Grant Programmes

Upstream / Downstream

The image of moving upstream in terms of health is best illustrated by imagining a village on a riverbank where increasing numbers of villagers are becoming sick. Day after day the medical clinic treats people. The clinic is overburdened, the ill don’t get well, and every day, more and more people become sick. This could go on for days or years as the local burden escalates. In this story, someone who goes upstream to the next village or the one beyond that finds a factory discharging chemicals and sewage runoff into the river.

Now comes the interesting part. That traveler must mentally link the discharge upstream with the sickness downstream and must convince others of the association. This is not easy, because people have different vantage points. For instance, the upstream villagers aren’t affected. It’s only the villagers downstream who are ill, and they’re not even near the upstream village.

Health returns to the downstream village only when the two villages and the owner of the factory find interests in common, and when the public’s health is considered alongside competing economic and environmental factors. Municipalities can help with this process by creating healthy public policies that will protect the public’s health.

When the discharge is stopped, the river can return to cleanliness. When the river returns to cleanliness, people return to health. The medical clinic is no longer overburdened, and once again able to meet the demand for treatment.

Adapted and reproduced with the permission of: Ontario Prevention Clearinghouse: The Case for Prevention: Moving Upstream to Improve Health for all Ontarians. February 2006.