Throw the Money Upstream: An Alternative Strategy to Improve Public Health

In 2004, almost $20 billion in health care philanthropy was directed toward “downstream” efforts that directly expanded access to care or improved quality of care. Although downstream investment is attractive because of its immediate and measurable impact, this approach has a lower return on investment than do “upstream” strategies, which focus on root causes. This article explores investment in the development of a health care workforce with core professional responsibilities of health advocacy, public leadership, and interprofessional collaboration as one such upstream strategy. By supporting students who are engaged in communities, funders can build health professionals who are able to fulfill core roles of service and advocacy and become meaningfully engaged in re-envisioning American health care.