Upstream: The Quest to Solve Problems Before They Happen

by Dan Heath

Okerstrom’s point is that focus is both the strength and the weakness of organizations. The specialization inherent to organizations creates great efficiencies. But it also deters efforts to integrate in new, advantageous ways. In upstream ways.

Richard Tremblay argues that the best time to prevent aggressive behavior is when the criminal is still in his mother’s tummy. Tremblay points to a cluster of risk factors involving the mother that predict a child’s chronic physical aggression: maternal poverty, smoking, malnutrition, anger, and depression, plus poor marital relations, low education, and having the baby as a teenager. These factors tend to come together, according to Tremblay—and more important, they can be changed. Tremblay is currently working on a program that helps pregnant women in these high-risk situations. “To solve the aggression problems, which are mainly a male problem, we need to focus on females,” Tremblay told Nature. “If you ameliorate the quality of life of women, it will transfer to the next generation.”

a student’s achievement specifically in the ninth grade that predisposes them to succeed or fail in high school.

That reversed the pecking order—usually the best teachers wanted to work with more mature juniors and seniors. But now you know that ninth graders deserve the A-team.

The term sexual harassment was coined in 1975 by the journalist Lin Forley, who’d been teaching a course at Cornell University about women and work. She invited female students to a “consciousness raising” session and asked about their experience in the workplace. “Every single one of these kids had already had an experience of having either been forced to quit a job or been fired because they had rejected the sexual overtures of a boss,” she said in a 2017 interview with On the Media host Brooke Gladstone. Forley cast about intentionally for a term—a label—that would capture these shared experiences, and she settled on sexual harassment. She later wrote in the New York Times, “Working women immediately took up the phrase, which finally captured the sexual coercion they were experiencing daily. No longer did they have to explain to their friends and family that ‘he hit on me and wouldn’t take no for an answer, so I had to quit.’ What he did had a name.”

But the more convincing case is that doctors prefer C-sections. After all, C-sections can be scheduled in an orderly fashion, one after another. No need to work late hours or weekends or holidays. And the financial incentives strongly favored C-sections: Obstetricians could make much more money performing C-sections—which require maybe an hour or two of work—than they could delivering babies naturally, which might involve intermittent work over a 24-hour period.

“The big head was one of those friendly ones,” she said. “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. I did,” she said. Problem solved. It frustrated her that it had taken so long to figure out what should have been obvious: that she had full control over the “problem.” Her memory of the chair-moving moment became a kind of instructional metaphor: “Whenever I start to get aggravated about some inane problem, I think, ‘Hey, move your chair, why don’t you?’ and it’s an internal code for trying a new approach,” she said.

“Move your chair” to re frame a problem in a way that gives you power in the situation

The addition of the words Men and Women was a simple way to extend psychological standing to both genders, and it was effective. As a result, students with a vested interest and those without one agreed to sign the petition and write statements in equivalent numbers.

Incusive organization titles vive more people psychological legitimacy to fee ownership of problems.

Two automobile safety champions write a pediatric journal article about a problem. The article spurs a Tennessee pediatrician to take ownership of the problem. He motivates a state to act, and that state influences 49 other states, and four decades later, thousands of children are alive who otherwise would have met violent, preventable deaths.

Forrest’s question can help us filter out the noise in complex situations. 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? What if school districts told the story of high school dropouts as if they were the only ones responsible? Asking those questions might help us overcome indifference and complacency and see what’s possible: I choose to fix this problem, not because it’s demanded of me, but because I can, and because it’s worth fixing.

When people are juggling a lot of problems, they give up trying to solve them all. They adopt tunnel vision.

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 people’s resources are scarce, every problem is a source of stress. There’s no way to use money as a buffer—by keeping a car’s maintenance up to date, by paying out of pocket for a dental visit, by taking a few days off work to stay with a sick parent. Life becomes a tightrope walk.

If you can’t systematically solve problems, it dooms you to stay in an endless cycle of reaction. Tunneling begets more tunneling.

There’s a paradox inherent in preventive efforts: We’ve got to create an urgent demand to fix a problem that may not happen for a while. We’ve got to make the upstream feel downstream,

In the 94597 ZIP code in Contra Costa County (Walnut Creek), life expectancy was 87.4 years. In the 94603 ZIP code in nearby Alameda County (Oakland neighborhood Sobrante Park), it plummeted to 71.2 years. Iton’s team had uncovered a 16-year gap in life expectancy in two areas that were 22 miles apart. The same pattern was unearthed in other cities where the data was compiled: Baltimore, Minneapolis, Los Angeles, and others. In Cleveland, a 4-mile walk from the Shaker Heights neighborhood to the Baldwin Water Treatment Plant took about 80 minutes, and over the span of that walk, 23 years of life expectancy vanished. “It’s like having Sweden and Afghanistan in the same city,” Iton said.

“Fundamentally, what causes people to get sick and feel sick is a sense of a lack of control over what’s happening to them,”

In 1962, the San Francisco Giants were preparing to host the LA Dodgers for a crucial three-game series, late in the season. The Dodgers, led by master base stealer Maury Wills, were five and a half games ahead of the Giants. Before the series began, the Giants manager approached Matty Schwab, the team’s head groundskeeper, and asked if anything could be done—wink wink—to slow down Wills. “Dad and I were out at Candlestick before dawn the day the series was to begin,” said Jerry Schwab, Matty’s son, as quoted by Noel Hynd in Sports Illustrated. “We were installing a speed trap.” Hynd continues: Working by torchlight, the Schwabs dug up and removed the topsoil where Wills would take his lead off first base. Down in its place went a squishy swamp of sand, peat moss and water. Then they covered their chicanery with an inch of normal infield soil, making the 5- by 15-foot quagmire visually indistinguishable from the rest of the base path. The Dodgers were not fooled. When the team began batting practice, the players and coaches noticed the quicksand, and so did the umpire, who ordered it removed. Schwab and the grounds crew came out with wheelbarrows, shoveled up the mixture, and returned soon after with reloaded wheelbarrows. It was the same bog. They’d just mixed in some new dirt, which made it even looser. Somehow the umpires were satisfied. Then Matty Schwab ordered his son to water the infield. Generously. By the time the game started, there was basically a swamp between ...

Gotta share this one with my baseball buds

Nothing is easy. The world is complex and there are no quick fixes. But if I can learn to uncross my arms and extend my hands, I can be someone who eases suffering rather than ignores it.

The thing to do, when you don’t know, is not to bluff and not to freeze, but to learn. The way you learn is by experiment—or, as Buckminster Fuller put it, by trial and error, error, error.”

Upstream work hinges on humility. Because complexity can mount quickly even in simple interventions.

“The best time to plant a tree is 20 years ago. The second-best time is now.”

The first rule of medicine “Primum non nocere,” “First do no harm,” binds not just doctors but all who serve in the health field, including actuaries. Perhaps especially actuaries since a bad doctor can only harm a few people but a bad actuary can harm millions. Therefore, the office should adopt a firm rule of never calculating in an estimate the resulting added cost resulting from saving a person’s life. Calculators are appropriate for determining how much doctors and hospitals should be paid, calculators are not appropriate for determining how long people should be allowed to live.