Driven Upstream: The quest for a healthy society

In medicine, you have a reflection of the political spectrum of society, and it’s not that surprising that you have some people really taking on a more socially minded, community-focused approach to things.

The following is an excerpt from the new book Upstream Medicine: Doctors for a Healthy Society, available now online, from the UBC Press and with local booksellers across Canada.

Melanie Bechard: Could you describe the organization Upstream a little bit more – what motivated its creation, and what your role is with Upstream?

Ryan Meili: Upstream is a non-profit, non-partisan organization with a national focus, though its home base is here in Saskatoon. It’s an active part of a larger movement to build a healthier society through evidence- based, people-centred ideas. To break that down, we really are trying to reframe Canadian politics around the concept of health as the primary goal. After all, what is government for if it’s not to improve our health and well-being? But that’s not how we measure the success of governments: we tend to measure through GDP and other numbers that don’t necessarily reflect the quality of our lives. Upstream is about refocusing our goal as being health and recognizing that healthcare is not the way you reach that. It’s only one element; you need to be looking at the social determinants of health: income, education, healthy nutrition, the wider environment, employment. These are really the stuff of politics, the stuff of government decisions, and that list of determinants is the road map to a healthier society.

"...being frustrated by the limitations of seeing patients, treating them, and then knowing  that  they’re  returning  to the circumstances that made them ill."

Upstream works with academics and advocates who understand the evidence of what the best options are to understand the social determinants of health, and we work to tell the stories of patients or people living in communities that can highlight the individual impacts of policy changes, good or bad. Through that, we build a community of individuals and organizations who are really looking at things through this lens, using this language to describe current struggles and the most hopeful, evidence-informed options to improve the current situation.


Upstream developed from a number of roots. It came from my own experience being a physician and enjoying the practice of medicine very much, but also being frustrated by the limitations of seeing patients, treating them, and then knowing  that  they’re  returning  to the circumstances that made them ill. It comes from the frustration of knowing that they or their neighbours will be back because we haven’t really dealt with the source of their illness. That frustration drove me to become involved in politics – I ran twice for leader of the New Democrats in Saskatchewan – and also to write a book called A Healthy Society. Between the book and the campaign, we built up a group that was really committed to these ideas, decided that there was a need and appetite for this work in Canada, and started Upstream to try and do that political frame-changing over the coming years.

We call it Upstream because of a classic story that you’ve probably heard. It’s the story of kids drowning in the river, of people diving in to save these children, and of kid after kid coming down the river. Eventually somebody says, “Who keeps chucking these kids in the river?” and goes upstream to find out. So it’s about trying to think proactively instead of reactively, thinking about how we create the conditions for good health in the long term rather than always responding to illness.

"...knowing that they or their neighbours will be back because we haven’t really dealt with the source of their illness."

MB: That’s the more effective and even more financially responsible method of looking after people’s health.

RM: Absolutely, and we make the economic argument at times. For example, we ran a campaign last year where we demonstrated that poverty was costing the Saskatchewan economy $3.8 billion per year. That’s 5 per cent of our GDP. We used that information as well as stories of people living in poverty to convince the Saskatchewan government to adopt a poverty-reduction strategy. So it can be helpful to bring in those economic arguments. I’m always a little bit cautious of this approach, however, because part of our current frame is that money is the most important thing, and we want to move away from that. We have to wisely know our numbers but really focus in on the fact that what matters most is the quality of our lives, not economic growth at an aggregate level.

MB: It’s really interesting to hear about your political involvement. I think that as physicians, we have a unique perspective, and that our active involvement in politics is really one of the most effective ways that we can influence health policy in this country. ...Have you encountered any of that pushback?

RM: The first time that I ran, there was a comment like that in the newspaper: “You should stay a doctor. We need more doctors. We have plenty of politicians.” We train physicians to improve our health. It’s the purpose of the profession. The clinical role is the most common set of tools for doing so. But really, the goal is the same. And if physicians use involvement in politics the way Virchow said, seeing politics as medicine on a larger scale, then it’s merely an extension of the work and the training, only with a different set of tools.




rm_bio.jpgDr. Ryan Meili is the founder of Upstream and formerly its executive director, now Saskatchewan MLA and public advocate for upstream thinking to bring a health and people-centric approach to our political policies and structures.

Connect upstream.