< Return to Video

Focusing on Upstream Factors

  • 0:02 - 0:03
    Hi everybody,
  • 0:03 - 0:06
    so welcome back to Social Determinants of Health.
  • 0:06 - 0:07
    Before we
  • 0:07 - 0:08
    get started,
  • 0:08 - 0:12
    I want you to take a look at this picture and think about what you see here.
  • 0:13 - 0:14
    You've got a river,
  • 0:14 - 0:17
    where we've got kind of the upstream part of the river.
  • 0:17 - 0:19
    You've got downstream part of the river,
  • 0:19 - 0:19
    right?
  • 0:19 - 0:20
    So, upstream is
  • 0:21 - 0:23
    a little bit closer to where the mouth of the river would be,
  • 0:23 - 0:24
    right?
  • 0:24 - 0:26
    And downstream is,
  • 0:26 - 0:26
    again,
  • 0:27 - 0:27
    downstream.
  • 0:28 - 0:30
    And I want to read a little story to you
  • 0:30 - 0:32
    that is from a book called
  • 0:32 - 0:34
    "Prevention Is Primary: Strategies for Community Well Being."
  • 0:36 - 0:36
    So here,
  • 0:36 - 0:37
    here's that little vignette.
  • 0:38 - 0:40
    While walking along the banks of a river,
  • 0:40 - 0:44
    a passerby notices that someone in the water is drowning,
  • 0:44 - 0:46
    and they help pull a person to shore.
  • 0:46 - 0:48
    After pulling the person ashore,
  • 0:48 - 0:52
    the rescuer notices that there's another person in the river in need of help.
  • 0:53 - 0:54
    Before long,
  • 0:54 - 0:57
    this person notices that the river is filled with drowning people,
  • 0:58 - 1:02
    and more and more rescuers are required to assist that initial rescuer.
  • 1:03 - 1:04
    Unfortunately,
  • 1:04 - 1:06
    some people just can't be saved,
  • 1:06 - 1:09
    and other victims fall back to the river even after
  • 1:09 - 1:11
    they've been saved and pulled out of the water.
  • 1:12 - 1:13
    At this time,
  • 1:13 - 1:16
    one of the rescuers starts walking upstream.
  • 1:17 - 1:18
    "Where are you going?"
  • 1:18 - 1:19
    Another rescuer asks.
  • 1:20 - 1:21
    The upstream rescuer replies,
  • 1:21 - 1:24
    "I'm going upstream to see why so many people
  • 1:24 - 1:26
    keep falling into the river in the first place."
  • 1:27 - 1:28
    As it turns out,
  • 1:28 - 1:29
    there was a bridge
  • 1:29 - 1:32
    that led across the water upstream,
  • 1:32 - 1:34
    and that bridge collapsed,
  • 1:34 - 1:37
    and people were falling into the water,
  • 1:37 - 1:37
    into the river.
  • 1:38 - 1:43
    The upstream rescuer realizes that fixing the bridge
  • 1:43 - 1:46
    will prevent other people from ever falling into that river
  • 1:47 - 1:49
    again in the very first place.
  • 1:50 - 1:51
    So,
  • 1:52 - 1:52
    there
  • 1:53 - 1:55
    is a quote that's by
  • 1:56 - 1:57
    an American feminist,
  • 1:57 - 1:57
    journalist,
  • 1:57 - 1:59
    and social political activist,
  • 1:59 - 1:59
    Gloria
  • 1:59 - 2:00
    Steinem,
  • 2:01 - 2:01
    and she said,
  • 2:01 - 2:04
    "We're standing on the bank of the river rescuing people who are drowning,
  • 2:05 - 2:08
    but we have not gone to the head of the river to keep them from falling in,
  • 2:08 - 2:11
    and that's our task in the 21st century."
  • 2:11 - 2:12
    She wants us to,
  • 2:12 - 2:13
    with this remark,
  • 2:13 - 2:17
    she's using this analogy to basically say that
  • 2:17 - 2:19
    we need primary prevention.
  • 2:19 - 2:20
    We need to stop people from
  • 2:21 - 2:25
    falling into that river in the first place by ensuring conditions,
  • 2:25 - 2:28
    so they won't fall into that river and put themselves in danger in the first place.
  • 2:30 - 2:31
    More often than not,
  • 2:31 - 2:33
    as public health practitioners,
  • 2:33 - 2:35
    as health professionals in general,
  • 2:35 - 2:38
    we focus on saving people downstream.
  • 2:38 - 2:42
    We find people when they have high blood pressure
  • 2:42 - 2:46
    and are at risk from complications from type 2 diabetes,
  • 2:46 - 2:50
    and we really focus on providing medical treatment,
  • 2:51 - 2:55
    instead of trying to really focus on helping people to prevent
  • 2:56 - 2:57
    conditions
  • 2:57 - 2:59
    that throw them in the river in the first place.
  • 3:00 - 3:01
    And this analogy,
  • 3:01 - 3:02
    this story,
  • 3:02 - 3:04
    this quote by Gloria Steinem,
  • 3:04 - 3:07
    is all about saying, "We need to go to the root of the problem,
  • 3:07 - 3:09
    we need to go upstream.
  • 3:09 - 3:10
    And look
  • 3:10 - 3:12
    at what's happening upstream.
  • 3:12 - 3:13
    What conditions
  • 3:13 - 3:16
    are causing people to fall into the river in the first place."
  • 3:17 - 3:19
    And so, instead of
  • 3:19 - 3:21
    treating individuals,
  • 3:21 - 3:23
    one by one
  • 3:23 - 3:23
    for
  • 3:24 - 3:25
    adverse,
  • 3:26 - 3:26
    health
  • 3:26 - 3:27
    such as,
  • 3:27 - 3:27
    you know,
  • 3:28 - 3:30
    disability and illness that's caused by
  • 3:30 - 3:32
    the complications of disease.
  • 3:32 - 3:35
    We really need to start focusing on what can we
  • 3:35 - 3:37
    do to really fix that hole in the bridge.
  • 3:38 - 3:39
    What can we do to focus on
  • 3:40 - 3:41
    factors that later on
  • 3:41 - 3:43
    cause disease and disability.
  • 3:43 - 3:46
    And those would be such upstream factors
  • 3:47 - 3:48
    as the social determinants of health,
  • 3:48 - 3:51
    such as socioeconomic factors,
  • 3:51 - 3:52
    as
  • 3:52 - 3:55
    working on the social environment of
  • 3:55 - 3:58
    an individual or even changing the built environment
  • 3:58 - 4:02
    around people to make it easier for them to live healthier lives.
  • 4:03 - 4:04
    How do we do that?
  • 4:04 - 4:05
    Well,
  • 4:05 - 4:05
    we
  • 4:05 - 4:07
    target social determinants of health
  • 4:08 - 4:10
    by changing policy,
  • 4:10 - 4:11
    by
  • 4:11 - 4:13
    making changes in the physical environment,
  • 4:13 - 4:15
    by making changes in
  • 4:15 - 4:16
    the built environment,
  • 4:17 - 4:18
    and so,
  • 4:18 - 4:22
    therefore really focusing on changing the context around an individual
  • 4:23 - 4:25
    to make it easier for them to live a healthier life
  • 4:25 - 4:27
    over the course of their lifespan,
  • 4:28 - 4:30
    instead of waiting until it's too late,
  • 4:30 - 4:34
    so that's what's meant by upstream and downstream factors.
  • 4:34 - 4:34
    And as
  • 4:35 - 4:38
    health professionals interested in the social determinants of health,
  • 4:38 - 4:39
    we want to know
  • 4:39 - 4:44
    what is upstream and what can we do to change upstream factors
  • 4:45 - 4:49
    to help prevent and control adverse events that happen downstream?
Title:
Focusing on Upstream Factors
Video Language:
English
Team:
BYU Continuing Education
Project:
HLTH-450(BYUO)
Duration:
04:51
abunn edited English subtitles for Focusing on Upstream Factors Jan 8, 2025, 12:54 PM

English subtitles

Revisions