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Hi everybody,
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so welcome back to Social Determinants of Health.
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Before we
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get started,
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I want you to take a look at this picture and think about what you see here.
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You've got a river,
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where we've got kind of the upstream part of the river.
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You've got downstream part of the river,
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right?
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So, upstream is
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a little bit closer to where the mouth of the river would be,
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right?
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And downstream is,
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again,
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downstream.
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And I want to read a little story to you
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that is from a book called
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"Prevention Is Primary: Strategies for Community Well Being."
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So here,
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here's that little vignette.
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While walking along the banks of a river,
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a passerby notices that someone in the water is drowning,
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and they help pull a person to shore.
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After pulling the person ashore,
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the rescuer notices that there's another person in the river in need of help.
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Before long,
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this person notices that the river is filled with drowning people,
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and more and more rescuers are required to assist that initial rescuer.
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Unfortunately,
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some people just can't be saved,
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and other victims fall back to the river even after
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they've been saved and pulled out of the water.
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At this time,
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one of the rescuers starts walking upstream.
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"Where are you going?"
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Another rescuer asks.
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The upstream rescuer replies,
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"I'm going upstream to see why so many people
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keep falling into the river in the first place."
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As it turns out,
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there was a bridge
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that led across the water upstream,
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and that bridge collapsed,
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and people were falling into the water,
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into the river.
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The upstream rescuer realizes that fixing the bridge
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will prevent other people from ever falling into that river
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again in the very first place.
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So,
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there
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is a quote that's by
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an American feminist,
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journalist,
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and social political activist,
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Gloria
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Steinem,
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and she said,
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"We're standing on the bank of the river rescuing people who are drowning,
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but we have not gone to the head of the river to keep them from falling in,
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and that's our task in the 21st century."
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She wants us to,
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with this remark,
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she's using this analogy to basically say that
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we need primary prevention.
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We need to stop people from
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falling into that river in the first place by ensuring conditions,
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so they won't fall into that river and put themselves in danger in the first place.
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More often than not,
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as public health practitioners,
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as health professionals in general,
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we focus on saving people downstream.
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We find people when they have high blood pressure
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and are at risk from complications from type 2 diabetes,
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and we really focus on providing medical treatment,
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instead of trying to really focus on helping people to prevent
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conditions
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that throw them in the river in the first place.
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And this analogy,
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this story,
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this quote by Gloria Steinem,
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is all about saying, "We need to go to the root of the problem,
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we need to go upstream.
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And look
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at what's happening upstream.
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What conditions
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are causing people to fall into the river in the first place."
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And so, instead of
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treating individuals,
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one by one
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for
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adverse,
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health
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such as,
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you know,
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disability and illness that's caused by
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the complications of disease.
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We really need to start focusing on what can we
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do to really fix that hole in the bridge.
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What can we do to focus on
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factors that later on
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cause disease and disability.
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And those would be such upstream factors
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as the social determinants of health,
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such as socioeconomic factors,
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as
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working on the social environment of
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an individual or even changing the built environment
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around people to make it easier for them to live healthier lives.
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How do we do that?
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Well,
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we
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target social determinants of health
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by changing policy,
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by
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making changes in the physical environment,
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by making changes in
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the built environment,
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and so,
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therefore really focusing on changing the context around an individual
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to make it easier for them to live a healthier life
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over the course of their lifespan,
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instead of waiting until it's too late,
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so that's what's meant by upstream and downstream factors.
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And as
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health professionals interested in the social determinants of health,
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we want to know
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what is upstream and what can we do to change upstream factors
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to help prevent and control adverse events that happen downstream?