Learning Outcome #3: Gain an appreciation of upstream approaches including policies and programs aimed at reducing global health disparities and promoting global health


A) Acute health care appears to be a downstream approach, this is because the hospital is treating people as they get sick and are seeking healthcare treatment. However, having an upstream approach means that health care professionals are working towards preventing disease and injury form occurring, before it occurs. As discussed in class, Upstream (n.d.) is an organization which works with people and works to target health concerns at the level of the determinants of health. By working in an upstream approach, the organization has been able to target disease at the source. thinking upstream means making better decisions and thinking of long term goals for a country, and the world. The goal of upstream projects is to create health for all. To do this, upstream approaches needs to start at the social determinants of health. in other words, and focusing health care initiatives and solutions towards that. For example, people with a low economic status is likely to not have proper education or money. This lack of education can lead to not obtaining a job that brings in enough money to pay for shelter or healthy food. Without shelter or good food, people are more likely to become sick. People who are homeless do not have an address, so when their health card expires, they are no longer covered under OHIP in Ontario, making it hard to access necessary medication and treatment, which leads to the worsening of disease, injury or infection.

B) Evidence outside of course content

Evidence 1:


Stajduhar, K. I., & Tayler, C. (2014). Taking an “upstream” approach in the care of dying cancer patients: The case for a palliative approach. Canadian Oncology Nursing Journal24(3), 144–148. https://doi-org.ezproxy.library.yorku.ca/10.5737/1181912×241144148

This article explains that advanced palliative care for cancer patients often happens and is planned near the end of life, and causes more stress on the family and patient. An upstream approach to end of life care  is proposing the idea of planning palliative care, earlier in the disease process (Stajduhar & Tayler, 2014). This upstream approach offers a better way of planning for the future of the patient and the family. The conversation should include plans for care, goals of care, comfort measures and needs and wishes (Stajduhar & Tayler, 2014). This upstream approach relates to course content because it targets intervention closer to the source, as opposed to waiting last minute to treat a patient.

Evidence 2:

Pinto, A. D., & Bloch, G. (2017). Framework for building primary care capacity to address the social determinants of health. Canadian Family Physician63(11), e476–e482. Retrieved from http://ezproxy.library.yorku.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=126371793&site=ehost-live

This papers objective was to develop a primary care program to support the social determinants of health (SDOH) to provide an upstream approach to primary care interventions. A committee of health professionals from Toronto was put together to specifically target the SDOH to determine social and environmental factors had an effect on how patients access and use healthcare (Pinto & Bloch, 2017). The committee focuses on interventions to help combat the negative SDOH, such as creating child-literacy programs in clinics and creating income security programs. This upstream approach to primary care increases accessibility and create an equal approach to health care services.



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