The upstream-downstream metaphor helps public health practitioners to choose cost-effective public health interventions. This post curates a set of peer-reviewed articles that deal with the upstream-downstream” metaphor. 1. The upstream versus downstream metaphor to reduce health inequalities In this article, Naoimh, E. McMahon reviews published literature until June 2020 to find how the upstream-downstream metaphor has helped us frame action to reduce health inequalities. The full text is available for free. Link to the article: https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdab157/6288548 In her previous article published in the Critical Public Health Journal, she describes how English researchers interpret the “upstream-downstream” parable. In Naoimh’s two blog…

Those who know public health know Prof. Irving Zola‘s “upstream vs downstream” parable. Irving Zola is a medical sociologist. His friend, John McKinlay, describes Zola’s parable in his 2019 article, “A case for re-focusing upstream: The political economy of illness”1. The “Upstream boat” sails through this upstream path. Following is the reproduction of the parable; ” I am standing by the shore of a swiftly flowing river, and I hear the cry of a drowning man. So, I jump into the river, put my arms around him, pull him to shore, and apply artificial respiration. When he begins to breathe,…