From health-care to well-care: what it means to be an “upstreamist”

From health-care to well-care: what it means to be an “upstreamist”

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.

Retrieved from OECD healthcare spending

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