There is an old story about a woman who sees someone drowning in a river and jumps in to save him. As soon as she does this, she notices even more people in the river in danger of drowning. She dives in again and again to help. She quickly becomes exhausted from rescuing everyone and she begins to wonder what is happening upstream to get people into difficulties in the river in the first place, and what can be done to keep them out of it.

It turns out that further upstream there are two communities, one on each side of the river. To get from one community to another, people have to wade across the river because there is no bridge. But the river is fast flowing and quite deep, not everyone can swim and only a few people can afford boats.

In population health, the idea is that the further “upstream” an action is directed, the greater the potential for improving population health. In the case of the people in the river, for example, the population health approach would be to build a bridge between the two communities and also to make sure that as many people as possible learned to swim.

This would probably be more effective than focusing resources on rescuing people already in trouble.

Written based on: An Introduction to Population Health