2.2 Upstream & Downstream Interventions

Upstream and Downstream are related concepts tied to different levels of intervention that can impact the SDoH. These intervention strategies are illustrated through the various ways that social structures and services support PWUS, and people experiencing SUDs.

Upstream Interventions are macro-level intervention strategies tied to structural determinants of health that look at the root cause of inequality in our society (Bharmal et al., 2015). Upstream thinking seeks to even out economic and social structures and provide an equitable distribution of wealth, resources, and opportunities amongst all populations (NCCDH, 2014). This typically involves both national and transnational strategies that are designed to improve overall societal structures. Such strategies are directly related to health, as those with lesser access to resources tend to have poorer health outcomes (NCCDH, 2014). 

Downstream Interventions are micro-level intervention strategies that focus on issues of equitable access to care resources and providing resources to those in need (NCCDH, 2014). For example, shelters, food banks, and soup kitchens are forms of downstream interventions that provide essential services to people who are unhoused or are experiencing housing instability. Such strategies aim to change the effects of the causes identified by upstream interventions (NCCDH, 2014).

VIDEO: Introduction to Upstreaming

The following video provides a visualization of what it means to look upstream and identify intervention strategies that get to the root of inequalities in our society.