What happens when we turn that attention to the world around us? To paintings and photographs, buildings and bedrooms, ordinary objects and extraordinary lives. What might they tell us about how we live, what makes us well, and all the things medicine has overlooked?

Medical Imaging is a new series from More Than Medicine, and a different way of seeing health. Each instalment begins with an image — where it takes us may be rather less predictable.

MEDICAL IMAGING #001

Image: Shelter England, from its Story of Social Housing campaign.

I keep thinking about the word temporary. It suggests a brief inconvenience — a stopgap, a pause before real life resumes.

Try explaining that to a five-year-old.

In England, 177,530 children are living in temporary accommodation. More than 22,000 households with children have been there for between two and five years.

For a child of five, that’s the whole story so far.

Long enough to lose your first teeth; learn to read; make a best friend; forget one, and find another. Long enough for the unfamiliar to become familiar, and for a child to stop asking when they are going home.

I meet children like this in clinic.

“That’s my house,” Daniel points his finger at a plastic bag.

Not a suitcase — a bag. The kind you get from a corner shop, wrinkled and soft from being carried. I peer in: a wet toothbrush, a pair of pyjamas and an upturned teddy.

I ask Daniel — he’s six — why he has three jumpers on in July.

“I’m saving my arms,” he says.

He means his things. If he wears them, he doesn’t have to carry them. And if he doesn’t carry them, he can’t lose them.

We have a curious habit of describing children’s lives in terms that only make sense to adults. Temporary accommodation is one of them. An administrative category, neat enough for a spreadsheet, that conceals the extraordinary amount of living going on inside it. Perhaps the strangest thing about our temporary housing system is how permanent it has become. We spend more than £8 million a day keeping it running, while over 300,000 homes in England have stood empty for at least six months.

Childhood has no pause button: it gets on with the business of becoming, wherever we happen to put it. A child does not wait for life to begin. They are living it, in rooms they may never be allowed to call their own. Uncertainty seeps into everything — even the ordinary business of growing up.

Much of my working life is spent looking at images of children’s bodies. X-rays, scans, growth charts. Searching for the faintest shadow, the smallest deviation. I've become increasingly aware, though, of how much falls outside the frame.

We carefully chart a child's height and weight, following the curves of their growth. But there's so much else shaping them that never appears on the page. The room they sleep in. Whether they can invite a friend home. The quiet arithmetic of what they stop asking for.

I wonder what we might find if we learned to look at the conditions of people's lives with the same precision we bring to their bodies.

At what point do we admit that what we keep calling temporary has become the only childhood they have?

The word is temporary; the childhood is not.

Sources and notes

The evidence: Ministry of Housing, Communities and Local Government, Statutory homelessness in England: January–March 2026, published 13 August 2026. As of 31 March 2026, 177,530 children were living in temporary accommodation, while 22,060 households with children had been there for between two and five years. Shelter’s analysis of government expenditure data found that English councils spent £2.93 billion on temporary accommodation in 2025/26 — more than £8 million a day. Government Dwelling stock estimates, England: 31 March 2025 subsequently recorded 303,185 long-term vacant dwellings in England as of October 2025.

A note on confidentiality: Daniel is a composite character drawn from real clinical encounters. Details have been changed and experiences combined to protect patient confidentiality while remaining faithful to the realities described.

I’m often struck by how much advice about living well assumes we have somewhere decent to live, enough money, and a little time left over.

Sleep more.

Eat better.

Spend time outdoors.

Yes. But when? Where? With what?

I’m Guddi, a paediatrician, researcher and broadcaster. In my working life, these questions have a habit of becoming very concrete. A child keeps returning with a chest infection. The treatment helps, but the damp flat they go home to remains damp.

That gap — between treating an illness and changing the conditions that keep bringing a child back — is where my thinking about care begins. It has also made me question how readily we ask people to change their lives while accepting the conditions in which they have to live them.

An essay here might begin with a hospital encounter, a school play, or a piece of advice we’ve heard so often we’ve stopped questioning it. Something troubles or intrigues me, and I want to understand it. How did things come to be this way? Whose experience have we overlooked? Why is someone being asked to solve a problem they had so little part in creating?

Working with children keeps bringing these questions into focus. So much of what they need is decided by people they will never meet, in rooms they will never enter. As adults, we have more say, but our possibilities are still shaped by our work, our homes, our relationships and the choices available to us.

Following those questions also means asking what we want more of. Time with people we love. Somewhere to play. Music, friendship, the chance to make something just because we want to. I’m interested in why these things matter so much to us, yet so often get squeezed out.

Surely we could organise things better than this?

That question runs through More than Medicine. I want to understand what stands in the way, learn from the people who are already changing things, and explore what we could make possible for each other. Along the way, I hope you'll find words for something you've struggled to explain — or a question that changes your next conversation.

If this sounds like your sort of conversation, you’re very welcome.

Where to begin

If you're new, these are two good places to start. If you've been here a while, they are two places to return to — or to send to someone who might find something in them.

→ The medicine we cannot see: Why justice belongs at the bedside.

As a child, I thought I wanted to be a lawyer. This essay follows that early longing into medicine, through Bryan Stevenson’s teaching and an encounter with a young woman named Chioma in a detention centre. It is the best place to begin if you want to understand why I write.

→ Who Raises Us?: On childhood, belonging and the world we make for one another.

A school play. A girl told she didn't "look the part." A memory that stayed with me — and a question about how much of raising a child we can ask a parent to carry alone.

Before you go

Everything I publish is free to read. I aim to write most weeks, though the form may vary. Paid subscriptions help give me more time to do this work, and I’m very grateful for them.

I’d love to hear what brought you here:

→What's something we've come to accept that you think deserves another look?

Leave a comment and tell me.

There is more to come — on childhood, on justice, on the conditions that make a life possible. I hope you'll stay for it.

With love,

Guddi

To me, the colour of envy is blue.

The girl chosen for Mary was blonde and blue-eyed. I was neither. I was six, and I had wanted a leading role. Being gender-egalitarian even then, either Mary or Joseph would have done. But I was told I would not “look the part.”

I coveted the royal blue shawl draped around Mary’s milky complexion, the way everyone’s gaze gravitated towards her light. Brow furrowed, I tugged at my dark, bushy pigtails while my classmates asked whether my brown skin was painted on.

They gave me the narrator’s part instead. A promotion, arguably, since this narrator was called God. But my small self felt only the stone of rejection in her belly. I had a loud voice, and I could read, they said. I was good enough to be heard, but not to be seen.

I did not yet have the words to explain what was happening. I knew I wanted to stand where the other children stood, and that something about me ruled it out. I also knew, without being told, that the matter was closed.

A school play is a small thing. So are many of the encounters through which a child comes to understand their place. But that question — whether there is room for someone — has followed me into medicine.

As a paediatrician, people expect me to have firm views about what parents should do.

I have a few. But enough people are telling you what you should have done differently before breakfast. Some have qualifications; others have a ring light. We have made parenting into a verb, an industry and something approaching a continuous assessment. There is advice for every hour of the day, and plenty for the hours when everyone ought to be asleep. Much of it is offered with care, and some of it might even help.

But I want to give more attention to the person on the receiving end — the person living the childhood.

And I want a word for that. Childing, perhaps.

Finding your place. Working out which rules make sense and which adults will listen. Making friends, falling out, trying again. Discovering what you love and whether there is room for it.

Childing: the world from a child’s eye view. The word gives us somewhere else to stand: beside the child, asking what their life feels like — and what happens when they need something the adults around them cannot provide.

If there is room for a child, what should be in it? That is the question that follows me into clinic and out again: what do we owe children, beyond asking their parents to do better?

“When are we going to see a doctor?”

I craned backwards to glimpse the clock. Three in the morning. I scribbled the name of another arrival onto the whiteboard’s list — all red. We were running out of time.

Frankie was four when she came to my emergency department. Oddly quiet, she pulled on the white cord of her mother’s stained hoodie. Christie pulled her away, then fumbled with the elastic to tie up her lank hair — coffee-coloured roots, straw-yellow tips — while she stared me down with bleary eyes. They had been waiting since before midnight.

I glanced down at the notes as I walked toward her. Presenting complaint: “cough.”

“It’s bad,” Christie said. Bad enough that neither of them had slept in days. “Please just give me the antibiotics. My shift starts at six.”

Christie was parenting Frankie alone, working on a supermarket checkout and as a cleaner. A juggle that left little room for a sick child or a late arrival.

I could hear Frankie bark from the doorway. The cough was real. But it was not what I ended up thinking about.

“What’s your favourite colour, my lovely?” I asked Frankie, as I let her hold my stethoscope.

Frankie turned her head toward her mother, then pointed to my bluebird scrubs.

“Favourite toy?” I tried.

Frankie, wide-eyed, looked at her mother again. Christie answered every question for her, gently stroking her child’s high, ivory forehead, without seeming to notice she was doing it. The words Frankie did have were few, and they came slowly, like beads that had not been threaded: each one hers, but loose, and not yet strung into anything she could hold up and show me.

I took her teddy on a tour of her body — up an arm, around a shoulder, over a knee — so that she would let me look. And as I looked, I found what the baggy tracksuit hid.

Frankie’s legs curved outward, the long bones bowing the way they do when they have not had what they need to grow straight. Flaky, thickened patches erupted across her elbows and knees, and a rash crawled up her forearms and neck like something I had seen in a textbook written for the tropics. Somewhere behind my clinical calm, a list of diseases I had been taught belonged to Dickens began to assemble itself. Rickets. Pellagra. Conditions you are supposed to read about in history, not find in a London emergency department in the 2020s.

I sniffed. “Money’s tight right now,” Christie explained away the musty smell of damp that gets into the walls and the bedding and the clothes, and stays. “Frankie’s not keeping up with the other kids, but then she’s missing a lot of nursery and school ‘cos she’s always getting sick.” She said it all with the clipped practice of someone used to being asked — and judged — for the answer.

I washed my hands at the stainless steel sink and looked at the wall again. Twelve minutes remained before Frankie crossed the department’s four-hour threshold. Somewhere down the corridor, a manager who did not need to know my name to punish me was keeping a list. The antibiotic would take two minutes to prescribe. The rest of it — vitamin D, niacin, a conversation about housing, a referral for her speech — would take longer than either Christie or I had.

I turned back. Christie’s head was down, scrolling. Her thumb swiped up to keep the anxiety where she could see it.

I could have told her that Frankie’s speech was delayed: that she needed to talk to her daughter more, read to her more, put the phone down. I could have explained that Frankie’s cough was the consequence of mould etched into her walls, and that her wages were evidently not stretching to buy the right things to grow healthy bones or skin. Or I could have skipped over the “social history” in the notes and gone on to the next patient.

But to what end?

Frankie had not been given what a child needs, and Christie had not been given the room a parent needs to give it. How could guilt make any of that better? A lecture certainly could not.

Worse, I could not prescribe most of what Frankie actually needed: a warm, dry home; nourishing food; a mother who did not have to choose between her daughter’s cough and the rent. None are in my gift.

So I did the only thing I could think of. I opened my purse and handed Christie a tenner.

Our eyes met. Hers flicked towards the door.

“I’m sorry. I know it’s nowhere near enough.”

“But at least you get it.”

I have thought often about that exchange. About what I hoped the money might do, and how little it could.

Children arrive in clinic with a whole life attached. There is the home they woke up in, the journey to school, the person they are missing, the thing they are looking forward to. None of it detaches itself because I have opened the medical record. Yet the record has its headings, and the appointment has its limits. We become pin-sharp about symptoms, while the life in which they occur is blurred into the background.

Then, we offer a plan.

But advice has an address. “Get more sleep” enters a bedroom that may be crowded or cold. “Go outside” depends on what lies beyond the front door. “Read together” arrives in an evening when someone is still working, cooking or caring for another person. Sometimes a family knows perfectly well what would help. Knowing is not what they lack.

In medicine, we call housing, employment, education and income the social determinants of health: useful headings, until we forget how they run into one another like paints on a palette. Christie lived the connections between them: the rent demanded the working hours, which left little time for care, and the sick child put the wages at risk.

For a time, we built services that recognised this. In the UK, Sure Start brought early learning, health and family support into local communities, and research has since found lasting benefits, including better educational outcomes for disadvantaged children. Yet spending fell by 73% between 2009–10 and 2021–22.

We cannot know what difference a particular service would have made to Frankie. But we can ask why we withdrew support while continuing to tell parents to do more. The UK is the world’s fifth-largest economy, and yet 4.3 million children live in poverty — one in three.

Christie did not fail Frankie; Christie was failed. By a housing system that gave her a damp flat and no way out. By a labour market that gave her two jobs and no time. By a health service that gave her a four-hour target and no appointment long enough to say what was actually wrong. She was failed by decisions made a long way from her, by people she will never meet, in rooms she will never enter.

Parents matter enormously; their care is intimate, particular and often exhausting. But that is precisely why we should take seriously the conditions in which they are trying to give it. Including at three in the morning.

We often say “it takes a village”. I understand the longing. A teacher or neighbour can give a child somewhere else to belong, a glimpse of a future their parents may never have imagined.

But my own village had told me I did not look the part.

What happens to the child whose family is new, isolated or unpopular? Their need for care is no smaller. A family’s access to help should not depend on whether the neighbours like them.

Care must reach people we do not know. That takes public services with clear responsibilities, and people we can hold to them. It also takes places where we can get to know one another, and enough time outside work to turn up.

More than a village, a community needs places to gather and people with time to participate, without asking already exhausted women to do more for free. Someone has to be paid to open the doors and keep the place running. Goodwill has difficulty keeping a library open on its own.

I have spent years on these questions, and they have not got smaller. There is a kind of vertigo in seeing how far the responsibility extends — and how easily that vertigo becomes an excuse to do nothing.

But there are things I can do. I can sit with a parent and write down what they tell me. I can put “damp” in the clinical record, where it belongs. I can ask a colleague whether there is more we might try. When the same difficulty appears across many encounters, we can ask our service to change — and bring that evidence to people with greater power.

Parents need room to care. Professionals need time, support and institutions capable of acting on what they find. Without these, children meet adults who pass them along — from one exhausted person to the next.

Raising a child was never meant to be a solo sport. We have arranged the world as though raising a child were a household responsibility. It is not. It never has been. And the cost of pretending otherwise falls hardest on those with the least room to absorb it.

A child’s life is made by many hands. When we speak as though it were made by two, we let every one of those hands off the hook.

I never did get to play Mary. I would be tidying the story too neatly if I said I am grateful for that. But I understand more now about the narrator’s responsibility: to notice who is missing from the account, and to keep asking what they are owed.

Childing asks us to stay with Frankie, not with the file. What did that night feel like to her? What would she have told me if we had had more time?

She would have told me, I think, that she was tired. That she liked bluebirds. That her legs hurt. That she was hungry.

We owe each other the habit of noticing a child who is not our own.

We have all been children. We are all still becoming. And somewhere, a child is learning how much room the world has made for them.

Afterthought:

Christie and Frankie are pseudonyms. Identifying details have been changed to protect their privacy; the account reflects a real clinical encounter.

Further reading and sources

Child poverty in the UK
Department for Work and Pensions (2026), Households below average income: financial years ending 1995 to 2025. The official source for UK income-poverty statistics. In 2024/25, 4 million children—27%—lived in relative low income after housing costs. This measure identifies households with incomes below 60% of the national median, adjusted for household size.

What Sure Start made possible
Institute for Fiscal Studies (2025), The short- and medium-term effects of Sure Start on children’s outcomes. Research tracing the programme’s effects beyond early childhood, including improvements in educational attainment. The report also documents the 73% fall in spending between 2009–10 and 2021–22.

For a shorter introduction, see the IFS’s summary of Sure Start’s long-term benefits.

When parenting advice becomes overwhelming
BBC News (4 October 2026), When parenting advice becomes too much. An exploration of the volume of advice parents encounter and the difficulty of navigating competing messages about how to raise children.

The Department for Education’s Parents supported to navigate early years misinformation online reports that 69% of surveyed parents felt overwhelmed by the information available, while 68% struggled with conflicting advice they found difficult to trust.

Gregory Peck as Atticus Finch in the 1962 film of “To Kill a Mockingbird”

As a child, I thought I wanted to be a lawyer. Not because I understood the law, but because I believed in stories—the kind where someone stands up in a courtroom, trembling but firm, and speaks a truth that cracks open the silence.

Behind my glasses, curls spilling across the page, I followed Atticus Finch as he faced the jury in To Kill a Mockingbird and later encountered the brutal clarity of A Time to Kill. There was something in the idea of justice—not abstract or procedural, but visceral, defiant, redemptive—that lodged itself inside me. I wanted to be able to do that: to look at someone whom the world had already judged, and insist that there was more to see.

For a long time, I thought I had chosen a different road. As a young doctor, I learned to examine, diagnose and intervene: to recognise a body in trouble and work out what might help. But the questions my patients brought me kept exceeding the answers I had been trained to give. We investigated their symptoms in detail, then compressed the context of their lives into a few lines of "social history"—even when that context was not the background to the damage but its author.

I hoped that widening my studies through public health at Harvard might stretch medicine’s frame. Before long, however, I found myself straying even farther from the prescribed path, crossing the Charles River to take a class at the Law School.

The old longing had resurfaced.

I was drawn there by the formidable Professor Elizabeth Bartholet, whose fearless work brought civil rights and child welfare into the same conversation. But it was her co-teacher and former student, Bryan Stevenson, who seized my imagination.

By then, Stevenson had founded the Equal Justice Initiative and made confronting racial injustice and the death penalty his life’s work. He spoke with a gentleness that made me lean forward, listen harder. Unhurried, clear-eyed, he carried the kind of moral weight that doesn’t shout, but settles in your bones. His words rearranged you.

He told stories of people the system had tried to disappear: children in adult prisons, people wrongfully condemned to death, families broken under the machinery of punishment. But what struck me most wasn’t simply the injustice. It was the way he spoke about mercy, dignity and the possibility of redemption. He told these stories with love, not pity—as if each one were a map pointing us back to our shared humanity.

He made us see the person at the end of the word criminal.

And then he made us follow the story backwards.

A person might arrive at a sentence for murder at the end of a long succession of circumstances over which they had had little control. Before the verdict, there had been a childhood. Before the act, there had been experiences, relationships, injuries and choices—some available, others foreclosed. The courtroom’s judgement could scarcely contain the life that had led someone to stand before it. The harm they had done still mattered—but it could not be the only thing that mattered.

“Each of us is more than the worst thing we’ve ever done,” Stevenson has said. In that classroom, I began to understand what it meant to act on that conviction. Dignity did not have to wait for acquittal.

I did not know it yet, but I had just been handed the first principle of a different kind of medicine.

Bryan Stevenson, founder of the Equal Justice Initiative.

I began to recognise something uncomfortably familiar. In medicine, too, we could allow a label to become a verdict: “the diabetic,” “the asthmatic,” “the alcoholic.” Useful descriptions could acquire a moral undertone, until a diagnosis began to sound like a judgement about the life that had produced it.

As clinicians, we tend to speak about someone’s weight, for instance, as though their body were a public record of poor decisions—without asking what food they could afford, what their work demanded, or what room their day left for rest and movement. We question their failure to follow our advice before we ask whether they were ever able to follow it.

From the other side of the consultation, this can feel like being judged before you have managed to explain yourself: knowing that your answer is longer than the appointment, and wondering whether the part that matters most will count.

But each of us is more than the worst thing we have ever done—more than a diagnosis or statistic, more than a body in a bed. When doctors forget that, the authority meant to help can become another obstacle to care.

Stevenson’s stories helped me see that justice concerned the terms on which a person was recognised in the first place. Who was believed? Whose circumstances were considered? Who retained the right to dignity when the account of their life became inconvenient?

I had come to public health thinking about systems: data, disease, demographics. In that classroom, those questions acquired faces. I began to wonder whether justice itself might be the medicine my patients were longing for, and whether law offered a way to provide it that my own profession had not yet taught me to recognise.

The Pinard fetoscope: medicine that asks you to lean in and listen.

I found out what that might mean in a place where I had not expected to practise medicine at all.

I laid my hands on Chioma’s swollen belly, cupping the edges of the form within. Ear pressed to the Pinard—the conical wooden fetoscope, almost laughably quaint and archaic equipment for 2015—I breathed a sigh of relief. The life inside her drummed a steady rhythm. A strong heart.

I turned back towards the dismal grey cell where a uniformed woman watched my every move. The metallic glint of handcuffs winked at me as I bent over my notes. I gouged my findings into the paper, the scratching loud in the silence.

Chioma had been raped by her uncle six months earlier. She had defended herself, injuring her attacker, and faced religious persecution from her community in Nigeria as a result. She had fled, needing to leave her country entirely to survive. I was a junior doctor, performing a voluntary clinical examination for Medical Justice, a charity supporting people in immigration detention. Chioma had been denied proper medical attention because her lack of immigration papers placed her under another kind of judgement. What she needed was treatment for her trauma and care for her unborn baby. Instead, she was being treated as though her suffering were somehow deserved. She was only 18.

The detention facility’s medical assessments had not recognised her needs within the diagnostic criteria they used. That failure carried consequences: her distress went unaddressed, and her need for protection remained inadequately documented.

I kept thinking about what it meant to be asked to establish your suffering in precisely the right terms before anyone would act upon it. Chioma had already fought her uncle; now she needed a doctor to explain why returning her would place her at risk, and why she needed care she could not access there.

Here was the question I had been circling since Stevenson’s classroom, made flesh. The person was there; the circumstances were there; the need was there. But the categories through which she was being understood were obscuring the relationship between them.

Unwilling to wait, swaying with the carriage, I typed up a medical report on the train home from Yarl’s Wood. It documented the risk Chioma faced if returned, and the care she could not access there. My clinical knowledge gave me a way to explain the significance of her context—and to place that account before people with the power to decide where she would have to live.

The report helped defend her right to stay. It also gave her something the system had withheld: the sense that her needs were real. I could not undo what had happened to her. But I could help defend the conditions in which she might receive care and begin to recover. The safety of her future belonged within the assessment of her health.

Before I left, Chioma grabbed my hand. She didn’t thank me for the diagnosis—she thanked me for listening. For seeing her. For believing her. That, too, was medicine. That, too, in a sense, was life-saving.

I never did become a lawyer.

Instead, I returned to clinical practice with new eyes, convinced that justice doesn’t only live in courtrooms. Now, as a paediatrician, I’ve seen it live at the bedside, in hospital corridors, in the quiet, daily choices of care, and in the moments I break the silence to speak up.

Medical knowledge could help challenge the conditions making someone unsafe, or could lend authority to their dismissal. The question was how we chose to use it, and what our institutions enabled us to do.

Chioma’s passage through the medical system had shown me how a person could be examined and still remain unseen. Dignity belonged within the clinical work: taking her account seriously, recognising her needs and using my knowledge to help protect her.

Even when we cannot cure, we can defend a person’s agency, their right to care and their place among others.

Yet an unequal world asks patients to keep proving that their suffering matters—and asks professionals to accept responses they know are inadequate. The harms on either side are different, and the power between them is unequal, but it degrades us to watch a person’s needs go unanswered and call that the proper performance of our job. The patient is diminished by the dismissal; the professional must live with having witnessed it, participated in it, or been unable to prevent it. Over time, that distance between what we understand care to mean and what we are able to offer can become a kind of moral injury. No one escapes unharmed.

This matters to anyone who has needed help—and to anyone who has tried to give it. We need institutions in which recognising a person’s circumstances changes what happens next—where attention becomes action, and where the responsibility for making that possible is shared.

Today, a decade later, I find myself writing a doctoral thesis called Justice-Based Medicine. That is no coincidence.

If social conditions shape health, what does that knowledge ask of us as doctors? How do we use our clinical power to defend dignity, and what must our institutions provide so that doing so becomes part of ordinary care?

Chioma needed treatment, and she needed somewhere safe to receive it. My report helped defend the possibility of both.

When I think of the child bent over those courtroom stories, I recognise her longing still: to stand beside someone the world had judged and insist that there was more to see. I have learned to find its expression in quieter places: a report written carefully, a conversation pursued, a person’s account carried into a room where decisions about their life—and death—are made.

Justice, it turns out, was never a detour. It was the road. It is the medicine we cannot see on a scan or report, but whose presence can be felt whenever a person is recognised, believed, protected—whenever the dignity that was always theirs is defended.

References & Further Reading

Harper Lee, To Kill a Mockingbird (1960)
The novel that first taught me what a courtroom could be — and what it could fail to be. Atticus Finch was my first model of someone willing to stand beside a person the world had already judged.

John Grisham, A Time to Kill (1989)
Grisham’s first novel, and the one that showed me justice could be messy, visceral, and morally complicated rather than tidy. A father takes the law into his own hands after his daughter is attacked; the novel never lets you settle comfortably into a verdict.

Equal Justice Initiative (EJI)
Founded in Montgomery, Alabama in 1989 by Bryan Stevenson, EJI provides legal representation to people who have been illegally convicted, unfairly sentenced, or abused in state jails and prisons. They challenge the death penalty and excessive punishment, and they work with communities marginalised by poverty and unequal treatment. EJI also operates the Legacy Sites — the Legacy Museum, the National Memorial for Peace and Justice, and Freedom Monument Sculpture Park — built to make visible the history of slavery, lynching, and racial segregation that shapes mass incarceration today.

Medical Justice
A UK charity established in 2005, Medical Justice is the only organisation in the UK that sends independent volunteer clinicians into immigration removal centres to document the physical and psychological scars of torture and trafficking, assess serious medical conditions, and challenge medical mistreatment. The medico-legal reports produced by their volunteer doctors form the basis of research, policy work, and strategic litigation aimed at ending the harm caused by immigration detention. My own work with them, and the report I wrote for Chioma (not her real name), was part of this effort.

There’s a question I keep getting asked at the moment.

It arrives from parents, mostly. Sometimes teachers. Occasionally someone in health. They all corner me and, you might think, they’re asking for my number.

They are - just not that one.

One hour? Two? Just five minutes before breakfast? None at all before sixteen?

We get to numbers astonishingly quickly. I understand the appeal. I’m a doctor - we love numbers. Numbers feel solid. Measurable. Something you can put in a guideline or stick on a fridge.

And there are real reasons to worry. Young children need faces and voices. They need movement, sleep, conversation, repetition. They need to grab the three-dimensional world with both hands, find out what gravity does, squabble with other children, get bored enough to invent something. They need adults who are looking back at them - preferably with love.

The evidence points in one direction: context matters as much as clock time. A 2024 systematic review and meta-analysis involving more than 176,000 children under six found that background television, age-inappropriate content and adults scrolling during shared moments were associated with poorer outcomes, while co-use was associated with better cognitive outcomes. Even the science is quietly telling us that “screen time” is too blunt a category to carry all the weight we have loaded onto it.

But the more I sit with this conversation, the more I think we’ve started in the wrong place.

Those aren’t the same thing. And treating them as though they are is how we end up counting the wrong things.

Sixty minutes is not always the same sixty minutes

I grew up with television. I remember the rituals around programmes, the strange, shared culture of everyone gathering around the same box, watching the same thing at the same time. I’m sure adults worried then too.

Now I have a four-year-old nephew who has just started school. He’s growing up in a world where screens aren’t simply something in the corner of the sitting room - they’re everywhere. They teach. They translate. They help him choose his lunch. They entertain, distract, connect, sell, soothe and demand attention - sometimes in a single swipe.

Screens can help a child speak to a grandparent thousands of miles away. For families like mine - migration in the blood, people scattered across countries - that isn’t trivial. But screens can also hold a child alone inside an endless stream of content engineered to keep them there.

Which is why I keep returning to one thought:

Sixty minutes is not always the same sixty minutes.

One child spends an hour on a video call with their grandmother. Another watches an endless sequence of algorithmically selected clips. Another uses a device because that’s the communication their disability allows. Another watches television beside a parent who has just finished a twelve-hour shift and needs twenty minutes to make dinner.

The clock records an hour in every case. The child experiences something entirely different.

So before we ask how much?, we need to ask some harder questions. What is the screen doing? What is it enabling? What is it replacing? And, most importantly of all: What is available instead?

That last question has been following me around.

What Is Available Instead?

At the Wild Summit recently, I found myself talking about children needing “more than flat glowing rectangles”. They need depth. Distance. Mud. Trees. Risk. Stories. Other children. Changing light. The surprise of a beetle. The peculiar politics of a football game.

They need the world.

And I wrote afterwards about wanting to give children the world back.

But saying it is the easy part.

Access to that world is not evenly distributed, and it never has been.

“Read them a book.”

Sure. Please do. But in 2025, around one in ten children and young people surveyed in the UK did not have a book of their own at home. Among children receiving free school meals, it was closer to one in six. And owning a book is only part of it. Reading together requires space, time, energy - a universe of impossibles for an adult who is trying to cook, work, care for someone else, or simply survive the end of the day.

“Send them outside.”

Again, yes. But outside where? A garden? A safe street? A nearby park? Or a busy road, no green space and a public realm in which children are more likely to be treated as a nuisance than a citizen? Even access to formal play space is unequal. Recent mapping of nearly 34,000 playgrounds across England found large disparities, with some deprived communities having fewer, smaller and more distant play spaces.

“Parents need to keep better boundaries.”

Of course, children need boundaries - but parenting doesn’t happen in a vacuum. It happens around shift work and childcare and housing and money and loneliness and neurodiversity and exhaustion, and whether there’s another adult around when you desperately need ten minutes to cook the tea.

I find something cruel in the shame that creeps into these conversations. A parent reaches for the tablet. Someone watches. And a judgement falls.

Bad parent.

Not trying hard enough.

Should know better.

Understanding that isn’t the same as saying anything goes - it’s the opposite. It means taking the problem seriously enough to ask: what would actually help?

Who else is responsible?

Once we stop asking only how to make individual parents better at resisting technology, we can start asking what kind of childhood we’re creating around them.

Are there places to play? Libraries still open? Grandparents, neighbours, youth workers, family hubs? Can children move safely through their neighbourhoods? Do parents have time - or work that leaves almost none? Do schools have space for art and movement and friendship alongside attainment?

And there’s another question we should be asking more loudly: What responsibilities sit with the companies designing the digital world children now inhabit?

We have spent decades learning that when commercial products can harm children, we don’t place the entire burden on parents. Instead we:

regulate

change defaults

restrict advertising

redesign environments

Digital life shouldn’t somehow sit outside that conversation.

This isn’t abstract. Ofcom has recently studied children who said they were spending longer online than they planned or realised, identifying design features - involving reward, impulse, dissociation and social influence - that could help keep them there. Many of the children and parents involved had little understanding of how these features might be shaping their behaviour. This despite the UK already having a Children’s Code requiring online services likely to be accessed by children to take their best interests seriously, including high-privacy defaults and restrictions on nudging children towards weaker protections.

They’re entering systems built by adults - often by companies whose commercial success depends, in one way or another, on keeping us looking.

Suddenly this isn’t simply a parenting question.

It’s a design question.

A public-health question.

An inequality question.

A commercial question.

A political question.

And underneath all of those, a much older one: What do children need in order to flourish?

The Older Question

That’s the question I want to keep pulling at over the coming weeks.

Not just screen time, but AI, attention, play, education, and our strange tendency to turn the things we value into numbers and then accidentally start treating the number as the thing itself.

All of them can tell us something. None of them is the life.

I don’t think the task is to decide whether technology is good or bad; that argument already feels too small. Technology is here. My nephew will grow up with tools I couldn’t have imagined at four years old. So will all our children.

The more interesting question is what we want those tools to serve. What kinds of attention do we want children to develop? What relationships? What should they be able to do with their bodies, their imaginations, their judgement, their curiosity? What parts of childhood should never be optimised away?

I don’t have neat answers yet - that’s partly why I want to write about it. But I increasingly think we need less panic about the fact that children are growing up in a digital world, and more seriousness about what kind of humans we’re trying to help them become within it.

So before we tell families to take the screen away, there’s one more question we owe them: What are we asking children to come back to?

Further reading and resources

1. Mallawaarachchi, S., Burley, J., Mavilidi, M. et al. (2024). Early Childhood Screen Use Contexts and Cognitive and Psychosocial Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatrics, 178(10), 1017–1026. https://doi.org/10.1001/jamapediatrics.2024.2620 JAMA Network

2. National Literacy Trust (2025). Children and young people’s book ownership in 2025. Based on responses from 114,970 children and young people aged 5–18 in the UK. National Literacy Trust

3. Brindley, P., Ma, Y., Wang, R., Martin, M. & Woolley, H. (2025). To Play or Not to Play: Mapping Unequal Provision of Children’s Playgrounds. Land, 14(3), 477. https://doi.org/10.3390/land14030477 MDPI

4. Ofcom (2026). Exploring the relationship between persuasive design on online platforms, and the time that children spend on them. Qualitative research with children aged 8–16 and their parents, published 21 May 2026. www.ofcom.org.uk

5. Information Commissioner’s Office. Age appropriate design: a code of practice for online services (Children’s Code). Statutory guidance for online services likely to be accessed by children, covering issues including best interests, default settings, profiling and nudge techniques. ICO

People often describe me as an advocate for creative health.

Usually they mean using music, dance, theatre or visual art to help people live healthier, happier lives. And they’re right - there is wonderful evidence that creativity can improve wellbeing, mental health and even physical health.

But over the last few years, I’ve found myself asking a different question.

What if creativity isn’t just good for people? What if it’s good for health systems too?

That question led my team on a journey that eventually became a paper in BMJ Paediatrics Open. But the paper isn’t really what I want to talk about today.

I want to talk about what surprised me.

Because the most interesting idea in the paper isn’t really about co-production. It’s about what happens when we radically rethink who gets to create healthcare.

We thought we were studying co-production...

The project was called Powering Up.

Across Birmingham and London we worked alongside more than one hundred young people, artists, clinicians, schools and community organisations. In Birmingham, young people became citizen scientists, investigating the causes of health inequalities in their own communities. In London, young people and clinicians spent a week making theatre, music, poetry and stories together.

On paper, they looked like completely different projects: one was science, the other was art. What united them wasn’t the method but a simple belief: Young people don’t just experience health systems. They understand them. And if we really want to reduce health inequalities, perhaps we should stop designing services for young people and start designing them with them. It’s what we call creative patient-led system redesign.

Three surprises

I expected creativity to make the workshops more engaging. I didn’t expect it to change what counted as knowledge.

Surprise Number 1

The arts weren’t simply an icebreaker - they levelled the playing field.

Doctors stopped being “the experts.” Young people stopped being “the patients.” Instead, they became fellow human beings trying to understand each other’s worlds. Stories carried things that questionnaires hide. Dance communicated experiences that words simply couldn’t. And poetry revealed truths that no survey would ever have uncovered.

Creativity wasn’t decoration - it became a different way of knowing.

Surprise Number 2

Relationships weren’t the by-product - they were the intervention.

Healthcare spends enormous amounts of time thinking about pathways, waiting lists and outcomes. We spend much less time thinking about trust.

Yet almost everything the young people told us came back to relationships. Did someone listen? Did they believe me? Did they keep their promises? Did they treat me like I mattered?

In the paper we describe this as the importance of Respect, Relationships and Reciprocity. Not because they’re nice values, but because they’re the infrastructure that makes change possible.

Surprise Number 3

On the outside, Powering Up was bright, bold, and beautiful. We even made it to the prestigious Health Service Journal (HSJ) Patient Safety Awards in just 6 months. But behind the scenes, the project nearly broke us.

Not because working with young people was difficult. Because building genuine relationships takes time. And time is the one thing modern health systems rarely fund.

One of the biggest findings in our paper had nothing to do with young people or even health. It was that meaningful co-production depended on enormous amounts of invisible work…

Late-night phone calls.

Checking in.

Travelling.

Listening.

Repairing misunderstandings.

Building trust.

The emotional labour that never appears in a project plan.

I am proud of Powering Up. Everyone praised it. Almost nobody paid for it.

That made me realise something uncomfortable. Perhaps the biggest barrier to health equity isn’t a lack of good ideas. It’s that we’ve built systems that celebrate relationships while systematically under-investing in them. In the paper, we call this institutional hypocrisy. It’s not that organisations are malicious per se, but there is a profound mismatch between what they say they value and what they actually resource.

The sentence that haunts me

Towards the end of the project, one young person said something I’ll probably carry with me for the rest of my career.

“Stop calling us ‘hard to reach’ when you’re holding the door shut.”

I’ve thought about that sentence a lot. In fact, it haunts me.

I don’t think they were just talking about young people and their clinicians. I think they were talking about institutions. Too often we describe communities as disengaged. Perhaps the truer, harder question is whether our systems have become difficult to engage with.

This is the conversation I want to have

Publishing this paper isn’t the end of the story. If anything, it feels like the beginning.

Over the past few years, my work has gradually shifted. I’m still a paediatrician and still passionate about child health. But increasingly I’m interested in bigger questions. How do health systems learn? Whose knowledge counts? What kinds of relationships make justice possible? How do we build institutions that don’t just deliver healthcare, but deserve people’s trust?

Those are the questions I want this space to explore. Because I have a growing suspicion that radically reimagining health won’t begin with a new technology or a new policy. It will begin by radically reimagining our relationships with one another.

📖 If you’d like to read the academic paper, you can find it here:

https://bmjpaedsopen.bmj.com/content/10/1/e003943

And if these are the kinds of conversations you’re interested in - about justice, creativity, medicine, systems and how we build a healthier society - I hope you’ll stick around. We’re only just getting started.

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Learn more here:

• Powering Up: a Health Foundation-funded project about co-producing solutions to health inequality with young people

• WHAM (Wellbeing and Health Action Movement: I co-founded and direct this special little organisation. We are a movement to inform, empower, and unite clinicians to fight health inequalities

I’m Guddi.

I’m a paediatrician by training, but increasingly my work has been taking me into all the things medicine has traditionally pushed to its edges: childhood, inequality, racism, creativity, climate, power, culture, the places we live, the stories we tell, and the question of what really makes us healthy.

On the surface, that can look like quite a lot of different things. Increasingly, I think they are part of the same story.

That is what More than Medicine is for.

Not to give you polished answers every week, but to think out loud about the questions that keep following me around: what kind of childhood are we creating? What does justice ask of medicine? What does it take for people to flourish? What are we asking individuals to carry that should really be held by communities, institutions or society? And what might change if we told a different story about health in the first place?

Some of you will know me through medicine. Some through WHAM, health inequalities, creative health, broadcasting, childhood, race and health, or something else entirely.

Wherever you’ve come from, I’m so glad you’re here.

*

Perhaps the best way to show you where this is going is with something I’ve been thinking about since speaking at the Wild Summit. I went there expecting to talk about children and nature. I came away thinking about a much bigger question:

What kind of world makes a good childhood possible - and what happens to all of us when we get that wrong?

Because childhood does not end neatly at eighteen. The conditions in which children grow up shape the adults they become: their health, confidence, relationships, sense of safety and belonging, even the opportunities they are able to imagine for themselves.

We have become very good at dividing children’s lives into separate problems: mental health, obesity, school attendance, screen time, inactivity, loneliness, behaviour, play.

They experience whether there is somewhere safe to play. Whether their parents have time. Whether there is food in the cupboard. Whether they can get outside. Whether they belong. Whether somebody notices when they are struggling.

That idea has stayed with me.

So I’ve written a new piece about it: Give Children the World Back. If you are interested in children, health, inequality, climate, play, nature, family life or simply the kind of society we are building, I hope there will be something in it for you.

And if you’re new here and want to wander a little further, you might also like:

• What if medicine took justice as seriously as science? - on why medicine needs to take justice as seriously as science.

• Creativity is not a luxury. It is prevention infrastructure - on why creativity belongs inside our understanding of health.

• What kids really need - on why children’s health is shaped as much by the places they grow up in as by what happens in clinics, and why belonging, play, and community are part of health too.

There will be more here over the coming months on medicine, childhood, race, digital life, creativity, professionalism, power and the social conditions that shape us.

But I hope the thread running through all of it is simple:

Thank you for being here. Maybe you’d like to bring others with you? And if something I write makes you think, disagree, remember something, or see a connection I’ve missed, do comment or reply. I’d like this to feel like a conversation, not a broadcast.

With Love,

Guddi

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A few years ago, I worked nights in a London hospital during a hot, polluted summer.

The department was full of children struggling to breathe. Tiny bodies gasping for air. Parents watching the oxygen monitor. That shared terror in the room when a child struggles to catch their breath.

As a doctor, my job was clear: treat the asthma attack in front of me: inhalers, oxygen, steroids. The familiar choreography of emergency care.

But I remember thinking, even then: this looks like a medical problem, but really it is a traffic problem. A housing problem. A planning problem. An environmental problem.

Paediatricians, I sometimes think, are the ones left holding the inhaler at the end of a very long chain of bad decisions.

We learned this most painfully through my friend Rosamund Adoo Kissi-Debrah, whose daughter Ella became the first person in the UK to have air pollution listed as a cause of death. That changed the public story. It made brutally clear that the environment is not somewhere “out there”. It is in children’s lungs, their bodies, their futures.

Recently, I spoke at the Wild Summit on a panel about urban nature. Mete Coban, Deputy Mayor of London, asked what it would mean to design every city with nature in mind.

My answer was: yes, absolutely. But I would push it further.

Because if a city works for children, surely it works for everyone. If a child can breathe, play, explore, find shade, hear birdsong, climb trees and feel they belong, then we have built a city that is cleaner, safer, kinder and fairer for all of us.

Me at the Wild Summit 2026 speaking to “Is lack of access to nature a social and environmental crisis?” with actor David Oakes

I offered three linked ideas.

1. If children are the indicator species of society, we must listen to what they are showing us

In ecology, an indicator species tells us whether an ecosystem is healthy. In paediatrics, children tell us the same thing about the world we have built around them. When children are anxious, asthmatic, overheated, sedentary, stuck indoors, unable to play outside or breathe clean air, these are not a set of isolated, individual clinical problems. They are a diagnosis of society.

This is what I see in clinic. It is also what I have seen in the stories I have been trusted to tell. In Why Is Covid Killing People of Colour?, with David Harewood on BBC One, we explored how Covid was never just about a virus. It was about whose bodies had already been made more vulnerable by overcrowded housing, insecure work, polluted air, chronic stress and political neglect. And in Three Ages of Child for BBC Radio 4, again and again, the question was painfully simple: do children have somewhere safe to be? Somewhere to play, move, belong, encounter the living world?

These are not soft questions. They are questions about the architecture of health.

The child in front of me in clinic is also telling me about the world around them. The question is whether we are willing to listen.

2. What children are showing us is that their world is shrinking - and shrinking unequally

We are coming off the back of yet another summer of heatwaves. I look around and see yellowing parks, brittle grass, trees struggling, children kept indoors, parents trying to cool homes never built for this climate.

Climate breakdown is no longer waiting politely to threaten the future - it is already making the present harder for children. Their world is being narrowed by heat, pollution, traffic, poverty, fear, loss of public space, and the growing amount of time spent indoors and on screens.

And this narrowing is not felt equally. A shaded garden and the money to escape a heatwave is one thing. A crowded flat beside a busy road, with no tree cover and nowhere safe to go, is another. Heat follows inequality. As does pollution, green space and the right to play.

A few planters outside expensive flats, a pocket park in a luxury development, a lifestyle amenity for people who already have choices. For children, nature is not decoration; it is part of the conditions they need to grow.

Whatever action we take must have equity at its heart. Otherwise, we will do what Britain has too often done: make things better for the already comfortable, while leaving poorer, racialised and marginalised families behind.

That is not prevention - that is inequality with nicer landscaping.

3. So a truly preventive society must be designed around children, nature, and justice

We hear a lot about prevention now, and I welcome that language.

But prevention has to mean more than asking people to make better choices in environments that make healthy choices impossible.

Prevention is not simply advice from a doctor, a poster in a waiting room, or another app telling parents to do better. If we believe that nature is a public good, it means giving people access to what they deserve. It has to mean clean air, cool rooms, safe walks to school, places to play, trees to sit under, neighbours to know, and a world children can feel is theirs too.

Prevention is whether a child can breathe clean air.

Sleep in a cool room.

Walk safely to school.

Play outside.

Sit under a tree.

Know their neighbours.

Feel that the world is theirs too.

It means we must stop building places first and then retrofitting nature, shade and play afterwards. From the beginning, our homes, streets, schools and neighbourhoods should be designed around children’s bodies: clean air, safe routes, tree canopy, green space, shelter, public toilets, benches, crossings, places to gather, places to be loud, places to be free.

As a neurodevelopmental specialist, I am often asked whether we should worry about screen time. Yes, we should. Children need far more than flat glowing rectangles. They need depth. Distance. Mud. Trees. Risk. Other children. Uneven ground. Changing light. The surprise of a beetle. The politics of a football game. The quiet sovereignty of a den.

But it’s not enough to ask about screens; we should also ask: what have we given them instead? For many of the families I see, the screen is the only safe substitute for what has disappeared: the safe park, the youth club, the garden, the sports field, the clean street, the public space where children are welcome rather than merely tolerated.

Design cities for childhood, and you design them for life

Here is what keeps me going: the science. One of the most extraordinary things about childhood is that harm can become biology - but good policy can too.

A recent Lancet Public Health study followed more than 3,400 children in London and Luton. Before London’s Ultra Low Emission Zone was introduced, children in London had smaller lungs than children in Luton. But as air pollution fell, their lungs grew faster. Four years later, they had caught up.

Just think about that for a second.

That is devastating, because it means bad policy is never abstract. It settles in children’s lungs and futures.

But it is also incredibly hopeful, because the reverse is true too:

Good policy can help children recover.

Good policy can help them breathe.

Good policy can give back some of what has been taken.

At its best, policy can be a kind of practical magic. Not the fairy-tale kind, but the real kind: adults making brave choices that change the air a child breathes, the street they walk down, the lungs they grow, the future they inherit.

Too often, we work in silos. Health over here. Climate over there. Nature somewhere else entirely, imagined as a place we visit at weekends rather than the living system we are part of.

But in children, we see what happens when all three are in trouble.

The child wheezing in A&E is a patient, yes, and also a message.

The child kept indoors during a heatwave is a warning.

The child without a safe place to play has not merely lost recreation; they have been denied part of the world.

Perhaps children must now become the heart of the story we tell next. Not as symbols of some distant future. Not as sentimental props. But as living proof of what our society values now.

Children remind us of what adults forget: the world is more than a resource to extract from, build over, sell off or consume. It is a living home to love, protect, explore and share.

So yes, design cities with nature in mind. But also with childhood at heart. Because if we design for childhood, we design for breath, play, shade, safety, beauty, belonging, justice and the future. Design cities for childhood, and you design them for life.

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Afterthought

This is the beginning of a thread I want to keep pulling: childhood as the test of a good society.

What would change if every major policy decision - on housing, transport, climate, planning, public health, education and the economy - had to answer one simple question:

Does this give children more of the living world, or less? And which children benefit first?

Medicine has never suffered from a shortage of evidence that injustice makes people ill.

We know that children growing up in cold, damp homes are more likely to develop respiratory disease. We know that poverty gets under the skin. That racism enters consulting rooms as well as lives outside them. That food, work, housing, education, safety, transport, belonging and power all leave their marks on the body.

We know this.

And yet, at the clinic door, a strange disappearing act takes place. The world that produced the illness is compressed into a few lines under social history.

The damp becomes asthma.

The empty cupboard becomes faltering growth.

The impossible journey becomes “poor attendance”.

The unaffordable prescription becomes “non-compliance”.

The frightened family becomes “difficult”.

Medicine becomes exquisitely precise about what has happened inside the body, while remaining curiously hesitant about what has happened around it.

I have spent much of my career troubled by that gap. As a paediatrician, I have often found myself treating the biological consequences of social decisions: prescribing inhalers for mould, offering dietary advice in the presence of hunger, tending distress produced by lives made unliveable. I was trained to diagnose the injury. I had far less language for the forces inflicting it, or for what my profession might owe in response.

Eventually, that discomfort became the question beneath my PhD:

Not in theory, but in practice.

What should a clinician do when a child’s asthma is being worsened by housing, a parent’s exhaustion is being driven by poverty, or a young person’s distress makes perfect sense in the circumstances of their life - but the machinery of medicine is designed to locate the problem primarily inside the individual?

Over time, trying to answer that question became my life’s work. Now it has a name: Justice-Based Medicine. At its heart is a simple proposition: justice is not an optional extra to good medicine, it is part of the treatment.

What the name holds

Justice-Based Medicine is not a new clinical speciality; it is a way of practising every speciality. It brings justice into the clinical work itself, rather than confining it to a checklist, an elective interest or the worthy work undertaken after the “real medicine” is done. It is a way of seeing and practising medicine that takes seriously the social production of health, the unequal distribution of power and the responsibilities that follow from both.

Evidence-based medicine asks: What works?

Justice-Based Medicine asks more:

What works, for whom, and under what conditions? Who is missing? What is preventing this from working? Whose knowledge counts? And what are we prepared to do about the inequities we can already see?

That does not make medicine less scientific. In fact, it makes us more faithful to the evidence.

If housing affects respiratory disease, housing is clinically relevant. If racism changes diagnosis, treatment, trust and outcomes, racism is clinically relevant. If poverty makes a treatment plan impossible to follow, poverty is clinically relevant.

And once we see it, we face a harder question: what should medicine do about it?

Between omnipotence and abdication

There is a professional discomfort here that medicine has never resolved.

On one side sits the heroic fantasy: the doctor who believes they must fix everything. On the other sits a kind of learned helplessness: poverty is not my job; housing is not my job; racism is not my job; there is nothing I can do.

Neither is adequate.

Doctors cannot abolish poverty between ward round and clinic. Nurses cannot repair the housing system before the end of a shift. Health workers are already carrying too much, in services stretched past safety. Justice cannot mean loading every social failure onto the shoulders of the individual clinician. That would merely reproduce the injustice it seeks to correct.

Sometimes, what is ours to do is small: ask a different question; write the letter; notice that a treatment plan assumes money, time or transport a family does not have; challenge the unsafe discharge; record the mould as part of the clinical problem, not incidental background; bring in the community organisation that understands the terrain better than we do.

Sometimes, it is to notice the pattern: why the same patients keep falling through the same gap, and whose needs the pathway quietly assumes away.

And sometimes, the work is collective: changing a protocol, a service, a professional norm, a budget or a policy.

I came to think of this during my research as ‘powering up’: helping health professionals recognise that our agency is neither limitless nor negligible. We hold different kinds of power - clinical, institutional, collective, civic. The ethical question is not whether we have power, but how we use it, when we share it and when we should get out of the way.

Justice-Based Medicine is not a demand for heroism. It is a practice of responsibility.

Listening changes what can be known

It is also a practice of humility.

Medicine is a knowledge-making profession. We observe, measure, classify, diagnose and interpret. But people living through illness know things too.

Parents know things. Children know things. Communities know things.

A mother may understand what is making her child worse before the laboratory does. A young person may know why a service designed “for them” feels impossible to use. A community organisation may see a pattern that never appears in any individual patient record.

Yet medicine has not treated all knowers equally. Race, gender, class, disability, age and professional hierarchy shape whose account is believed, whose pain is interpreted sympathetically and whose knowledge enters the official story.

So listening is not simply good bedside manner.

This is why the question What matters to you? can be as clinically important as What is the matter with you? It returns the patient to the story as a person, not merely the site of a problem.

To listen seriously is to accept that expertise is real, but it is not singular. The clinician may know disease. The patient knows the life into which our treatment must fit. Good medicine begins when those forms of knowledge can meet without one automatically silencing the other.

Justice belongs inside clinical excellence

Why call this justice? Because the distribution of health is not random. Nor is the distribution of attention, credibility or care.

Some people are more likely to become ill because of the conditions in which they live. Some are more likely to receive good care once they do. Some are more likely to be believed. Some have treatments designed around lives like theirs. Others are repeatedly asked to contort themselves around systems that were never built with them in mind.

These are not questions sitting outside clinical excellence. They are part of what clinical excellence means.

I have become increasingly uncomfortable with the idea that justice is an additional aspiration: noble, perhaps, but peripheral to the serious work of medicine. There can be no clinical excellence without equity, because care that predictably works less well for some groups is not excellent care.

And there can be no credible ethics of care that asks clinicians to absorb the consequences of political failure in silence. Professionals need time, support, community and institutions capable of acting on what they see. Concern cannot flow in only one direction. A system that depends on the endless self-sacrifice of its carers will eventually make good care impossible.

Justice-Based Medicine therefore asks us to widen the frame: from the individual encounter to the institution around it; from the institution to the society it serves; from personal virtue to shared responsibility.

It asks not only, Was I kind? Did I follow the guideline? but also: What made this illness likely? What made this care difficult? Who benefits from the way this system is arranged? Who bears its costs? And what part is mine to change?

What kind of doctor does this moment require?

Not, I think, a more heroic doctor.

We need doctors who can hold complexity: who can be excellent scientists without imagining that biology is the whole explanation; who can recognise structural injustice without becoming paralysed by its scale; who understand the limits of their power without surrendering it.

Doctors who know when to lead, when to collaborate, when to stand beside and when to step aside. Doctors who are curious not only about which disease a person has, but about the world in which that disease has taken hold. And doctors who keep asking one deceptively difficult question:

What, here, is mine to do?

That question sits at the heart of Justice-Based Medicine. It has been sitting, in one form or another, at the heart of my work for years.

My PhD gave me language for some of it. Clinical practice keeps complicating it. The people and communities I work with keep showing me where the theory is incomplete.

More than Medicine has already been a place where I have explored the forces that make and unmake health beyond healthcare—from creativity and childhood to inequality, attention and care. Justice-Based Medicine draws those threads together. This is where I will work out what follows—in public and, I hope, in company—through stories from the front line and ideas from philosophy, public health, politics and culture. Over the coming weeks, I will explore its origins and its demands: power and professional responsibility; evidence and ethics; care, attention and whose knowledge counts. Above all, I want to explore the strange boundary medicine has built between the body and the world in which bodies must live—and how we might cross it together.

Justice-Based Medicine is my answer - or, more truthfully, the beginning of one.

If these questions trouble you too, let’s figure it out together.

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Author’s Note:

I recently introduced some of these ideas in a conversation with the Royal College of Physicians and in the accompanying commentary, “What kind of doctor does this moment require?”.

🎧 Podcast: https://player.rcp.ac.uk/podcasts/medicine/19624898

📝 Commentary: https://www.rcp.ac.uk/membership/commentary/what-kind-of-doctor-does-this-moment-require/

Justice-Based Medicine grows out of my doctoral research into how clinicians understand and respond to the social determinants of health.

A teenager once told me, “There’s nothing for us here, so I just stay in my room.”

He wasn’t lazy. He was bright, funny and desperate to be out in the world. But his local park felt unsafe, the youth club had closed and the nearest sport sessions cost more than his family could spare.

By the time he came to my paediatric clinic, what looked like a “health problem” – low mood, poor sleep, weight gain – was really a place problem.

Why local spaces are key

We often talk about children’s health as if it starts in the hospital or the GP surgery, but as I explored in my recent BBC Radio 4 series, Three Ages of Child, the real foundations of health are laid much earlier and elsewhere: in homes, schools, streets and parks – places where children feel they belong in their own areas.

Sport England’s new research puts numbers to what many of us see every day. like the fact that over half a million children – one in ten 12–17 year-olds – say they don’t feel they belong in their community.

This means that almost one in five don’t feel proud of where they live, often because there’s nowhere to go to for young people and because of the worries about crime and antisocial behaviour.

Step back, and that paints a stark picture of children growing up in places that feel unsafe, unwelcoming and not really “for them”, so it’s no surprise that in those conditions, activity levels are low and health problems multiply.

The same research also points to part of the answer.

When asked what gives them a sense of community – beyond friends and family – the top answer from young people was sports clubs and activity groups.

Anyone who has ever watched a child beam with pride after football training or a dance class knows why: a club is not just about exercise; it’s about belonging.

It offers a safe place to go with people who know your name and that offers the chance to be part of a team.

Dangers of the postcode lottery

But access to those opportunities is deeply unequal. In England’s most deprived places, over a third of people are inactive, compared to around a fifth in the least deprived areas – a postcode lottery for physical activity that deepens health inequalities.

As a paediatrician, I see every day that a child’s postcode can be a stronger predictor of their health than their genetic code.

When local streets feel unsafe, there’s nowhere affordable to go and young people don’t feel they belong, it shows up in their bodies and in their minds.

If we care about the future of public health, we have to turn our thinking on its head. Health isn’t built in hospitals. It’s built in communities.

Exercise and sport are a kind of miracle cure – for health, wealth and happiness – but only if everyone can actually take part. Every pound spent on community sport and activity brings multiple pounds back in benefits to health, wellbeing and the wider economy.

That’s why I welcome efforts to work in a genuinely place-based way – including Sport England’s commitment to invest in the areas facing the greatest challenges. But beyond any single organisation, the principle stays: you can’t fix place-based problems with purely top-down solutions.

Making children proud

For me, this is what it looks like to move from treating symptoms to changing systems.

You can’t lecture a child into feeling proud of their area or prescribe their way out of a broken play park.

But you can bring together the people who know that place best – including children and young people themselves – and invest in the spaces, clubs and connections that allow them to move, play and belong.

That means co-production, not just consultation: listening to what families say they need; backing trusted local organisations; designing activities that reflect different cultures, bodies and lives and being in it for the long haul.

Our children are telling us they want to feel proud of where they live and part of something bigger.

Working locally, listening deeply and backing places over the long term is how we start to make that real – street by street, pitch by pitch, park by park.

Originally published on the Sport England website.

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A national review [1] into the possible “overdiagnosis” of mental health and neurodevelopmental conditions such as ADHD and autism in children risks overshadowing another crisis: a generation being made ill by deprivation.

In my paediatric practice, and in communities across the country, I see children whose mental and physical health is deteriorating due to poor conditions and lack of support. We should not blame overdiagnosis alone, we must question why children are being overwhelmed in the first place.

Children from more materially advantaged backgrounds are experiencing rising levels of distress, linked to academic pressure, performance culture, social media, and wider uncertainty about the future. Declining mental health is not confined to any one social group. [2] But the burden of illness and the consequences of poor mental health are not evenly shared: social and economic disadvantage still shape who is most exposed to adversity, who has the fewest buffers, and who can access timely help when they need it. [3]

In public debate – and increasingly in clinical conversations – one group worries about “TikTok psychiatry” and the medicalising of ordinary stress. Another is concerned that talk of overdiagnosis will be used to justify restricting access to already overstretched services, and to ignore the damage done by long waiting lists for mental health, social care, and other support. Both perspectives, however, risk missing the same truth: children’s mental health is being shaped upstream by poverty, housing insecurity, racism and discrimination, and an unforgiving digital world.

As a paediatrician working in some of the UK’s most deprived areas and as a researcher studying inequality with adolescents, I see this daily. [4] I meet teenagers whose anxiety began when food ran out at home, children whose “behaviour problems” followed yet another move into temporary accommodation, and young people unable to sleep after years of community violence or racial bullying. Their distress is not mysterious or inexplicable, it maps directly onto their living conditions – even though much public discussion of the “youth mental health crisis” treats these problems as if they arise de novo within young people, detached from the material and political conditions of their lives. [5]

This is not simply anecdotal. We know that poverty and inequality are toxic for mental health. Large epidemiological studies consistently show that social and economic disadvantage, discrimination, and adverse childhood experiences are major determinants of child and adolescent mental health. [6,7] Child poverty in the UK has now reached record levels, with more children growing up in families unable to afford basic necessities. [8]Recent analyses describe “medieval” health inequalities, with deprivation driving illness into hospitals at a cost comparable to the defence budget and estimate that nearly a million children are at risk of poverty because housing support has failed to keep pace with rents.[9,10] In that context, we must consider that we have created conditions that are actively making children ill—leaving healthcare to pick up the pieces.

When these structural drivers are so powerful, a debate that centres only on whether we are “overdiagnosing” children is badly misaligned and risks two serious errors. Firstly, it lets systems off the hook. Talk of rising “demand” can obscure the extent to which this crisis is manufactured. In the UK, for example, a new child poverty strategy was only deemed necessary after years of benefit freezes, rising housing costs, and cuts to local services and broader austerity policies that reduced investment in public services, including the NHS, had pushed millions of children into hardship. [11] When families are living with food insecurity, overcrowding, and instability, and when mental health and other support services have been allowed to decline, it is unsurprising that consulting rooms are overwhelmed. This is the clear outcome of poor policy choices.

Secondly, it moralises suffering. The language of overdiagnosis implies that young people are too sensitive and parents too demanding, rather than acknowledging that many children’s lives have become intolerably hard. The implied solution is to toughen children up and tighten eligibility, rather than to make their lives less punishing.

From my research with adolescents a consistent picture emerges. [4] When we ask them what affects their wellbeing, they do not begin by naming diagnoses or “mental health problems”. Instead, they talk about mould on walls, unsafe streets, shame in classrooms, and the constant online pressures.

Digital life adds another layer. Recent research found that one in four teenagers in England and Wales have turned to AI chatbots for mental health support, with Black teenagers twice as likely than white teenagers to do so. [12] Many describe these tools as “a friend,” preferring them to overstretched professionals. Chatbots are clearly being used to fill gaps in inadequate services, but there is also growing evidence that heavy use of social media and online platforms is associated with increased depressive symptoms and self-harm in young people. [13] Whatever we make of AI in care, it is a bleak indictment of how far traditional services have drifted from what young people say they need.

Scrutiny of clinical practice remains essential. There are legitimate concerns about rushed assessments, limited follow-up, and medication prescribed without comprehensive psychosocial evaluation. However, the review’s focus on overdiagnosis fails to confront the deeper causes of children’s distress. A diagnosis should be a tool that opens the door to appropriate support, reasonable adjustments, and protection – not a way of relabelling social suffering as an individual defect while leaving its causes untouched. A more honest question would be: what are we diagnosing them for?

Responding constructively will require action at several levels. Clinicians and health systems should treat deprivation itself as a key clinical risk factor, routinely asking about and documenting income insecurity, housing conditions, school exclusion, racism, and exposure to violence alongside symptom checklists, and using this information to guide care plans and advocacy. Commissioners and service planners should build these structural factors into referral criteria and service design, prioritising long-term, multidisciplinary, relationship-based care over brief, transactional diagnostic encounters that do not change children’s circumstances. Health leaders and policymakers need to work with local government, education, and social care to reduce child poverty and housing insecurity as core public-health goals, and to support social protection policies that prevent families from falling into crisis. Finally, regulators and governments should take children’s digital environments seriously as determinants of health, ensuring that platforms and AI tools used by young people are subject to youth-centred safety, transparency, and accountability standards so that commercial and technological forces are not left to shape children’s mental health unchecked.

Many of the children I see are not “overdiagnosed”; they are overexposed—to poverty, insecurity, and a digital economy designed without their wellbeing in mind. A review that helps us see that will be valuable. One that blames families for reacting to intolerable conditions will have made the gravest diagnostic error of all.

Originally published in the British Medical Journal.

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References:

1. Department of Health and Social Care. Review launched into mental health, ADHD and autism services [Internet]. London: GOV.UK; 2025 Dec 4 [cited 2025 Dec 30]. Available from: https://www.gov.uk/government/news/review-launched-into-mental-health-autism-and-adhd-services

2. Miall N, Pearce A, Moore JC, et al. Inequalities in children’s mental health before and during the COVID-19 pandemic: findings from the UK Household Longitudinal Study. J Epidemiol Community Health 2023;77:762-769

3. Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry. 2024 Feb;23(1):58-90.

4. Singh G, Zhu H and Salama M. POWERING UP: A qualitative evaluation of the art and science of meaningful co-production for health equity. BMJ Paediatr Open. Forthcoming; (in press).

5. Pavlova A, Berkers P. “Mental Health” as Defined by Twitter: Frames, Emotions, Stigma. Health Commun. 2022 May;37(5):637-647.

6. Reiss F. Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med. 2013 Aug;90:24-31.

7. Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, Currie C. Adolescence and the social determinants of health. Lancet. 2012 Apr 28;379(9826):1641-52.

8. Child Poverty Action Group. Child poverty statistics: new record high and further breakdowns [Internet]. London: CPAG; 2024 [cited 2025 Dec 30]. Available from: https://cpag.org.uk/news/child-poverty-statistics-new-record-high-and-further-breakdowns

9. Booth R. Britain’s “medieval” health inequality is devastating NHS, experts say. The Guardian. 2025.

10. IPPR. Almost one million children at risk of poverty due to housing costs. 2025.

11. Department for Work and Pensions. Child poverty strategy [Internet]. London: UK Government; 2025 [cited 2025 Dec 30]. Available from: https://www.gov.uk/government/collections/child-poverty-strategy

12. O’Carroll L. ‘I feel it’s a friend’: quarter of teenagers turn to AI chatbots for mental health support. The Guardian. 2025.

13. Orben A, Przybylski AK. Screens, Teens, and Psychological Well-Being: Evidence From Three Time-Use-Diary Studies. Psychol Sci. 2019 May;30(5):682-696.

James Baldwin, the Black American writer and civil-rights essayist, captures why the truth about healthcare is heavy — and clarifying.

Those of us in clinical and organisational leadership are used to carrying targets, safety metrics and workforce crises. It is tempting to believe that if we just work harder within the system, we can fix it.

But some truths sit upstream of any dashboard. They are about who our systems were designed around, whose risks are considered acceptable, and whose lives are quietly treated as less valuable. Facing those truths is uncomfortable. It might also be the most important leadership work we do.

The comforting story of “the good doctor”

Medicine trains us to see ourselves as good people doing our best in a difficult world. When things go wrong, we look first to individual failings or resource gaps. The system may be “stressed”, but rarely is it described as unjust.

Global health colleagues have challenged that story for years. They remind us that health systems — including our own — were built through empire, slavery, industrialisation and racial capitalism. The benefits and harms of those histories were not evenly distributed, and they still aren’t.

If you work in the NHS or another well-resourced system in the global North, you work in what some scholars call the imperial core: countries that have long benefited from global extraction and still hold disproportionate power over capital, data and knowledge.

That does not make us villains. But it means our systems are not neutral. They reflect decisions in which some groups have always had more protection and more room for error. Leaders who cling to the “good doctor” story — we are doing our best, leave the politics at the door — risk guarding the status quo.

Listening as a leadership act, not a soft skill

One of the most radical things we can do as leaders is to change who we listen to, and what we treat as “real” knowledge.

Patients, families, nurses, porters, reception staff, junior doctors, migrant colleagues, Black and Brown staff who are routinely overlooked or disciplined more harshly — none are voiceless. They are often unheard.

Global health scholar, Seye Abimbola, describes the “foreign gaze” in academic publishing: work written to impress distant gatekeepers rather than serve the communities being described. A similar gaze shows up in leadership. We make decisions shaped by regulators, reputational risk and political optics, rather than by the lived analysis of those most exposed to harm.

Listening as an ethical practice means:

1. Treating repeated patterns of harm — such as disproportionate disciplinary action or worse outcomes — as system messages, not anomalies.

2. Believing people the first time they tell us what the system is doing to them, even when it unsettles our sense of fairness.

This is not about “hearing all perspectives equally”. It is about weighting the voices of those historically ignored.

Using privilege without re-centring ourselves

For many of us, the word privilege still triggers a defensive reflex: I work hard. I’m exhausted.

But privilege in healthcare leadership is not about ease. It is about how the system responds to us.

Leaders are more likely to be believed, given the benefit of the doubt, and able to shape agendas. We hold access to rooms, budgets and journals others do not.

The question is not guilt. The question is: what do we do with the power we already have?

In a recent BMJ Global Health editorial, Mark Shrime calls for “prioritarian scholarship” — work that deliberately centres those who are worst off. Leadership can borrow that lens.

Prioritarian leadership would mean:

1. Designing decision-making around those most affected. If you change outpatient access, are service users genuinely present — or only their data?

2. Shaping metrics that reveal structural harm. Overall improvement can mask widening inequities. A prioritarian lens asks first: what is happening to those at the sharpest edge?

3. Taking more personal risk so others can take less. Speaking up about racism or bullying carries different consequences for a junior migrant nurse than for a medical director. Leaders can choose to absorb the fallout.

This is not heroism. It is simply using the insulation we already have to create more safety for those who don’t.

What this means for leadership culture

If we take seriously the idea that we are leading from the imperial core, a few implications follow.

First, we must stop pretending health systems are merely technical machines. They are moral and political projects. Decisions about who waits, who gets seen and who is believed are value-laden, even when wrapped in neutral language.

Second, we need to be honest about how our own careers have been supported by structures that disadvantage others. Many of us trained in institutions easier to access if you were wealthy, white or already connected. Our publication records may owe as much to precarious colleagues’ labour as to our own brilliance. Facing this is not self-flagellation; it is part of redistributing opportunity.

Finally, we must move from statements to practice. Most organisations now have EDI strategies. Fewer have:

• Transparent equity-stratified data — discussed at the highest level.

• Governance structures that give real power, including budget and veto, to staff networks and community representatives.

These are not optional extras. They are core competencies in a world where patients and staff are increasingly unwilling to accept polite inequality as the price of care.

The heavy, beautiful work

The truth about our systems is heavy. It implicates us. It asks us to see that we are not simply rescuers in a broken world, but also beneficiaries of arrangements that harm others.

But there is beauty in that clarity. Once we understand the forces shaping our institutions, we gain new freedom to act differently within them.

Leaders in the imperial core cannot undo centuries of extraction, racism and exploitation. But we can decide what we normalise. We can decide whose voices are amplified, whose risks are reduced, and whose flourishing becomes the measure of success.

That is the invitation: to move beyond being “good doctors” in unjust systems, and instead to become honest, accountable collaborators in changing the conditions that make injustice feel inevitable.

The truth is heavy. Leadership is choosing to carry it — and then doing something with it.

Originally published on the BMJ Leader Blog.

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REFERENCES

1. James Baldwin, “As Much Truth as One Can Bear,” The New York Times Book Review, 14 January 1962

I’m Dr. Guddi Singh: a paediatrician in the NHS, a broadcaster, a researcher, and a trustee of the National Centre for Creative Health.

Across all those roles, I keep returning to one question: what would medicine look like if it understood that health is made long before anyone arrives in clinic - in the places we live, learn, work, play, love, struggle and belong?

That question feels especially urgent now. The NHS 10 Year Health Plan is built around three major shifts: from hospital to community, from analogue to digital, and from sickness to prevention. But if neighbourhood health is simply a matter of moving clinical services into smaller buildings, we will have missed the point.

Prevention will not happen with a leaflet. It will not happen by app or AI alone. And it will not happen by giving already exhausted people one more lifestyle instruction to fail at.

So when we ask whether creativity should be promoted as a health behaviour, my answer is yes - but only if we understand creativity as much more than another behaviour.

Too often in health, we take deeply social problems - loneliness, poverty, grief, racism, disconnection, hopelessness - and translate them into individual instructions:

Eat better.

Move more.

Stop smoking.

Drink less.

Be resilient.

Download an app.

Manage your stress.

And then, when people cannot comply, we call them “hard to reach”.

Very often, they are not hard to reach at all. They are easy to reach. We just have not built anything worth reaching for.

Creativity is one of those things worth reaching for. As a neurodevelopmental specialist, I can tell you that creativity is also a human capacity. A language. A form of connection. It is how people make meaning out of pain, how communities metabolise grief, how children learn who they are, and how people who have been silenced find voice.

I say that not only as a clinician, but as someone who needed it.

I was trained in the hard sciences: molecules and mechanisms, diagnoses and drugs. For a long time, if you had suggested that poetry, painting, music or dance had anything serious to do with medicine, I might have laughed in your face.

But then medicine itself nearly broke me.

As a young doctor, after a run of difficult child deaths, I burnt out badly. I blamed myself. I felt I was not cut out for a profession in which immigrant women of colour from working-class towns in the north-east were not exactly made to feel they belonged. For people like me at that time, therapy was not an easy word to say. Distress was something you swallowed. You carried on.

What pulled me back from the brink was not a pill or a policy document. It was a Bollywood dance class.

I say that carefully, because I am not suggesting dance is a substitute for therapy, medication, housing, safety, income or justice. But I am saying that, for me, music and movement turned a light back on inside me. It returned me to my body. It reminded me that I was not just a doctor, and not just a machine. I was a human being.

That experience changed the way I practised medicine.

I started bringing dance onto the paediatric ward. At first, it was awkward: doctors, nurses, children, parents - all of us in the playroom, trying not to look embarrassed. But then something shifted. The hierarchy softened. People smiled. Children got out of bed. Staff spoke to each other differently. For a moment, the ward became less clinical and more human.

That is creative health: not art as ornament, not murals to distract from underfunding, not a nice little extra once the “real medicine” has been done.

Creative health is the real medicine - if by medicine we mean the work of making people well.

The evidence is now far stronger than many people realise. The World Health Organisation’s scoping review of arts and health synthesised global evidence on the role of the arts in improving health and wellbeing. Research has also mapped hundreds of mechanisms through which arts and cultural engagement can affect health: biological pathways such as stress regulation; psychological pathways such as confidence and emotional expression; social pathways such as belonging and trust; and behavioural pathways such as movement, motivation and adherence.

This matters because the NHS is facing problems that biomedicine alone cannot solve.

In England, about one in five children and young people aged 8 to 25 had a probable mental disorder in 2023. One in four adults has at least two health conditions. Healthy life expectancy in the UK has fallen for the first time in a century, to around 61 years.

These are not problems that can be solved by prescribing more individual willpower.

If we are serious about turning the tide, we need to stop pretending prevention is simply about telling people to make better choices.

Prevention is whether a child has somewhere safe to play. Whether a teenager has a place to belong. Whether an older person has a choir, a library, a dance class, a reason to leave the house. Whether a mother has a community. Whether a young person can tell their story before their distress becomes a diagnosis.

Making Three Ages of Child for BBC Radio 4 taught me this viscerally. I went looking for child health in clinics and policy documents, but I kept finding it in baby banks, playgrounds, schools, youth projects and family hubs - in the places where children are either given room to flourish or taught to shrink.

This is where creativity becomes powerful. It reaches places that formal services often cannot. It can cross language, class, age, shame and mistrust. It can create the conditions in which people speak honestly about their lives.

I have seen this in my own work through the Wellbeing and Health Action Movement (WHAM) and Powering Up, where we used creativity with young people from underrepresented communities to radically reimagine health services. They made poems, music, drama and dance - but what they were really making was knowledge. They were showing clinicians what our systems look like from the other side.

And once you have heard a young person say, “People tell you to stay off the street, but no one tells you how - sometimes staying at home just isn’t an option,” you cannot go back to pretending that health is simply a matter of individual behaviour.

So how do we encourage the public to engage with creative health?

First, we stop patronising them. The public is already creative. Creativity is not owned by galleries, concert halls, universities or people with inherited confidence. It belongs in kitchens, temples, mosques, barbershops, playgrounds, WhatsApp groups, street corners, schools, even wards and waiting rooms.

Second, we fund it properly. Access matters. If creative health is only available to the already comfortable, it will widen inequalities while congratulating itself on doing good.

Third, we prescribe it carefully. Social prescribing must not become “go away and join a choir” when what someone needs is housing, safety or income. The best creative health work is relational. It walks alongside people.

Fourth, we embed creativity into the NHS, education and community life as infrastructure: not as charity, not as a pilot, not as the first thing cut when budgets tighten, but as part of how a humane society keeps people well.

A serious neighbourhood health strategy must ask not only, “Where are the clinics?” but also: where are the libraries, playgrounds, choirs, dance floors, youth workers, artists and community connectors? Where are the spaces where people can be seen, heard and held?

So yes, promote creativity as a health behaviour. But more than that: defend it as a public good.

Because the real question is not whether creativity can help health. The real question is whether we are brave enough to build a health system - and a society - that understands human beings need more than survival.

We need meaning.

We need beauty.

We need belonging.

We need joy.

And sometimes, before a person can tell you what hurts, they need a song, a story, a drumbeat, a poem, a paintbrush - perhaps even a dancefloor.

That is not soft.

That is not fluffy.

That is health creation.

Further reading and resources

1. Department of Health and Social Care. 10 Year Health Plan for England: fit for the future [Internet]. London: DHSC; 2025 [cited 2026 May 28]. Available from: https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future

2. Fancourt D, Finn S. What is the evidence on the role of the arts in improving health and well-being? A scoping review [Internet]. Copenhagen: WHO Regional Office for Europe; 2019 [cited 2026 May 28]. Health Evidence Network synthesis report 67. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553773/

3. Fancourt D, Aughterson H, Finn S, Walker E, Steptoe A. How leisure activities affect health: a narrative review and multi-level theoretical framework of mechanisms of action. Lancet Psychiatry. 2021;8(4):329–339. doi:10.1016/S2215-0366(20)30384-9

4. NHS England Digital. Mental Health of Children and Young People in England, 2023: wave 4 follow up to the 2017 survey [Internet]. Leeds: NHS England Digital; 2023 [cited 2026 May 28]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2023-wave-4-follow-up

5. Department of Health and Social Care. Major conditions strategy: case for change and our strategic framework [Internet]. London: DHSC; 2023 [cited 2026 May 28]. Available from: https://www.gov.uk/government/publications/major-conditions-strategy-case-for-change-and-our-strategic-framework/major-conditions-strategy-case-for-change-and-our-strategic-framework--2

6. Office for National Statistics. Healthy life expectancy, UK: between 2011 to 2013 and 2022 to 2024 [Internet]. Newport: ONS; 2026 [cited 2026 May 28]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/between2011to2013and2022to2024

Despite sleep being one of the most essential aspects of infant development—and one of the most agonising concerns for new parents—it remains scandalously under-researched and under-taught. In all my medical training, I received perhaps an hour on infant sleep. No specialist module. No gold-standard protocols. We’re left to piece together advice from outdated behavioural theories, personal instinct, and a little desperate Googling. Meanwhile, families are short-changed by a system that can’t answer their most urgent questions.

This is why Helen L. Ball’s How Babies Sleep: A Factful Guide to the First 365 Days and Nights feels so necessary. Ball, a professor of anthropology and director of the Durham Infancy & Sleep Centre, brings together evolutionary biology, cross-cultural research, and feminist critique in a guide that is as compassionate as it is clinically rigorous. The result is a quiet revolution: a myth-busting, parent-respecting, evidence-soaked call to rethink everything we think we know about infant sleep.

Cultural Blind Spots: Why “Normal” Sleep Is a Myth

Ball’s central thesis is simple but radical: babies are not broken—our expectations are. In the UK, US and Australia, around 30% of parents report infant sleep problems. In Japan and Korea, that number is closer to 5–7%. The disparity isn’t because Asian babies are better sleepers—it’s because their parents aren’t at war with biology. In Japan, kawa (family co-sleeping) is the norm, with babies in close proximity to parents on futons. In Korea, infants are carried in slings during the day and breastfed on demand at night. These practices align with babies’ needs rather than try to suppress them.

Ball’s work aligns with that of biological anthropologist James McKenna, whose research into mother-infant “sleep synchrony” similarly challenges dominant models that equate solitary sleep with success. It also resonates with Cecilia Tomori’s Nighttime Breastfeeding: An American Cultural Dilemma, which explores how breastfeeding and sleep become incompatible under neoliberal ideals of productivity. Both scholars bolster Ball’s claim that Western sleep guidance reflects not science, but ideology.

Meanwhile, in the West, parents are told that babies must “self-settle” and sleep independently from an early age. Ball shows this isn’t grounded in biology, but in cultural ideals of autonomy and post-industrial life. She traces this ideology back to John B. Watson, the American psychologist who warned in 1928 against hugging or kissing your children, lest you make them emotionally weak.

Babies, Ball reminds us, are “exterogestates”—neurologically unfinished at birth, their brains still undergoing rapid development best fuelled by proximity, frequent feeding and human contact. Expecting them to sleep alone for 12-hour stretches is, she writes, like expecting a kangaroo joey to hop.

Cross-cultural examples show the absurdity of Western norms. In Hungary, infants are swaddled tightly to mimic the womb—resulting in deeper sleep. In Japan, furniture stores advertise beds by how many family members they fit. Among the Hadza of Tanzania, infants are passed among many caregivers. They wake just as often as Western babies, but no one calls it a “problem.” In these communities, sleep is social, shared, and interdependent—never a solitary milestone to be conquered.

I remember one South Asian family who came into the emergency department late one night, anxious but calm, their baby feverish but settled in the arms of his grandmother. When we asked about sleep, they told us—in a matter-of-fact way—that the whole family shared a bed. Around the room, I felt the temperature shift. Colleagues exchanged glances laced with disapproval. The family became, in that moment, a clinical problem to be managed. I said nothing. But inside, I felt the sting of recognition. I, too, had grown up in a bed shared with parents, siblings, and more than once, a visiting auntie from abroad. It had never felt unsafe—it had felt safe. And yet, in that room, under the fluorescent light and the weight of medical orthodoxy, I found myself questioning my own childhood.

The Feminist Cost of Sleep Training

Ball’s critique is profoundly feminist. Western sleep advice pathologises night waking, undermines breastfeeding, and heaps guilt on mothers. Maternal exhaustion becomes a personal failing rather than a symptom of systemic neglect. As Tomori argues, the cultural construction of the “good mother” relies on uninterrupted infant sleep—an ideal incompatible with the reality of care work.

Breastfeeding is often abandoned early because it’s seen as incompatible with sleep training. Yet breast milk at night contains melatonin, helping babies—and mothers—fall back asleep. And while breastfed babies wake more often, research by Kendall-Tackett et al. shows breastfeeding mothers often get just as much, or more, sleep than those using formula. The problem isn’t babies waking; it’s the expectation that mothers should survive on fractured sleep while managing alone.

Class compounds the injustice. In her work in Bradford, Ball notes how middle-class mothers, often isolated in nuclear households, cling to routines and sleep-training regimes in a bid for control. In contrast, Pakistani-British mothers in multigenerational homes embrace co-sleeping and shared care as the default. Like the Beng in West Africa—whose babies nap communally—these families support maternal wellbeing through kinship networks. The current NHS guidance is well-intentioned but often lags behind evidence. The official line—that babies must sleep separately in a cot—is based on concerns about SIDS. As such, some guidance continues to promote one-size-fits-all advice that alienates these practices and families.

Nuance, Not Dogma: Rethinking the NHS Line

This book should be required reading for every GP, health visitor and paediatrician. The current NHS guidance is well-intentioned but often lags behind evidence. The official line—that babies must sleep separately in a cot—is based on concerns about SIDS. But as Ball points out, the binary between “safe cot” and “dangerous bed” doesn’t hold up to scrutiny.

The problem isn’t co-sleeping per se—it’s unsafe co-sleeping: babies on sofas, with intoxicated adults, or in cluttered bedding. But exhausted parents, shamed by scare tactics, often do precisely that in secret. Ball’s harm-reduction approach is rooted in reality. She advocates evidence-based guidance on safe bed-sharing: firm mattress, no pillows, breastfeeding dyads, and sober, non-smoking adults. Her argument is not against safety—it’s against inflexible dogma.

Much of the mainstream advice—from The Baby Whisperer to NHS pamphlets—echoes a behaviourist model of child-rearing, where independence is king and emotions are distractions. These texts offer a seductive fantasy of control, but at what cost?

The NHS could save resources and trauma by adopting a more culturally aware, nuanced approach. This means moving beyond the binary of “safe cot” vs “dangerous bed” to acknowledge that many families already share sleep in ways shaped by culture, kinship and necessity. A more effective approach would combine realistic education on safer sleep (especially harm reduction for co-sleeping), training for clinicians to engage sensitively with diverse parenting practices, and a reframing of infant night waking as developmentally typical—not pathological. Meeting families where they are, rather than demanding they conform to outdated ideals, would not only prevent stigma and burnout, but reduce unnecessary referrals, prescriptions and A&E visits. A parent who understands that night-waking is normal is less likely to seek unnecessary reflux medication or specialist referrals. A father who’s encouraged to share overnight care—as in Japan’s kawa model—can help prevent maternal burnout. This isn’t about promoting one method of sleep—it’s about giving parents permission to choose what works, safely and without shame.

The Takeaway: Trust Babies, Support Parents

How Babies Sleep is a deceptively gentle book. Underneath its calm, practical tone is a powerful political argument: that infant sleep cannot be separated from maternal mental health, gender inequality, or the economic structures that shape parenting.

The psychoanalyst Lisa Baraitser has written that maternal time disrupts capitalist rhythms: it is repetitive, unpredictable, emotionally intense. Night feeds and midnight wakings don’t fit into productivity metrics. They demand a different value system—one based on interdependence and care.

For clinicians, Ball’s book offers both a wake-up call and a toolkit. For parents, it’s permission to stop blaming themselves—and start asking harder questions about the world we’ve built around babies.

The most revolutionary thing in this book isn’t the science—it’s the solidarity. And perhaps, that’s the real “sleep solution” we’ve been searching for all along.

Originally published in BMJ Paediatrics Open

Book References

Ball, Helen L.
How Babies Sleep: A Factful Guide to the First 365 Days and Nights. Cornerstone Press, 2025

McKenna, James J.
Sleeping with Your Baby: A Parent’s Guide to Cosleeping. Platypus Media, 2007.

Tomori, Cecilia.
Nighttime Breastfeeding: An American Cultural Dilemma. Berghahn Books, 2014.

Baraitser, Lisa.
Maternal Encounters: The Ethics of Interruption. Routledge, 2009.

Hogg, Tracy, and Blau, Melinda.
Secrets of the Baby Whisperer: How to Calm, Connect, and Communicate with Your Baby. Ballantine Books, 2001.

Journal Article

Kendall-Tackett, Kathleen A., Cong, Zhen, and Hale, Thomas W.
“Mother–Infant Sleep Locations and Nighttime Feeding Behavior: U.S. Data from the Survey of Mothers’ Sleep and Fatigue.” Clinical Lactation 1, no. 1 (2010): 27–31.