I was drawn to the title of a Pediatrics Perspectives article that is being early released this week by Pediatrics, entitled, “Accelerating Upstream Together: Achieving Infant Health Equity in the U.S. by 2030” (10.1542/peds.2021-052800). I was drawn to the title partly because my research focuses on infant mortality, and partly because I was wondering: what does “accelerating upstream” mean?
The authors, Dr. Michael Warren, Dr. Ashley Hirai, and Vanessa Lee from the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA), explain that if we are to improve infant mortality rates in the US, particularly rates among infants of color, we have to do more than take care of the patients who are in front of us; we have to move “upstream.”
Moving “upstream” means moving from tertiary prevention (for instance, caring for preterm infants once they are born) to secondary prevention (screening for diseases and problems) and primary prevention (interventions to prevent the disease – for instance, by vaccinating patients or placing infants on their backs to prevent a sudden and unexpected infant death).
Accelerating “upstream” means moving even further up to social and structural determinants of health. That seems great, but daunting. How to do we do that?
The authors provide us with practical suggestions and challenge us to do more, whether it be on a personal level, practice level (how about a QI project to improve screening for social determinants of health?), or working with local, state, or national governmental agencies.
Most importantly, we have to work with our communities and listen to them to see what they need. The authors express this in powerful words: “Despite our clinical inclinations to ‘save babies,’ Black and brown families do not need us to ‘save’ them. They need us to value them, to hear what they want and need, and to empower and partner with them in the development and delivery of solutions to advance racial justice.”
It only takes one step to start moving – and even accelerating – upstream. As the first step, please read this Pediatrics Perspectives. It will motivate you to work on your second and third steps.