December 2022: Reflections On 10 Years In The Upstream Movement

Dear friends,


We’re marking a huge milestone as 2022 draws to a close: HealthBegins is 10 years old! It’s hard to believe. As we celebrate and reflect on both our organization and the Upstream Movement, we see that what’s crucial is not just what we have accomplished—together with you, our partners—but how.


HealthBegins began in late 2012 as a volunteer-led, virtual home for isolated health professionals—we called ourselves “Upstreamists”—to come together, learn from, and support each other as we worked to integrate health and social care and address the social drivers of the health inequities and harms we saw in the lives of our patients and communities. Now HealthBegins is a national consultancy supporting some of the country’s most courageous leaders in health systems, health plans, and communities to embed health equity into the practice of health care and transform the social, institutional, and structural factors that shape it. But there’s something more to our story than size—something with implications for all the people we work with, the institutions we accompany, and the movements we support.


We’ll break it down here.


When our partners ask us how to engage in the challenging journey upstream, a significant part of our answer is that the work must be rooted in HealthBegins’ three guiding values: equity, growth, and joy


Equity is essential in part because addressing social needs and social determinants of health can’t work without an equity focus and a deep understanding of the ways systems and structures put many groups of people in harm’s way. Yet equity is also essential in the way we do the work ourselves. It matters that we pay attention to who is at the table as we design upstream strategies and deliberately elevate those who have lived facing inequity. And it’s crucial that we use the power of our positions to improve hiring, employment, and procurement practices to support thriving communities. Equity is not only the intended end of our work, it is also the means to get there.


Growth arises in the spirit of humility and courage that makes equity work possible. Everyone who pursues equity takes personal and professional risks to do so. The chance to advance demands that we listen deeply, acknowledge mistakes, admit uncertainty, and share power with historically disenfranchised communities—as individuals and as institutions. And we have to grant each other the compassionate, safe space to do so, humbly and in solidarity.


Joy lives in the conviction that our humanity, in all its fullness, underpins our work. We are not only workers for health equity. We are spouses, parents, children, siblings, friends, and individual humans in our own right. We need rest, nourishment, and companionship. We need more space for our dreams, and space to experience joy and receive encouragement, candor, love, and support as we all navigate important but difficult terrain. Our work is about recognizing and uplifting everyone’s humanity; we must ensure that we never diminish—or allow others to diminish—our own humanity in the process. 


This year represents an inflection point for our work at HealthBegins—but also in the scope of history for those who have pursued health equity for decades. In the past couple of years, the healthcare industry has begun to reckon with the urgency of health inequity and racial injustice and recognize its role in identifying and preventing these harms, thanks to long-standing movements for civil and human rights. As we enter 2023, we have a critical opportunity to seize. If we work wisely, we can not only make health and social care integration the norm, but push further upstream to transform the institutional practices and structures that create health and social inequities in the first place. Delivering on this moment will require rigor, accountability, emotional resilience, and a shared commitment to protect the values that matter most. 


At HealthBegins, we commit to continuing to identify and work at the front lines of the Upstream Movement and equip courageous leaders to traverse that frontier. We commit to creating more spaces to not only spotlight barriers to equity and opportunities for progress, but also to support those moving upstream and help prevent the exhaustion that can come with this important work. We feel proud to host some of these conversations (as in our recent webinar) and move them forward with the candor, compassion, and courage they deserve.


This holiday season, we feel grateful to you, the rapidly growing community of Upstreamists, for the work you do and the courage you bring to it. Our New Year’s wish is that every one of us has opportunities to see hope and progress and reaffirm our commitment to the values that animate us. Because it is only through equity, growth, joy, and love that we can lay down more pathways for liberation—together with you, every step of the way.


Happy holidays to you and your loved ones,

                      Sadena Signature for Public Documents

Rishi Manchanda, MD, MPH.                                         Sadena Thevarajah, JD

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