Faruqui Neha, Jegasothy Edward, Rodriguez Javier M, Abimbola Seye
School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
BMJ Glob Health. 2025 Sep 14;10(9):e019131. doi: 10.1136/bmjgh-2025-019131.
In this practice paper, we reflect on our practices, experiences and observations of teaching global and public health, with a focus on navigating the upstream-downstream tension. The concept of upstream determination of health encompasses how the social, structural and systemic drivers shape health and well-being. This paper discusses the challenges of foregrounding this concept in pedagogy through four key themes: (1) a lack of uniformity in integrating upstream concepts across disciplines related to health, and the ways in which it could be better integrated specifically into global health curricula; (2) helping students navigate the upstream-downstream tension by reflecting on why downstream solutions are more prevalent and how to better understand the structural responses, which are needed for achieving health equity; (3) why upstream thinking is hard to teach and learn, given that upstream determination can be complex, less familiar and abstract (we outline conceptual barriers and pedagogical challenges, common missteps and potential strategies to overcome them); (4) looking upstream in global health roles; how future graduates may consider ways to work upstream in their role as global health professionals, given that many job opportunities tend to focus downstream. This paper highlights the challenges of teaching upstream determination in global health, with a call to more uniformly integrate its concepts into curricula and offers potential strategies for teachers to meaningfully and collectively foreground such concepts within pedagogical delivery.
在这篇实践论文中，我们反思了在全球健康与公共卫生教学方面的实践、经验和观察结果，重点关注如何应对上游与下游之间的张力。健康的上游决定因素这一概念涵盖了社会、结构和系统驱动因素如何塑造健康与福祉。本文通过四个关键主题探讨了在教学中突出这一概念所面临的挑战：（1）在与健康相关的各学科中整合上游概念缺乏一致性，以及如何将其更好地具体融入全球健康课程；（2）通过反思为何下游解决方案更为普遍以及如何更好地理解实现健康公平所需的结构性应对措施，帮助学生应对上游与下游之间的张力；（3）鉴于上游决定因素可能复杂、不太为人熟悉且抽象，为何上游思维难以教授和学习（我们概述了概念障碍和教学挑战、常见失误以及克服这些问题的潜在策略）；（4）在全球健康角色中向上游看；考虑到许多就业机会往往集中在下游，未来的毕业生如何作为全球健康专业人员思考在其角色中向上游努力的方式。本文强调了在全球健康教学中教授上游决定因素所面临的挑战，呼吁将其概念更统一地融入课程，并为教师提供在教学过程中有意义地共同突出此类概念的潜在策略。
