I come from a background in public health where the upstream parable is often used to discuss the importance of prevention. The parable goes something like this:
A medical professor and his student are walking together along a river. As they walk, they discover a drowning man. The student immediately jumps in to save him. Farther along, a woman is drowning. Again, the student jumps in while the medical professor stands and watches. They continue walking and encounter two more people drowning in the river. Once again, the student dives in to save the people, and he barely survives with his own life. The professor just continues walking along the river.
Exhausted and infuriated, the student confronts the professor and asks, "Why didn't you help me? Those people were dying, and I barely made it out alive!" The professor keeps walking and says, "I'm going upstream to see why all these people are falling in the river."
Soon enough, the professor and student come across a bridge. People need the bridge to get to their farmlands across the river, but they are falling into the river because the bridge is in poor condition. The professor sets to work repairing the bridge.
Last October, the HealthInsight Management Corporation Board of Directors, and the respective Boards in each state, voted on a series of True North Measures to guide the work of the organization. The boards selected high school graduation rates as a True North Measure. This is an example of an upstream measure as there is a clear association between educational attainment and future success and health status.