The Mushroom Tower and Equitable Cancer Care
David Benjamin once grew a building out of mushrooms.
Not a metaphor. An actual 40-foot tower in New York, made from 10,000 bricks he grew in five days using mycelium, the bit of fungus that lives underground and does all the interesting work while the mushroom takes the credit. When the exhibition ended, they composted the whole thing. It turned back into soil.
Benjamin is an architect. But the problem he solved, construction waste choking the planet, did not yield to architectural thinking. It yielded to biological thinking. He stopped asking “how do we build better?” and started asking “what if buildings grew, lived, and died like organisms?” Suddenly, waste was not a problem to manage. It was a design flaw to eliminate.
I think about this tower more than is probably healthy. Especially when I sit in health care partnership meetings watching brilliant people arrive at the same conclusions they arrived at earlier.
The Usual Suspects
Let’s take an obvious example: A meeting to ensure UK cancer care is equitable.
Here is how these meetings go: NHS Managers who know the system. Cancer Specialists who know the disease. Public health leads who know the data. Patient advocates who have lived experience. Local authorities who know the communities. Maybe a university researcher if we are feeling cutting-edge.
Everyone is smart. Everyone cares. Everyone has read the reports showing that cancer outcomes in the UK are wildly unequal depending on your postcode, your skin colour, how much money you have, etc., etc. Everyone agrees this is unacceptable. Everyone commits to partnership working.
And then, inevitably, someone says “we need better referral pathways” and someone else says “we need more culturally sensitive communication” and someone else says “we need stronger data-sharing agreements” and everyone nods because these things are true and also these things have been true for a decade and the disparities remain.
The problem is not that these people are wrong. I think the problem is that they are too right. Too expert. Too familiar with the problem.
What if the room had some weirdos in it?
My personal story
A few years ago, I was tasked with figuring out digital literacy for tradespeople who struggle to read. Standard stuff. Worthy problem. Obvious stakeholders.
I invited the experts. Adult education specialists who understood literacy barriers. Digital inclusion practitioners who lived and breathed accessibility. Social media experts who managed the platforms. These are good humans doing important work.
My standard MO once I got a good understanding of anything is to disrupt it. I like to tease out the forces that are shaping the context, I connect dots that ordinarily don’t seem connected, and I uncover the not-so-obvious or cast the obvious in a new light. This perspective has helped me broker impactful partnerships and design long-term engagement models.
So, going by my standard, I invited three people who had absolutely no business being there.
A game designer, a theatre director and someone who ran a repair café where people fixed broken phones together.
The experts opened with familiar territory. Simplified language. Audio options. All sensible. All things they had tried before with mixed results. The conversation had a well-worn groove to it, like a path people had walked so many times the grass no longer grew.
Then the repair café person, who had been quiet, spoke up.
“Nobody comes to my café to learn. They come because their phone died and Computer Village wants forty quid for a new one. But while we are fixing it, I show them how to find repair videos online, how to spot scam websites, and how to tell if information is trustworthy. They do not think they are learning digital literacy. They think they are fixing a phone. But they are learning.”
The room did that thing where everyone goes very still because someone just said something that does not fit the framework but made sense!
The experts looked impressed. These were not evidence-based interventions. They did not map to existing programme logic models. They were weird.
We built a pilot anyway. Community storytelling sessions embedded in repair events where digital literacy for business growth was a side effect of doing something people already wanted to do. It worked. Not because it was rigorous. Because it was strange enough to bypass every barrier the rigorous approaches kept hitting.
Six Questions (That Only Work If the Room Is Strange)
The tool I use to make this repeatable is stupidly simple. Six questions, lifted from Critical Systems Heuristics, that sound obvious until you try to answer them in a room full of people who disagree:
- What are we actually trying to achieve? (Not the mission statement. The thing.)
- What needs to happen to get there? (Specific actions, not vibes.)
- Who is going to do those things? (Names, not “the system”.)
- Who wins and who loses? (Both. Out loud.)
- Who can kill this? (Knowing this early saves months.)
- What constraints actually apply? (The ones we pretend are not there.)
Run this with the usual suspects and you get consensus, which is another word for nobody saying the uncomfortable bit out loud. Run it with a room that includes someone who fixes phones for a living and you get friction. Friction is where the good stuff hides.
What Cancer Care Partnerships Can Do
Imagine running those six questions for equitable cancer care, but the room includes:
The person who coordinates logistics for a national food bank and knows exactly how to reach people who are invisible to every official database. The urban planner who can tell you why your cancer centre is accessible by car but unreachable by bus, which is a problem when your patients do not have cars. The behavioural economist who will cheerfully explain why asking people to lose a day’s wages to attend a free screening is not actually a free screening. The community organiser from a completely unrelated sector who has built trust in populations that have every reason not to trust you.
Not instead of the cancer specialists. With them.
The urban planner might say: “Why are your treatment centres where they are? Did anyone map them against actual transport routes, or did we just put them where the buildings happened to be?”
The behavioural economist might say: “You have designed a system that requires people to act against their immediate economic survival in order to access prevention. Then you are surprised when they do not. What if we paid people to attend screenings?”
These are not health questions. That is why they are useful. The experts have been staring at the problem so long they may no longer see the shape of it. The outsiders see it immediately because nobody taught them what to ignore.
The Final Bit
I have a hunch, which is that equitable cancer care will not improve through better coordination of the same partnerships. It will improve when we get brave enough to put people in the room who have no idea what they are doing there and let them ask the questions that make experts take the back seat for some minutes.
David Benjamin did not solve construction waste by being a brilliant architect. He solved it by thinking like a biologist who wandered into architecture and refused to accept that buildings had to be dead things. The tower grew. It lived. It composted. It left nothing behind but soil.
Maybe cancer care partnerships need their own version of a mushroom tower. Not a better framework. A weirder room.
If you are working on equitable cancer care and you fancy a conversation about who should actually be at the table, please get in touch. I have some frameworks and I am increasingly certain we may need to start asking weird people.