Upstream: The Quest to Solve Problems Before They Happen
by Dan Heath 2020
What if we could travel back in time and stop disasters to make sure they never happen? You could prevent deaths, relay critical information, and prevent untold suffering if you just had a time machine. Or could you? Sometimes I think I would go back and no one would listen to me because I was asking them to change. Are we all stuck in an inevitable cycle of predestined events, or can we change the future meaningfully with actions today?
We don't need a time machine. We can change the future every day with our words and behaviors, and the butterfly effect magnifies our every activity in both good and bad ways. People today don't have to worry about polio because of the works of Dr. Jonas Salk. We may owe our lives today to of the quick thinking of an obscure Russian general, Stanislav Petrov, who discounted radar images showing a US attack and refused to order a counter-attack in 1983. Our parents have shaped our lives in many good and not-so-good ways, and we spend much of our lives trying to figure it out.
Upstream tries to look at how we can maximize impact today on problems of the future, and why that's preferable to only reacting to things as they happen.
Dan Heath, one-half of the popular Heath brothers writing team, has added to their great stable of thought provoking books like Decisive, Switch, Made to Stick, and the Power of Moments. Their website is chock full of helpful study guides, handouts, and additional materials that I recommend to any readers.
Heath uses the metaphor of upstream thinking to mean any action that's meant to prevent problems before they happen, or to at least lessen the harm caused by problems when they happen. Upstream thinking can be done hours before something is supposed to occur, days, weeks, months, or even generations. He sees three main reasons why we neglect to act more preventative, choosing to react to problems instead.
1- Problem Blindness. This is the belief that bad outcomes are natural and unavoidable, and therefore not a problem. It's easier and more tempting to focus on the problems right in front of us, and those tend to crowd out other more complicated problems involved with upstream thinking. Sometimes we have no choice but to react to crises when they are urgent enough. We pretend to be blind to things we know might happen but don't want to tackle by shrugging them off as "that's just the way things are."
2- Lack of Ownership. Many people see problems every day, but ignore them because they believe "that's not my problem." Especially with individualistic cultures such as America, the problems of others take second place to those of us and our in-group. In many cases the people most affected by a problem have limited power to solve them, while those that do have the power don't feel it's their place to solve them.
3- Tunneling. When the quantity of problems becomes overwhelming, people give up trying to solve them. Long term thinking gets tossed away and crisis management allows only the most immediate problems to get attention. People get tunnel vision, where only the short-term problems get temporary fixes, only to break again down the road.
One can see these three issues at work in government, business and personal decisions all the time. Environmental problems such as global warming get worse every year because people don't want to take ownership of them, and governments are worried only about short-term problems like winning elections. Businesses, too, are focused on short-term results and profitability, and all problems outside of the scope of their mission of maximizing profits are ignored.
There are several huge issues that Heath uncovers that make upstream planning and thinking more difficult than downstream action. First, the world is so complicated that it's hard to know all the repercussions of one series of actions. In the Back to the Future movie trilogy, Marty and Doc mess with the history through time travel, and find themselves dealing with a tangled web of unintended consequences from their actions. Heath tells the story of the frustrating attempts to manage an island ecosystem where rabbits and mice were overpopulated, then killed, poisoned, and subjected to viruses, Predators were introduced and the rabbits and mice finally all died, which led to weeds infesting the entire island because the rabbits weren't eating them. Systems are complicated and every action can have surprising results. The book details the famous cobra problem, where leaders in India tried to reduce the numbers of cobras by introducing a bounty for them, only resulting in people breeding them to get the bounty money, and then abandoning them when the bounty was discontinued, leading to more cobras than ever before.
The second and more confounding issue is how do you know preventative steps are working? If a disaster doesn't occur, how do you know it was your steps that prevented it? Or is it possible you just wasted a bunch of time and money on something that was never going to happen. Heath talks about the Y2K project, when computer experts all around the world tried to re-write computer code so that the systems wouldn't crash in the year 2000. Nothing happened that year, and people today still don't know if that was because of the work of the computer experts or the whole thing was overblown.
And third, there is the problem of getting people to pay for prevention that doesn't affect them right now, but maybe sometime in the distant future. Called the wrong pocket problem, this calls into question our very identities as a civilization. Do we pay today for things that will help our grandchildren? Our neighbors? People on the other side of the border who aren't like us? Getting people to sacrifice today for a future benefit is getting much harder for leaders to ask. Pandemics, mass shootings, natural disasters, financial collapses, and environmental calamities are all things that could all be prevented or helped ahead of time by laws, regulations, disaster plans and upstream thinking. But how do you get people to agree to do something?
There are some wonderful and inspiring stories in this book that illustrate the author's points very well.
- A group of Icelanders figured out how to change the culture of teenagers who were staying out late at night and drinking- not with strict punishments- but rather with upstream attempts by the entire community to engage the teens in better, healthier activities.
- A school system in Chicago figured out how to improve its graduation rates by looking hard at the freshman year and pouring resources into struggling students then, rather than giving up on them later. Getting the teachers on board gave them ownership of the problem of student drop-out rates, which many schools just figure are out of their control.
- A program called "Becoming a Man" uses cognitive behavioral therapy to help at-risk teen boys deal with anger and self-worth issues, keeping them off the streets in tough neighborhoods where the spiral of drugs and jail time awaits their peers.
- An employer prevented internet viruses by sending fake spam messages to its employees thus educating the 29% who erroneously clicked on dangerous messages and exposed the company to hacking.
- A program called the nurse-family partnership matches registered nurses with low-income, first-time mothers, so that they can educate the new parents on caring for infants and toddlers, potentially preventing a large set of problems. A similar program called Parents as Teachers is run by many school systems to provide screening and early childhood training to all new parents in their school districts.
Upstream focuses much of its attention on our health care system, where many of the incentives are in treatment instead of prevention. Public health initiatives such as immunization, hygiene, fluoridated water, and improved water and sewer systems have dropped the death rate from infectious diseases from 33% at the turn of the 20th century to less than 3% today. But public health spending is a tiny fraction of the huge bills run up by hospitals, drug companies, and diagnostic labs. Most of the health care dollars we spend today are to treat symptoms, and not address root causes such as obesity, substance abuse, stress, environmental contaminants, and poor dietary habits.
Much of the problem is with the incentive structure of the US health care system. Heath describes something called an Accountable Care Organization, where groups of doctors join together and their rate of pay is more determined by how healthy their patients are and not how many services they can provide. Preventing ailments like cancer, diabetes, and heart disease could be much more affordable than the current burden of tests, drugs, and surgeries. In my sixty some years of going to the doctor I cannot recall one time when they asked me about my lifestyle or my mental health. Most doctors have their little corner and lack ownership for anything bigger.
We live in an age of tunneling. As I write this the world is experiencing the Covid-19 pandemic, something that had been warned about by many public health professionals in prior years. But instead of preparing, the US government disbanded their pandemic response team, leaving them without a plan and facing chaos. Other crises loom in the future- global warming, an aging population, crumbling infrastructure, and debt financing that's pushed substantial money problems into the future. A book like this is just what we need for leaders all around the world who want to escape the tunnel and guide their organizations into the future. Focus more of your efforts upstream- solving problems that you might never personally have to face. Work on systems and not symptoms. Catch problems in early childhood and you save a human being a lifetime of making the same mistakes.
I give this book five out of five stars because it enlightened me to think more carefully about how to be effective. The following story is not from the book, but one I've heard before that pretty much sums things up. Not sure where it came from.
The “Parable of the River”
Once upon a time there was a small village on the edge of a river. The people there were good and life in the village was good. One day a villager noticed a baby floating down the river. The villager quickly swam out to save the baby from drowning. The next day this same villager noticed two babies in the river. He called for help, and both babies were rescued from the swift waters. And the following day four babies were seen caught in the turbulent current. And then eight, then more, and still more!
The villagers organized themselves quickly, setting up watchtowers and training teams of swimmers who could resist the swift waters and rescue babies. Rescue squads were soon working 24 hours a day. And each day the number of helpless babies floating down the river increased. The villagers organized themselves efficiently. The rescue squads were now snatching many children each day. While not all the babies, now very numerous, could be saved, the villagers felt they were doing well to save as many as they could each day. Indeed, the village priest blessed them in their good work. And life in the village continued on that basis.
One day, however, someone raised the question, "But where are all these babies coming from? Let’s organize a team to head upstream to find-out who’s throwing all of these babies into the river in the first place!"
The seeming logic of the community elders countered: "And if we go upstream who will operate the rescue operations? We need every concerned person here!"
"But don't you see," cried the one lone voice," if we find out who is throwing them in, we can stop the problem and no babies will drown! By going upstream we can eliminate the cause of the problem!" "It is too risky," said the village elders. And so the numbers of babies found floating in the river increase daily. Those saved increase, but those who drown increase even more.