The U.S. health care system is really more of a “sick care” system. Recognizing this, some health professionals have started trying to assess and improve the “upstream” social and environmental conditions that shape health outcomes. The movement gets its name from a parable about children being swept down a river. Rescuers make heroic efforts to save one child after another from drowning until finally it dawns on them to venture upstream to stop whoever is throwing the children in the river. The upstream movement is exemplified by HealthBegins, an online community founded by Dr. Rishi Manchanda, author of the book The Upstream Doctors; and the Canadian nonprofit Upstream, directed by Dr. Ryan Meili, a family physician in Saskatoon.
