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

from David M. Lawrence, former chairman and CEO of Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals:

When clinicians don’t reflect the communities they serve, it becomes that much more difficult to understand health in its social context.

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?

first began to understand health as a social phenomenon that starts and ends outside the clinic walls.

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.

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

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

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

*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.