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Exploring East London’s public health history

Public health walks introduce concepts such as the community and health disparities to trainee community public health nurses


Public health history walks around Shoreditch and Tower Hamlets are helping students in the School of Health Sciences better understand their community and the historical contexts in which health care is delivered.

Health inequalities remain a significant issue in the UK, and with students moving into the health service a historical grounding into the causes and effects of health inequalities can help students understand the barriers to good health that exist in certain communities in London. The walks also improve students’ understanding of how our National Health Service functions, especially if they are not from the UK.

The walks were created and led by Rosa Benato, a senior lecturer in the School of Health Sciences. Rosa started the walks as an induction for trainee community public health nurses (district nurses, school nurses and health visitors) as a way to introduce concepts such as the community and health disparities to them.

“Although the walk is only in one area of London the principles of, for example, gentrification, poverty, social exclusion and health inequalities apply across the board,” said Rosa. “What I think and hope students get from the walk includes an understanding of what 'community' really means along with the role the social determinants of health play in people's lives.”

Starting at Arnold Circus, the site of the earliest social housing scheme built by a local authority, the walk explores many of the different facets of the health inequalities people in east London face. Built on the site of the Old Nichol slum, construction of the Boundary Estate in Arnold Circus began in 1890, with the rubble from the demolition used to build a mound in the centre which now houses a bandstand. Built to alleviate poverty in the area – while still retaining the community spirit - the housing helped improve the appalling conditions which had existed previously with up to 60 people living in one house with life expectancy as low as 15.

Down the road from Arnold Circus the next stop on the walk is St Leonard’s Church. With the current building built around 1740, the graveyard was targeted in the Victorian era by body snatchers who stole bodies for medical research, as medical schools at the time paid a good price for cadavers.

Across Shoreditch High Street, which supposedly takes its name from the old English for Sewer Ditch, the walk visits Shoreditch Town Hall. High up on the façade, a figure holds a torch and an axe with the inscription ‘More Light, More Power’, harking back to the area’s power generation role.

Across Hoxton Square on Coronet Street and past a restaurant known as the Electricity Showrooms, there is further evidence of this power generating past in the shape of the Vestry of St Leonard’s Shoreditch Electric Light Station. Built in 1896, the building is proudly adorned with the Latin phrase ‘e pulvere lux et vis’, meaning ‘Out of the dust, light and power’. It was here that local rubbish was burned, providing steam for the electricity generator while also heating the public baths next door, which have now been demolished. The building now houses Circus Space, a school for the circus arts, which makes use of the height and open space of the old turbine hall for trapeze classes.

“I first started doing the walks as a local with some interest in local history and public health history,” said Rosa. “The reason why I chose Tower Hamlets and Hackney is that I wanted to include Arnold Circus as it’s such an important part of local social history. I worked out an interesting route from there that wasn't too long, would include all the key things I wanted to include to prompt discussions around poverty, gentrification and the social determinants of health, such as poor housing, but which also had some quiet spots on the way to allow for discussion with students.”

There is also another famous resident from Hoxton Square whose name is forever immortalised in association with Parkinson’s Disease. Born in Shoreditch in 1755 and living on the corner of Hoxton Square, James Parkinson worked in local hospitals, also providing medical care at local workhouses.

On the other side of the Square up Hoxton Street resides a handsome red brick building. No. 34 was the site of a large, private psychiatric hospital, which housed up to 800 residents at its peak, and offered large gardens and a theatre. With the walk passing Hoxton Hall, one of the oldest Victorian music halls still open in the UK, up the road the last location of our trip was St. Leonard’s Hospital.

With an imposing façade on Hoxton Street that states ‘Offices for the relief of the poor’, St Leonard's Hospital was originally the infirmary for the St Leonard’s Shoreditch workhouse. Opening in 1777, St Leonard’s offered those unable to support themselves accommodation and employment, but conditions were often harsh and unforgiving. It is round the corner at the entrance to the hospital that the old workhouse is evident, with the place still carrying strong feelings for the older residents in the community who remember what those walls once contained until its closure in the 1930s.

This final stop is an excellent example of why it is important for people working in the community to really understand the social and political history of the area they are working in, and explains why St Leonard’s remains a stigmatised place for some older residents, associated with extreme poverty and desperation. Certainly not somewhere they would want to go to for health care.

But the discussions about health inequalities and the challenges that exist don’t end with the walk, as the idea is that students can also feed their newfound knowledge and experience into other areas of learning and practice, as well as other geographical areas.

“Afterwards we can use the walk as a launch-pad for ethical debates on poverty and health,” added Rosa. “As a result, by also thinking about the historical and cultural context of an area students get the key to understanding patients from that area. A walk through the community and seeing the range of housing, leisure and food shopping opportunities local residents have provides a valuable insight into their lives.”

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