When you spend years responding to problems, you can sometimes overlook the fact that you could be preventing them.
Downstream actions are reactions to problems. These efforts are fast and tangible.
Upstream actions attempt to prevent those problems from happening in the first place by systematically reducing the harm caused by those problems. These efforts are slower and broader. A sign of upstream work is that it uses systems thinking.
Example: You can offer a homeless person a meal today, but to figure out how to reduce evictions so that people don't become homeless might take years.
In 2014, the C-section rate in Brazil was 57%, the highest in the world. In the country's private health system, 84% of children were delivered by C-section. The system was designed to prefer C-sections. After educating doctors and patients, the upstream solution caused a 40% increase in natural childbirth.
The move away from problem blindness is the shocking realisation that you've come to treat the abnormal as normal.
Organisations have a tendency for downstream thinking. To succeed, leaders should change the focus to upstream thinking.
Find new ways of working together:
Measures can fool you in three ways:
Banning plastic bags in San Diego caused serious unintended consequences.
The deadly 2017 hepatitis A outbreak in San Diego is attributed to the lack of plastic bags. Homeless people used the bags to dispose of their own waste. But when the bags became hard to come by, the alternatives were much less sanitary.
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