Journalism with a stethoscope: why listening matters for facing health’s wicked problems

In health care, we excel at fixing what’s in front of us: mending broken bones, prescribing treatments, creating care pathways. We prefer problems with guidelines and measurable outcomes.

But wicked problems – poverty, inequality, mental health, fragmented services – defy simple fixes. They gnaw at the edges of our system, yet feel too big, too political. So we push them aside. And while we fix the fixable, these problems only grow.

That dilemma pushed me, a paediatrician and researcher, to step outside the clinic and into journalism. For years, my work – whether through my PhD on justice in medicine or projects like Powering Up, supported by the Q community – has circled the same question: how do we tackle the social determinants of health when the system keeps sidelining them?

I wanted to ask the questions our health service avoids, listen to the people it too often fails to hear and learn how improvement can help. That impulse led to Three Ages of Child, a BBC Radio 4 series I call public interest journalism with a stethoscope.

For the series, I journeyed across England through childhood’s three stages: the early years, primary school and adolescence.

I met mothers choosing between heating and baby formula, teachers doubling as social workers, youth workers calling for joined-up thinking and young people explaining what health really means to them. I spoke to the whole spectrum of society – from children with nowhere to play to world experts like Professor Sir Michael Marmot. The voices were different, but the message was the same. Britain, the world’s sixth richest country, is failing its children.

Why are children needing baby banks for a safe bed? Why are playgrounds feeding the hungry? Why are teens waiting years for mental health support?

The series kept bringing me back to the same nagging question: if we know what works, why aren’t we doing it?

Three Ages of Child showed me several truths that are easy to lose sight of in daily work — lessons that cut to the heart of why improvement efforts so often falter.

1. Health is built – or broken – far from hospitals.

In clinic, I see the end result of problems that began years earlier: asthma from damp housing, obesity rooted in food poverty, anxiety born of unsafe streets. Health’s real building blocks are housing, nutrition, education and play.

2. Services are fragmented when they should be joined-up.

Families are passed from service to service, with no one holding the whole picture. In Hartlepool, a school had also become a food bank and warm space. Where health, education and community groups collaborate, crises can be prevented.

3. Communities are already creating health – but need resources and structural change.

I saw baby banks, family hubs, schools and grassroots projects filling gaps left by overstretched services. They are lifelines running on goodwill and donations. They cannot replace systemic investment.

4. Inequality is the root – and a moral choice.

Poor housing, fewer opportunities and greater stress are political choices, not inevitabilities. Tackling inequality is not just technical work, it is moral work.

These lessons are deeply personal for me. I grew up in Hartlepool, one of the country’s most deprived towns, and the stories I heard rang true.

But they are also central to the Q community. Q is about quality, improvement and systems change – but without confronting wicked problems, no amount of process mapping will suffice.

The good news is that across Q we already see inspiring examples, like Gill Phillips’ work on co-production and Mathew Mathai and the Born in Bradford team’s life-course approach. These show what’s possible when we listen, share power and design across silos. They are proof that improvement science can be justice oriented and human centred, not just technical.

This summer, the government launched its new NHS 10-Year Health Plan for England, promising to shift focus from hospitals to prevention and community. When I asked a government minister how we would ensure this new funding actually reaches the grassroots groups preventing crises, the reply focused on structural reorganisation. But to me, this suggests the old risk: that top-down system change will once again be prioritised over directly resourcing the community-led action we know works.

In improvement, we know the hardest part isn’t writing the report – it’s living it. Will resources reach baby banks, schools and youth programmes? Or will the system drown in pilots and paperwork?

Policy is only the starting gun. The race is run – or stumbled – by those of us on the ground.

Health alone can’t fix these problems. But we must not give up.

Three Ages of Child shows that when we listen to families, when services collaborate and when we pay attention to the wider determinants of health, lives change.

For the Q community, the challenge is to resist the urgent and act on the important. To embed a social determinants perspective from the start. To build cross-sector partnerships. And to continue asking uncomfortable questions.

This is why I develop spaces for change beyond the clinic. For clinicians wishing to expand their roles to tackle inequality, we set up WHAM – the Wellbeing and Health Action Movement. For those interested in co-production, Powering Up is our youth-led project using creativity to redesign health from the ground up. Both experiments believe the knowledge we need already exists in communities and among front-line professionals. Our job is to connect, amplify and act.

I invite you to listen to Three Ages of Child on BBC Sounds — public interest journalism with a stethoscope. It starts by listening. So I ask you: what wicked problem will you face, and what is the first small step you will take to begin?

Three Ages of Child airs on BBC Radio 4 every Monday at 11am from 29 September.