August 2018: Our webinar on racism set a new record. Here’s how to act on it.


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Vol 1 Issue 5

Dear friends,

You, our upstream community, set a record this week.


While our monthly webinars typically attract several hundred registrants, this one drew nearly 800. The topic? Equity, structural racism, and our role as healthcare professionals.


Not only did you come to this discussion, but you vigorously engaged. Questions from participants poured in. People wanted to know how to start addressing the ill health caused by racial injustice, how to make an impact, and how to convince others to care.


This show of passion about a critical, neglected issue is worth celebrating — but celebration is not enough. We need to empower those who are passionate about equitable, just, upstream care with the tools and the influence to do something about it.


At HealthBegins, we see a critical opportunity where the work of Diversity and Inclusion (DI) meets the work of Social Determinants of Health (SDoH).


We already work with clients to approach change through Upstream Quality Improvement (QI): a method that applies rigorous goals, steps, and measures to the journey upstream. Now it is time to merge a third stream into that river: Diversity and Inclusion. DI, SDoH, and QI all naturally intersect. They belong together.


We need to recognize that racism and other forms of discrimination ARE social determinants of health. And we need to understand that we in healthcare, isolated as we might feel in our clinics, actually do have the power to affect them. The inspiring work of our webinar guests, from the Southern Jamaica Plain Health Center in Boston and AcademyHealth, prove that’s true.


We can exercise that power by integrating DI and SDoH and folding them directly into the daily business of healthcare, which includes the machinery of QI. We can write our contracts with community partners to reflect and reinforce the true spirit of this work — as HealthBegins is already beginning to do. Unless we take this kind of strategic action, equity and inclusion will remain lofty ideals rather than substantive pursuits.


Reflecting on the overwhelming response to our latest webinar, all of us at HealthBegins are feeling one thing keenly: responsibility. Part of our role is to look ahead at the next bend in the river, to foresee how to navigate these waters correctly, to help everyone ask the questions that need to be asked.


You are an essential part of that. Do you have ideas, resources, stories, or requests for this mission? Please share them with us here.


With you as partners, we hope to catalyze this movement. We’ll create even more spaces for these conversations to continue and expand. We’ll model methods to operationalize these goals. We’ll help others get past the tipping point from talk to action.


Rishi Manchanda

New from The Upstreamist, the HealthBegins Blog:

A Hospital Marketer Pushes Primary Care Upstream

Upstreamist in Action: As a community-relations specialist, Jessica Saunders knew the community around Dayton Children’s Hospital deeply. Then she used that closeness to the community, along with Upstream QI, to lead her hospital upstream.

Charting a Course for Social Determinants of Health

Healthcare systems are talking about moving upstream. The Upstream Strategy Compass can help them get there.

A One-Time Medical Assistant Empowers Rural Clinics to Meet Social Needs for the Homeless

Upstreamist in Action: Dana Valley discovered early in her career how intimately social needs affect medical health, especially for the homeless. Now she spearheads a data-driven effort to identify and meet those needs — and shares the new social-determinants questionnaire that her clinics use with patients.

Coming soon! Watch for an invite to our September webinar:Preparing Clinic Leaders and Staff for Success
Tuesday, September 25 at 10 a.m. PST / 1 p.m. EST

Upcoming Events: Find HealthBegins Here

All In National Meeting
September 12 | DenverAll In: Data for Community Health hosts 250 stakeholders from around the country. Participants are at the forefront of the movement to improve community health and whole-person wellness through multi-sector partnerships working to share data.

Blue Cross Blue Shield of Montana Employer Summit 2018
September 19 | Big Sky

A gathering of national healthcare experts and key healthcare stakeholders to discover innovative and emerging ways to improve employee health and lower costs.

American Public Health Association Annual Meeting
November 10-14 | San Diego

More than 12,000 professionals attend this forum for new public-health research, where HealthBegins will present an abstract.

Upstream Opportunities

The UCSF HEAL Initiative is recruiting its fifth class of global health fellows. Fellows, who include U.S.-trained physicians from various specialties, spend two years immersed at partner organizations aiding the underserved, splitting their time between U.S. and international sites. The priority application deadline is Sept. 15.

If you have opportunities you’d like us to share, please email us at

Upstream News

Curated highlights of happenings affecting upstream care. Links are not endorsements.

Rx for Health: A Place to Call Home
Health Affairs Blog

The Hidden Social Factors Driving Disparities in Childhood Cancer Survival Rates
USC Annenberg Center for Health Journalism

A New Vision of Patient Care
U.S. News & World Report

Risk Adjusting for Race and Poverty Bolsters Rankings of Some Hospitals
Healthcare Finance

Andy Slavitt and AVIA Oversee the Medicaid Transformation Project
MedCity News

Social Determinants As Public Goods: A New Approach To Financing Key Investments In Healthy Communities
Health Affairs Journal

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