By Sarah Mapes
In the work of health care systems change, or social change in general, there is a lot of talk about upstream and downstream solutions. The standard (and quite macabre) story that explains the difference between these is that of two people standing on the shore of a river when bodies of those who have drowned or are drowning begin to float by. One jumps in to save those that he or she can, while the other runs to find the source of the problem and keep any more people from falling in.
Downstream solutions are reactive and often focus on individual-level interventions, while upstream solutions are proactive and focus on solving the underlying problem. We see examples of these all the time: helping individuals control their diabetes is an important downstream solution, while ensuring communities have access to healthy food and exercise opportunities so they don’t get diabetes in the first place is an important upstream solution. The key element of both, however, is action. Neither person on the side of the river stays standing there when it becomes clear that lives are at risk.
Colorado, it’s time to act. The data is clear: there are significant and alarming health disparities in our state, and they are threatening the lives of our friends and neighbors. Hispanics and Latinos are less likely to receive important preventive care. Southeast Colorado has well above average rates of high blood pressure and heart disease. Seniors living in poverty are twice as likely to suffer from three or more chronic diseases as higher income seniors. Children living in low-income families are much more likely to be obese, and much, much more likely to face issues with food insecurity, compared to those in higher income families. Our health is affected by our income, race and ethnicity, education, and where we live, learn, work, and play, and we all deserve the opportunity to live a healthy life. But that equal opportunity doesn’t currently exist.
Addressing these inequities will take more than a focus on nutrition education, lowering alcohol and tobacco consumption, and increasing physical activity. These and many other important downstream solutions are already in place, but we need to take bigger, bolder action if we are to solve the underlying problems of poverty, racism, and other social inequalities that put people at a disadvantage from birth.
We as a state must both explore the upstream solutions that we could pursue to tackle health equity head on, while strengthening the programs and projects that are helping individuals overcome barriers to good health. That means increasing data collection to understand the experiences and needs of those facing disparities, engaging those affected in designing solutions, advancing economic opportunity, supporting community innovations, and much more.
The Colorado Coalition for the Medically Underserved, in partnership with a number of other Colorado organizations focused on these issues, have identified some opportunities for action to improve health equity. They focus on disparities of race and ethnicity, income, and geography, as well as the unique disparities facing children and seniors. However, many more opportunities exist, and it will take a shared commitment and intentional investment of resources to make progress on this very challenging issue.
Whether we as individuals are affected directly or indirectly by issues of health equity, we are all affected. It increases costs to the health care system when patients are unable to achieve their best health. It reduces the economic potential of our communities when workers are less productive due to health issues. It places an unfair burden on some, and we have a responsibility to take action to help when we have the opportunity to do so. The opportunity is here, and the time is now. I look forward to moving off the shore to improve health equity for Coloradans now and into the future, and I hope you’ll join me.