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The urgent need to move upstream in caring for people with rheumatic and musculoskeletal diseases

Bouraoui, Aicha; Rutter, Megan; Williamson, Luke; Fisher, Corinne; Sofat, Reecha; Sen, Debajit


Aicha Bouraoui

Megan Rutter

Luke Williamson

Corinne Fisher

Reecha Sofat

Debajit Sen


Coronavirus disease 2019 has exposed the significant influence of social deprivation and racial disparity on health outcomes and the urgent need to move upstream for equitable, people-centred care.

The upstream–downstream public health parable describes downstream villagers living by the side of a river, who come to the rescue of those who fall into the water upstream (Fig. 1). The older villagers recall how difficult this was initially, with scarce resources available to them. Over the years, as the downstream heroes rescued more and more people, they invested in the system. They trained teams of swimmers, bought lifeboats and even built a hospital by the side of the river. In fact, they were so busy that they did not have the time to go upstream and understand why people were falling into the river in the first place [1].


Bouraoui, A., Rutter, M., Williamson, L., Fisher, C., Sofat, R., & Sen, D. (2022). The urgent need to move upstream in caring for people with rheumatic and musculoskeletal diseases. Rheumatology Advances in Practice, 6(3), Article rkac092.

Journal Article Type Editorial
Acceptance Date Jul 1, 2022
Online Publication Date Nov 7, 2022
Publication Date Nov 21, 2022
Deposit Date Sep 27, 2022
Publicly Available Date Nov 7, 2022
Journal Rheumatology Advances in Practice
Electronic ISSN 2514-1775
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 6
Issue 3
Article Number rkac092
Keywords Rheumatology
Public URL
Publisher URL


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