The Upstream Doctors: Medical Innovators Track Sickness to Its Source (Kindle Single) (TED Books)

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The healthy housing program we had set up had helped thousands of children and adults like Veronica. We had worked with a community partner to set up a produce stand and resource guide to help families experiencing hunger and food insecurity. A medical-legal partnership we had created shortly after I started at the clinic was blossoming. Thousands

As a result of regulatory, cultural, and financial obstacles, doctors and nurses who aspire to be upstreamists on the front lines face challenges in five key areas. To remember these, think of the acronym TRIDNTT (pronounced “trident”): 1. Time and Resources (both human and capital) 2. Incentives (at individual and system levels) 3. Data that’s acc

California, for instance, recently launched a Health in All Policies initiative to factor health into a wide swath of state decisions.

Mitch Katz directs the Los Angeles County Department of Health Services, the second-largest county health care system in the country. He described to me how economic incentives can stack up against upstream care. “Because there’s been little money toward prevention, there’s no payer or mechanism for prevention research like there is for medical res

Third and finally, it’s urgent that we go beyond utilitarian arguments to continue to stake moral claims for improving access to quality health care for all. Increased efficiency and lower costs, though important, are not the alpha and the omega of health care improvement, and they are still less of a factor in the improvement of health itself. The

Ask if and how it distributes financial rewards and bonuses, if any. Are staff payments or salaries linked to measurable improvements in community health outcomes?

*For more insight on this type of model, I recommend two articles published in 2010: “A Framework for Public Health Action,” by Thomas R. Frieden, in the American Journal of Public Health, and “A Conceptual Framework for Action on the Social Determinants of Health,” by the World Health Organization.

There are three basic elements of this cultural challenge: a lack of sociocultural competence; the skewed demographic composition of our health care workforce and its cultural implications (that is, a lack of diversity); and a lack of mentorship.