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Let's Talk: Moving upstream

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The fifth release in our “Let’s Talk” series defines and illustrates three levels where public health can intervene to reduce health disparities:

  • Downstream to address  immediate health needs
  • Midstream to address material circumstances such as housing and employment
  • Upstream to advocate for greater fairness in power structures and income

The four-page guide argues that we can adopt an upstream attitude by being alert to the causes-of-the-causes of poor health, whether we work in direct service, management or policy. It suggests ways that public health staff can contribute to an upstream shift:  among other things, we can challenge our assumptions about the causes of health and illness, and develop our skills in partnership building, advocacy, and community organizing.

The resource includes discussion questions to help public health staff examine their work in terms of its upstream, midstream or downstream placement, and think of ways to more fundamentally address why some populations are healthier than others.

Use this resource to:

  • consider the breadth of  public health’s mandate to prevent disease
  • reflect on ways you and your organization can address the causes-of-the-causes
  • learn about ways that public health is working with organizations outside of health to improve the conditions that affect our health
  • spark dialogue and action in lunch room and staff meeting settings


Glossary of Essential Health Equity Terms

More from the Let’s Talk Series


National Collaborating Centre for Determinants of Health. (2014). Let’s Talk: Moving upstream. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Key concepts, Leadership & capacity building, Document, Report / Document, Let's Talk