By Denise Crismon
Three friends are walking along a
river. Suddenly they notice that there are people in the river and a waterfall
up ahead. One friend, a strong swimmer, goes in and begins to pull people to
safety. Another friend builds a raft to help more people at a time. The third
friend is seen swimming upstream. The friends call after her, “what are you
doing?” Her reply: “I’m going upstream to find out who’s throwing the people in
the river.”
Introduction
As medicine and technology advance, people are becoming more
focused on living life well, not just prolonging it. To do so, heathcare needs
more upstreamists. Dr. Rishi Manchanda, M.D., a
leading expert in the upstream approach, explains that we need all three
aspects depicted in the parable. The first friend represents the specialists,
the ones you need when you are in dire straits or when you need help
immediately. The raft builders are primary care providers. The friend who went
upstream makes the connection between the healthcare system and the community
to bring better health to all. Dr. Manchanda argues that there need to be more
upstream providers and they need to be supported by communities, governments,
and organizations. An upstreamist focuses on where health begins.
Health Begins
Where does health begin? It begins where people work, play, sleep,
and eat. It begins with invisible and visible government structures that decide
how resources are distributed. Being an upstreamist is more than simply
focusing on preventative health over treating disease (sick care to health
care). To concentrate upstream, the provider has to look for the environmental
or social factors that bring on disease. In order to truly have health and
wellness, clinicians and communities have to work together to improve health
where it begins. Dr. Manchanda provides resources to clinicians who want to be upstreamists
on his website Health Begins.
Organizations
Private clinicians are not the only ones looking upstream,
organizations are too. In Boston, hospitals
are partnering with legal non-profits to address upstream needs, such as
adequate housing, food, and safety. A medical provider can refer a patient to
an attorney as part of the patient’s healthcare plan. According to the National
Center for Charitable Statistics, there were more than 1.56 million nonprofit organizations
registered in the United States in 2015, many focused on health. If
organizations and medical providers work more closely together, they can stop
disease where it begins.
Government
Governments are also getting involved in this movement. In
response to the high number of people with chronic diseases in the U.S., the
CDC’s National Center for Chronic Disease Prevention and Health Promotion
(NCCDPHP) is focusing on “improv[ing] health
across the lifespan where people live, learn, work, and play.” NCCDPHP does
this by measuring how many Americans have chronic illnesses, improving
environments to facilitate better choices, strengthening the healthcare system
to provide prevention services, and connecting clinicians and community.
Despite NCCDPHP’s work, six in ten adults in
the U.S. still have a chronic disease and four in ten have two or more. Chronic
disease is the leading cause of death and disability in the U.S. and a major
portion of the $3.3 Trillion in annual health care costs. More needs to be done
in the fight for wellness.
Communities
Society can do better. Communities need to be more actively
involved; regular people need to be empowered. Many are, but there are still too
many who do not have enough resources to even know where to find help.
With all of the money and resources infused into the healthcare
system in the United States, by focusing upstream, many more people could live
full, productive lives, instead of simply living longer. According to the World
Health Organization, the U.S. is expected to spend 20 percent of GDP on
healthcare by 2020, which is the most of any country. The graph below shows the
percent of GDP the U.S. spends compared to other countries. As communities work
together to better their circumstances and advocate for a more equal
distribution of healthcare resources, they can be the means of bettering their
lives. These resources need to be used more efficiently and effectively.
Conclusion
Many
advances are being made by governments, organizations, and communities to move
from health care to well care. While applaudable, the efforts are not enough.
Many at the bottom are still being left out of the progress being made. As
everyone works toward an upstream approach to healthcare, we can achieve
wellness, not just the rich, but the underprivileged also. As a nation, we will
be healthier, happier and better equipped for the future.
References
Cable,
K. (n.d.). The Transition from Sick Care to Well Care and the Rise of the
Patient-
Consumer. Retrieved from https://techcrunch.com/2015/09/29/the-transition-from-sick-care-to-well-care-and-the-rise-of-the-patient-consumer/
Chronic
Diseases in America. National Center for Chronic Disease Prevention and Health
Promotion (NCCDPHP). Centers for Disease Control and Prevention
(CDC). Retrieved from https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
Health
Begins. (n.d.). Our Approach. Retrieved from https://www.healthbegins.org/our-
approach.html
McKeever,
B. (2019). The Nonprofit Sector in Brief. Urban Institute, National Center for
Charitable Statistics. Accessed on July 19, 2019. Retrieved from https://nccs.urban.org/project/nonprofit-sector-brief#overview
National
Center for Medical Legal Partnership (n.d.). Retrieved from https://medical-
legalpartnership.org/
Zaugg,
J. (n.d.). Rishi Manchanda: “Health is too rarely perceived as a group
phenomenon.”
Retrieved from https://www.invivomagazine.com/en/mens_sana/interview/article/196/rishi-manchanda-health-is-too-rarely-perceived-as-a-group-phenomenon
