1.3: Focus on Prevention
- Page ID
- 116077
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)The Public Health "Upstream" Story:
Every profession has its particular stories and myths. If you work in public service in the U.S., you probably have heard the story about George Washington not telling a lie after chopping down the cherry tree. If you work in public health, you've probably heard the "upstream" story. Here's my version of the story.
One day, a person is walking by a river and they see a baby floating in the river. Quickly, she jumps in to pull the baby out of the river. No sooner does she save one baby, than she sees another baby coming along in the river too. She pulls that one out, and soon sees another baby, and another one. She calls to a man on the river bank to come help her, and he jumps in the river to help pull the babies out of the river. Still more babies are coming down the river, so they call to another person on the bank to come help. This person comes close enough to see what is happening, then takes off running. The woman and the man in the river call to him, "Hey, where are you going?" He answers, "I'm going upstream to see how these babies are falling into the river."
Public health workers often see themselves as the ones running upstream to identify the causes of the problems we face. Can you imagine why this might be a useful metaphor for public health work?
Prevention is the primary focus of public health.
Preventing an illness or an injury before it starts is the "gold standard" for public health.
You will hear or see the terms "downstream" and "upstream" frequently in public health readings. "Upstream" generally refers to more "primary prevention," addressing the root causes of the problem or preventing an illness (or injury) before it starts. "Downstream" refers to working closer to the effects of a problem - helping those who are harmed by a health issue, or dealing with the consequences of an illness (or injury) so nothing worse occurs. Of course, there is a continuum between "upstream" and "downstream" - many places along the river where we can intervene.
For example, if the health issue is heart disease (the #1 cause of death in the United States), a "downstream" approach might be to offer rehabilitation exercises to people who have already had one heart attack, to try to prevent a second one. An "upstream" approach might include a policy to limit tobacco use in public, as tobacco often leads to heart disease, or to increase time spent in gym class in schools so that children develop the habit of being active from an early age.
Reflection: What are some examples you can think of to improve health in your community in an "upstream" way?