Upstream Medicine

When patients visit a clinic or hospital, they bring stories of the everyday life conditions that made them sick in the first place – stories about where they work, live, and play; stories about income, food security, and housing. Doctors today are listening. Personal stories and patient encounters illuminate the social determinants of health, that is, the upstream source of what too often become complex, painful, and expensive downstream problems. Upstream Medicine features interviews by medical students and residents with leading physicians whose practices bring evidence-based, upstream ideas to life. They show how we can change the practice of medicine to build a healthier society.

Upstream Medicine features interviews with physicians who are identifying and addressing the upstream conditions that lead to good health and long lives, thus avoiding more complex, painful, and expensive downstream medical problems later on. By transforming how we imagine the practice of medicine, this book will help us build a healthier society.

Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health was released in September 2019, before the World Health Organization declared COVID-19 a global pandemic in March 2020. Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond. The consistent and compelling evidence on how social determinants shape health has led to a growing recognition throughout the health care sector that improving health and health equity is likely to depend â€" at least in part â€" on mitigating adverse social determinants. This recognition has been bolstered by a shift in the health care sector towards value-based payment, which incentivizes improved health outcomes for persons and populations rather than service delivery alone. The combined result of these changes has been a growing emphasis on health care systems addressing patients' social risk factors and social needs with the aim of improving health outcomes. This may involve health care systems linking individual patients with government and community social services, but important questions need to be answered about when and how health care systems should integrate social care into their practices and what kinds of infrastructure are required to facilitate such activities. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health examines the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes. This report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation's health and reduce health inequities.

This timely book takes seriously the idea of understanding how our social world – and not individual responsibility or the healthcare system – is the primary determinant of our health. Kathryn Strother Ratcliff puts into practice the "upstream" imagery from public health discourse, which locates the causes (and solutions) of health problems within the social environment. Each chapter explains how the policies, politics, and power behind corporate and governmental decisions and actions produce unhealthy circumstances of living – such as poverty, pollution, dangerous working conditions, and unhealthy modes of food production – and demonstrates that putting profit and politics over people is unhealthy and unsustainable. While the book examines how these unhealthy conditions of life generate significant class and ethnic health disparities, the focus is on everyone's health. Arguing that none of us should be placed in health-threatening situations that could have been prevented, Ratcliff's provocative analysis uses social justice and human rights lenses to guide the discussion "upstream," toward possible changes that should produce a healthier world for us all. Using data and ideas from many disciplines, the book provides a synthesis of invaluable information for activists and policymakers, as well as for professionals and students in sociology, public health, and other fields related to health.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.

Wall Street Journal Bestseller New York Times bestselling author Dan Heath explores how to prevent problems before they happen, drawing on insights from hundreds of interviews with unconventional problem solvers. So often in life, we get stuck in a cycle of response. We put out fires. We deal with emergencies. We stay downstream, handling one problem after another, but we never make our way upstream to fix the systems that caused the problems. Cops chase robbers, doctors treat patients with chronic illnesses, and call-center reps address customer complaints. But many crimes, chronic illnesses, and customer complaints are preventable. So why do our efforts skew so heavily toward reaction rather than prevention? Upstream probes the psychological forces that push us downstream—including “problem blindness,” which can leave us oblivious to serious problems in our midst. And Heath introduces us to the thinkers who have overcome these obstacles and scored massive victories by switching to an upstream mindset. One online travel website prevented twenty million customer service calls every year by making some simple tweaks to its booking system. A major urban school district cut its dropout rate in half after it figured out that it could predict which students would drop out—as early as the ninth grade. A European nation almost eliminated teenage alcohol and drug abuse by deliberately changing the nation’s culture. And one EMS system accelerated the emergency-response time of its ambulances by using data to predict where 911 calls would emerge—and forward-deploying its ambulances to stand by in those areas. Upstream delivers practical solutions for preventing problems rather than reacting to them. How many problems in our lives and in society are we tolerating simply because we’ve forgotten that we can fix them?

Since 1965 the foreign-born population of the United States has swelled from 9.6 million or 5 percent of the population to 45 million or 14 percent in 2015. Today, about one-quarter of the U.S. population consists of immigrants or the children of immigrants. Given the sizable representation of immigrants in the U.S. population, their health is a major influence on the health of the population as a whole. On average, immigrants are healthier than native-born Americans. Yet, immigrants also are subject to the systematic marginalization and discrimination that often lead to the creation of health disparities. To explore the link between immigration and health disparities, the Roundtable on the Promotion of Health Equity held a workshop in Oakland, California, on November 28, 2017. This summary of that workshop highlights the presentations and discussions of the workshop.