Using walking to set the community in a social, political and historical context: The Public Health History Walk

I have been using walking as part of my teaching for a while now, and there are a number of ways this can be incorporated into your educational activities, some of which I will describe in future vignettes. Here, though, I will focus on one particular method of using walking in teaching, the guided walk, using an example from my own teaching: the Public Health Walk.

The Public Health Walk is a 2.5 hour walk around Shoreditch and Hoxton, exploring some of the areas’ key contributions to public health and social and political history. The walk gives students an overview of the key social, political and historical aspects of public health and the community. Walking around such diverse yet densely populated areas gives me the opportunity to discuss variations in life expectancy in neighbouring areas as well as examine and illustrate the social determinants of health with students. The walk additionally gives students the chance to explore one of the communities of practice where they will be working. Students are from the public health nursing degree/PG Dip programmes, with up to 55 students each intake; the walk is part of their induction.

I begin the walk in the bandstand in Arnold Circus, E2, the centre of the Boundary Estate which was Britain’s first social housing (1895). This is a quiet place in which to introduce the walk and give an overview of what we will be covering over the following couple of hours, as well as starting to facilitate discussion around poverty, deprivation, migration, gentrification and how these impact on communities and the work of public health practitioners.

 

bandstand

 

Students find it difficult to comprehend that this lovely estate replaced the over-crowded slums of the Old Nichol, where up to 60 people shared one small house and life expectancy was only 16.This is also an ideal opportunity to talk about the ongoing discourses of the deserving and undeserving poor, social versus private housing, both issues as topical and politically charged as 120 years ago.

 

old nicol

 

As we then walk through very gentrified sections of Shoreditch and Hoxton, we stop at a number of sites which are significant in terms of social or public health history. These include James Parkinson’s house, where he first linked patients with the ‘shaking palsy’, Shoreditch Electricity Generating Station, where rubbish was burnt to generate electricity and hot water for local residents and Shoreditch Church, where we discuss the birth of medical and pathology schools via the cases of local grave-robbers.

parkinson plaquejpg                                Shoredith electr1                      shoreditch ch

 

The walk then takes us through a different part of Hoxton, an area very different to gentrified Shoreditch, with poor housing, limited shopping and food choices for residents. Life expectancy here is up to 8 years lower than Shoreditch, just a few hundred metres away. Students can see and feel the difference between the two areas and this prompts lengthy and detailed discussion around the social determinants of health and what public health practitioners can do to support people in the community.

St L's

We finish the walk at St Leonard’s Hospital, a former workhouse, most of which remains intact from the Victorian era. Many students are unfamiliar with the concept of the workhouse and were shocked to hear that the workhouse was in operation until 1930, with frequent outbreaks of cholera due to overcrowding. St Leonard’s in now a community hospital and is an ideal and quiet spot from which to reflect on what we have covered during the walk, as well as understand that for many older local residents, the hospital retains the stigma of the desperate and the outcast. Many older people refuse to use the services at the hospital because of the building’s former use. This is a good and powerful place to end the walk, and is near to public transport and cafes for a warming cup of tea!

Overall, then, the walk has been great for:

  • Thinking about health and disease in a holistic way
  • Setting care and attitudes within a socio-historical context
  • Understanding how communities change and the factors behind eg: rapid gentrification
  • Seeing great wealth and great poverty in close proximity
  • The importance of the welfare state and the NHS, especially for students who are not from the UK

 

Top tips for devising a guided walk

Although students find the walk stimulating and interesting, giving them the opportunity to live and breathe the different communities within a small geographical area, there are a number of logistical and practical issues for those wishing to organize a guided walk for their students.

Firstly, identify a small area, with a good starting and end point, which are of significance to your subject area and also quiet. This is vital for your introduction and summing up. It helps if both points are near to good public transport.

You would then need to do a lot of historical research on the area of your choice, finding a few key spots to stop on during the walk which illustrate the issue in question, or which are of particular historical, political or social significance. Personally, I do not think it matters too much if they are not all health-related, so long as they are of significance, but the start and end of the walk should be focused on health in some way.

Use the start and the points along the way as prompts to introduce concepts and in-depth discussions about topics you want to cover during the walk. These can be surprisingly complex despite not having traditional visual aids to help you: what you see around you are your visual aids.  I additionally have a number of old maps and photographs which I have blown up to A3 size and had laminated. I use these at points along the walk to illustrate certain points.

I have quite detailed notes which I take with me, with the main points I want to get across and prompts for discussion or questions and where I want that to happen. Over the years these have become annotated with extra information I have out or things I want to ask. this keeps the walk as up to date as possible.

There is also the matter of getting a number of students to the start of your walk and then not losing them on the way, or getting them run over by vehicles. Make sure you are clear about a start time and where students should be and then either take them there or agree to meet them there at the specified time.

You should not take more than 10-12 students out on a guided walk alone: I do generally have a colleague with me but on one occasion it was just me and 55 students which was really very stressful!

The issue of being heard on noisy, busy London streets is very real; if you do need to make a stop on a busy street, make sure you introduce and discuss the point of interest in the quiet place before that stop, and then again afterwards once you reach the next quiet spot.

Crossing major roads are always difficult, especially with a large group of students who are distracted and depending on you for guidance.

Keeping students engaged during the walk is not a problem but there will always be those who are slower than others; this may be due to problems with mobility (and this is something you must consider and discuss with the class or individuals before the walk: it should not be compulsory to attend if not everyone is able to participate). It is useful to have a colleague at the back, as with a school group, making sure that people keep up.

In 2015, the Educational Technology team filmed the walk and we are just finishing the final voice-overs. I will ensure a link is provided here for the film when finalized.

I would also like to make available a detailed and guided voice recording of the walk, so that people can download it and do the walk themselves, using their phones or ipads and headphones.

Happy walking!

 

 

 

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