An Upstreamist’s Wish for 2018

Girl-at-BUILD-class

Maria is a single mom who lives in South Los Angeles. She has two beautiful boys.  Maria doesn’t have a car, but luckily, she has a job at a nursing home nearby.  After work one day she was extremely thirsty, urinating excessively, feeling very tired and having a hard time concentrating.  She packed up her boys and took the bus to the Emergency room at California Hospital.

After running a few tests, the emergency room doctor said, “Well Maria, it looks like you have Type II Diabetes.  Fortunately, at this point we can keep you off insulin as I think you can control this by simply making a few changes to your lifestyle.  I would like you to: Eat More Fruits and Vegetables and get more exercise. Now, if the symptoms persist or get worse, then come on back.”

Maria thanked the doctor and started the bus ride home.

On the way home Maria passed 5 McDonalds, 4 liquor stores, 3 Taco Bells, 2 In and Out Burgers and 1 Panda Express.

Not one grocery store. Not one produce vendor.

After a few weeks of trying to do what the doctor recommended, Maria had made little progress and was still experiencing the same symptoms. She returned to the emergency room. Discouraged with Maria’s lack of progress, the Doctor assumed she simply did not understand the instructions he had given her. He assigned Maria to a care manager who swiftly signed her up for an educational nutrition class to teach her how to eat better. Maria certainly understands what a vegetable is. But living in South Los Angeles, Maria didn’t have access to fresh produce or outdoor space in which to exercise or play with her children.

At National Health Foundation (NHF), we are a team of upstreamists who believe that health can be improved by addressing the root causes of health disparities. We also believe that if clinicians, and the systems that they work in, have the ability to address health problems in the context of patients’ lives, perhaps we could arrive at a new standard of patient care.

Today Maria has her diabetes under control, but to get her there required an upstream approach to healthcare that included NHF and the partnership of several community-based groups, 2 local markets, a group of energetic high-schoolers and a local clinic. Not only is Maria’s diabetes under control but 3,000 South Los Angeles residents now have access to fresh produce, and free fitness classes are available at local parks and community centers. Furthermore, local healthcare practitioners can prescribe fresh produce and give their patients a $5 voucher to be spent in a local market to buy fruits and vegetables. The upstream solution that restored Maria’s health may ward off a similar fate for 3,000 of her neighbors!

Upstream health solutions provide sustainable and measurable impact.

As we close on 2017, I have a wish. Let’s bring together healthcare systems and payers, public health agencies and departments and say: Let’s look at our data together. Let’s see if we can discover some patterns in our data about our patients’ lives and see if we can identify an upstream cause, and then, let’s align the resources to address them!

Here’s to a healthy and prosperous 2018 to you and yours,

Kelly Bruno Nelson