Control, Stress Pathways and Rights of the City: Associates Workshop #4

With John Hume and Dr Ellie Cosgrove

A social determinant of health

“Control is central to our health as both individuals and as communities. Studies show that we fare less well without it, individually and collectively. When we don’t have enough control, we’re less satisfied, we get ill sooner and we tend to die younger, when combined with other factors.” That was the view of John Hume, who opened our first Associates workshop of the year, focused on the theme of Control.

John is Chief Executive of the People’s Health Trust and a member of the Advisory Board for NIHR’s School for Public Health Research, Chair of the Living Wage Friendly Funder Committee for Living Wage Foundation and a member of the Living Wage Advisory Council.

He explained how an example of lack of control at an individual level could be as simple as: I’ve got a job, but it pays below the living wage or is a zero-hours contract. I have little control over the shifts that I work. I have little control over when I take my breaks, let alone the duties that I perform. Having little permanence in your role is highlighted too, which is one of the Foundation’s themes.

This ‘low pay’ scenario could be swapped for any socio-economic situation — the housing crisis, discrimination, lack of green space, a poorly maintained built environment or living in a poor economic circumstances. The experience is not linear; and no one thing happens in isolation. It’s a combination of different dimensions which interact, and they layer on top of each other, causing stress (relatable to all of us), culminating to negatively impact some groups of people.

“Whether it’s acute or chronic, stress pathways lead to significant disruptions in biological processes in our bodies. They can exacerbate or cause physical ailments such as cardiovascular disease, diabetes, hypertension, and weakened immune systems”, he continued.

Moreover, vulnerabilities tend to ‘cluster’ in neighbourhoods, leading to increasingly disenfranchised groups of people who are likely to become more susceptible to shocks around them. Compounding the problem, these stressed communities are seldom talked about — precisely because they don’t have control or a voice. At its worst, this experience contributes towards residents dying younger.

Control is recognised as a social determinant of health in World Health Organisation reports (2008) and Marmot reviews (2010 and 20). John and his team are now seven years into a ten-year programme about ‘collective control’ and agency in the community of Lozells, ranked the third most deprived neighbourhood in Birmingham and which suffered from disproportionately high rates of Covid deaths amongst the largely South Asian population.

The programme supported Aspire and Succeed in Lozells to lead local people in taking control over decisions about issues which matter to them, drawing on their wisdom and needs to define priorities and actualise their agency. Steering groups of local residents took control — and slowly the neighbourhood witnessed massive confidence emerging, particularly with the girls and women. The organisation was key to encouraging vaccination uptake. As a result of high COVID deaths residents used their local agency to call for an inquiry. They’ve since launched a commission in partnership with Warwick University which will review the statutory services provision within the neighbourhood. The results will launch in April 2022.

Power | Control | Rights

Dr Ellie Cosgrave, who leads Publica’s not-for-profit arm and its research team, is a leading expert in making cities safer for women and girls, and chairs the My Body Back project, offering sexual health services for victims of sexual violence. She spoke about power, control and rights being quite usefully interchangeable.

Ellie clarified the difference, “Power is about being able to use force to make a difference. Control is about having power over the nature of that change. And rights are about justice being incorporated and that people have a right to act, but also a right to basic needs and services.”

“When we’re starting to think about control, we can think of the Rights of the City as a useful container”, referring to social theorists David Harvey and Margit Mayer’s outline of the demand for the Right to the city as a kind of request for all the people who live in the city. According to Harvey:

“The right to the city is far more than the individual liberty to access urban resources: it is a right to change ourselves by changing the city. It is, moreover, a common rather than an individual right since this transformation inevitably depends upon the exercise of a collective power to reshape the processes of urbanization. The freedom to make and remake our cities and ourselves is, I want to argue, one of the most precious yet most neglected of our human rights.”

Gender dynamics affect who has power to reimagine and remake the city; and who has the power to create public spaces which are easy and safe to access for all. “When it comes to those who have the power, professions associated with city-making tend to be male dominated. These tend to be policymakers, engineers, urban designers and police”, she shared. Inversely, “a disproportionately higher number of women and transwomen avoid empty streets at night, their testimonies are often taken less seriously by authorities and they have different levels of access to funds to make changes to spaces than men”.

Ellie highlighted successful case studies from Europe and the UK. For nearly 30 years Vienna has been a leader in looking at the ways in which gender disaggregated data can be collected to understand what is happening in the city and redesign with that data in mind.

“The city discovered that up until about the age of 8 years old, boys and girls were using the park at similar rates as one another. After the age of eight the girls tended to disappear from public spaces, due to the children having to socially negotiate the space. It tended to be the kind of ‘boys’’ activities that won out over others. Designers have started creating separate spaces for sports activities than those for sitting and talking, but importantly an equal provision of both”.

Following the breakout room discussions amongst speakers and Foundation Associates, it was posited that gender dynamics are at play with women accessing safe cycling. While society has a huge priority to encourage active transport for health, planetary and infrastructure reasons, barriers are raised earlier to girls, via social conditioning around danger of being on the roads as well as body functions such as sweating in public.

Safety is often linked into a sense of ‘control’ and is often synonymous with power for one’s own body. When you invest in giving groups power to determine processes and outcomes or places and how they can move in them, you can create spaces without assumptions that serve the community.

Many thanks to Warren Lever, Urban Designer and developer of the QOLF Training programme for Local Authorities, for chairing the event. If you are interested in becoming an Associate, please find the relevant information and contact form here.