Bromley by Bow: Listening to communities and shaping public spaces to improve health

Traditionally, service provision within communities, such as health centres, has focused on the problems and needs of the local population. It assumes that a professional intervention is the solution, and the physical spaces created to deliver these interventions often reflect this approach. The individual is a patient or beneficiary visiting a centre owned by the professionals – communities often have little say in shaping these spaces.

The model used by the Bromley by Bow Centre and Health Partnership is based on the premise that health and wellbeing is created through focusing on assets and strengths, rather than deficits. We support families, young people and adults of all ages to learn new skills, improve their health and wellbeing, find employment and develop the confidence to achieve their goals and transform their lives

For this to work, it is critical to assess the purpose, function and nature of the environment where their provision interfaces with individuals and communities.

At the Bromley by Bow Centre, our impetus has come from within our community and its desire to develop an environment that builds connections between people, where daily lives can be lived in a manner that is enriching and promotes health and wellbeing. We are supporting a growing network of health and community centres, who have radically reassessed their fundamental purpose: to create vibrant, resourceful communities.

At the core of what Bromley by Bow does are our active values:

• be compassionate
• be a friend
• have fun
• assume it’s possible

And it is the physical space (both the design of our buildings and green space) that creates an environment where our values and an asset-based understanding of health can become a reality.

Be compassionate and a friend

If we are to move away from paternalistic relationships to ones where shared decision making and co-production between communities and providers is possible, we need to build spaces that enable and embody these new interactions. At Bromley by Bow, we designed a space that blurs institutional and public space. The features that distinguish staff and public are minimised. Instead of receptionists, we have patient assistants. There are no push button entry systems, signing in sheets or intrusive CCTV cameras. Where appropriate, our staff meets with people in our social enterprise café, or when the weather is good, in the park. This means that you can see people working with staff to tackle debts, look for jobs, or find an exercise class they are interested in, all beside each other in a deliberately informal way.

Have fun

Each month we host lots of events in our community-managed three acre park: from Eid celebrations and festivals to breakdancing classes, yoga and school sports days. They provide an opportunity for new residents to visit the centre and get to know our staff and services. But above all, they are designed to be fun, and allow people to engage with the centre on their terms. Bromley by Bow’s friendly welcome and informality allows people who might be put off by institutions to feel ‘at home’. This means they are more likely to come back and make use of other services, while also feeling empowered to contribute to the Centre’s development.

Assume it’s possible

Visiting Bromley by Bow 35 years ago, one would have encountered nothing more than a dilapidated church and hall (used only for a couple of hours on a Sunday morning by an aging congregation of 12 people) backing on to a scrappy, ill kept, local authority park (littered with dog poo, broken glass and syringes). That the Bromley by Bow church didn’t close its doors once and for all, convert into apartments, or become a bingo hall is testament to its community’s endeavour. Instead it became one of the most successful Healthy Living Centres in the UK, with perhaps the only health centre owned by the patients. It was the local community that took leadership and built our centre, and their legacy can be found in every corner.

Our centre has grown organically thanks to our community, staff, artists and architects. They have moulded and shaped it based on their understanding that its design was critical to fulfilling its purpose in bringing people together. This process has created buildings and spaces that are invested with huge character, while also offering their users permission to be themselves, and feel empowered to take ownership of their own health.

This guest blog from Dan Hopewell and Sara Thomas at Bromley by Bow Centre is in support of our series of infographics exploring the social determinants of health. Dan is Director of Knowledge and Innovation at the Centre, and Sara is Knowledge Share Programme Manager. You can follow the work of the centre on Twitter at @sois_bbbc.