During the formative phases of our ‘medical scepticism’ project with TSIP and Impact on Urban Health, that we came across the work of Dr Caitjan Gainty (Kings College London) and the ‘healthy scepticism’ project. We had come across Caitjan’s work via various media sources and decided that it would be well worth us networking with her and seeing if there were any shared research areas in which we could collaborate. We found Caitjan to be conscientious, proactive, highly intelligent and a key partner in this space.
After some initial meetings, we then decided to formulate a piece of research which combined academic rigour with community-based nuances related to health within parts of the urban locale which possess health narratives and activities often regarded as being under-the-radar. The particular locale which we wanted to focus on was Brixton, South London, due to its significance when it comes to health activism and community-based initiatives and proactive actions taken by local people to improve their health, often parallel to official health institutions, and via converging a range of medical and therapeutic modalities.
We built on similar research conducted by Goldner (2004) in San Francisco, Lock and Nguyen (2010), and more recently, by Rivera and Concha in Bolivia (2018), Sundararajan et al in Uganda (2020), Pemunta et al in Kenya (2020) and Cant (2020) in her recent research on British Asian communities. We saw this as an unexplored area of the Brixton healthscape and the market of ethnomedicine for Black British communities.
Subaltern Counterpublic Spheres of Brixton
Brixton is now seen as a haunt for fashionable trendsetters who have for their entertainment an assortment of new cafes, bars, clubs, restaurants and eateries while for those who wish to reside in such surroundings, plush apartments and multi-million pound properties are available. This bustling conurbation with its diverse residents has been the target of international property developers, allured by the opportunities which Brixton offers them. While politically during the Brexit referendum, the highest ‘remain’ vote in the country was in Lambeth, with Brixton at Lambeth’s core.
Lee (2003) suggested that the hyper-gentrification which has occurred in London, since the time of New Labour, has been the focus of huge investment by super-rich financiers fed from the fortunes of the financial services sector connected to national and local government policy (Gould and Lewis (2017: 71). Brixton and Peckham are relevant as within these locales, such forces have been evident.
The arrival of more wealthy people into neighbourhoods which were historically associated with the urban poor is a process referred to as ‘gentrification’. The impact in terms of health and environment is an underdeveloped research nexus and one which we hope to explore in our collaboration as communities exert more agency over their health.
Yet, although the poor and rich may live side by side, there are gaps between both when it comes to health and living environment. There may also be repercussions in terms of health outcomes as gentrification may lead to negative health outcomes for minority and low-income communities. Changes in residence can impede access to health care, healthy food, social networks and recreational facilities.
But, before this modern resurgence of Brixton as a bustling fashionable hub, this modern iteration is built off the back of Brixton’s original counter-cultural subaltern spheres. The counter-public vibrancy of Brixton, its marginalised status and offstage quirkiness has been the selling point for property developers to generate income on the back of this aesthetic and narrative.
Former sites of industry in the urban landscape, such as disused warehouses, train arches or old warehouses now represent middle-class consciousness as the main spaces for art exhibitions, clubs, bars and eateries. Zukin (1992) has discussed how industrial buildings, once woven into the fabric of the working-class community life, now form new hubs for a new class of high-income pleasure-seekers and city-dwellers.
Research by Addae and Danquah over the last few years has demonstrated how and why a range of subaltern counter-public spheres have taken root in Brixton in particular. This was largely due to the Black community presence in Brixton which crossed several generations and decades, wherein global resistance identities and radical narratives were able to settle and thrive since the 1960s.
These discursive spaces however were marginalised by the broader society and dominant hegemony. For instance, McLeod (2004: 131) in ‘Postcolonial London: Rewriting the Metropolis’ noted that the American Black Panther movement should be liaised with in order to start a branch on Shakespeare Road in Brixton in 1968. In America, the Black Panthers had established ‘community hospitals’ to serve communities, in doing so, enabling greater local agency over health. This has been looked at in depth by Alondra Nelson in her 2011 book ‘Body and Soul’.
The ‘Race Today Collective’ began in 1973 and published the‘Race Today’ journal after breaking away from the Institute of Race Relations. With Darcus Howe at the helm, this exemplified a key subaltern counter-public sphere in Brixton. The main mentor of the collective, C.L.R. James, spent his last years housed at a building run by the Race Today Collective.
Other Black-led publishing houses were New Beacon Books and Bogle L’Ouverture, the latter of which was founded by Guyanese born, Eric and Jessica Huntley in 1967, who also both ran the Walter Rodney Bookshop and were part of the Race Today Collective (Alleyne, 2002: 58; Williams, 2015: 277).
In 1973, the Black feminist, anti-racist, activist and founder of the Brixton Black Women’s Group (BBWG), Olive Morris, built on Black radical tradition in Britain and became concerned with issues impacting communities (Fisher, 2012: 75-77). Morris and her image have attained an almost legendary status within Brixton.
Mackay (2015) in ‘Radical Feminism: Feminist Activism in Movement’ reveals that as well as leading the first South London-based squatting movements, Morris also founded London’s first Black Women’s Centre.
Morris’s iconic image is captured on the cover of the 1979 Squatters Handbook where she can be seen scaling a wall in Brixton. In 1974, the Home Office had identified Brixton as a core location for future conflicts between Black youth and the police. The ‘SUS’ laws, which at the time gave sanction to the police to stop and search individuals based on suspicion that a crime had taken place, disproportionately targeted Black youth. Riots had already erupted in 1980 in St Paul’s in Bristol.
Significant in all of this is that this all emerged quite before the 1981 Brixton riots and indicate that the disturbances did not happen in a vacuum (Dancygier, 2010: 90).
Riots also occurred in 1981 in Toxteth in Liverpool, Handsworth in Birmingham, and Chapeltown in Leeds.
Counter-public and counter-cultural elements in Brixton helped to shape resistance identities and develop subaltern and offstage discursive spaces for a range of issues to be discussed and where hidden transcripts to deciphering new challenges exchanged. Indeed, Harris-Lacewell (2004: 7) suggested a Black counter-public sphere will often function beneath the surveillance of the dominant classes.
Activism and Health
Activism has a positive impact on the wellbeing of individuals and for Black communities, this can transcend both subjective feelings of wellness to tangible initiatives for improving health outcomes. It was noted earlier that the type of activism associated with the Black Panther movement was influential in 1960s Brixton, which served various communities, and in the 1960s was establishing community hospitals and helping communities to tap into their own transformative potential - Nelson (2011: 58).
Zoller (2005: 348) categorised health activism as covering three key areas, with the first one being medical care access and improvement. The next being illness and disability activism and then finally, public health promotion and disease prevention activism. Carver et al. (2009: 305) discuss how seeking knowledge is a proactive coping strategy, giving the example of individuals learning about heart attack risks to see how their health may be affected.
Proactive efforts in health promotion have also been studied in regard to cardiac rehab patients and have found that the most optimistic individuals were more likely to be eating lower-fat foods, involved in exercise and taking vitamins. We opine that it has been such proactivity when it comes to health which can be seen in Brixton and also helps to increase optimism, reduce depression and contribute to more positive effects on physical health.
Aspinwall (2011: 343) also mentions improving one’s general health, building social resources for support, building the financial resources in anticipation of long-term health needs and perusing the medical literature and other sources for information about the condition and its treatment as examples of a proactive approach. She highlights exercise, insurance, predictive genetic tests, assessing family risks and predispositions to particular diseases as specific proactive behaviours. Optimists therefore are more likely to take proactive steps to reduce their risk and safeguard their health and do not ignore threats to their wellbeing.
Wei et al. (2010) posited that there are five common coping strategies adopted by people of colour who experience racism and discrimination; education/advocacy, resistance, internalisation, detachment and substance misuse. Education involves being involved in educational activities about discrimination or advocacy, regarding it at both an individual and societal level.
Such activities have been associated with life satisfaction, self-esteem and a strong sense of one’s ethnic identity. Resistance is the active challenge against racism and discrimination and confrontations to this end. Hence, it could be argued that the proactive approaches to health, along with activism in the form of health education, advocacy and resistance to barriers to health, have been adopted in Brixton.
Repercussions of this Research
Communities, such as those within Brixton, have been proactive in forming their own discourses when it comes to health. As Broad (2016: 46) highlights:
A host of intersecting concerns – related to poverty, the built environment, environmental injustice, education, racial bias in the criminal justice system and a lack of economic opportunity, among other factors, intersect with food issues to influence health and well-being.
Izenberg et al. (2018) have highlighted how low-income residents struggle to afford good healthy food, along with living in overcrowded homes in environments susceptible to a range of ecological hazards. Brixton has demonstrated how via collective efficacy and self-determination, residents have utilised their own agency, resilience and initiative to shape their own health actions away from official health institutions.
The ‘collective efficacy’ model, outlined by Steinmetz-Woods et al. (2017), has arguably taken place in conurbations like Brixton. Brixton has been home to an established health-counter public sphere which has facilitated the opening of many health stores and a proliferation of vendors focused on self-care. This has led to wellness and health activism in its diverse community and has informed the lucrative health, wellness and vitality sector in urban locales like Brixton.
The UK has high rates of amenable mortality among developed nations which may also serve to understand that communities with higher levels of preventable deaths and obesity are taking their health into their own hands. The UK also has poor neonatal and perinatal mortality rates and has low outcomes for those who suffer from life-threatening conditions, such as cancer and heart attack. The UK also spends less than average among developed countries on its healthcare system per capita and as a percentage of GDP.
As a result of this, we opine that it possibly should come as a surprise that those at greater risk and from lower-income groups are thinking proactively about their health without any over-reliance on over-burdened and under-funded national health services or medical institutions. Dismissing communities’ efficacy and proactivity to better its health in light of the challenges on the NHS also, as merely being the excesses of the ‘wellness industrial complex’ (Gunter, 2019), may not serve to adequately understand why these communities have been open to a broad repertoire of health improvement approaches.
Brixton demonstrates that even though the community was subject to various forms of dominant hegemonic control, it was able to deploy human agency when it came to health. In health studies, it could be assumed that the relative powerlessness of a community undermines their ability to develop. Indeed, subaltern counterpublic spheres emphasise how disadvantaged groups contextualise experiences of stigma, power, domination and subordination.
Spivak (1988) suggested that the subaltern has to adopt Western ways of knowing and language in order to be heard and seen, yet what is evident is that the contrary may also be the case. The ability of marginalised groups to resist hegemonic power and self-organise to contest the negative consequences of health crises.
Agency is a key aspect of the navigational repertoire of adapting to health challenges these communities face. Agency is therefore a fundamental component of the larger remit of pro-social response for individuals and communities.
This feature to contest, challenge and overcome adversity demonstrates resilience, which many public health studies highlight as a positive determinant of health as it is interlinked with optimism and control, facilitating recovery from life-threatening disease. In this way, these individuals in Brixton are agents of health care, albeit a healthcare quite different from that sanctioned or even supported by the state and medical institutions. Their collective agency is evident in their associations and narratives which confer control over certain medical and health epistemologies.
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