Complex problems: simple solutions, or how an umbrella can cure constipation

‘The best ideas are simple ideas.’ This was the assertion of a friend I met up with earlier this week for a pie and a pint, with a side order of his own-recipe barstool wisdom.

I found his stance difficult to agree with at first – it reminded me too much of my terrifying old English teacher gesturing at my waffly essays and barking, ‘What’s your argument? If you can’t explain it in ten seconds then you don’t have one!’ Yet over the course of this week I have come to see that he has a point. While we must always be mindful of the complexity of the problems we face as a society, if an idea cannot be expressed or enacted in a way that is meaningful to others then it is of very limited value. 

Last Tuesday’s launch event for the new ‘Science, Medicine & Society Network’ at University College London served as a lesson in this principle. The Network is a new international academic partnership bringing together experts in health from a range of disciplines, and I had been worried that I would understand little of what the distinguished panel of medical clinicians, political scientists, lawyers and anthropologists would be discussing. Refreshingly though, the central, easy to comprehend message of the event was that although the challenges to global public health are complex and varied, the solutions must be grounded in simplicity, attainability, and relevance to the communities they affect. 

For example, Lord Nigel Crisp, the former NHS senior manager and author of Turning the world upside down: The search for global health in the 21^st century, spoke about his discussions with public health officials around the world on the question of how to reduce maternal mortality. An Indian government minister had presented a complicated series of rubrics and metrics, lofty policies and programmes, and a confusing mishmash of approaches that Lord Crisp struggled to follow let alone imagine being implemented. In contrast, an official at BRAC, the hugely successful Bangladeshi NGO, responded to Lord Crisp’s question simply: ‘Empower the women’. In recent years, this radically simple approach has contributed to a dramatic fall in Bangladesh’s maternal mortality figures. 

Another speaker at the event offered a different example. Professor Cyril Chantler shared a story that he likes to tell his UCL first year medical students. When he was a consultant to Guy’s Hospital in the 1970s, a young boy was brought to see him with rectal bleeding apparently caused by a small cut on his skin – a straightforward diagnosis, one might think. However, Prof. Chantler suspected that the underlying cause was more complicated than this, so he began to investigate further. Why did he have this cut? Because he was constipated. Why was he constipated? It transpired that the boy’s family, who lived in a poor neighbourhood, did not have an indoor toilet and instead shared a communal lavatory with other households in the street. The roof above this communal toilet leaked, and the little boy didn’t like getting his head wet, so he stopped going to the toilet. Prof. Chantler said that he likes to challenge his students to suggest a solution to this problem: many say that the family needs an indoor toilet. This may be correct, but Prof. Chandler is not a plumber. The more politically-minded students might suggest that the socioeconomic situation is the problem, and that the boy’s family should not have to be so poor that they share an outdoor toilet with other people in their street. This also has the ring of truth, but again it is beyond Prof. Chandler’s capacity to change this from his clinical consulting room. So what did Prof. Chandler do? He gave the boy an umbrella. The boy no longer had to get wet when he needed the loo, he stopped getting constipated, and the bleeding went away. 

I was again alerted to the potential for apparently simple ideas to help solve complex problems when the RSA, in partnership with Kingfisher PLC, hosted a seminar this week on the subject of building ‘sustainable, stronger communities’. Luminaries from business, the public sector, think-tanks, and charities discussed the potential for businesses to help promote community cohesion and social change through initiatives such as those pioneered by Kingfisher, including the online local networking website StreetClub. Much of the debate centred on whether initiatives like these should be high-concept, ambitious attempts to organise society and ‘create new cultural norms’, or whether a simpler, lighter touch was called for, striving to ‘do one thing very well’. Personally, I found the latter option more compelling. StreetClub’s core strength in encouraging neighbours to share tools is reminiscent of that other simple idea I blogged on recently, the Big Lunch. Both of these schemes harness the latent potential for communities to become more connected around a simple excuse to get together; to borrow a ladder or to share a lunch. As one attendee at our seminar sagely observed, successful initiatives like this ‘don’t change communities; they create the platform for change’. 

Simple ideas which create the platform for change are what the RSA’s Connected Communities programme is all about. Our research found that some older people in South East London have low wellbeing because they are isolated and don’t have any way of transporting themselves away from their homes; we’re developing a project that will provide them with a social environment and a free lift in a minibus to help them get out and about. We found that people’s mental wellbeing can suffer when there is a lack of social support; we’re going to identify key members of local social networks and train them as peer support counsellors.

Complex problems: simple solutions. My friend in the pub swears by this equation, and so, presumably, did the little boy who trotted down the street with an umbrella every day. It’s an equation I’m coming around to too.