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Upstream: The Quest to Solve Problems Before They Happen

Jason Shen
Jason Shen
15 min read
Upstream: The Quest to Solve Problems Before They Happen

Reading Notes on Preventative Interventions

In a Nutshell: Upstream is a book about prevention: how to not just mitigate the damage of problems after they happen (downstream) but address the underlying drivers of the problem such that the problem no longer occurs or is much less severe.

  • This type of work is hard but important in just about every field: operations, climate, city planning, health care, safety, etc.
  • The key to solving this kind of work is to first ensure people actually recognize the problem exists and have convincing evidence that it's a serious issue.
  • Then you have to ensure a diverse set of stakeholders are working together on the problem, make sure you have rigorous ways of evaluating progress long the way, and then experiment with lots of strategies to address problem.

The Author: Dan Heath is a Senior Fellow at Duke University’s CASE Center, which studies and shares knowledge on building successful social enterprises. He is the co-author, with his brother Chip, of some of my favorite books of all time - Made to Stick, Switch, Decisive, and The Power of Moments. Their books are always insightful, funny, and full of memorable examples and concrete strategies.

Here are some of my favorite ideas from the book. All quotes are from Upstream/Dan Heath unless specified.

Downstream efforts (aka "fighting fires") is visible while upstream work is not.

Heath uses the example of 2 police officers: one who is very visible and makes drivers more careful, while the other pops out of the shadows to ticket drivers making illegal turns. One prevents accidents and comes back empty handed, the other returns with a stack of tickets.

That’s one reason why we tend to favor reaction: Because it’s more tangible. Downstream work is easier to see. Easier to measure. There is a maddening ambiguity about upstream efforts.

But nearly everyone agrees that doing upstream work is really important.

When different political groups were asked how they might allocate spending to best promote health in the US, from black Democrats to white Republicans, they ended up with nearly the same distribution, with 1/3 going to the formal health care system while the rest going to things like healthy food, affordable housing and childcare.

So, even as we engage in fierce fights with people across the aisle, we’re all secretly in agreement about how our spending should be allocated. Across the political spectrum, we think the best way to “buy health” is to invest two-thirds of our money into systems that make people healthy (food, housing, etc.) and one-third into systems that heal sick people. To say it a different way, for every $1 we spend on downstream health care, most of us think it would be wise to spend $2 upstream.