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.

[@srimansrini]

I think using technology, we can collect the maximum information from the patients before he entering to the doctor's cabin. And slowly the attitude of the people also change and they may seek better advice or learn on their own how to lead a healthy life. Regarding the smoking currently i don't have the precise data. I believe that also will come down in the future, once people understand its danger. Thanks for your inputs.

[@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!

[@LoadOfCrabby]

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

[@aimezmoi13]

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!

[@Rh1no1]

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.

[@hanavaughan6956]

perfectly put and well said

[@rachelperkins2739]

“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.

[@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.

[@LG-cz6ls]

I agree. He is part way there, but not appreciating that there is a further upstream to aim for. Or to acknowledge the word Poverty. To understand that inequality in health is due in many ways to financial inequality. In the UK, the Black Report is regarded as a starting point, but awareness of this reality goes further back than that. For some at least. Our leaders keep making the same errors in thinking though. Ideologically opposed to viewing those at the "lower" end of the social scale as worthy of consideration. Another aspect he missed is trauma. ACE scores and also trauma in adult life. They impact physical and mental health, but nobody in power seems to care.

[@Briemerald]

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

[@mctm1221]

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

[@javimartinez6625]

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

[@0peacehommy0]

Very true

[@efortune357]

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.

[@AnimeshSharma1977]

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 :)

[@stevenkefason]

Wow! This is unbelievably amazing. i am overwhelmed by this new knowledge. Thank so much Doc.

[@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.

[@bruce7305]

Acid-reflux medication is just one of the many tragic jokes in modern medicine. They work by either lowering the stomach acid's PH or by reducing the production of it. This can lead to a non-sterile environment in the stomach as well as reduced release of pancreatic enzymes, resulting in carbohydrate malabsorption and bacterial overgrowth, which leads to more bloating and intra-abdominal pressure, resulting in more acid reflux. In other words, the medication that is supposed to aid against acid-reflux might give temporary relief, but will ultimately make the condition worse, as well as introduce a whole slew of other health problems (as you've experienced). You can read more about this in the article series written by Chris Kresser: chriskresser.com/what-everybody-ought-to-know-but-doesnt-about-heartburn-gerd "Antibiotics for life" - jeez.. just think of all the health problems that would arise from this, considering you'd be basically killing off your own immune system. Let's just say your skin would be the least of your problems.. Acupuncture however is something that I do believe can aid against many (if not most) illnesses, through the body's own self-healing mechanisms. Many perceive it to be "wooo wooo" medicine, much due to mistranslation of ancient chinese texts, which have led to the belief that it works by manipulating the flow of energy. The actual meaning in those texts however correspond well with our current understanding of the human body. Chris Kresser has an article series on this too: chriskresser.com/acupuncture PS: I'm not affiliated with Chris Kresser in any way, just a big fan of his articles.

[@Fiorella2694]

No hay subtitulado al español?

[@MridulPeter]

Completely agree !!

[@badoocee1967]

Great info on healthcare for people to acknowledge and learn.

[@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.

[@dmytrobravchuk2064]

great ideas

[@Razmatazuk]

Excellent talk The present medical situation in the west has veered too much to only looking at reactionary measures when it comes to medicine. As things are we are seeing the successes of treatment stalling in some areas, and going into decline in many areas. Nothing short of a medicine revolution is needed. We need a new, holistic approach, that examines the reasons why things happen, and doesn't just deal with the effects. As the talk said, lifestyle and environment are two massive contributing factors that need to be included in health discussions. I support the project and hope it snowballs into a revolutionary change in medicine and health.

[@gailmccray9504]

Thank you, Dr. Manchanda, for raising the visibility of CHWs -- a great solution for our health care system issues hiding in plain sight. I still watch and share this video all these years later.

[@0peacehommy0]

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.

[@amandaleopold1687]

Exciting to hear a Dr that gets it.

[@robertgoldman2338]

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.

[@Mia-ei4mh]

This is gold ❤️ doctors who are like family and care for you are the most effective in the world 👪🌍

[@henriksotto8497]

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

[@SunSunSunn]

Quit peddling conspiracies. This isn't Q-anon.

[@filipecoimbracastico2328]

Anyone knows where I can find the UK study that he is referring when he spoked about the relationship between green spaces and cardiovascular diseases? Thank you

[@007hor]

www.biomedcentral.com/1471-2458/10/240

[@filipecoimbracastico2328]

007hor thanks ! :)

[@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.

[@donaldclark9649]

This seems like the right way to do preventive care.

[@polanco187]

We need more specialists in environmental medicine.

[@polanco187]

many of our symptoms are a manifestation of sick building syndrome.

[@hannabellelle]

Good storyteller

[@ParaditeRs]

It appears many of those commenting suffer from ignorance.

[@Rh1no1]

Welcome to KZbin. :D

[@pressurepointss]

i've been sick every month since may, bcs of acidic stomach and sore throat, every single month, and its exhausting.

[@Kookaburra19]

Looking upstream is important in all concepts not just the medical profession. In the words of 'Geoff Barclay' if there is a problem in workplace look upstream to see where the problem is coming from. All things are influenced by other factors, we always need to analyze these other factors.

[@peterg6992]

to the camera man, and director, it is very distracting to keep moving the camera to audience

[@user-yy6nn3yf5p]

wow so powerful we need more people like this Doctor

[@TheCheckitoutgirl01]

Health does not begin in the four walls of a hospital or doctors office, it begins where we live, our community, and the places we work. Many think that just because of a person’s degree they only know certain things. But in this video though the medical assistant only had a GED in medicine, they knew many things about the communities in the state of California. It is true that we do have to stop just holding them back and allow them to do their job and let us know the things they know more about the world around us. I know I think doctors are only suppose to tell me what is wrong with me, but dont believe them when they try and tell me where my many different health issues come from. Thinking they don’t know anything about my surroundings, or my way of living, when they dont have to know all of that they just know the things that could possibly contribute to my issues based off of my medical records and what I tell them when I come into the office. Listening to the part of this video when he speaks on the fact that his patient Veronica has mold, water leaks, and roaches in her home made me think of how those things affect me, being a person who has Eczema, Psoriasis, and Asthma. People put little thought into those things, and how they can affect your everyday life living. It’s a good thing doctors are trained to notice things with one glance of a patient. Dr. Rashi noticing things about her skin, that told him her whole medical story. Across the bridge of her nose being the allergic salute. Though this being something that is really found on children, he knew Veronica had an intensive allergy problem. Caused by her rubbing her nose constantly up and down, trying to get rid of those allergies making their way into her system. Him then telling her exactly what was wrong with her, just from the glance at her face. We have to start allowing doctors to do their job, and help us help ourselves. We can most definitely save yourself from a lot of trouble by just listening. To stop listening to reply, just listen and understand and take heed to what these highly educated people are saying.

[@meatmoneymilkmonogamyequal5583]

THE WHOLE PACKAGE!!

[@safardebon9720]

The approach you are describing of going upstream will be slightly better but not fundamentally different, it is still about quality control, its just that the quality (in this case the quality of health outcome) is managed more upstream. But if we move to an idea of quaility circles, then this is a fundamental shift. This is what the Japanese did to improve product quality. With quality circles approach in health, you build health quality into the life and it starts at birth, and into the kindergarten. It is actually remarkably simple, eating whole plants as much as possible, not eating meat/dairy/fish/eggs, exercising everyday for 25 to 45 min and keeping a relaxed mindset - you are very unlikely to visit a doctor because you have built health into your life. Choose an appropriate vocation and home - all this can be achieved in a three to five years. All the best for bringing quality circles into your health

[@Luckygamester2]

This talk definitely supports some of the work going on in Camden that was featured in this documentary from a few years ago: www.pbs.org/wgbh/pages/frontline/doctor-hotspot/

[@lokynokey4822]

This guy overspoke. Basically his point is that USA needs more people in healthcare that try to find the cause of the problem by asking about patient's person life. I don't know about USA but in Europe doctors always go somewhere like this "Let me guess, you did this and you were there."

[@EcoHubIndia]

8.21

[@VectorShiftZero]

looking upstream is a start but if you really want to solve problems you need to look at the very source. people might be throwing kids in the stream but even further up, there is people dumping stuff in the stream that is making people downstream crazy. i have studied the very source of all problems and know how to solve healthcare, economics and the quality of life but to do anything i require the help from as many people as possible.

[@Raofin]

This guy is real life Dr. Gregory House!

[@RavenJay]

A real life Dr House without the attitude.

[@Nempty94]

Just ensure direct and honest correspondance between the department for public health(UK) and the NHS. If they both worked hand in hand, then the policies that come out of parliament would be more effective. If this already happens then this video is mearly reinforcing and showing support for something that does already happen.

[@amandajacobson2230]

yes this is common sense, but how often do people sit around the dining room table talking about this? It's important to raise awareness and open minds

[@josepaulloor6449]

Sounds like a good point. I need to have more of this thinking.

[@efortune357]

I think an Unconditional Basic Income would do a lot to alleviate the work and life conditions for most.

[@HumanOptimization]

It's nice to see doctors like him thinking about alternative methods outside of money making, body killing chemicals and drugs!

[@MikeTrieu]

If you're looking for better upstream data, why not source it directly from the patient in the form of a wearable environmental sensor platform? The patient could be assigned a lightweight device for a limited period of time that would sample air, water, radiation, noise levels, etc. and create a composite profile of their daily lives. I believe we're already beginning to see this in the form of networked smartwatches with built-in heart rate monitors and pedometers. There are also existing Open Hardware projects using cheap, readily available sensors that can be cobbled together on a modest budget. What valuable information might be gleaned from, say, a galvanic skin response sensor about stress levels throughout the day? People should be able to measure and take control of their own environment.

[@DarthStuticus]

why does this look like a tedx talk and not a real ted talk........

[@efortune357]

"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.

[@MrRishik123]

Hi my name is Rishi too.

[@hannabellelle]

Do you want a cookie?

[@MrRishik123]

No! That would be cannibalism! *gasp*

[@stanley3384]

uhhhh preventative treatment isn't old news, if this doctor only came to the realization of this concept now, then man he's pretty slow.

[@xapemanx]

neat

[@attackwail7620]

The closer you are to parks and trees the lower your chances of heart disease

[@nyaruko-do2ok]

Naturopathic doctor> Medical doctor

[@janetplace5536]

This is an important video, but none of this is new. This is public health--stopping injury and illness from starting in the first place. People are paying attention to this because Manchanda is a doctor, but he did note that the parable came from public health. Public health and health care are not the same thing. Health care falls under the public health umbrella.

[@letsliveallday4259]

EPIGENETICS!

[@kulik03]

Never gonna happen, the pharmaceutical business is way too important unfortunately.

[@MrZiemwit]

so the answer is ... not to go to free public hostpital but to very expensive clinic where for small fortune there will be a doctor who care :)

[@justcallmeassinine]

Gee poverty and brutal work have something to do with health ? DUH ? (nice well meaning speaker,hope he makes it into politics)

[@oliviawronski6387]

Great! Now if all Americans had PTO... and if those that had it could actually use it...

[@CarterColeisInfamous]

I disagree that its more important than genetics... but im bias #dnarules

[@rudyperez9940]

Pffft whatever xbox is still better than play station.

[@txvoltaire]

You mean sickness isn't caused by sin? I'm so shocked!

[@flemmons]

This really bugs me. Because it makes everyone else responsible for fixing the patient's life. The reason ZIP Code affects health more than genetics is because people in more affluent areas are more likely to take the actions necessary to fix a health problem. Cleaning your house will control mold better than any landlord can. And a clean house and a few dollars of roach control would solve 99% of the problems. Yes ,look up stream!l and teach people the health benefits of keeping A clean home.

[@Utsusemi]

how will you make money if all of your clients dont need you anymore? loleoleoeooolol

[@amandaleopold1687]

Why engage colourmeignorant...let him lean on the current healthcare system he so dearly loves, and God speed.

[@dustyrhoads1]

Can this be done without growing the welfare state and deputize doctors? ...I have a feeling that less gov't intrusion into our homes and daily lives will not be in the plans on this one.

[@3LinkTriforce]

This was kind of.... common sense. So this is just a plea for reformation of the system?

[@ParaditeRs]

If this was common sense, don't you think something might have changed a long while ago?

[@3LinkTriforce]

ParaditeRs Not really. He already said it himself in the talk that most of his colleagues already knew about the problems with the people's home/work environments (which I was referring to as 'common sense'). Even though most of them already know about this, it was still necessary for him to have a TED Talk about it. Things don't just change that easily, it seems once again.

[@3LinkTriforce]

***** Yeah, I know (and agree with) all the things you say. It's sad that it has to be like this. I had almost put something similar in my original comment, but deleted that part just before posting. I think the reason why I deleted that part was because I just wasn't in the mood for starting a real argument about 'ignorant people' and corruption and such xD

[@bruce7305]

"Common sense is not so common." - Voltaire

[@3LinkTriforce]

***** Ah ok, don't worry about it :3 It was probably for the best to add this insight to this conversation after all^^

[@arbitrarylib]

The medical field won't look upstream unless the dollars do.

[@klattalexis]

God's Kingdom is that solution. jw.org

[@Thegoodlol]

brainwashed

[@TristanMorrow]

"God's kingdom" is an upstream problem. Just thought someone should tell you.

[@klattalexis]

YourLife Nope! Not at all, as you will very soon find our, my friend.

[@klattalexis]

Tristan Morrow Actually it is bad news for for the wicked but good news for the righteous, it depends what side of the fence you are on, in regards to Universal Sovereignty, according to Revelation 21:3,4 & 8, (Bible)