What makes us get sick? Look upstream | Rishi Manchanda

Rishi Manchanda has worked as a doctor in South Central Los Angeles for a decade, where he’s come to realize: His job isn’t just about treating a patient’s symptoms, but about getting to the root cause of what is making them ill—the “upstream" factors like a poor diet, a stressful job, a lack of fresh air. It’s a powerful call for doctors to pay attention to a patient's life outside the exam room.

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[srimansrini]

All over the world, doctors are repeatedly making the same mistake of trying to treat the symptoms instead of the root cause. In this video, Dr. Rishi Manchanda tells that message very clearly with relevant examples. Where you live and work also matters in finding out the root cause of our problem. At the same time, we should not forget what we are is what we eat. So, a doctor should thoroughly examine all these factors before starting the medication to the patients. Good and informative talk. Highly recommended.

[aimezmoi]

I really loved the children drowning analogy. We need EVERYBODY working together to improve health, not just doctors, not just community workers, not just public health officials. Great talk Rishi!

[FrozenAmy]

Dr. House always used to ask about the patient's home to see what's causing the patient's conditions!! even if his team has to break in to house!

[Rhno]

All this boils down to is support for a more holistic, humane and thorough way of treating patients. However, this is more of an Eastern approach to medicine. In America, if you visit a doctor, the doctor usually only has a short  amount of time allotted for each patient. Patients are often left frustrated and their health problems remain. Health care is primarily a business and like most institutions, it is ruled by money rather than by the needs of the public.

[LoadOfCrabby]

Just come to Finland, our healthcare has done this for decades.

[David_J._Kozirovsky]

The problem is that "training upstreamists", and generally _enforcing_ more of these sorts of practices, just makes the actual relevant part of the inquisitive process _procedural_ - simply going through the motions. Now, anecdotally, based on already having done this and otherwise simply logically, I understand this has some level of effect and therefore value to do (improvement on how perhaps it was), but because the issue is so fundamentally _systemic_ (as was mentioned), it's hard to actually influence how people think when approaching these problems as a whole.

Inevitably, when people return back into the "real world", they conform to whatever is structurally reinforced by the system in the first place - kind of feeling hopeless, idealistic, and naive about the endeavor - broken down by the hardship and harshness of the forces that be. Structural incentives (the economic model we employ) pushes ideals to the side - anesthetizing people and making them bitter with respect to such pertaining notions. You're forced into the mentality of _fending for yourself_ (not to defend or further justify people's actions). A holistic approach requires holistic considerations on the part of those who struggle for solutions.

Without conceit, as an "upstreamist" myself, I have found this task (engaging it, similarly, for over a decade I would say) to nearly be an impossible one, given how strongly it almost always clashes with the already preexisting and established social order. It requires a degree of influence through authority which is the only thing most people respond to. The more reason/logic was introduced as part of the process of conveyance, the more people would simply resort to a kind of dismissiveness, as it would require adaptation in their lives which literally goes directly against the tides of the stream. People would rather throw such people (those who challenge) down the stream rather than to look up it themselves.

I certainly don't disagree. Actually, I MORE than agree with everything that was said here, and as Rishi Manchanda mentioned, it's not only on the basis of some basic intuition but actually based on the increasing amount of scientific studies and research done in this area. If there's anything which brings this into perspective and points to what the cause of much of this truly is, it can be termed _structural violence_ - a kind of willful ignorance to externalities within the system which don't account for psychosocial stress or other ecological factors which plague the health of human beings and the whole of the earth itself, for the benefit of the few who sit on top that stream. And no, when you have a level of inequality where you have to go back to the times of the pharaohs in Egypt to compare/account for it, it's not just mindless "Marxist" talk, regardless of other relative statistics.

The problem is, resources simply aren't allotted to encourage this sort of thinking/behavior (to be furthered by education), and if they are, it's an "imposition of will" through "socialist" and "big government" force which "takes away our freedoms". Of course, "We need an _"actually free"_ market/economic system, _"purified"_ from the corruption of state government or any kind of further regulation and accountability!"... :/

Quite frankly, as perhaps further explication, it is impossible to have _anything_ which isn't corrupted by this socioeconomic system/model, because with any group of people in control of anything, they inevitably get "corrupted" by the same values/incentives inherent to the order of the structure to begin with (not just a cynical perspective).

In any case, I guess the point is: my hope is that more of this sort of spreading of consciousness and awareness raising pushes us more in a direction which seeks to target _structural problems_ and apply a _systems approach to management_ to the whole of our operations (not just sectors of individual industries for their monetary sustenance) as a reflection of how we can better manage our total resources (including _human_ resources). Seems more like it's time for about another revolution in how we think and view/understand these kind of issues - a kind of cultural renaissance if you will.

I am very grateful for individuals such as Dr. Manchanda (and I'm sure his colleagues) who seek to influence and make change within their field - disrupt the faulty and destructive standardization which runs though their industry. This really is what's needed! We certainly don't otherwise need further reinforcement of the old or more people, like the first two friends in the parable, who only know how to apply bandages on an ever-increasing gushing wound/tear running through the fabric of our society, only to continually worsen upon getting reopened. Not even going into the details of what's further inherent to this, this further causes those aware to have their daily stress substantially increased in response to these matters (in the realest of ways), making it even more difficult for people to push past the destructive root mechanisms at play, causing the problem. Invariably, those "patchers" are also the very same people who simply accept everything as "just how it is", leading to the sort of unspoken alliance and mentality which blockades against whatever _movement(s)_ conflicting (or directly confronting) the establishment (institutionalized modes of operation).

I guess conformity has always been a, if not _the, _ problem in most any social group, the difference being that now, we really do have the tools/technology to bring the inescapable part of this reality to a practical end where we wouldn't need or furthermore rely on people to follow any encompassing levels of dictated norms as contrived by other human beings. In any case, I really do hope this talk (and others like it) inspires more people to think and move in this direction of _systemic thinking._ I further hope that the critical lens through which I put this may also contribute to this sort of inspiration - expanding upon the value of what was otherwise already said XD

I'd love to know if anyone has any solutions of their own to offer, as at the end of the day, any improvements we can make in any given industry, abetting a full-scale transition, is the best which we can hope to do and further leverage.

[efortune]

8:20 "Scientists now know that the living and working conditions that we all are part of have more than twice the impact on our health than does our genetic code. And living and working conditions, the structures of our environment, the ways in which our social fabric is woven together, and the impact those have on our behaviors; all together those have more than 5 times the impact on our health than does all the pills and procedures administered by doctors and hospitals combined. All together living and working conditions account for 60% of preventable death."

~Rishi Manchanda, M.D., M.P.H.

[javimartinez]

If common sense like this was applied to most of the world's issues the world would be revolutionized.

[Briemerald]

This TEDTALK should definitely have more views. This guy is a gem.

[DopamineOverload]

Great video. While what I'm about to write as a comment might not fully be on the subject of this man's talk, I feel it is pretty relevant.

For three years I had severe singing problems, where my ENTs (several) all said that I needed to be on acid-reflux meds and to angle the head of my bed up, and to not eat a few hours before bed. I did this for many months. No voice improvement. Additionally, for almost 5 years, I had pretty severe rosacea (acne/pimples on forehead and cheeks). Dermatologist suggested I be on antibiotics for life, and to buy a $200 topical cream (that I had to buy every 2 months or so), to keep my face clear.

Then, my girlfriend suggested acupuncture. Like most people, I kind of blew it off.... but eventually said "ok, I'll try it."

The acupuncturist actually LISTENED to me, when she asked what my symptoms were/how I was feeling/what I was stressed about.... she actually paid full attention to everything I said, and after only three treatments, my face cleared up and my singing greatly improved. Quite simply, she suggested I started eating better, exercising more, relaxing/meditating periodically (trying to do more frequently), walking to work instead of driving (only live a mile from work), getting more fresh air in general (cold or hot weather), and getting semi-regular appointments for acupuncture. It completely fixed my singing problems, and cleared up my skin entirely... no antibiotics, no topical creams, no reflux meds, for very little cost. I'm happier, I'm healthier.

Look upstream, indeed. Kudos to this doctor (and ALL medical professionals) who are aware enough, to spread true care/treatment, and knowledge. And major kudos to my acupuncturist.

If you're at a loss with conditions or diseases you may have.... please give acupuncture a shot. It's a LOT older than traditional western medicine, and there's a reason it's still around.

[AnimeshSharma]

At least in India, this use to be the core of the whole medical education. We were pretty much taught all this and much more in a course called Preventive and Social Medicine which was the only subject spread across all the years of medical school :)

[rachelperkins]

“Looking upstream” is a great idea and kudos to the physicians who practice this already! Transitioning from just focusing on the problem at hand, to more preventive care for the patient. I think it is, in face, important to ask about the context of a patient’s life so that more accurate diagnoses can be given. Doctors can relay patient information to different departments in health and see that they are taken care of in order to prevent the same problems to reoccur. This will make medicine more personable, and in turn creating a better oiled machine that is the healthcare system. As patients, I think we need to work with our doctors as well and make sure we are asking them any questions we have or give information that could be essential for better care.

[robertgoldman]

Dr. Manchanda's sort of has it right and sort of has it wrong. His proposals are politically correct. The real problem are poverty, socioeconomic inequality, and not investing on kids in early life. The epidemiological data are clear; these factors are the most important for promoting the health of a population.

While his solutions for Veronica are on the right track, they are band aides for an individual for one health issue and do nothing to address the deeper problems. Dr. M said it. It is the zip code problem. To address the real root causes, one needs to make it so that the zip code has little impact on health. Our underlying political, social and economic institutions have created deep structural problems, the zip code problem, which Dr. Paul Farmer talks about as structural violence. These are the problems in desperate need of solutions. Dr. M is just taking but the first step, for which I applaud and agree.

[MsParklover]

Very good points. I agree with him that we need to find the root causes of health problems. It is also interesting that he did not address the importance of nutrition. What food we put in our body three times a day matters as much, if not more than all the factors he mentioned.

[henriksotto]

The only problem with this is that the pharmacy companies wouldn’t make any money from people who don’t need there medicine and have found the root of there sickness.
Unfortunately this is why there aren’t enough upstreamists

[utubedano]

Most of what Rishi said was just common sense but unfortunately most of the health care systems in the world don't seem to have it.
Perhaps all of them should watch this TED talk and be reminded of the whole point of their respective professions.

[ParaditeRs]

It appears many of those commenting suffer from ignorance.

[mctm]

Thanks...we need this to improve our human conditions...

[polanco]

We need more specialists in environmental medicine.

[peacehommy]

I would expand on this idea much more! This is the right way, as a medical student with experience in the healthcare I see a great future in preventive care! I would even go as far as saying that what we call now as healthcare will be called barbaric damagecontroll, none the less as long as we only have this we need to make the best of it.