It’s called “upstreamism,” and understanding the concept may go a long way to understanding health outcomes in America and beyond.
Big Think reports: “Rishi Manchanda, founder of HealthBegins and upstreamism advocate, says that ‘one’s zip code matters more than your genetic code.’ In fact, he points out, epigenetics shows us that our zip codes can shape our genetic codes.”
Indeed, in this TED talk, Manchanda explains “has worked as a doctor in South Central Los Angeles for a decade, where he’s come to realize: His job isn’t just about treating a patient’s symptoms, but about getting to the root cause of what is making them ill—the “upstream” factors like a poor diet, a stressful job, a lack of fresh air. It’s a powerful call for doctors to pay attention to a patient’s life outside the exam room.”
Manchanda tells the story of a patient, Veronica: “What was it about this different approach we tried that led to better care, fewer visits to the E.R., better health? Well, quite simply, it started with that question: “Veronica, where do you live?” But more importantly, it was that we put in place a system that allowed us to routinely ask questions to Veronica and hundreds more like her about the conditions that mattered in her community, about where health, and unfortunately sometimes illness, do begin in places like South L.A. In that community, substandard housing and food insecurity are the major conditions that we as a clinic had to be aware of, but in other communities it could be transportation barriers, obesity, access to parks, gun violence.”
The Big Think post continues: “People living in low-income neighborhoods face far more negative social and cultural health influences than those living in wealthier areas. Patients from such environments are less likely to have access to pollutant-free water, full-service grocery stores and farmers markets, and parks and playgrounds. The stress of such environments leads to higher rates of depression, unresponsive parenting practices, and even increased rates of mortality.”
Said Michael J. Dowling, president and CEO of Northwell Health: “If you’re living in a very, very good neighborhood, […] you will live years longer than the person who lives in a very, very poor area, in general. So if I want to improve your health, I’ve got to make sure that I have doctors, and nurses, etc., to provide medical care to you. But I’ve also got to figure out how to work on all of these other things.”
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