Moving Public Health Practice Upstream to Reduce Inequities
Illustration of Stick Figures

Course Objective

  • Describe why public health practitioners should take on “”upstream”” or distal causes of ill health
  • Describe how public health professionals in state and local health departments can take action on “”upstream”” or distal causes of ill health
  • Describe how public health professionals can become allies of current social movements to advance the efforts for health equity

Date: September 1, 2015

Reviewed June 30, 2020

Nicholas Freudenberg, DrPH
Distinguished Professor of Public Health, Faculty Director
New York City Food Policy Center at Hunter College, City University of New York School of Public Health and Hunter College

Traditional public health focuses on downstream forces – those that influence individual behavior rather than those that put people at risk – such as housing, living conditions, air quality, income inequality. These are the things social epidemiologists call the “causes that cause”. In this webinar lecture, Dr. Freudenberg expounds five strategies public health practitioners may use to tackle upstream influences on health in order to challenge health inequities. Skill development and establishing collaborative exchanges with social movements, putting data into the hands of people who can use them in political arenas, and recognizing our own roles as citizens outside of our public health identities are a few of the suggested approaches in this talk. Dr. Freudenberg also discusses the challenges of applying these strategies in public health practice despite the substantial political and social risk often inherent in taking action.

Region 2 Public Health Training Center