Upstream The Quest To Solve Problems Before They Happen By Dan Heath

I read the book “Upstream: The quest to solve problems before they happen”, by Dan Heath. This book walks through barriers our society faces to thinking upstream and how to overcome them. Heath defines upstream thinking as “efforts aimed to prevent a problem from happening or to systematically reduce the harm caused by those problems” (p. 3). Our society is quick to react and slow to prevent. This is because downstream work, or reactive thinking, has a faster payoff and is more tangible. Heath sets this book up in three parts: forces that push us downstream, questions to ask as upstream leaders, and upstream thinking in our own lives. One quote stood out to me: "so often in life, we get stuck in a cycle of response. We put out fires. We deal

23). A major component of problem blindness is accepting the problem and believing it cannot be changed. The second barrier is a lack of ownership, which is the mindset of “that’s not mine to fix” (Heath, 2020, p. 43). One could compare problem blindness and lack of ownership to the bystander effect – thinking someone else will see the problem and take action. The last problem is tunneling, which occurs when people are juggling several problems and give up trying to solve them. Tunneling can be caused by a scarcity of resources and is often rewarding since our society praises quick fixes. To break the cycle of tunneling, we need enough resources to develop lasting solutions (Heath, 2020, pp. 55-59). Problem blindness, lack of ownership, and tunneling prevent us from engaging in upstream thinking at both individual and societal levels. These barriers are evident when exploring points of leverage, the cost of prevention, and system-wide change within a public health

We cannot fix our country’s systemic barriers overnight, but we can be conscientious of them and develop interventions that minimize their impact. A pivotal ELSI concept is that health is determined by more than your medical history. To “move the needle” on someone’s health you need to consider SDOH and the impact of systemic biases (Heath, 2020, pp. 128-129). In 2019, researchers at the New York School of Medicine found that cities with higher rates of racial and ethnic segregation have more pronounced disparities in life expectancy by zip code. For example, the life expectancy gap in Chicago is 30.1 years. This is the concept of weathering: these communities are “incubators of stress” since people are often struggling to find housing, access education, find jobs, and eat healthy food (Heath, 2020, p. 99). This is a call to action to (1) acknowledge the deeply rooted impact of systemic racism and segregation on the health and (2) design programs to address these inequities and foster change (Ducharme & Wolfson, 2019; Walek, 2019). This life expectancy gap highlights our society’s ‘problem blindness’. The information published in 2019 is not new, but rather an appalling truth we continue to overlook. People fall into the trap of believing ‘this is not possible to fix’. By applying SDOH frameworks to public health, we can attack these disparities at various levels. For