Sunday 29 July 2007

Winchester Cathedral

Sunday, July 29, 2007

Today we took a trip by train to Winchester, a modest-sized town to the southwest of London. Peter Duncan, my academic sponson at Kings College London, and his wife Jane and the two girls, invited us to lunch and a tour of the town. Peter met us at the train and drove us to his house, a lovely 100 year-old, duplex-style house (attached) to which they had made many terrific improvements. It was quite warm and cosy. Jane cooked us a delicious home-style meal (one of our few in many days) complete with red current wine made by their neighbor. It was really good--more like a light port.

After a hearty meal and some wonderful conversation, they drove us to the Winchester Cathedral, a huge structure set off in an enclosed church area (a "close"). Entrance is free on Sunday (so we made a donation), and we got to hear part of a service, including the ever marvelous choir, including the boy sopranos. I still can't get over that sound echoing off the cavern-like stone walls of the cathedral. Winchester Cathedral is not as ornate as some others we visited, but it has one of those high, stone, fan-like ceilings and external flying buttresses on one side.

After a brief visit, we walked into the town and marveled at the main street--a double row of mixed historic structures winding and climing up the hill. Later we passed the old Guild House and the statue of King Alfred (founder of Britain???). More historical details to catch up on later.

So Linda and I caught the train and enjoyed the hour ride back to London, talking about our wonderful day and how the fantastic sites and lovely friends seem endless.

Saturday 28 July 2007

Prayers and Pizza!

July 27, 2007
Day 28

Prayers and Pizza in Southwark

Sorry for the slightly irreverent heading, but it does describe our activities last evening.

First we attended a brief service at the Southwark Cathedral, home of the Anglican Diocese in this area. The Cathedral lies on the South Bank of the River Thames close to London Bridge on a site occupied by a Church for over one thousand years. The main structure of today's church was built between 1220 and 1420. http://www.southwark.anglican.org/cathedral/

Today this lovely structure is crammed in, between office buildings, restaurants, pub, cobbled streets and even the initial ramp of the London Bridge. I would describe the ground-level, historic, structure (although best seen from the sidewalk of the bridge, some 20-ft above) as “hunkered-down” in the midst of all this mélange. However the upper levels, including the spires, windows and bell tower, reach into the sky, like the blooms on a flower searching for light and air!

I’m not much of an architect or cathedral expert, but found the inside of the cathedral to be altogether lovely and expansive—clearly the rival of much more celebrated churches we have seen. It only opens for church services and tours with appointment; so we took advantage of the service of readings to gain entrance.

I don’t think I can improve on the physical description of the web link above, but the service was simple, informal and quite calming. Only about a half-dozen people were present; so the reader invited us up into the choir area, if we wanted. We remained in the sanctuary hall with the beautiful stained-glass window before us and the fan-styled, stone roof high above.

The reader told the story of King Saul, when Samuel announced that he would loose his kingdom to another because he made a burned offering to keep the people happy. What a commentary on our world today! Also at the end, during the Lord’s Prayer, they used the phrase, “forgive us our sins as we forgive those who sin against us.” What a beautiful and difficult way to say it.

At the close of the service, I lit a candle for my brother and for a friend who helped him. In the presence of this beautiful, peaceful cathedral, surrounded by so much anxiety and noise, it seemed like the thing to do.

By the way, the Londoners don’t say “South-wark” the way it is spelled. The best I can describe it is “sudth-erk” with the emphasis on the “sudth.” Go figure!

As far as the pizza part of my story is concerned, we tried a local pizza restaurant in the shadow of the cathedral. We had a great salad, some wine and shared a pizza (NOT NY style), but something crisp, aromatic and quite tasty.
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Friday 27 July 2007

Fulbright Project and "Wicked" in London!

27 July 2007
Day 28

Fulbright Project

The “project” is beginning to come together (at last!). Jeff French, the NSMC director and I discussed it again yesterday and decided that developing a draft framework of an American National Strategy for Social Marketing in Public Health would be a useful exercise both for the England (mainly because it is based, in part, on my observations of the NSMC and the development of social marketing here), and possibly for the US. I am not aware of a US national strategy, or of an ongoing discussion regarding a plan for its development. According to a few colleagues, there have been discussions in the past, but they were abandoned without resolution.

Admittedly, it is presumptuous that I should undertake such a task—certainly alone, perhaps at all. I am not a “patron saint” in the social marketing field, by any means. But I believe that social marketing can and does make an important contribution to public health (and to other areas of “public good”). Also I believe that we need to realign the disconnects between public policy, funding, research, training, professions and practice (including partnerships with other sectors) if we are to realize the full potential of social marketing in the US. It’s a big challenge, but if I can only revive the discussion and help to give it momentum, it may be a worthwhile endeavour.

The contrast between the US and England is becoming clearer to me after a few weeks of observation. England created a policy umbrella at the highest levels of government—including the Department of Health (DH), the NCC/NSMC and several other governmental agencies. This appears to result from a large amount of luck (being in the right place at the right time with the right people) and taking advantage of opportunities created through hard work and vision. The key players plan to work out along the ribs of the umbrella, as it were, to bring in other policy partners and expand the overall field. Also, the NSMC identified 10 demonstration sites (under its contract with the DH) and works with them to train staff and provide technical assistance. These activities, along with an incredible number of superb supportive documents, meetings, plans and other excellent work by a small core staff, support the policy-level infrastructure with the potential for stimulating an ever-wider penetration of social marketing into the national, regional and local levels.

According to one report, there are number of academic centers involved in social marketing teaching and research in the UK, but only one has a robust, long term program. Otherwise, teaching and research in social marketing is described as being “relegated to modules within other degree programs.” Obviously, the success of social marketing at the policy level and its intended extension into practice raises the question of “who is going to train social marketing professionals in the future?” So although the English model has real strengths, there are also clear challenges.

The US, on the other hand, seems to approach social marketing from a more combined academic and pragmatic point of view—as counterintuitive as that may sound. There are several key US academic centers offering social marketing training and research, (although I am not sure there is a current and systematic listing of these programs). The RI Department of Health has hired several regionally-trained public health professionals over the past few years with real expertise in social marketing. Many more of us got our training from the USF National Conference on Social Marketing in Public Health, or from the associated field schools and related activities. In addition, the Robert Wood Johnson Foundation (RWJF) funded the Turning Point Initiative. Started in 1997, Turning Point created a network of 23 state partners and five National Excellence Collaboratives to transform and strengthen the public health system in the United States. Although the program has closed, many of its products are archived on the turning point website http://www.turningpointprogram.org/ and are available for use. Obviously, the participating states and others still benefit from involvement in this excellent program.

It appears that one could describe the evolution of social marketing in the US as more of a “grass roots” approach rather than a policy approach. In other words, a few key academic centers have produced modest sized classes of students prepared in social marketing practice; some expanded these programs into conferences and special schools. At the same time, an increasing number of state and local health agencies, as well as private, voluntary organizations are using social marketing-based interventions. Unlike England, the US does not have a social-marketing friendly policy (e.g. designated funding and exclusive status as a public health intervention) at the highest levels or a series of documents and plans to promote social marketing throughout the governmental and public/private practice sectors. This may change with the relatively new Coordinating Center for Health Marketing and Communication at CDC. However, as far as I am aware, neither country has policies to fully address the development of social marketing in the academic and professional (competencies, benchmarks, and certification) sectors.

So, once again, my apologies to more knowledgeable colleagues for any errors or misconceptions in this analysis, so far. I hope that you will give me your encouragement, advice and point me in the right direction for more information.


26 July 2007-07-27
Day 27

Wicked Good Time!


Last night Linda and I went to see “Wicked” the rave London musical telling the story behind the two witches in Oz: Glinda, the “good” witch and Elphaba, the “wicked” witch. It was a wonderful production—one of the best I have ever seen! The cast portrayed their characters with energy and style, the voices were wonderful, the choreography thrilling and the sets fantastic. The sets included a backdrop of moveable panels with gigantic gears and levers and other mechanical devices. And the flying monkeys were so believable! They reminded me of the authenticity of the feline characters in Cats; after a while I forgot they were actors!

Wednesday 25 July 2007

Academic meeting and Site Visit

25 July 2007
Day 26


Today I met with Ann Wylie, PhD, Senior Tutor at the KCL Undergraduate Medical School. We enjoyed a long discussion about her efforts to teach health promotion to medical students in each of the 5-years of training. She has some rather innovative methods, in my opinion, of exposing medical students to some of the ecological issues of health and the difficulties and strategies for changing risk behaviors. I don’t believe we have anything like it in the States, although my direct experience with medical education is limited.

What I liked about her approach is that it was a way of helping practicing physicians to be aware of population health promotion and developing support in that sector. We also talked about the possibility of including social marketing in that curriculum as a way of building support for the strategic program into the future. Although I am still struggling to fully understand the structure of government, public health and academic sectors in England, we talked about the position of the Faculty in Public Health (and the Voluntary Register) as well as some of the other organizations involved, such as the Association of Study of Medical Education (ASME), the Association of Medical Education Europe (AMEE) and the Society of Academic Primary Care (SAPC)---about their position on social marketing. I think it’s fair to say, they don’t have one.

Here again, I think there is a valuable opportunity to garner strategic support for social marketing in primary care medicine and medical education. I believe key academic partners are willing to play a role (and seem to have a strong strategic position in the relevant organizations) but would need support from NSMC and other partner organizations. A more informed discussion with her, perhaps a presentation to one or more of the relevant groups, an article in one of the professionals journals (Health Education Journal?) and some other activities would go a long way to making this possibility a reality. I can’t imagine a more powerful, strategic support for social marketing in public health than to have the understanding and support of primary care professionals—especially corps of new physicians (the KCL medical class alone is more than 400 each year!) over the next decade or so.

Also, I plan to take some of these ideas back to Brown with me and talk there about the possibility of including social marketing (along with health promotion in general) in the medical curriculum. (See A. Scott-Samuel and J. Wills in Health Education Journal, 2007:66, 115 for an article: “Health Promotion in England: sleeping beauty or corpse?”

Metropolitan PCT site visit (Hamlet Towers):

At an earlier meeting, one of the associate staff at a local PCT offered to give a tour and site visit. Linda joined me and we set off on the tube for the East London area known at Whitechapel. I knew something was radically different when we emerged from the station into a busy street filled with sidewalk merchants and people of every conceivable nationality or ethnicity. There were turbans, sarongs, burkas, shorts, robes etc., etc., reminiscent of a busy street in Cairo or Istanbul—hardly what I expected in London. Our guide explained that 40% of the population in this area is Muslim (from various countries) with white Britishers accounting for another 40%. The remainder comes from all over the world and settles here due to the more reasonable living costs (compared to downtown London). After only a few moments, we passed across the street from the London Mosque which was broadcasting the call to prayers throughout the neighbourhood.
This is also the world of Sherlock Holmes, Jack the Ripper and alas, the start of the Salvation Army (of which my parents were officers). We explored the narrow streets filled with restaurants, shops and artists only to emerge on the edge of the financial district and below a unique building widely known by the nickname "The Gherkin." It is 180 meters (590 ft) tall, making it the second-tallest building in the City of London. I like to think of it as the “lipstick”—but that’s just me.
So we walked through the open markets, back alleys and broad avenues trying to soak up some of the diverse culture of the area. I didn’t directly observe any desperate poverty, but can only imagine some of the issues that exist in the vast expanses of public housing and tenement towers. It was more difficult to imagine trying to promote health in an area with so many different languages and cultures. But our guide persisted in pointing out the richness of the culture and the essential energy of the population crowding the streets. Perhaps this reminds us that while health is certainly one of the most valued things, it is not the only thing that matters…..
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Monday 23 July 2007

"Commissioning" for Social Marketing

23 July: Day 24

“Commissioning” (Contracting) for Social Marketing


The longer I spend over here, the more I become convinced that many of the public health challenges in the two countries (England/USA) are similar. This came out earlier in a training session when participants said that the three biggest obstacles to using social marketing in public health were: getting permission, getting enough time to do it right, and getting sufficient money to support it. I often hear the same three issues in America.

This morning I sat-in on a briefing session with senior-level representatives from a metropolitan PCT (Primary Care Trust) with a large, mostly disadvantaged population. The topic was guidelines for contracting with consultant firms. Senior NSMC staff did a brief orientation and review of social marketing; then presented a number of checklists and tips on “commissioning”—materials (and discussion) that I thought were really helpful. The “What Is Commissioning?” slides discussed the balance between advocating for the public and stewardship of tax revenues. The 10-point checklist established a number of characteristics that potential contractors should display, such as “evidence of systematic scoping (formative research) and development phase;” “evidence of working with multi-sector delivery coalitions,”—in other words, have they really done social marketing before and will they do it for me?
A briefing template takes the public health professional through a step-by-step plan for organizing the social marketing project. It helps to answer the question about whether the formative research (or the firm’s usual approach/product) will have the greatest effect on the project design or what partnerships or stakeholders need to be informed. In addition there were other tip sheets and “working in partnership” guidelines available.

The contracting process in England seems at least as rigid and proscribed as it does in the US. So I thought that the practical guidelines for an agency that was new to matching up social marketing interventions with a chorus of prospective consulting/contracting firms was really a good idea. I hope I am able to bring some of these ideas home and adapt them to our own situation and encourage others in other state and local health agencies to do the same thing. When they appear on the NSMC website (most are still in draft form), I will add a link to my blog.

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Sunday 22 July 2007

Hyde Park and Kensington Palace

LD 22 July
Day 23

Hyde Park and Kensington Palace

Today is a rest day, no work and no extensive touring around the country—just an afternoon trip to Hyde Park, Kensington Palace and the Mayfair embassy district.

These parks are really impressive. We took the tube to Green Park, just north of Buckingham, then walked a short distance to Hyde Park. The Speaker’s Corner is around to the northwest side and we found it packed with people, many of whom were listening to speakers decked out in various forms of costume or props (flags, pirate outfits, blue jeans, house dress, etc.) One speaker said “…that’s what women really want, a man to put them in their place….” We left before the riot started!!! (just kidding!) Others talked about race, religion and various topics—often without anyone stopping to listen.

After Speaker’s Corner we walked quite a distance through the park to the Kensington Palace, which contains the State Apartments, home to the royal family for 900 years. The building was quite ordinary on the outside (we didn’t go in), of dark brick. However, the gardens were extravagant and even contained some huge metal flowers to commemorate the 10th anniversary of Princess Diana’s death.

Later we took the tube to Bond Street and turned southward to explore the Mayfair embassy district. The building here were quite unique and attractive—not just the embassies, but many of the others as well. The Qatar embassy was an old, red brick structure right on the street—reminiscent of an old school house.

Grovsnor Square includes several embassies, Canada, Italy and USA. The latter was encased in cement barricades and iron fencing. I don’t know if it is just construction or security measures, but it definitely changed the character of the area. Also there is a nice statue of FDR and a memorial to all those who died on 9/11.

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Saturday 21 July 2007

Little church near Rugby

20 July 2007
Day 21

Rugby:

Today we traveled to Rugby, about 1 ½ hours northwest by train to visit my cousin Hugh and his wife, May. We had a wonderful reunion and discussed all the family things that have occurred since our last visit 3 years ago.

After a wonderful lunch (beef burgundy, scalloped potatoes, fresh vegetables, trifle (for dessert), assorted cheese with grapes and wine!) we piled into the car for a tour of the area. It turned out to be cool and quite cloudy in Rugby, but we enjoyed exploring some of the back roads and even stopped at a little pub in Ashby St. Ledgers, a little village with thatched-roof homes, to stretch.

A local gentleman suggested that we check out the Norman-built church. When he said it was always open and contained some drawings “over 1000 years old” I was hooked! It turned out to be wonderful advice! I found a website below that describes the little church better than I ever could. However, we immediately felt a sense of intimacy with the heavy, moldy gate, the dark-thick door and the small group of pew boxes inside the sanctuary. Unlike many of the other elaborate cathedrals we previously toured, this one was modest but somehow comforting—almost as if it invited us to sit quietly and consider all that has taken place over the centuries since its beginnings. Truly, this was a treasure of a find!

http://www.ashby-st-ledgers-church.info/

Side Trips

July 18-19
Couple of side trips

Greenwich:

I had a afternoon meeting on Thursday near London Bridge (close to our “dorm”; so Linda and I decided take advantage of the good weather and head out to Greenwich, a short tube or boat ride down-river from London.

The Cutty Sark, the 19th century sailing vessel, was damaged and covered in plastic and scaffolding; so we dedicated to walk straight up to the Royal Observatory on the hill overlooking Greenwich town, the Naval College and far-off London.

I never really thought about it too much—how we take for granted being able to find out where we are on the face of the earth. Now we have Google maps, GIS devices—even exquisitely detailed maps are a relatively recent invention. Apparently, latitude (the distance north or south of the equator) is easy to determine through celestial navigation. Longitude, the location east or west of some fixed location (like Greenwich) is more difficult—especially without an accurate clock. The time distance between London and NYC, for example, is 5 hours, representing 75 degrees of longitude or 15 degrees for each hour. Determining the time in a far-off ocean using the stars/sun/moon is not to hard, but knowing the time back home is much more difficult in an era of pendulum and stone weighted clocks that are affected by the temperature, humidity and movement of the ship across the water. It wasn’t until someone developed a reliable timepiece and until the Admirality established Greenwich as the “prime meridian” that navigators could accomplish both requirements of determining their location. Fascinating!

So Linda and I took turns straddling the prime meridian; then toured the observatory where observers sat and charted the heavens to establish accurate celestial maps for use in navigation. Hence, the British ascendancy as the “ruler of the seas”. I have a whole new appreciation for the self-taught watchmaker who solved the problem and made it possible.

It’s an interesting analogy for the public health profession. Knowing where we are takes a thorough knowledge of where we started (prime meridian) and what has happened in the interim—how long we have traveled. I think it is a case for evidence-based interventions and good evaluation—the first providing a reference point and the latter, a measurement/observation of the facts.

As an instance of irony to this analogy, Linda and I got on the wrong train for the return trip and arrived at London Bridge station without a ticket. The gate attendant was kind enough to listen to our sad story and let us through—his smile indicating that this was not the first time it has happened.

Broad Street Pump and British Portrait Museum

It poured rather vigorously on Friday morning; so Linda and I decided to stick close to home and explore some indoor attractions. Fortunately, the weather broke just long enough for us to fit in a visit to the Broad Street Pump, just north of Piccadilly Circus.

In 1853 cholera ravaged London. John Snow, a local physician, noticed that the people on Brewery St. (who drank the beer) did not suffer as greatly as those who lived on Broad (now Broadwick) street who drank from a local well. Without fully understanding the germ theory or the oral-fecal route of disease transmission from sewage in the water, he took the handle off the pump in an effort to quell the outbreak. Hence, the beginnings of modern epidemiology and the name of this blog.

I have to admit that the pump, a rather inconspicuous metal affair in the middle of the sidewalk on a corner of the street, holds a fascination for me. John Tierney, our former Deputy Director and mentor to many of us, frequently referred to it and often accompanied his wife on flea market forays with the intent to find “the handle on the Broad Street pump.” He found a likeness, and it now hangs in the Director’s Conference Room with the story of John Snow. By the way, there is a John Snow Pub just across the street in case a devout public health professional want to “hoist a pint” in Snow’s honor!

National Portrait Gallery

From here we went to the Portrait Gallery for a quick tour. I can’t say that I am an admirer of classic art, but the extensive collection displayed portraits from the modern to those many centuries old. We recognized some of the more famous names (Churchill, Gladstone, Johnson, Burns, Montgomery, etc.). My favorite was the display of Princess Diana—a collection of formal and informal poses with some almost “tomboyish” renderings. What a loss!

We also marveled at several paintings of the Houses of Commons and Lords commemorating some important event. One wall-sized painting showed 259 individual faces, each one distinctive and fully-rendered, an undertaking of 10 years work by the artist. Remarkable!

The weather finally broke into a sunny, arid afternoon; so we decided to walk down by the Embankment along the Thames and toward our “dorm”. It was a beautiful walk, punctuated by statues, riverboats, panoramic scenes of the waterfront on the opposite side, and, of course, other people hurrying home from work or out for a stroll. We were surprised to find ourselves back in the neighborhood in so little time—a 4 mile distance as we later determined. So we were more than ready for dinner in the local pub.

Thursday 19 July 2007

An Eye to the Academics....

17-18 July

If you are wondering about the curious title, just hang on……

I have been meeting with some of the public health related faculty at Kings College London (KCL) as I previously reported. They include: Dr. Peter Duncan, my academic sponsor; Dr. Margaret Sills, Academic Director of the Higher Education Academy (Health Sciences and Practice) and Dr. Ann Wylie, Health Promotion Lead, KCL Undergraduate Medical Education Team, General Practice and Primary Care.

I don’t want to report further on individual conversations, but I would like to update everyone on the gist of the discussions as they occur.

Most recently I had a long conversation with one of these faculty about the potential role for the academic sector in social marketing research and training. The question is, if social marketing is wildly successful in England (as it well might be) who is going to train the public health professionals in this approach to project planning and intervention? I believe that there is a real strategic role for academia in this, both in the UK and in the US—one that I am not sure is fully envisioned.

What I did find is that there is a project at the English Dept of Health (DH) that is mapping out all the places where public health is being taught—maybe even what is being taught in each program. This would be a good place to start. I also discovered that there is a network of regional directors of public health teaching in England (everything seems so organized over here!) that could be brought in as partners to the social marketing effort. Most public health professionals are “certified” in England by the Faculty in Public Health (I am still trying to get all the names and acronyms straight); so it might be possible to explore getting social marketing included as one of the basic competencies in public health, or to have it included as one of the benchmark criteria used to regulate the profession. I don’t have all the details right, but the general plan is correct. I plan to follow up on this at the NSMC next week.

Also, I attended an informal discussion group sponsored by DEMOS, a London think-tank specializing in public health and policy work. The presenter, Perri, did an analysis of the behavior change related policies of may English government departments. Using a very conservative and restrictive methodology, he found that that DH had the most policies, followed by education and a few others. Some departments had none. He also looked at whether these policies were extensive and intensive (coercive) and constructed a “bossiness” index. He found that the social departments were twice as “bossy” as the other, most focused on the poor and low income populations and that they did not focus on policies where there was a significant economic “risk transfer” to the general population. Many of these policies and programs were communications campaigns to persuade (or dissuade) the target public from some behavior.

This report prompted a lot of discussion, including whether or not it matters about the programs unless we know how effective they were. In other words, is government really bossy and intrusive if the programs don’t really work? Good questions….and many others that I didn’t take notes on.

Once again I found it interesting that the same issues about policy, politics, government responsibility vs individual responsibility, effectiveness, paternalism, community duty, etc., etc. become issues in both England and the US—in spite of the differences in our governmental structures and cultures

Oh yes, the “eye” part……….The British Airways London Eye is the world’s tallest observation wheel—raising 135 meters above the bank of the River Thames across from Parliament. Linda and I took a bus to Waterloo, walked down to the river by the Royal Performance Center and took a ride on the Eye (15 pounds each). It is a wonderful experience and truly provides a bird’s eye view of London, one that is completely different from the ground level perspective. It moves slowly and without a perceptible vibration or a feeling of being up high. It is more the feeling a soaring in the air. Maybe that’s why the attendants say “Have a good flight” when people get on.

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Presentation for NSMC Associates

LD 16-19 July

WOW, the 15th was my last entry, and here it is the 19th already. So much for a “daily” record!!!!

On Monday, 16 July I gave an all day seminar to the NSMC associates and some core staff on the US perspective on social marketing. There were about 15 participants in all; including field staff from various PCTs and other organizations. As I understand it, NSMC contracts with professionals, either individuals or from other agencies, as associates to help with the planning and implementation of the overall project. I used RI case studies (clinical preventive services, hospital quality, emergency preparedness, etc.) as examples but also discussed some projects from my colleague Heidi Keller in WA State DOH as well as some examples from colleagues at the University of South Florida.

Given the comments following the presentation, I would say that the group liked the discussion of “marketing social marketing” the best. This is an exercise that I have used many times in the past to get emerging social marketers to use the approach to overcome obstacles faced when trying to conduct social marketing projects. Just like colleagues in the US, the group noted getting permission from their bosses, getting funding and being given a reasonable amount of time to go through the social marketing process were the most common obstacles. I felt a little lost trying to apply this exercise to the English public health structure (with the NHS, SHA, PCTs, DH etc.) but the group was very gracious and helped me through it.

I got a lot of great questions and some challenges (Can we call it social marketing if there is no service or “product” offered? What is the exchange in this circumstance? ) It was really stimulating.

One of the key objectives of my presentation was to confirm the realization that social marketing is not just about communication, but about a mix of the 4 P’s (product, price, place, promotion) and about behaviour change, not just about knowledge and awareness. The group agreed that this continues to be an issue in England, just as it is in the US and perhaps elsewhere.

Tuesday 17 July 2007

Day Trip to Canterbury

LD14Jly
Day 15
Trip to Canterbury

I have to admit that this is a lot harder than I thought, both the demands of keeping up with the activities at NSMC and the touring. I will just have to do my best….

Today we decided to take the train to Canterbury in Kent. We caught the train right at London Bridge station and arrived about 1 ½ hours later in this medieval wonderland after some interesting sights of the countryside to the east of London.

After a short walk, we came to the West Gate Towers, one of England’s best-preserved medieval fortified gatehouses. The arch beneath leads into St. Peter’s street (which becomes High St. then St. George’s St. later on), a busy pedestrian mall lined with shops, pubs and historical attractions. We stopped briefly to consider the river cruises and view the famous “dunking stool” (if you confessed you were a witch you were burned; if you didn’t you were drowned!).

The highlight was the Cathedral, of course, most famous for as the place where Archbishop Thomas Beckett was murdered (I believe the date was 1070). It rests in it’s own enclosed compound, surrounded by lawn and out buildings. There was an Evensong scheduled for that day; so we were not permitted to tour the entire building, but later caught part of the service and were able to hear the choir and the organ. We also toured the crypt, a dark, cool place with some ancient paintings and many stations for lighting candles.

A walkway surrounds the cathedral and provides a lovely survey of the exterior. We also happened on the Chapter House, a large, rectangular room where a volunteer guide told us that the monks congregated here each morning for brief prayers and to discuss the operations of the monastery.

Next we walked to the end of High St. and found the Roman wall surrounding the city. Only about a quarter of the structure still exists, at least for walking, but it give a nice view of the town, including the John Dane park, a lovely place for a stroll through trees, flowers and monuments. In an interesting way, the wall divides the medieval town from the bustling traffic and commercial activities on the outside, in much the same way that the original wall protected the town from the various assaults from without.

Finally, we arrive at Canterbury castle, a very old Norman Keep, mostly in ruins, but providing some interesting views of the architecture and building methods of the day—many of which seems surprisingly sophisticated, given the available materials and intricacies of the windows, towers and other elements.
We continued to wander around the inner town for some time before settling on a restaurant for dinner—one located just beside the river than meanders through the community. The terrace at the rear was sheltered, overhead, with a trellis and grape vines, many of which had cluster of green, immature grapes dangling overhead. We enjoyed a very tasty dinner, then made our way back to the train and home to London (after 11 local stops along the way!).

Site visits 12-13 July

12-13 July
Days 13 and 14


Some new acronyms that may crop up from time to time:

PCT – Primary Care Trusts (covering all parts of England and receive budgets directly from the Department of Health (DH). PCTs are responsible for primary care in an area)
SHA – Strategic Health Authorities (Created by the Government in 2002 to manage the local NHS on behalf of the Secretary of State and monitor performance and standards.)
A&E – Accident and Emergency (the equivalent of US ERs or emergency departments)


SITE VISITS
Brighton-Hove

Early on July 12th , Linda and I journeyed to Brighton to join up with member of the NSMC core team scheduled to give training in social marketing. Brighton is a recreation/resort destination of about 250 year-round residents on the south coast of England about 2 hours from London by train. (By the way, the trains here are really on-time, comfortable and not too expensive—about £20 round trip to Brighton). Linda went shopping and touring.

The group gathered at the Brighton-Hove PCT and included about 20 local representative and 5 core NSMC staff (plus me). As I understand it, the NSMC is contracted by DH for 10 demonstration sites, including training of site staff. So this was a “typical” training. The group included: physicians, nurses, nutritionists, health educators, a midwife, advisers, managers, communications officers, coordinators, teachers, trainees and other various professional and organizational representatives. For many this appeared to be the first intensive training in social marketing.

Rowena (Dr. Rowena Merritt) lead the training and used a rather nicely organized and comprehensive workshop agenda. It covered:
This thing called social marketing
Defining behavioural goals (SMART objectives)
Understanding the target audience
Moving beyond promotion-using all 4 P’s
Strategic social marketing
Ethical considerations
Taking an action plan back to work

One of the exercises I liked extremely well was a group collage on the target audience. The instructions asked us to think about our customer (in our case a teen mom who was not breast feeding) and to cut/paste items from various newspapers and magazines on to a sheet of newsprint. We thought of our customer “Jordan” as:

16 years old
White
Living with mother in a tenement house
Divorced parents (since age 9)
Experienced a period in child custody
Smokes
Childs father not around
Passion for handbags
Baby’s name “Brad” tattooed on her arm
Low self-esteem
At risk of another pregnancy
Tied to the house
No clear direction in life
Etc.

Then we choose and discussed pictures and headlines that seemed to reflect this customer. It really made the exercise come alive. Other groups focused on binge drinking young males, smoking teens, HIV risk men and obese teens.

Some broader observations:
One attendee mentioned that research found that only 30% of 4-year-old know their surname, but 70% recognized McDonalds
Several attendees objected to the “Road Crew” program in Wisconsin that provided limos for young men who binge drink on the weekend (27% reduction in crashes) because it promotes binge drinking. They didn’t seem to have a problem with needle exchance (to prevent HIV).
Typical of my experience in the US, a few of the more experienced professionals had difficulty stepping into the social marketing mindset of exploration and “scoping.” Sometimes they would respond to proposals with a kind of “we tried that audit won’t work” sort of comment.

This experience make me wonder how to provide sufficient training and technical assistance to public health professionals doing social marketing in local health agencies—both in the US and the UK. I think it is an important issue that brings together government, academia and practice-based organizations.

After the training, I rejoined Linda and took a bus to the Brighton city center with access to the beach and oceanfront. It was not a typical Brighton-esque day; rather it was cloudy, quite windy and showered from time to time. We only had the opportunity to walk out onto the Brighton pier and have a beer in the outside corner of a pub—sheltered from the fierce wind. The beach and line of houses went on forever both to the east and west of where we sat. The “sand” appeared to be more like marble-sized pebbles and I thought, for a moment to gather a sample for a friend who collects such things. But with no plastic baggie and facing another driven shower, I decided to try again at another location (sorry Brick).

Dudley

The next day, 13 July, I accompanied Rowena to Dudley, a community of about 300,000 in the “Black Country” a region near Birmingham (2 hours by train) known for its industry and historical “black smoke” emanating from factories. We arrived at the modest train station and got a ride to the PCT building.

This was a simple introductory visit involving some orientation and technical assistance. This welcoming group was smaller (about 4 participants) and included a senior manager and her 4 young field staff—mostly nutritionists, I believe. The only previous exposure to social marketing was a briefing by a NSMC leader. The key issue was obesity and access to fruits and vegetables (5-a-Day).

The site proposal clearly outlined the problem as multiple pockets of “deprivation” including widespread socio-economic and health issues. The field team currently conducts “let’s get cooking” program for residents of these areas (and others), but feels that one of the problems is access to fresh foods (as an alternative to packaged and fast foods). We encourage them to use the cooking programs as a way to gather scoping data and building partnerships.

As we worked through the social marketing process (as an orientation) I was impressed by the amount of available data at the community level. Later, they provided us with several extremely well-produced and comprehensive reports about Dudley’s demographic profile, population changes, health inequalities and obesity problem. When the discussion ended, the group agreed to schedule an all-day training on social marketing in the near future. It was clear that this professional staff, like many others in the UK (and certainly in the US) needs training support and technical assistance to launch successful social marketing interventions.

As another broader comment, I have found that my observation about using social marketing to find “an emotional hook” between the product and the customer to be well received both here and in the US. Public health people tend to get focused in on the health issues (maybe as a consequence of the epidemiologic, scientific and clinical orientations). An acknowledgement that people are emotional creatures and that it is ok for us to incorporate that into our planning, seems to be welcomed, maybe even liberating, by most.
###

Meetings and standards

London Diary 11 July 2007
Day 12 (with some references to days 6 and 7)

Catching up……


It’s time I dealt with catching up with my journal of events—especially those dealing with some meetings and site visits Brighton and Dudley.

I attended NSMC meetings on July 4th, 10th and 11th on various topics. The organization is quite impressive and reflects in both the content and the conduct of the various meeting. For staff meeting, the chair rotates from person to person—given people leadership experience and a shift in the ambience of each meeting.

The social marketing effort is organized into six different programs—each headed up by a key staff person:
1 – Practitioner development, support and events
2 – Government interventions, technical assistance and support
3 – Standards development, innovation and learning
4 – Communications, resources and events
5 – Research, intelligence and insight
6 – Health inequalities

The meetings are divided into parts such as: standing items, climate scan/intelligence, upcoming meetings/events, update reports (on each of the 6 program areas) and other items. The interaction makes for good discussion of new items and updating each other on a broad range of activities. I found them to be quite interesting and informative. Of course, I still have a lot to learn about the overall project and my participation in the meetings really helps.

I also attended a meeting of the National Social Marketing Standards Development Steering Group. By “standards” it means competencies and certifications for social marketing. One of the representatives from the MSSSB (Marketing and Sales Standards Setting Body) reported on preliminary efforts to develop standards for social marketing. My understanding is the MSSSB is the lead agency for such development, given its charter regarding professional standards (see below)

The MSSSB was established by the Department for Education and Skills (DfES) in September 2001 in order to develop world-class benchmarks of best practice for the Marketing, Marketing Communications, Sales and Telesales occupational areas. The benchmarks will form the basis for all Government funding of Marketing and Sales related courses. MSSSB will work with key stakeholders to help develop a national educational and training framework that support these professions. http://www.msssb.org/

One of the staff also prepared a nice draft table that cross-walks the NSMC benchmark criteria (http://217.154.246.74:8209/images/CoreFiles/BenchmarkCriteriaTOOLDec2006.pdf) and 10-point checklist with key standards, organizational policies and references in the literature (e.g. Ed Maibach’s People and Places, BMC Public Health c.2007). It made a very systematic link between the NSMC framework for social marketing and both the literature and the regulatory bodies.

n.b. Maibach’s article has a great bibliography and makes a very useful observation about social marketing in the US. “Much of what is called ‘social marketing’ by practitioners and academics is not marketing, however, because neither products nor services are developed, distributed, or promoted. Rather, most of what is referred to as social marketing in public health involves exclusively the provision of information, and is therefore more correctly characterized as communication.”


There were many other useful discussions during this meeting—too many to go into here. Clearly, there is an emphasis on building partners at all levels of government, community and academia. Also I met Dr. Sue Peattie, from the marketing department at Cardiff Business School, Wales. Among many other publications, she and her husband wrote an article in 2003 about reducing social marketing’s dependence on commercial marketing theory (Marketing Theory, Sep, 2003).

After this discussion, I recommended that the group consider the larger context of public health in the standards (competencies) process—such as the 7 areas of health education competencies developed by the National Commission for Health Education Credentialing (NCHEC) www.nchec.org. It would be a way of assuring the public health expertise as well as the social marketing expertise of the workforce.
###

Wednesday 11 July 2007

Diary of Fulbright Experience in UK

Robert Marshall
Fulbright #385 to UK
June 30 – August 12, 2007

Disclaimer:
The purpose of this informal diary is to memorialize my observations and reflections during my 6-week stay in the UK. The intent is not to evaluate or rate any individual, program or organization; neither should these comments be taken to represent the positions, personal or official, of any person or organization. They are entirely my own creation and in the unavoidable event that they upset someone, I offer my most sincere apologies. Having said that, I hope that these observations will record both my personal and professional experiences during the Fulbright Senior Specialist program in the UK and will serve to remind myself and convey to others how fortunate I feel to have been given this opportunity for a professional and academic exchange, to meet these wonderful people and to visit so many fascinating places. I will try to remain faithful to a roughly daily entry, but already see how that may be a challenge after a long day of traveling to different public health sites or cultural attractions.

LONDON DIARY

June 30, 2007, Day 1:

We arrived at Heathrow Airport on Saturday at 6:30am after a long but uneventful night in the air. The sun came up at 5am and shined through the cabin windows; it was ‘way too early, according to our US timeclock, to be seeing the sunshine.

After a long hold on the runway, and a long line in immigration/customs, we headed for the “underground.” Somehow the £8 for the “tube” seemed more reasonable than the £40 each for a cab or shuttle. (I just learned how to make the English “pound” symbol!) We transferred at Kings Cross to the Northern line and made our way to the Borough Station —dragging our suitcases of course-- for a 5-minute walk to the “dorm”. It was a huge, fortress-like building on the street with a green, tarnished-copper tower roof.

I call it a dorm because during the school year, it houses students at the King’s College, London—which seems to be located all over this part of town—are area called Southwick, which is directly south of London Bridge, about a 15 minute walk from here. Part of the Fulbright procedure is for the sponsoring university to make housing available to the visiting scholar: so after a brief check in, we went into the cavernous inner courtyard, to the “block 9” entrance and up the elevator to the 4th floor.

The room is quite functional, with twin beds and a ship-style bath—one where the shower is not separated from the rest of the facilities, the water just goes all over the place—not that the place is that big to start with. It takes a bit of getting used to, but the ample hot water felt good after a long day of travel.

Since it as about 6am US time, we flopped on the bed and took a nice long nap to recapture our energy for the day. When we arose, we walked in a light rain (which sometimes got worse) north to London Bridge, the eastward past the Shakespeare theater and national theater along the Thames River. It is a spectacular sight! At the Waterloo Bridge, we took the stairs to the street and located the administration building for Kings College London (KCL), my academic sponsor. Its all looks so different from Brown and most other universities I’ve been to—probably because of the central urban setting. There we lines of multistoried buildings down most adjoining streets, but nothing that looked like a campus or “quad” in our sense of the word. Of course, I may just be showing my American ethnocentrism and may discover yet more wonders of this incredible place.

I have to admit, that after a long, long walk and dinner at a local pub (there are certainly plenty of those over here; we already made a list!) we turned in well-fed and with high expectations for our next day in London.

July 1, 2007, Day 2:

We weren’t nearly as rested as I thought and got off to a late start on Sunday, which turned out to be a cool, blustery and dry day. (One gent offered that he had not seen a rainy day in London in the past 20 years!). After a leisurely breakfast, including on the largest and best cups of coffee I have EVER had, we decided to take another even longer walk to a shopping center near a place called Canada Waters. (Unusual place names in this part of the world! One “tube” stop is called “CockFosters” and another is “Elephant and Castle.”) We walked for about 2 hours, cutting northeasterly across the Southwark section of London and through a residential peninsula area called Rotherhithe. This was filled with upscale condos and multi-family townhouses and other residences scattered between lovely parks and gardens. I later asked a passerby in the area about how to say this name, and still haven’t a clue. Anyway it was beautiful—the area, I mean (so was the “pint” in a local pub after a long walk).

We found the shopping center hidden behind a gigantic bowling alley and a couple of “American-style” restaurant/bars (like TGI Friday’s). The shopping was quite civilized, with a couple of dozen (or so) stores and a food court. The biggest attraction was the TESCA store, the modest equivalent of WalMart in the US. We purchased a pressed coffee maker, some coffee, a small desk fan, and a few other items, then backtracked to that American-style bar (this is where the “pint” came from that I mentioned earlier). Afterwards, we headed towards the Canada Waters underground station and learned that the name comes from a small lake formed by a canal from the Thames. That explained some of the drawbridges and other aquatic features we passed on our previous walk. After a short tube ride, we walked with our TESCO plastic bags back to the Great Dover Street Apartments, and tried out the fan (it worked good after I put it together!)

We crossed the street to the Truman Pub for dinner and access to the free wireless internet connection. We sent a couple of note home and got an immediate response from our daughter Alexis, wishing us well. After dinner, we walked north again to the London Bridge, then eastward along the Thames toward the Tower Bridge. It is truly magnificent at night, with the lights shining and the Tower of London in the background. They must have known we were there, because there was a 15 minute display of fireworks on the far side of the bridge, adding to the beauty of the evening. On the walk home, we found a restaurant for breakfast and planned to visit it soon—who knows, maybe tomorrow.

July 2, 2007, Day 3:

As Robbie Burns said, “the best laid schemes o’ mice an’ men gang oft’ agley. So we did not make the restaurant for breakfast but enjoyed some fresh “pressed” coffee in the kitchen next door and took our time getting out into the Monday bustle. We did walk up to the restaurant, but they stopped serving breakfast; so we went to a nearby breakfast bagel sandwich kiosk on the Thames and enjoyed the lovely view. I had already contacted Rowena, one of the program managers at the NSMC project and said that we were planning to stop by; so we hopped on the tube and made our way to Grovsnor Gardens.

The “Gardens” is a triangle-shaped park surrounded by rows of stately stone offices and just a stone’s throw from Buckingham Palace. (My dream of tea with the Queen may not be so far fetched after all.) Rowena met us on the 4th floor and spent a hour and a half orienting me to the project. As it turns out, England has nearly 50 million people who are the focus of the project. (Scotland, Wales and Northern Ireland have their own Departments of Health—some of which are doing similar projects). England is plagued by many levels of public health from the national ministry to the regional agencies and local health departments—even local service areas for the National Health Service. Thus, it faces many of the same problems of fragmented governmental levels as the US. Rowena and I traded professional stories and anecdotes for a while, getting to know each other. I found that we communicated quite well and were able to focus on some common professional ground rather quickly. We did some preliminary planning for field trips to Brighton and Cambridge next week. She introduced us to the others in the office, Denise, Steve, Patrick (Communications) and Aiden (the IT guy) and, of course, Sarah, the executive assistant—the ones who always seem to run the show.

Rowena had to attend a meeting so Linda and I left to explore the neighborhood a little before returning to the “dorm” for shorts and t-shirts. We later walked across the London Bridge to the northern side, then westward along the Thames pedestrian walk. At the Southwark Bridge we recrossed the river and stopped in a local pub (surprise) for dinner. I had steak and ale pie, both delicious and filling. We stopped on the way home to pick up some groceries and get ready for tomorrow.

July 3, 2007, Day 4

And what a day tomorrow turned out to be. We had cereal and “pressed” coffee in the communal kitchen and enjoyed a brief chat with some “pigment” scientists holding an exhibition at the Royal Society hall near Pall Mall.

After breakfast, I walked to the London Bridge station and took the tube to “work” at Grovsnor Gardens. Oh, yes, I purchased one of the Oyster cards that work electronically and give a discount rate (about ½ ) on the tube and busses. So the tube was less expensive but still hot and humid. After about a half-hour (and two changes) I arrived at Victoria station and walked the block to Number 20.

Aiden set up a desk and computer (with email and internet access—hooray!) in a vacant spot, but I hardly got a chance to use it before getting invited to a meeting to discuss “standards.” As it turns out, standards really refers to competency criteria in social marketing. This was one of Veronica’s assignment with help from Simon who was seconded (pronounced sec-KON-ded, meaning on loan) from another department. Veronica seemed very well oriented to the subject and brought some articles from various journals to inform the discussion. I offered to review one by Ed Maibach (GWU) about a framework for differentiating between the roles of communication and marketing as tools for public health. I thought it was quite useful and offered an excellent bibliography! I was quickly drawn into another meeting, but a subsequent conversation focused on adding a few items to the NSMS benchmarks—such as ethics, science research and a couple of others. The purpose of this is to offer a starting place for competency standards in social marketing for the NSMS—if not a larger collaborative of interests.

In the next meeting, Clive Blair-Stevens (NSAMC Deputy) briefed a colleague from Australia on the NSMS. Liz King works for the AUS Dept of Health and Aging in Sidney with some strong interests in youth and alcohol prevention. It was amazing to hear the similarities among the three of us about agencies, governments, policies, finances and other challenges. Clive described the roots of the NSMC in the Choosing Health documents and subsequent recommendations. Some of the success resulted from being there at the right place at the right time with the right people—especially at the senior and ministerial level. Of course, I imagine there was some hard, prolonged work that made this possible. He described how many government agencies were separated into policy, communication and research/development offices—often without much coordination or communication between them. He regards social marketing and the NSMC as a way of overcoming those challenges. They are planning a World Social Marketing Conference in April of 2008.

Next, I met with Dr. Peter Duncan, my “official sponsor” at Kings College London (KCL). We enjoyed a long talk about our backgrounds and the major challenges of our respective roles. He asked me to work on an approach to basic social marketing training for undergraduate students; I mentioned the CDCynergy materials and the NTCSM website from USF. He also asked me to talk individually with several of his colleagues in health promotion, research networking, preventive health practice and medical education. I am really looking forward to the interaction and expect to learn more than I offer in these discussions—since this is the way things have been going so far.

Wednesday July 4, 2007, Day 5

Is it a cultural faux pas to celebrate the 4th of July in England?
NSMC Team Meeting
[ Temporarily lost document: will add when retrieved].


Thursday, July 5th, 2007
Day 6
To Cambridge

Today we arose early and caught the train to Cambridge. It went through several neat-sounding towns like “Bishop’s Stanforth” and such over the 1 ¼ hour ride. Cambridge turned out to be everything one could imagine. The station bustled with people of all age; some clearly involving parents with young people checking out universities. We walked about a mile into the town and arrived at the market place, packed with people and stalls offering food and various retail goods.

After a quick lunch, we took the 2-hour walking tour of the area with Nancy, a 70-ish resident of the area. She took us to the nearby church with a Norman tower dating back many centuries. Nearby way the laboratory where Watson and Crick figures out the double-helix DNA and where the first splitting of the atom occurred. She mentioned how many Noble laurets were educated or worked at Cambridge—no wonder, with 32 independent colleges in the university. We explored the many side streets and peeked in of the college greens of Trinity College, Kings College, Clare College and several others.

The highlight of the trip (for me at least) was the Kings College Chapel, a wonderously elaborate structure of stone set in the middle of the campus. Nancy explained how some of the mason carved a little likeness of their face amongst some of the elegant sculpture along the walls. The ceiling alone is the largest unsupported stone-vaulted structure in the world, with 2000 tons of stone arching many stories over the sanctuary in a fan or web-like design. The wooden screen between the chapels (walnut) bore he initial of Henry VIII and even Queen Anne Boleyn—one of his ill-fated wives.

The real highlight for me came later with the service of choral music, including the traditional choir of boy sopranos. I’ve never quite heard a sound so beautiful and haunting. The execution was perfect and yet wonderfully penetrating and moving. My goose bumps cropped up prolifically—one of my sometimes reactions to excellent music.

Before heading for the train again, we stopped for a pint at the Eagle, the bar frequented by Watson and Crick, indeed the scene of their announcement about DNA. It was also recognized as one of the regular haunts of the RAF flyers during WWI and WWII.


Friday July 6th, 2007
Day 7
Office meeting and staff lunch



Saturday July 7th, 2007
Day 8
Excusion to St. Albans.

One of the colleagues at NSMC suggested an excursion to St. Albans, about 25 miles north of London, to view some Roman ruins. So today, Linda and I set out from London Bridge Station on the train toward a new destination.

We arrived at the St. Albans station after about 35 minutes and walked the mile into town. Again, we found a market square filled with people and stalls offering food, produce and many retail items. The tourist information office gave us a walking tour map and we set out toward our first destination.

The huge cathedral at St. Albans consists of several individual sections and chapels dating back to 1077AD. The oldest Norman section uses bricks “recycled” from the nearby Roman ruins. Subsequent sections were erected (and destroyed) by various nobels and kings during wars, neglect and pilferage to replenish the royal treasury. Central to the church is the shrine of St. Albans, the destination of many pilgrims during its day and destroyed by Henry VIII in 1539 and reconstructed in modern times.

Two highlights of the visit included a wedding in the “Lady Chapel” dedicated to the Virgin Mary in the 14th century, and a rehearsal by the cathedral choir, again including the boy sopranos.

Leaving the cathedral, we found our way to the roman ruins at Verulamium, set in the midst of a verdant expanse of park area. The ruins included both occasional walls, long sense stripped of the finished stone outer surfaces (something we noticed during a previous trip to Hadrian’s Wall on the border with Scotland), as well as an excavated roman city (Roman Theatre) located about ¼ mile away. The “hypoclaust” presents a stone mosaic floor from Roman times, including an enclosed underfloor heating system.

It was a beautiful day with bright sunshine and dry breeze and we decided not to push on any further; so we walk back to the town and returned to the train station. After the short ride back to London, we ate in a local pub and decided to replenish our strength for the following day.


Sunday July 8, 2007
Day 9

Something a little different today. Linda got a brochure on “Walks Around London” and we decided to take advantage of one dealing with a place known as “Little Venice.” This is an area in “northwest” London (?) around the Grand Union Canal, which connects the Docklands of London with Birmingham—a 3 weeks+ journey by horse-drawn canal boat.

We took the Bakerloo Line to Warwick Ave. and met up with a group of about 50 other participants. The area was quite upscale and lovely, with row upon row of stucco-faced attached homes. Shortly, we moved into the even more upscale detached mansions, which the guide informed us were often inhabited by movie stars and other famous people and cost in the many millions of pounds. Give the prices and exchange rate in London, about 2 to 1, I readily believed it.

It wasn’t always like this. Apparently in years past this area hosted many of London’s upscale bordellos. Several of the streets were named after Randolph Churchill (Winston’s father), and the addresses (13 Randolph Terrace) were often shortened to “number 13 Randy”—hence the origin of the term “randy” in the English language.

As we walked among the various neighborhoods, the architecture changed repeatedly from Victorian, to Edwardian to post WWII and even more modern. The highlight was the canal, lined with canal boats and house boats—including some refitted as restaurants, pubs, flower shops and sightseeing craft. We crossed back and forth on these delightful wrought iron bridges and stairs, getting a good chance to look down on the boats passing underneath. At one point on the tour, the guide pointed to an apartment house with the name “Fleming House.” He told the story about how Fleming accidentally discovered penicillin at the nearby Paddington Hospital, won the Nobel prize and had this complex named in his honor.

One thing I have discovered about touring (especially 2-hours on foot) is that enough can sometimes be too much, so at the end of the tour, Linda and I rested for a few minutes in a famous pub, with a pint, of course, gathering our energy for the tube ride home. Fortunately, the Bakerloo line goes right to Elephant and Castle station, which is on a short walk from our “dorm”. By the time we had dinner in the pub across the street, we were well-ready for bed and preparing for early Monday morning.

Monday-Tuesday, July 9-10
Day 10-11
Under the weather…..