Upstream Interventions

We’re continuing our deeper dive into HRSA/MCHB’s strategic paradigm “Accelerate Upstream Together”. This newsletter we’re exploring how the LCIRN is moving interventions “upstream” to either prevent the development of health challenges, or address and reverse them as soon as they occur. Upstream interventions are more likely to be successful than interventions that are applied only after conditions are well established.

Yet these interventions are also more challenging to design and implement because there are so many factors that contribute to the development of health challenges over long periods of time. The Life Course Health Development (LCHD) framework indicates that in order to develop effective upstream interventions we must understand those “pivot points” or key factors in a child’s developmental ecosystem that are most important in the genesis of health challenges, and how and when to intervene to act on them. Upstream interventions may address:

1. Events and experiences early in life, including the sensitive pre-and peri-conception periods. Evidence suggests that certain aspects of this life stage are particularly important in setting the foundation for future health, including secure early relationships, capacity for emotional regulation and establishing healthy behaviors.
2. Aspects of the child’s family and community environment that are not traditionally targeted by health interventions, including social and structural determinants of health – factors in the child’s family and community environments that can impact their sense of well-being and their life-long health.

In order to design and implement effective interventions to improve health, we need to understand when and how these factors exert their influence, and how to either prevent events or experiences that pose health threats from occurring, or to mitigate any potentially harmful effects once they occur.