Introducing 'Upstream Health Project'
Welcome to my new blog that is a part of the Upstream Health Project.
My intention with Upstream Health Project is to demonstrate the fundamental importance of looking ‘upstream’ when trying to understand how to improve both health and medical care. By ‘upstream’ I mean to explore and document how health issues are deeply shaped by broad social, economic and environmental conditions that occur long before disease, disability and death happen. This perspective is a reality grounded in an overwhelming amount of excellent research that reinforces the crucial role of the ‘social’ in health. Despite our knowledge of the importance of the social for health we, through our governments, spend much more of our money downstream, on treatment for disease rather than on upstream prevention and equity. And our medical system is broken. Millions of people do not have access. Health care providers are burned out and over-worked. We need to fix these problems and I have some ideas about how.
Picture this:
You are downstream on the bank of a beautiful river. You look around to take in the scenery, but you see people are in the water and about to drown. You respond urgently. You jump in and pull people, one after another, out of the water. This goes on continuously, and you (who is doing life-saving work) become tired and frustrated and the people who are saved become traumatized, or at least thoroughly wet, from the ordeal. This is what happens when we focus on problems downstream. All of the effort goes into solving difficulties faced by individuals, one wet (or sick) person after another.
Now imagine this different scenario:
You are upstream and engaged in building all sorts of safety nets and guardrails, as well as resting places for seeing what is happening downstream. You make sure that everyone is protected and that very few people fall in the water. In the world of health care, these safety nets and guard rails consist of policies ensuring equity in income, education, race and gender statuses and so on. Your guardrails and nets are enabling almost everyone to be more prepared and able to take helpful and health-giving action to avoid or delay falling into the river.
In this project I want to contribute to conversations that shift perspectives from downstream to upstream, from hyper-medicalization to examining the role of social influences. I see our current focus as a society as an over-emphasis on medicine in everyday life. I want to expand an understanding of the impact of broader social conditions such as equity and justice on health and wellbeing. This is a socially grounded perspective (in SDH) and is central to understanding the crucial place of upstream interventions in mitigating rates and experiences of sickness, disability and death.
The Upstream Health Project asks us to look beyond immediate symptoms and medical diagnoses to fundamental causes of illness such as income inequality, housing stability, social isolation, access to education, employment, racism, social cohesion and the structure of our healthcare systems themselves. In this project, we recognize the importance of social-demographic factors such as gender, ethnicity and racialization status. While downstream interventions—clinical treatments, medications and acute care—are essential, they often address the consequences or symptoms rather than the origins of illness and distress. The Upstream Health Project is based on the belief that meaningful, lasting improvements in health and well-being require us to engage more directly with these upstream social determinants.
The Upstream Health Project is both a reflective and practical endeavor. It aims to create space for dialogue, writing and knowledge-sharing that uses social analysis in an accessible and human-centred way.
Through the blog and social media pages, I hope to explore questions such as:
- What are the limits of healthcare models that focus on individualized treatment?
- How does our focus on medical interventions (or ‘hyper-medicalization’) shape the way we understand ourselves and live our daily lives?
- How can we better integrate awareness of the social determinants of health into everyday policies?
- How can we amplify the perspectives and voices of people with lived experience of sickness and as carers within our medical care systems?
- How will putting a spotlight on the social determinants of health benefit medical care?
- How much will attending to the social determinants of health decrease rates of sickness, disability and death?
This project is also informed by my work as a medical sociologist and also hearing the stories of individuals and families facing various serious health challenges such as cancer, heart disease and mental illnesses. In these stories, relevant research and my own lived experience, it has become especially clear how the health care system can cause harm and is far from perfect. For individual patients and families, financial strain, caregiving demands, cultural expectations and systemic gaps in support often intersect with the medical journey – creating extremely difficult and challenging conditions to navigate. Health care providers suffer from the current policies. They may face, among other things, despair, addictions and even suicide because of our failures to care for the caregivers.
An upstream lens does not replace clinical medical care, but it expands the frame—allowing for a more equitable and humane, contextualized understanding of what people inside outside of the system are going through before they get sick and seek medical care.
At its core, this initiative is an invitation: to think more broadly, to question taken-for-granted assumptions and to consider how we might shift both practice and policy in ways that are more responsive to the social realities people face. It is also an attempt to contribute, in a modest way, to ongoing conversations about how to build more equitable and sustainable approaches to health.
I do not see upstream health as a fixed model or the solution for all issues, but as an evolving perspective—one that benefits from interdisciplinary dialogue and from the insights of those with lived experience of caregiving and receiving.
Thank you for taking the time to read this introduction. I look forward to sharing more as the project develops and to engaging with others who are interested in these questions. Be sure to subscribe to the blog and follow along for more content on the Upstream Health Project social media pages:
