We all think we know what good medicine looks like: smart doctors, stethoscopes, imaging machines, high-tech tests, and the best prescriptions and procedures money can buy. However, that picture is vastly incomplete. In his eye-opening book, The Upstream Doctors, physician Rishi Manchanda, says that our health may depend even more on our social and environmental settings than upon our most cutting-edge medical care. Manchanda argues that the future of our health care depends on a new generation of health care practitioners. We need doctors who look upstream for the sources of our problems, rather than simply go for quick-hit symptomatic relief. These upstreamists, as he calls them, are doctors and nurses on the frontlines of medicine who see that health (like sickness) is more than a chemical equation that can be balanced with pills and procedures administered within clinic walls. They see that health begins in our everyday lives, in the places where we live, work, eat, and play. If our high-cost, sick-care system is to become a high-value, health care system, the upstreamists will show us the way.
Upstreamists — who may be doctors, nurses or other clinicians — know that asthma can start in the air around us, or from the mould in the walls of our homes. They understand that obesity, diabetes and heart disease originate in our busy modern schedules, and in the unhealthy food choices available in our stores and even in the design of our neighbourhoods. They believe that depression, anxiety and high blood pressure can arise from chronically stressful conditions at work and home. Moreover, just as important, these caregivers understand how to translate this knowledge into meaningful action.
Experts often think of five general health-defining forces: genes and biology; behaviour; medical services; social environment (the formal and informal ways we relate to one another); and physical environment. The latter two, often referred to together as the social determinants of health, are significantly more powerful drivers of wellness than medical care. The social determinants are shaped by the power and resources that people have, all of which are influenced by the policy choices we make as a society. These policies and our social and physical environment influence the behaviours and choices we make every day. The problem is that, with the current standard of care in medicine, health care often ignores and fails to alter these forces in order to help patients and communities lead healthier lives.
The book is available, in several electronic forms, at TED Books.