By Mary Owen, Michael Westerhaus, Amy Finnegan, Laalitha Surapaneni, Winona LaDuke

Health-care workers often conceptualise addressing the social and structural determinants of health as working upstream.

In response to the racial disparities of the COVID-19 pandemic and theĀ Movement for Black Lives, health systems are acknowledging systemic racism, promoting implicit bias training, and screening for the social determinants of health. Although welcome, these changes will not achieve the social transformation necessary to eliminate health inequities. We must move even further upstream.

Water Protectors, working upstream on the Mississippi River in northern Minnesota, USA, provide a model of what this work entails.

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