The perils of iatrogenic disease

Town & Country Planning, February 2009

It is well over 35 years ago now, so not even I remember the Israeli doctors' strike. But it remains a fascinating statistical peculiarity, because – for no obvious reason – the regular death rate dropped dramatically. For some reason, never explained, when the doctors didn't work, people didn't die so much.

The strike happened in 1973, the days of Ivan Illich's attack on the whole doctoring business, Limits to Medicine, which explained why people latched onto statistical peculiarities like that. Illich also coined a phrase which is now largely forgotten, by almost everybody except me. Iatrogenic disease.

Let's face it, this always was rather a mouthful. But I found myself using it at a conference of senior officers in Sutton Council a month or so back, when they were discussing how to deal with the economic crisis.

So here's my defence of the mouthful at a time like this. If iatrogenic disease means disease caused by doctors, we need a phrase which means economic unravelling caused by regenerators. Otherwise we will not be seeing clearly what is happening around us, and there is no doubt that Mad Regeneration Disease disease is horribly real.

I realised this doing a TV interview for BBC London, where I had unwisely assumed I was about to go on the radio and failed to bring a comb – perhaps that is why they billed me as 'Dave Boyle'.

The thesis was that the first shops that are being boarded up are not actually the small, family stores. It is the big chains. Sure enough, the very day after my wander through Wimbledon in front of the cameras, the shop we started at – Tchibo – closed its doors.

Certainly in my own neighbourhood of Crystal Palace, it is mainly the big chains which are now providing the great gaps – McDonald's , Woolworths, even and of course poor Woolwich, torpedoed so egregiously by Barclays a year or so ago.

This is something of an extrapolation from word of mouth. There must be many locally owned and family firms that are seriously suffering as well. But it does imply that, when my colleagues at the New Economics Foundation developed their 'clone town survey', they were inadvertently developing a broad measure of economic vulnerability.

The more cloned the high street, the more gaps there will be appearing in it over the next few months. We will see.

More seriously, there are a number of forms of iatrogenic disease out there at the moment, and it is worth being aware of them:

1. Mixed use retail and residential blight: the problem is that the laboriously negotiated Section 106 agreements depended on property prices being at a level where, it hardly needs saying, they no longer are. So there are a number of developers quietly walking away from sites where demolition has started but seems unlikely to be finished.

2. Destruction by superstore: in the dash for superstore growth, very few local authorities looked at the likely effects the new developments would have on money flows, taking it for granted that any big name was a potential anchor store. But if the big name has ambitions to do and sell everything, they are just as likely to corrode the shops around them, and will anyway be funnelling local spending out of the area – compared to local shops which buy and sell from each other and keep the money circulating.

3. Fake regeneration that turns out to be degeneration: all those major developments which relied on massive demolition and rebuilding with middle class housing were not actually regeneration at all, just a deliberate decanting of poorer people to somewhere else. Now, of course, the new housing is unsellable.

All these versions of iatrogenic disease are not just making things worse than they would have been if the regeneration professionals had steered clear. They are also microcosms of the global economic crisis. They are the result of using just one centralised formula, which nobody in the mainstream ever questioned.

If there is a way out for these places, it is going to involve a whole range of different models of building affordable housing. It is also going to involve a complete rethink of the assumptions of regeneration – starting with where the money goes.

When we build again – a potent old phrase that – we are going to have to pay a whole lot more attention to the fine mesh of a place, the way the money flows around it, how enterprising it is and could be. Then we are going to have to find ways of keeping the money circulating locally, rather than subsidising a handful of retailers to suck out whatever is left.

We have spent a decade or so squeezing enterprising local shops out of our high streets – using higher rents and expensive redevelopment – only to find we have built some highly vulnerable places. Even if that vulnerability just lies in the multinational shops being more footloose.

Of course they are. In flooded New Orleans, the first coffee shops to re-open were the local ones, while the boarded up Starbucks shops just gathered rude graffiti. Perhaps we will see the same in Wimbledon.

David Boyle is a fellow of the New Economics Foundation and the author of Toward the Setting Sun and other books. www.david-boyle.co.uk