As 2018 began, I met at a conference with colleagues championing upstream care, and a flash of clarity hit me. The national interest in upstream care was growing; our shared message was sticking. But I realized that in the midst of this surging activity on social determinants of health, we have to sharpen our focus on why we do this work — and that purpose is equity, the making of a more just world.

As 2018 now draws to a close, I’m grateful that we’ve had the chance to pursue that mission, and to do it with courageous clients, partners, and champions in many different communities.

This year we’ve taken what was a labor of love for a community of caregivers convening online and turned it into a full-time operation that supports Upstreamists in all sorts of real-world settings. We’ve worked with a range of partners — from some of the largest health systems in the country and a Fortune 50 self-insured employer to individual clinics working at ground level to improve health and well-being.

What we’ve discovered is this: Day to day, with the advent of new service models and technical solutions, the work of moving upstream may sometimes seem transactional. Optimizing the transactions that connect healthcare and social services is indeed essential. But when this work is meaningful and sustainable, it’s not just transactional, it’s transformational.

The journey upstream transforms healthcare systems’ sense of themselves and their role in the world. It transforms patients and their communities into our full partners, not only recipients of our services. And it transforms each of us personally — as we discover new depths to our patients and ourselves, in fellowship with other Upstreamists — whether we expect it or not.

Hard as it is, this transformational work can even be joyful. It can renew us. And for that I also am grateful.

As we reflect on the year ahead, we at HealthBegins are renewing our commitment to transform healthcare and systems to drive demonstrable improvements in the lives of people everywhere. We commit to doing so with a clear focus on equity and justice, by providing clarity of thought and actionable tools to support that mission. And we commit to doing it with the fellowship of you, our friends and partners.

We have faith that, through the journey, we each can also renew our purpose and joy.

Happy holidays!

Best,

Rishi Manchanda