The same is true for the Kaiser-Permanente program in California. The Kaiser hospitals have been hailed in a recent article as “ones which shift the emphasis away from treatment of illness and toward the maintenance of health (William H. Glazier, “The Task of Medicine”). Members of Kaiser are entitled to a multi-phasic examination yearly, intended to give every member a complete picture of the state of his health. But the conception of health which is created by this multi-phasic program is still “freedom from sickness.” It is essentially negative. There is no effort made toward the positive creation and maintenance of actual, blooming, health. And besides, the Kaiser Center
TOWNS
is still nothing but a giant hospital. People are treated as numbers; the center is so large and concentrated that the doctors cannot possibly see their patients as people in their natural communities. They see them as patients.
The only health center we know which actually devoted itself to health instead of sickness was the famous Peckham Health Center in England. The Peckham Center was a club, run by two doctors, focused on a swimming pool, a dance floor, and a cafe. In addition, there were doctors’ offices, and it was understood that families—never individuals—would receive periodic check-ups as part of their activities around the swimming and dancing. Under these conditions, people used the center regularly, during the day and at night. The question of their health became fused with the ordinary life of the community, and this set the stage for a most extraordinary kind of health care.
For example, it seems that many of the mothers in working-class pre-war England, were ashamed of their own bodies. This shame reached such proportions that they were ashamed of suckling and holding their own babies, and in many cases they actually did not want their babies as a result. The Peckham Center was able to dismantle this syndrome entirely by its emphasis on health. The program of swimming and dancing, coupled with the family checkups, allowed women to become proud of their own bodies; they no longer felt afraid of their own newborn babies, no longer felt shame about their bodies; the babies felt wanted; and the incidence of emotional disturbance and childhood psychosis among the children in later years was drastically reduced within the Peckham population, starting exactly from the year when the health center began its operation.
This kind of profound biological connection between physical health, family life, and emotional welfare was truly the beginning of a new era in human biology. It is described, beautifully, and at length, by two doctors from Peckham Center (Innes Pearse and Lucy Crocker, The Peckham Experiment, A Study in the Living Structure of Society, New Haven: Yale University Press, 1946). Only when biological ideas of this depth and power are taken seriously will it be possible to have real health centers, instead of sickness centers.
47 HEALTH CENTER
Therefore:
Gradually develop a network of small health centers, perhaps one per community of 7000, across the city; each equipped to treat everyday disease—both mental and physical, in children and adults—but organized essentially around a functional emphasis on those recreational and educational activities which help keep people in good health, like swimming and dancing.
small centers
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| ❖ *t* |
Keep the medical teams small and independent—small services without red tape (81), but coordinated with each other and other clinics, like birth places (65)—throughout the town. Give each center some functions that fuse with the ordinary course of local work and recreation: swimming pool, workshops, sauna, gym, vegetable garden, greenhouse. But don’t force these facilities to form a continuous “health park”—knit them together loosely with other parts of the town—housing in between (48), local sports (72), adventure playcround (73), home workshop (157), vegetable garden (177). Perhaps the most important subsidiary pattern for helping people to keep healthy is the opportunity for swimming; ideally, try and put a swimming pool on every block—still water (71). . . .
255
SUMMARY OF THE LANGUAGE
172. GARDEN GROWING WILD
173. GARDEN WALL
174. TRELLISED WALK
175. GREENHOUSE
176. GARDEN SEAT
177. VEGETABLE GARDEN
178. COMPOST
go back to the inside of the building and attach the necessary minor rooms and alcoves to complete the main rooms j
179. ALCOVES
180. WINDOW PLACE I 8 I. THE FIRE
182. EATING ATMOSPHERE
183. WORKSPACE ENCLOSURE
184. COOKING LAYOUT
185. SITTING CIRCLE
186. COMMUNAL SLEEPING
187. MARRIAGE BED
188. BED ALCOVE
189. DRESSING ROOM
fine tune the shape and size of rooms and alcoves to make them precise and buildable;
190. CEILING HEIGHT VARIETY
XXX
| 48 HOUSING IN BETWEEN** |
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256
. . . most housing is in residential neighborhoods, and in the dusters within neighborhoods—identifiable neighborhood (14), house cluster (37); and according to our patterns these housing areas need to be separated by boundaries which contain public land and work communities—subculture boundary (13), NEIGHBORHOOD BOUNDARY (15), WORK COMMUNITY (41). But even these work communities, and boundaries, and shopping streets, must contain houses which have people living in them.
Wherever there is a sharp separation between residential and nonresidential parts of town, the nonresidential areas will quickly turn to slums.
The personal rhythms of maintenance and repair are central to the well being of any part of a community, because it is only these rhythms which keep up a steady sequence of adaptations and corrections in the organization of the whole. Slums happen when these rhythms break down.
Now in a town, the processes of maintenance and repair hinge on the fact of user ownership. In other words, the places where people are user-owners are kept up nicely; the places where they are not, tend to run down. When people have their own homes among shops, workplaces, schools, services, the university, these places are enhanced by the vitality that is natural to their homes. They extend themselves to make it personal and comfortable. A person will put more of himself into his home than into any of the other places where he spends his time. And it is unlikely that a person can put this kind of feeling into two places, two parts of his life. We conclude that many parts of the environment have the arid quality of not being cared for personally, for the simple reason that indeed nobody lives there.
It is only where houses are mixed in between the other functions, in twos and threes, in rows and tiny clusters, that the personal quality of the households and house-building activities gives energy to the workshops and offices and services.