Upstream Prevention: Health Is Not a Luxury, It Is a Right

Investing $1 in system and policy change (upstream prevention) can save $7 to $10 in post-disaster recovery costs (Public Safety Canada, 2019). Should we spend 7 million dollars on building homeless shelters and psychiatric facilities, or invest 1 million dollars in a system-level change with a policy direction oriented towards reducing the need for homeless shelters or psychiatric care? This is the goal of upstream prevention methods: investing wisely by solving the root of the issue (Halsall and colleagues, 2024).

Social Collapse River Analogy

Imagine a river where people are constantly being swept downstream. We can save individuals by pulling them out one by one, but more people keep falling in. This represents downstream interventions like providing emergency shelter or food banks, which address immediate needs but do not solve the underlying problem.

To truly prevent people from falling into the river, we need to go upstream and target the social determinants. Here, we might find a broken bridge causing people to fall in. Fixing the bridge represents upstream prevention, addressing systemic barriers that lead to issues such as poverty, hunger, and suicide.

Neglecting these upstream factors eventually leads to increased strain on services, higher rates of chronic illness, widespread poverty, and ultimately, social collapse due to the overwhelming burden on resources and infrastructure.

Holding Policy Makers Accountable: Poverty and Hunger Crisis

The United States and Canada, amongst several other countries, are committed to achieving the ‘Sustainable Development Goals (SDG)’ of the United Nations. Countries must do their part by honestly reporting and taking action on these national and international policy priorities. There seems to be a discrepancy between the recent report versus the population statistics.

Canada SDG Dashboards and Trends

Source: Sustainable Development Solutions Network. (2024). SDG dashboards and trends [Photograph]. In Sustainable Development Report.

According to the Sustainable Development Report 2024, which tracks progress on the SDGs, Canada is on track to achieve the goal of 'No Poverty' while progress on the goal of 'Zero Hunger' is stagnating (Figure 1: Sustainable Development Report, 2024).

However, these reports seem to lack integrity. ‘Zero Hunger’ is not stagnating as Canada reported, it is the worst it has ever been in history. Food bank use in Canada hit a record-breaking high in 2024 (Food Banks Canada, 2024).

Canada also reports that the goal of 'No Poverty' is on trajectory to being achieved. However, the reality is that a third of renters in Canada cannot afford their rent and homelessness and encampments are on the rise (Canadian Centre for Housing Rights, 2024).

This crisis highlights the need for upstream prevention strategies to address the systemic issues contributing to poverty and hunger.

Mental Health Crisis: Suicide

Suicide is the fourth leading cause of death in people between 15-29 (World Health Organization, 2023). One upstream prevention strategy might involve improving access to natural environments as they have been shown to reduce suicidality (Helbich and colleagues, 2018). The World Health Organization (WHO) and various public health studies have highlighted that equitable access to natural environments is crucial for addressing the mental health crisis (Ayala and Meier, 2017).

Outdoor Running for Vitality and Freedom

There is one simple tool that can dramatically improve our mood for the day: a 10-minute outdoor run in the morning (Oswald and colleagues, p.10). Many studies provide evidence that outdoor running positively increases mood, as seen in a scoping review of 116 papers (Oswald and colleagues, 2020). Running outdoors has been shown to increase emotional expression (Giles and colleagues, 2018). It is sort of like a great big ‘wake up’ and ‘shake up’ in the morning that might get us feeling fully alive (vitality) and relaxed (free) in our bodies, which are basic human rights, not luxuries.

Barriers to Natural Environments

The Children and Nature Network emphasizes that a connection with nature is a fundamental determinant of health and development, supporting the argument that access to such environments should be a right for all individuals, regardless of socioeconomic status​ (Louv, 2021).

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While many privileged individuals do have access to these environments, significant barriers currently prevent numerous people from the healing benefits of nature. These barriers include constraints related to time, transportation, and location (Wolff and colleagues, 2022).

Modern Worklife: From the perspective of the basic need to have daily exposure to nature, it is inhuman to be locked indoors in urban environments for five days a week. In his book Happier, No Matter What (2021), Dr. Tal Ben-Shahar, a Harvard University positive psychologist, recommends micro-level recovery practices that include taking nature walks and macro-level recovery that involves taking maybe three days off per week.

Transportation: There is agreement on the need for transportation to natural environments for marginalized communities (Nature Canada, 2022).

Historical inequality: Investment needs to be channeled toward building trails for the public in government-owned properties or national reserves. In Canada, almost all lakes are privately owned, with very limited public access. Publicly accessible lakes are often busy or full on bright summer days, denying a vast majority of marginalized communities their basic right to enjoy and benefit from nature. This situation presents significant challenges for individuals with disabilities, such as Tourette's syndrome or autism, where busy environments can be particularly distressing.

The disparity arises from historical inequality rooted in the allocation of nature-rich indigenous lands among a few. This has become a generational issue because those properties have been passed on to their privileged offspring, limiting public access.

“The question is not whether the world has the resources or will to take such actions, but whether humanity can survive if we fail to make this effort.” (The Lancet, 2023).

Circling back to where we began, investing in upstream systemic change effectively tackles homelessness, hunger, and mental health crises by fixing systemic barriers and preventing downstream emergencies. Canada's statistics show a need for genuine action against the poverty and hunger emergency. We need to make a societal-level effort by getting educated, volunteering, and pursuing careers in the direction of advocacy, policy, and research in upstream prevention. The whole society needs to be engaged in the effort to help every human being have access to basic physical and mental health needs: Housing, food, and time outdoors.