On this week’s episode of Talking Radical Radio, Scott Neigh speaks with Monika Dutt and Jared Knoll. They talk about Upstream, an organization that is working to get ordinary people, health professionals, and governments thinking about how inequality, injustice, and other social factors shape our health, and to promote social policy that gets to the root causes of ill-health by addressing those factors.
Maybe you’ve heard the old story about the babies in the river: You’re standing by a river, minding your own business, and all of a sudden you see a baby floating past. So, of course, you rush to rescue the baby. You pull it out of the river, bring it to safety, dry it off. And then you see another baby floating in the river, and another, and another, and you and other people around you are all taken up by rescuing these babies from the river. It’s important work. But the point of the story is that, hopefully, sooner rather than later, someone thinks to ask, “How are all of these babies getting into the river?” and heads upstream to find out. It’s a story about the importance of thinking not just about harmful impacts but about causes — not just about what’s happening downstream, but about what’s going on upstream that’s creating those impacts.
That distinction between “downstream thinking” and “upstream thinking” is the source of the name for the organization Upstream — in fact, a version of the story about the babies in the river shows up in an introductory video on their website. The organization was originally based in Saskatchewan but has a growing presence across the country. Monika Dutt is a family doctor and public health physician, as well as Upstream’s executive director, and Jared Knoll is the organization’s communications coordinator.
Applying upstream thinking in the realm of health means recognizing the profound importance of social factors. Sure, eating well and getting plenty of exercise are still good things, but a big part of how healthy we are depends on social circumstances that are beyond our individual control. It’s hard to eat well if you don’t have the money to do so, for example, or if colonization and climate change mean you can’t hunt for food the way you used to, or if your urban neighbourhood has no grocery store nearby. And beyond that, there is substantial evidence that systemic experiences of wealth inequality, racism, colonialism, misogyny, homophobia, climate change, and other forms of injustice can take a toll on your health in all kinds of ways. “Social determinants of health,” these factors are sometimes called.
Upstream responds to this understanding in a number of ways. It works with researchers and specialists with expertise in specific areas to stay on top of the most up-to-date evidence around how these social determinants shape our health. It uses that evidence in working with partners to establish recommendations for policy changes that will improve people’s health. And it uses storytelling based in that evidence as a way both to engage in general public education around these issues and also to build networks of people that share the vision of not just fishing the babies out of the river but of going upstream, understanding what’s happening, and addressing the root social causes of people’s ill health.
Dutt and Knoll speak with me about the social determinants of health, about the importance of storytelling (especially storytelling that is evidence-based), and about the work of Upstream.
You can learn more about Upstream here.
Talking Radical Radio brings you grassroots voices from across Canada. We give you the chance to hear many different people that are facing many different struggles talk about what they do, why they do it, and how they do it, in the belief that such listening is a crucial step in strengthening all of our efforts to change the world. To learn more about the show check out its website here. You can also follow us on FaceBook or Twitter, or contact firstname.lastname@example.org to join our weekly email update list.
Talking Radical Radio is brought to you by Scott Neigh, a writer, media producer, and activist based in Hamilton (formerly Sudbury), Ontario, and the author of two books examining Canadian history through the stories of activists.
The image modified for use in this post is in the public domain