October 2019: Building an armada of Upstreamists


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Vol 2 Issue 10

Dear friends,

Six years ago, I called for the training of a new generation of Upstreamists. “To truly realize medicine’s potential,” I wrote in my TED Book, The Upstream Doctors, we need more than lone pioneers. We need a whole fleet of “dedicated professionals who redesign care and improve the health of people and communities” by improving social drivers of health and equity at all levels — from individual social needs and community-level social determinants to structural reforms.


I’m excited to declare that the moment to fulfill that call is now arriving.


At HealthBegins, we’ve been working for years to build this essential workforce. We’ve developed upstream learning modules for professional health care associations and led clinician trainings for large health systems. Our 2016 Medscape course on upstream medicine was viewed by over 10,000 learners. And the TED book and accompanying TED Talk have become required reading/viewing in universities and courses around the world.


We’re accustomed to working like a strong and nimble tugboat in this movement, helping sway the big ships to move upstream. Now the big ships are moving.


Calls to train Upstreamists are coming from all directions. Last month, the National Academies of Sciences, Engineering, and Medicine released a report on the need to move upstream to improve the nation’s health. Among its key recommendations: “Build a workforce to integrate social care into health care delivery.” This call is resonating. The American Hospital Association now has a social-determinants curriculum for clinicians, and the American Medical Association recently took major steps to advance equity and other upstream drivers of health. Meanwhile, interest in community health workers is surging.


These developments have inspired HealthBegins to update our pioneering call to action with one to meet this new moment in this movement. Here it is:


We intend to train 25,000 Upstreamists within the next two years.


Will you join us?


The dream of a workforce that includes Upstreamists — professionals equipped to move healthcare upstream at all levels — is starting to take shape. To make this a reality, we’ll need to build strong structures in three areas:

  • Skills: Establish a clear consensus about the skills required for Upstreamist leaders, in such areas as Upstream Quality Improvement, social epidemiology, leadership and community partnership skills, social health financing, and community health informatics.
  • Systems: Develop mechanisms for teaching these skills at every stage in the workforce pipeline, both within existing training programs, such as universities and graduate programs, and on-the-job settings through continuing education and professional development.
  • Support: Build ongoing support systems and communities of practice, because Upstreamists succeed when given the opportunity for continuous learning and improvement. It’s also essential to recognize community expertise in this work, bringing in community members not just as patients but as partners.

In early 2020, HealthBegins will be announcing major strategies and partnerships to achieve this vision. If you’d like to play a role and partner in this mission, contact us. (And if you’re already using our materials in your training program, please let us know!) We’d love to collaborate. Because to traverse this next leg on the journey upstream, we need an armada of ships rowing together.


Rishi Manchanda


From The Upstreamist, the HealthBegins Blog:From Transactional to Transformational: The Next Level of Upstream Care

“Give a man a fish and you feed him for a day; teach him to fish and you feed him for a lifetime.” But what if he can’t afford the lesson? What if the pond is polluted? Why not teach a woman to fish? This post calls us to drive change on all levels of scale.

When Moving Upstream, Don’t Go Chasing Waterfalls

With so many emerging initiatives and projects to address social needs and social determinants of health, the opportunity to improve the lives of patients and communities is more real than ever. But we face a real risk of squandering this opportunity.

Time to Manage Upstream Programs Like Investments

Through partnerships and collaboratives, healthcare organizations are launching programs to address social needs and social determinants of health. We have budgets and plans to reach specific goals, but is the way we’re spending our resources putting us on a path to achieve long-term goals for community health? At the moment, the answer is no. In this post, Rishi Manchanda outlines why it’s time to view upstream interventions as investments for long-term financial, health, and social impact.


Watch our September webinar:

From Public Charge to Voting: Five ways healthcare leaders can tackle structural determinants of health

A famous proverb states: “Give a man a fish and you feed him for a day; teach him to fish and you feed him for a lifetime.” But what if he can’t afford the lesson? What if the pond is polluted? Why not teach a woman instead?

As healthcare and community partners work to improve care and individual health-related social needs, there is growing acknowledgment of a fundamental challenge. Even the most effective relationships between healthcare and social services still take place in unequal systems, where the communities in which patients live and work are shaped by unjust structures and unhealthy policies — what the WHO calls the “the causes of the causes.”

This webinar brought together leaders from the nation’s largest FQHC and the nation’s largest public health care system to highlight real-world examples of ways institutions are adding systems and structural transformation to their upstream investment portfolios. We discussed the potential impact of the new proposed public charge rule, due to go into effect in October, and what health care systems can do to prepare and respond. And, in honor of National Voter Registration Day (Sept 24th), we provided concrete examples of how to address one of the most significant upstream drivers of health — voter and civic engagement. Finally, drawing on real-life examples, we identified five specific ways health care leaders can support efforts to transform health policy and structural determinants of health across America.

Interested in more webinars from HealthBegins? You can find recordings of all of our past webinars here.

Upcoming and Recent Events: Find HealthBegins Here

Putting Care at the Center 2019
November 14 | MemphisAnnual conference of the National Center for Complex Health and Social Needs, focused on creating a shared agenda for the emerging field of complex care. 

Presenting powerful upstream results at an upcoming conference? Nominate yourself to be featured as a HealthBegins Upstreamist in Action at info@healthbegins.org.

Upstream Opportunities:

From Hunger Vital Sign™ National Community of Practice: The period to submit comments on changes to SNAP Broad Based Categorical Eligibility has been re-opened. Submit comments by the November 1st deadline here.

From the National Quality Forum: With support from the Aetna Foundation, the National Quality Forum has released five key recommendations to address SDOH and drive equitable health improvements through payment innovation. Access the recommendations here.

If you have fellowships, events, or other opportunities you’d like us to share, please email us at info@healthbegins.org.

Upstream News

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

Five Victories For Public Health: Courts Enjoin The Public Charge Rule
Health Affairs Blog

Can Medicaid Expansion Prevent Housing Evictions?
Health Affairs

President Trump’s Proclamation Suspending Entry for Immigrants without Health Coverage
The Henry J. Kaiser Family Foundation

Border Patrol’s Growing Presence at Hospitals Creates Fear
Modern Healthcare

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