provide healthcare in the fullest sense of the word, it needs Peckham-style centres to keep people healthy. For the Peckham centres to succeed, they need a Universal Basic Income for people to be liberated.

Jack Czauderna is a retired family doctor and chair of the Pioneer Health Foundation, which aims to keep alive the legacy of the Peckham Experiment.