What makes us get sick? Look upstream | Rishi Manchanda

Summary

In this powerful talk, a doctor shares the story of Veronica, a patient with chronic headaches caused by poor living conditions in South Los Angeles. By asking about her housing, the doctor uncovers underlying issues like mold and leaks, which were contributing to her health problems. This approach, called the 'upstream' model, focuses on addressing the root causes of health problems in the community, such as housing, food security, and environmental factors. The speaker advocates for a healthcare system that moves beyond treating symptoms to improving health where it begins, by integrating public health resources and empowering clinicians to become 'upstreamists'—professionals who identify and address the systemic causes of illness.

Takeaways

• 😀 Health begins outside the clinic: The key to improving health is understanding the broader social determinants, such as housing, work, food, and environment, rather than just treating symptoms in the doctor's office.
• 😀 Veronica's story highlights the importance of considering living conditions: Veronica’s chronic headaches were linked to poor living conditions, including mold and water leaks, demonstrating the importance of asking about the context of a patient's life.
• 😀 Traditional healthcare often overlooks upstream issues: Many doctors fail to ask about patients' living environments, focusing instead on symptoms, which can result in missed root causes of illness.
• 😀 The 'upstream approach' focuses on prevention and addressing root causes: The approach advocates for understanding and addressing the social, environmental, and economic conditions that lead to illness before they require medical intervention.
• 😀 Upstreamists are crucial in healthcare: Upstreamists are healthcare professionals who look beyond treating symptoms and actively work to improve the social determinants of health, such as living conditions or access to food.
• 😀 Social factors have a larger impact on health than medical interventions: Studies show that living and working conditions have a far greater impact on health than genetics or medical treatments, accounting for 60% of preventable deaths.
• 😀 There is a gap between awareness and action: While many healthcare professionals recognize the importance of social determinants of health, only a small percentage feel confident in addressing them within the healthcare system.
• 😀 Health is a common good: Health is not just an individual responsibility but a shared goal that requires collaboration between healthcare professionals, community organizations, public health sectors, and patients.
• 😀 A system that addresses upstream issues requires collaboration: Building a healthcare system that addresses root causes of health problems requires cooperation between doctors, social workers, public health agencies, and even lawyers to solve environmental issues.
• 😀 The 'upstream approach' can lead to better health outcomes: By addressing the root causes, as seen in Veronica’s case, patients experience significant improvements in their health, fewer emergency visits, and better quality of life.

Q & A

What is the 'upstream approach' in healthcare?

The 'upstream approach' focuses on addressing the root causes of health issues, such as social and environmental factors, rather than just treating symptoms. It looks at where health begins— in the places where we live, work, eat, sleep, and play— and aims to improve health by addressing these conditions.

How did Veronica's living conditions contribute to her health issues?

Veronica’s chronic headaches were linked to her living conditions. She reported mold, water leaks, and roaches in her home, which were likely contributing to her chronic allergies and migraine headaches. Addressing these environmental factors helped improve her health.

Why does the healthcare system often fail to address upstream issues?

Healthcare systems typically fail to address upstream issues because the current structure prioritizes treating symptoms and procedures over addressing broader social determinants of health. Additionally, there is insufficient time, resources, and training to address these issues within the typical medical model.

What role does an 'upstreamist' play in healthcare?

An 'upstreamist' is a healthcare professional who works to identify and address the root causes of health issues by focusing on social determinants like housing, access to food, and environmental conditions. Upstreamists mobilize resources to improve patients' living conditions, often working with community health workers, public health experts, and even legal professionals.

How does the 'upstream approach' differ from traditional healthcare practices?

Traditional healthcare tends to focus on treating the immediate symptoms or illnesses that patients present with, often neglecting the underlying causes. The 'upstream approach,' on the other hand, aims to understand and address the factors in a patient's life that contribute to their health issues, such as their environment and living conditions.

What scientific evidence supports the importance of upstream factors in health?

Studies have shown that social and environmental factors, such as access to green spaces and living conditions, have a greater impact on health outcomes than genetics or medical treatments. For example, a study in the UK showed that living closer to parks and green spaces can significantly reduce the risk of heart disease.

What is the 'don't ask, don't tell' approach in healthcare?

The 'don't ask, don't tell' approach refers to the tendency of healthcare professionals to avoid asking about or addressing social determinants of health, such as housing or environmental issues, due to lack of time, resources, or confidence in being able to do something about it. This results in patients' broader health needs being ignored.

How can healthcare professionals address upstream issues effectively?

Healthcare professionals can address upstream issues by asking patients about their living and working conditions, identifying potential environmental factors that could be contributing to health problems, and mobilizing resources—such as community health workers, public health initiatives, and legal assistance—to create long-term solutions.

What is the role of community health workers in the upstream approach?

Community health workers play a crucial role in the upstream approach by helping patients navigate their social environments. They may visit patients' homes to identify and address issues like mold, poor housing conditions, or food insecurity, and connect them to relevant resources such as legal aid or public health services.

Why is the 'upstream approach' considered more effective than traditional medical interventions?

The upstream approach is considered more effective because it addresses the root causes of health problems—such as poor housing or lack of access to green spaces—rather than just treating symptoms. By improving the living conditions that contribute to health issues, it can lead to longer-term improvements in health and reduce the need for repeated medical interventions.