What is the “upstream effect”? For that matter, what is an “upstreamist”? Dr. Rishi Manchanda is an upstreamist. (We checked Webster’s about that one. It’s not there.) He’s also chief medical officer at healthy snack producer, The Wonderful Company. The upstream effect is Dr. Manchanda’s approach to improving the quality of primary care: tackle social and environmental issues before they lead to health problems—before they reach a doctor’s door. Former lead physician for the Los Angeles VA Homeless Primary Care Program, Dr. Manchanda knows what happens outside the doctor’s office can impact what goes on inside. His goal is to make the upstream effect a component of the primary care routine. He’s also doing all he can to get the rest of us on board—including Webster’s.

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