This Is Public Health Book Club discussion

In Chapter 1 the author starts by adapting a public health parable about stopping kids from being thrown into a river instead of rescuing them one by one from the river. The idea is that the downstream action, which reacts to a problem is a constant need to jump in the river and save a child from drowning, but the upstream task, aimed at preventing the problem from happening is stopping those children from getting in the river to begin with.
Throughout the section, the author discusses other explanations within and outside of public health where deciding to fix the problem before it happens leads to better outcomes overall.
This is much easier said than done. Throughout the section, the author brings up the main issues with moving from downstream action to upstream aims. These are problem blindness or saying that there is just how it is nothing we can do about it, ownership, who is responsible for the upstream actions, and tunneling, where individuals are spending their capacity dealing with immediate needs and don’t have the bandwidth to reflect on issues and put in action to have an upstream effect.
Chapters 2-4 describe these issues and provide many examples.
What examples do we have from our lives/organizations where we are too focused on downstream action to put in effective upstream initiatives?

Discussion Questions
1. The author talks about how US healthcare is focused downstream instead of upstream and is different from other countries. Do you have examples from life or public health studies where an upstream investment would have prevented negative health outcomes?
2. A theme in this chapter is that the upstream heroes do not get recognized. How do you think as a society we can bring attention to public health interventions and programs that fix problems before they start to showcase how important they are?
3. An example of problem blindness was the dropout rate of the Chicago Public School District, as it turns out there were actions that could be taken to reduce the rate. Did anything stand out to you about the Chicago Public School story and the reduction of the dropout rate?
4. How does ownership of problems get sorted between upstream and downstream?
5. Do we think that public health issues suffer from the problems of blindness, lack of ownership, and/or tunneling.