Upstream: The Quest to Solve Problems Before They Happen

by Dan Heath

When you spend years responding to problems, you can sometimes overlook the fact that you could be preventing them.

Remember, both countries spend roughly the same on health (upstream and downstream) as a percentage of GDP. Norway is not spending more; it’s just spending differently. We cranked up the treble, Norway cranked up the bass. Our choice as a nation has been to get better and better at fishing drowning kids out of the river. We could choose differently.

To succeed upstream, leaders must: detect problems early, target leverage points in complex systems, find reliable ways to measure success, pioneer new ways of working together, and embed their successes into systems to give them permanence.

They had fallen prey to a phenomenon called “inattentional blindness,” a phenomenon in which our careful attention to one task leads us to miss important information that’s unrelated to that task.

The escape from problem blindness begins with the shock of awareness that you’ve come to treat the abnormal as normal.

Next comes a search for community: Do other people feel this way?

The upstream advocate concludes: I was not the one who created this problem. But I will be the one to fix it.

What do you do when you realize that the cause of an enormous problem is… your own actions?

“You know the kind, tilting first to one side and then another in an attentive way. Driving me nuts. I kept tilting in the reverse to accommodate: He’d tilt left and I’d tilt right. Then he’d tilt right, and I would swivel left. I could feel myself getting aggravated… Suddenly it occurred to me that I was completely capable of moving my chair instead of getting further annoyed.

The first force, problem blindness, means: I don’t see the problem. (Or, This problem is inevitable.) A lack of ownership, though, means that the parties who are capable of addressing a problem are saying, That’s not mine to fix.

What if you told the story of your relationship problems as if you were the only one responsible? What if employers told the story of their employees’ health as if they were the only ones responsible?

These are easy victories. All they require is an awareness of the problem and a small measure of planning. Yet in my interviews, I found that it was difficult for most people to think of their own examples. (This is not my way of bragging, by the way: Remember, I shuffled power cords for years—and what finally sparked action was, um, writing a book on upstream thinking.) Which raises the question: If upstream thinking is so simple—and so effective in eliminating recurring problems—why is it so rare?

When people are juggling a lot of problems, they give up trying to solve them all. They adopt tunnel vision. There’s no long-term planning; there’s no strategic prioritization of issues. And that’s why tunneling is the third barrier to upstream thinking—because it confines us to short-term, reactive thinking. In the tunnel, there’s only forward.

When your emphasis is always forward, forward, forward, you never stop to ask whether you’re going in the right direction.

“You can’t solve a dynamic problem with static data.”

The result of that constant juggling is stress. These communities were “incubators of chronic stress,” he said in a TEDx talk. “Low-income people are physiologically different than high-income people. Not because they were born that way, but because we made them that way.” There’s a well-established link between chronic stress and a variety of health problems, among them cardiovascular disease, diabetes, and inflammation.

The writer David Foster Wallace once told a story: “There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says ‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’ ”