Especially in the realm of public policy, we often take for granted that solving a problem is something we do after a problem arises and causes harm. We mitigate. But why do we not put more effort into preventing problems in the first place?
In his book, Upstream, Dan Heath offers a compelling case for why we should try to solve problems before they happen. He begins with a parable: you and a friend are having a picnic by the river when you hear the sound of a child drowning. Of course, you both jump in and rescue the screaming child. Then, another screams in need of rescuing. And then another. Why are all these kids drowning in this river?
Your friend wades out of the water toward the shore, and you ask where is he going? To you, it seems like he’s abandoning the problem at hand. “I’m going upstream to tackle the guy who’s throwing all these kids in the water,” he says.
The analogy comes from the world of public health, a big focus of the book, but it applies to a wide range of policy issues from education to crime to affordable housing. Heath makes clear, however, that we are much better at plucking people out of the currents than we are at preventing them from being tossed in.
There are a lot of good lessons for policy makers in Upstream, but implementing many of them requires not just the willingness to take a wide-angle lens to policy problems, but also to sacrifice the role of superhero and even take criticism. Rarely are upstream efforts met with triumphant flourishes.
This week in Wisconsin, the legislature completed its work on the next state budget. Once again, the process has reminded me that much of the taxpayer money the state spends is on addressing problems downstream. Many of our spending programs are intended to alleviate issues that afflict society, but those issues often stem from factors at work upstream.
In particular, a meaningful portion of our Medicaid expenses could be averted or minimized by incentivizing healthier lifestyles and encouraging more preventive care. Instead the debate boils down to lines in the sand over dollars and cents and, at the end of the process, we remain content dealing with symptoms and stuffing more money into the status quo. Compounding this problem, federal Medicaid dollars come with so many requirements, from cost-to-continue mandates to an impenetrable waiver process for almost any novel policy, that they hamstring innovation and actually punish states for identifying and solving problems upstream.
Heath spends many pages discussing the benefits to public health of upstream thinking. European countries tend to be much better at preventing health problems and, even though America excels at treating diseases and cancers after they occur (people come here from all over the world to get treatment), we could use a lot more creative, upstream thinking.
Heath also talks a lot about incarceration, a massive cost in both dollars and in human terms in Wisconsin and America. Upstream thinking when it comes to crime involves, at least in part, fundamentally reforming failing schools and looking to the root causes of unhealthy or non-existent family lives. Unfortunately, bringing such things up is often scoffed at or worse. The debate seems limited to either how many years someone should be sent to prison or how many people we should let out early.
Crime is the definition of a downstream problem. It occurs today because of problems not dealt with years ago, like limited economic opportunities and unsupportive home environments. It will occur in future years because of our failure to think upstream today. In other words, we are standing upstream right now and if we want to avert crime and other social ills, we need to solve the K-12 issue today and we can start by opening all public schools immediately.
Liberals, whose rhetoric frequently positions them as the vindicators while conservatives are portrayed in press releases as skinflint villains, are particularly fixated on downstream solutions. They try to be seen as the heroes saving children from the river. Then, if one of their political adversaries attempts to redirect the conversation to address the problem by looking upstream, the recriminations are immediate.
Since public spending, as in the state budget, goes up year after year but problems the money is supposed to address persist or get worse, it is worth asking if it’s not the quantity of money but to where it is directed. Perhaps we should look upstream.
This is especially true in housing. The loudest calls for affordable housing come from citizens in America’s most progressive cities, where housing is so expensive that even solidly middle class families can’t afford a decent apartment. Yet the solutions offered by progressive policy makers from New York to San Francisco to Chicago are evidence that their downstream answers like rent controls and rental assistance is nothing more than symptom management that actually backfires and makes the problem—and the quality of life in cities they run—worse.
Upstream calls for bigger thinking, and sometimes the ideas that have the biggest impact in the future sound modest today. That’s one more factor standing in the way of upstream thinking, but Heath goes through numerous examples of big successes that started small.
One similar policy I have been pushing for years is a “pay-for-success” model to help improve maternal and child health outcomes for lower-income families. Through partnerships between the state’s Medicaid program and not-for-profits in communities, state funding is set aside and distributed in a way that incentivizes improved outcomes in pregnancy, child health and development, and the health of the mother. All of these objectives work upstream so that other factors, from the child’s health and education to the mother’s wellbeing and ability to provide for her children, are positively impacted downstream.
That’s an example of one of Heath’s main points in Upstream: upstream policies have the tremendous power to reduce costs by preventing problems, but the primary purpose of upstream thinking is to improve people’s lives over the long haul.
To paraphrase Heath, we usually lionize people who come to the rescue as heroes. We certainly should. But we should also encourage and admire the innovative work of those who are unsatisfied with what everyone thinks of as “normal” and, as a result, look upstream and create innovative ways of preventing problems before they happen.
Dale Kooyenga (R-Brookfield) represents Wisconsin’s 5th Senate District in the state legislature. He is also a Certified Public Accountant and an Army Reserve officer.
