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

You’d be wise to spend only about $10 of your budget on medical care and spend more on improving social and environmental factors such as substandard housing, job stress, poverty, discrimination, and dangerous neighborhoods — what experts often call the “social determinants of health.” When we think about what really shapes our health, medical care

“A conceptual model that includes partialists, comprehensivists, and upstreamists makes sense for the work of population health management in health care. Each of those three key functions must be performed. For this to be wieldy, though, there would also need to be coordination among those three functions. But the nature of how we currently segmen

Focus on food insecurity and slum housing, they said. And create a patient-centered medical home to deal with people’s medical and social issues.

healthbegins.org.)

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.

*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.

And even as we compensate for services, we pay a lot more for some services — like expensive, high-tech tests and procedures — than for others — like the time it takes a clinician to think, evaluate, come up with a plan, and help a patient follow it.

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

In our shared imagination, the concept of health has been shaped by this downstream activity, where doctors and nurses discover and treat disease.