WAF Newsletter - Health space planning and history - November 2020

Health, space, planning and history

Jeremy Melvin, 2 November 2020

In 1722 Daniel Defoe published his novel, A Journal of the Plague Year. It uncannily describes some of our current conditions, writes Jeremy Melvin.

Ostensibly the novel looked back to the London of the Bubonic Plague in 1665, which Defoe (born around 1660) might just have remembered. Its chief interest is its depiction of a city in crisis, its citizens in panic. In this it foreshadows by a century and half the condition of the modern metropolis, characterized by uncertainty and random forces, described by (among others) Georg Simmel and which became familiar in modernist novels like John Dos Passos’ USA and Alfred Doeblin’s Berlin Alexanderplatz, where the city itself becomes a protagonist in the narrative.

Even that prescience pales into insignificance given its echoes of our own Covid-plagued condition. One of the Journal’s most memorable attributes is the way in which Defoe maps statistical data onto geography, for instance in the tabulated register of deaths in various parishes across London. This reflects the then emerging realization, best encapsulated in the work of the proto-statistician Sir William Petty (1623-87), that such figures could guide political decision-making. Petty called this process ‘political arithmetick’ (sic); the straws it offered for politicians to clutch have uncanny foreshadowing of the way data is now being used to guide policy in the UK and elsewhere.

Another harbinger of the future Defoe describes is the belief that pharmacology will save humankind. ‘. . . it is incredible and scarce to be imagined how the posts of houses and corners of streets were plastered over with doctors’ bills and papers of ignorant fellows, quacking and tampering in physics . . .with such flourishes as these: ‘’Infallible preventive pills against the plague . . .exact regulations for the conduct of the body in the case of an infection….’’ He adds that ‘. . . such a number more I cannot reckon up, and if I could, would fill a book of themselves to set them down’. Just how many vaccines for Covid are now in development, and what proportion of them are likely to succeed?

Defoe’s scepticism about 17th century pharmacology is palpable. So what is left to his protagonist, a saddler who is concerned to save his business and has no family to worry about (his brother has gone to the country with wife and children). He wanders the streets rather as ‘our mutual friend’ does in Dickens’ eponymous novel of 1865. Accurately described and familiar to his readers as these locations are, Defoe’s skill as a novelist is to skew the impression they make on the reader, making them eerily different in the way some apocalyptic movies mix the familiar and the uncanny. All this reinforces the realization that the only reliable prophylactic for the disease is space – as it had been more than three centuries earlier in respect of the Black Death, the first visitation of the Bubonic Plague. And not too different to now, when we are told to wear masks and keep our distance from each other.

Have we reverted in our ways of dealing with disease to the Middle Ages, and do the techniques then adopted have anything to offer to us now? The answer to both questions is interlinked. We have of course moved far beyond the 17th century in pharmacology and may well have either viable treatments or vaccines for Covid in a matter of months. But even then they may not be fully effective, so we could well remain a least partly dependent on spatial design and configuration (aka social distancing) for some time yet. Are our physical environments and urban infrastructure suited to these conditions?

Defoe may have identified the issue, but his older contemporary John Evelyn (1620-1706) made a more significant contribution to its discussion. In 1660, as part of his welcome to the restored King Charles II, he wrote a pamphlet called ‘Fumifugium’ subtitled ‘The inconvenience of the aer and smoak of London dissipated together with some remedies humbly proposed’. In essence, he recommended burning aromatic plants, relocating noxious trades beyond the City, and using planting to improve air quality and so health. Those ‘remedies’ would probably not have mitigated the plague five years later, but Evelyn was early in identifying a relationship between public health and urban form.

Evelyn’s remedies have something of the 19th century about them. Various Acts of Parliament from the 1840s onwards legislated the control of cholera and pollution, improving water supply, dealing with sewage and banishing ‘noxious trades’ from central London east to the Lea Valley. The most significant result was the creation of the Metropolitan Board of Works in 1855; its most significant achievement, before morphing into the London County Council in 1889, was to create the Embankment along the north side of the Thames, providing sewerage, transportation and public space. Ever since John Snow demonstrated in 1854 (using statistics, but beyond any reasonable doubt) that one water pump in Soho was the prime cause of a cholera outbreak, infrastructure became a focus of disease control alongside spatial distance and quarantine. With population growth and urban graveyards filling up, disposal of dead bodies was also a priority (this was one of the lures used by the public health pioneer Edwin Chadwick to attract Gottfried Semper to London in 1849).

John Snow Memorial

All this began a chain of events that led to responsibility for urban planning falling to the Ministry of Health, where it remained until a specialized Ministry of Town & Country Planning was established in 1942. In addition to urban design and infrastructure, housing, such as the post-World War I ‘homes for heroes’ programme also came under the aegis of the health ministry for decades: the strong link between design and health was forged.

After 1942 that relationship changed and became less close, possibly to the detriment of both. The new planning ministry was created on the recommendation of the minority report of the Barlow Commission, set up in 1937 to consider how to align centres of population with locations where employment was plentiful. This followed the depression on the early part of that decade, when some areas such as the North-east of England suffered far more than places such as London, where new industries such as the making of electrical goods prospered. Economics, rather than health, became the basis of planning (the Barlow Commission built on the work of the early Macmillan Commission, whose leading intellectual force was JM Keynes).

This separation accelerated as a result of World War II developments. Architects and planners, their status enhanced by the new ministry, annexed (in what might be regarded as a sleight of hand) the credit of economic planning to promote their vision of spatial planning, while the commitment to create a national health service took public involvement in health provision to new heights. Inter alia, the huge amounts of public sector investment in health transformed the prospects for pharmacology, leading to new and better treatments for numerous conditions, going way beyond what even the most enlightened and imaginative design could achieve. In short, design and health both acquired a new raison d’être that no longer required them to support each other.

Thus, through a sequence of contingent factors, health and planning set off on divergent paths. Covid has exposed the problems of this split. Pharmacology, so far at least, has not proved equal to the task, leaving policymakers with no more than the old principles, some of them very old indeed, of adapting the physical environment to control the disease. Whether the ‘slough of despond’ which we inhabit is a consequence of poor environmental design, or a failure of those policymakers to understand how to use it – or a combination of both – remains to be seen.

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