{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T07:21:58Z","timestamp":1778052118338,"version":"3.51.4"},"reference-count":118,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2015,3,31]],"date-time":"2015-03-31T00:00:00Z","timestamp":1427760000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Educ Behav"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>Growing evidence shows that unequal distribution of wealth and power across race, class, and gender produces the differences in living conditions that are \u201cupstream\u201d drivers of health inequalities. Health educators and other public health professionals, however, still develop interventions that focus mainly on \u201cdownstream\u201d behavioral risks. Three factors explain the difficulty in translating this knowledge into practice. First, in their allegiance to the status quo, powerful elites often resist upstream policies and programs that redistribute wealth and power. Second, public health practice is often grounded in dominant biomedical and behavioral paradigms, and health departments also face legal and political limits on expanding their scope of activities. Finally, the evidence for the impact of upstream interventions is limited, in part because methodologies for evaluating upstream interventions are less developed. To illustrate strategies to overcome these obstacles, we profile recent campaigns in the United States to enact living wages, prevent mortgage foreclosures, and reduce exposure to air pollution. We then examine how health educators working in state and local health departments can transform their practice to contribute to campaigns that reallocate the wealth and power that shape the living conditions that determine health and health inequalities. We also consider health educators\u2019 role in producing the evidence that can guide transformative expansion of upstream interventions to reduce health inequalities.<\/jats:p>","DOI":"10.1177\/1090198114568304","type":"journal-article","created":{"date-parts":[[2015,3,31]],"date-time":"2015-03-31T23:22:40Z","timestamp":1427844160000},"page":"46S-56S","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":51,"title":["New Approaches for Moving Upstream"],"prefix":"10.1177","volume":"42","author":[{"given":"Nicholas","family":"Freudenberg","sequence":"first","affiliation":[{"name":"City University of New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Franzosa","sequence":"additional","affiliation":[{"name":"City University of New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janice","family":"Chisholm","sequence":"additional","affiliation":[{"name":"City University of New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Libman","sequence":"additional","affiliation":[{"name":"City University of New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,3,31]]},"reference":[{"key":"bibr1-1090198114568304","doi-asserted-by":"publisher","DOI":"10.1016\/j.jue.2005.04.002"},{"key":"bibr2-1090198114568304","volume-title":"The New Jim Crow: Mass incarceration in the age of colorblindness","author":"Alexander M.","year":"2012"},{"key":"bibr3-1090198114568304","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.22174"},{"key":"bibr4-1090198114568304","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-62"},{"key":"bibr5-1090198114568304","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwt090"},{"key":"bibr6-1090198114568304","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000087"},{"key":"bibr7-1090198114568304","volume-title":"State of the health equity movement 2011 update","author":"Bezold C.","year":"2011"},{"key":"bibr8-1090198114568304","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.1303"},{"key":"bibr9-1090198114568304","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.91.9.1398"},{"key":"bibr10-1090198114568304","volume-title":"Working and poor: How economic and policy changes are affecting low-wage workers","author":"Blank R.","year":"2008"},{"key":"bibr11-1090198114568304","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-005-9007-4"},{"key":"bibr12-1090198114568304","volume-title":"Equity, social determinants and public health programmes","author":"Blas K. 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