Upstream issues for downstream folk

I have been mulling over various social and health inequality issues recently, mostly prompted by a literature review I wrote on a range of youth issues.

What struck me was how similar the risk and protective factors were across a wide sweep of issues – homelessness, drug and alcohol use, self-harming, depression, living in care – the list goes on. As does the list of risk factors.

It really stood out to me that all these issues are so very interconnect, or intersectional as posh researchers like to say – as the web of risk and protective factors are so similar.

No wonder then, I wondered, that services often fail, We are trying to tackle one or a few risk factors at once rather than dealing with them all at once. Despite the best efforts of holistic, child-centred and integrated care, services usually pick and choose what to deal with and have practice thresholds preventing them from addressing it all.

A further issue is that these are all downstream issues, for the downstream and insignificant people. What matters and what will make a difference is tackling the upstream issue that only important people get to deal with. And by that I mean poverty. Most, if not all, social and health inequalities are worsened by income and wealth inequality. And yet no one does anything about it. No one even talks about it much these days. We seem to have become completely blind and immured to poverty.

My next challenge is to work out what I might do to play my part in highlighting and tackling this prime issue, the single issue that really can transform a wide range of risk factors and inequitable outcomes later downstream.

Perhaps this is the major social issue that the rich can pay their way out of? If only they were willing to.

I’d welcome any ideas anyone else has too…..??


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