I love this TED talk because it touches on a lot of issues that are related to what we do at IFAST. Rishi Manchanda, a physician practicing in South Central LA, argues that we more “upstreamists” — for example, community health workers, who can do things that doctors and nurses typically can’t. For example, if a patient has mold growing in her apartment, and that mold is causing infections or allergies, the community health worker can help find the mold and get the problem addressed with the landlord.
The word “upstreamists” comes from the often-told parable about finding a bunch of children drowning in a river. You jump heroically in to save the children, but as soon as you save one, another one comes down the stream. After a few hours of doing this, someone eventually says, “Wait! Let’s go upstream and find out who’s pushing the kids in!”
A few thoughts prompted by this talk:
1. I like to think of IFAST as part of the upstreamist team. We aren’t community health workers, but we do work with physicians and other health care professionals to keep you healthy before you get sick. We’ve successfully prevented people from getting unnecessary knee surgeries and shoulder surgeries, for example. I always say that if you can deadlift more than your bodyweight, you’re unlikely to end up in a nursing home.
And we’ve arguably prevented some clients from getting diabetes, heart disease, and other illnesses that are profoundly affected by nutrition and exercise habits. Which brings me to my next point:
2. At 8m20s, Dr. Manchanda says, “Scientists now know that … living and working conditions … have more than twice the impact on our health than does our genetic code. And living and working conditions … the ways in which our social fabric is woven together, and the impact those have on our behaviors, altogether, those have more than five times the impact on our health than [do] all the pill and procedures administered by doctors and hospitals combined.”
I LOVE this quote. It drives me crazy when people say things like “My dad and my grandfather both had heart disease, so I guess I have bad genes.” Your genes are profoundly affected by your environment and your lifestyle. Stay active, eat real foods, go out for a walk, make lots of friends, and you are much less likely to die of heart disease than someone with “good genes” who eats McDonald’s every day and is a professional couch-sitter.
3. To further argue my point above in #2: At 9m15s, Dr. Manchanda mentions a study that showed that the closer you live to green space (e.g., a park), the lower your risk of heart disease. This holds true for both rich neighborhoods and poor neighborhoods. This study was summed up wittily as “Your zip code matters more than your genetic code.”
So, to reiterate: go outside and take a walk, preferably with a furry creature or some other companion (humans are okay too). Stay active.
4. At 10m30s, Dr. M says “in health care, we often treat symptoms without addressing the conditions that make you sick in the first place.”
This point is perhaps the most important one of all. Please understand that I am dating a physician and I have the highest respect for the profession. My significant other will readily admit that sometimes, our health care system is not the greatest at addressing chronic health issues.
If you get hit by a bus or a bullet, a hospital is exactly where you want to be, under the care of world-class surgeons. In contrast, I would argue that if you have chronic knee pain, a knee specialist is probably (literally) the last person you should go see, after you’ve done some work “upstream”: are your hips aligned? How about your feet? (I’m assuming your knee pain isn’t the result of getting hit by a bus or a bullet.)
I often tell the story of how Bill Hartman diagnosed my “plantar fasciitis” (pain on the bottoms of my feet) like this: “You have a hip problem, not a foot problem.” Far too few physical therapists and doctors in the world who take a comprehensive view of the human body, and we are very lucky to have Bill on staff at IFAST. Because if you have a doctor who doesn’t look upstream, you may end up treating symptoms (foot pain) without ever addressing the root cause (a misaligned pelvis). Or you may end up having an expensive surgery that doesn’t fix your problem at all.
I hope you enjoyed this talk! If you have any TED talks or links to share, please let us know!