A woman stands beside a river, watching as the current flows swiftly by. Suddenly she hears a desperate scream. Focussing her gaze in the direction of the sound, she notices a drowning man, slipping below the surface of the water. She jumps into the river, retrieves the unconscious body, and immediately begins trying to revive the man with artificial respiration.
As soon as the man is resuscitated, she notices another body floating in the water. Once again she jumps in for the rescue. Dragging the second victim to shore, she repeats the process, only to look up and see even more people struggling to stay afloat or passing by unconscious in the river. She must now work faster to keep up, even pushing herself to the brink of exhaustion. It does not take long, however, for her to recognize the vicious cycle of the situation: “I am so busy jumping in, pulling them to shore, applying artificial respiration, that I have no time to see who the hell is upstream pushing them all in.”1

This story is a common analogy in medicine, but it is also applicable in many arenas of life. As in healthcare, the most effective remedy to a problem is usually systemic prevention: it is far better to keep people from falling in the river in the first place than to deplete all available resources pulling them out. However, the fires of crisis tend to usurp our attention. As Charles Hummel noted, it is easy to become a slave to the “tyranny of the urgent.”2 Venturing upstream to address the root issues can easily be neglected due to the demands of the catastrophe immediately at hand. Urgent matters can be tyrannical: the more aggressively they usurp our energy, the less energy they leave us to deal with their underlying causations.

Balancing the demands of present calamities against the necessity of investigating upstream situations is a crucial discipline of leadership. It requires significant strategic focus to reallocate resources anywhere else when bodies are floating by right here. But remember, even the most urgent matters do not materialize out of thin air; they always come from somewhere.

  1. McKinlay, J.B. (1990). A case for refocusing upstream: the political economy of illness. In P. Conrad & R. Kern (eds). The Sociology of health and illness: Critical perspectives (3rd ed). New York: St Martin’s Press. p. 502 

  2. Hummel, Charles E. (1994[1967]). Tyranny of the Urgent. Madison, WI: Inter-Varisty Christian Fellowship. 

Cite this page:
Shelley, James. (2020). 'Upstream' (in System Thinker Notebook). Originally published on August 5, 2020. Accessed on September 29, 2020. Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Permalink:
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