The Jordan Harbinger Show - 350: Dan Heath | Solving Problems from Upstream

Episode Date: May 12, 2020

Dan Heath is a Senior Fellow at Duke University's CASE center, which supports entrepreneurs who are fighting for social good. He is the co-author of four New York Times bestsellers, and his latest book is Upstream: The Quest to Solve Problems Before They Happen. What We Discuss with Dan Heath: How many problems in our lives and in society are we tolerating simply because we’ve forgotten that we can fix them? Why are we more often stuck in a cycle of response downstream of problems rather than upstream where we might prevent them from happening in the first place? What lessons can we learn about upstream versus downstream thinking by examining our current pandemic crisis? What the federal response to Hurricane Katrina tells us about an ounce of prevention being worth a pound of cure. Upstream versus downstream thinking regarding the healthcare debate in the US. And much more... Full show notes and resources can be found here: https://jordanharbinger.com/350 Sign up for Six-Minute Networking -- our free networking and relationship development mini course -- at jordanharbinger.com/course! Like this show? Please leave us a review here -- even one sentence helps! Consider including your Twitter handle so we can thank you personally!See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Welcome to the show. I'm Jordan Harbinger. As always, I'm here with producer Jason DeFilippo. On the Jordan Harbinger show, we decode the stories, secrets, and skills of the world's most brilliant people and turn their wisdom into practical advice that you can use to impact your own life and those around you. We want to help you see the matrix when it comes to how these amazing people think and behave. We want you to become a better thinker. If you're new to the show, we've got episodes with spies and CEOs, athletes and authors, thinkers and performers, as well as toolboxes for skills like negotiation. body language, persuasion, and more. So, if you're smart, you like to learn and improve, you're going to be right at home here with us. Dan Heath joins us on the show today once again. This time, we'll dissect the concept of upstream thinking. Now, this might seem obvious to many of us,

but spotting and solving problems before they happen, otherwise known as prevention, is almost always the best solution. There's a reason for the cliche that an ounce of prevention is worth a pound of cure. But if that's the case, why aren't we doing more to encourage this? Today, Dan and I discuss many of the reasons for this, as well as the ways in which we can foster

upstream thinking in our own lives or our own companies or our own families and increase our skill set when it comes to spotting problems before they arise. If you want to know how I got this great guest roster, well, it's all about my network and my relationships and I manage my relationships and my network using systems. I don't have to remember stuff. I don't have to spend 20 minutes a day doing it. I'm teaching you how to do this for free and not like enter your credit card free, just free free over at Jordan Harbinger.com slash course. By the way, most of the guests on the show

actually subscribe to the course and the newsletter. So come join us. You'll be in smart company where you belong. Now, here's Dan Heath. Dan, thanks for coming on the show, man. I appreciate it. Thank you, Jordan. Now, this book with the concept of upstream is brilliant and yet so simple, but that's always where the best ideas come from, right? It's like, how did no one think of this? Oh, right, that's kind of the point, is it's a simple idea that might be trickier to implement and practice. You know, it struck me when I first heard this word upstream, probably 11 years ago. I first heard it in the context of this parable that I share in the book that goes like this. You and a friend are having a picnic by the side of a river. And just as you're kind of sitting down to have your

lunch, you hear a shout and you look back in the direction of the river and there's a kid thrashing around, apparently drowning. And so you and your friend instinctively dive in the river. You save the kid. You bring him to shore. And just as your starting to relax a bit, you hear a second shout. You look back, it's another kid. And so back in you go, you rescue that kid, you fish them out. Then there's two more kids. And so begins this kind of revolving door where you're in, you're out, rescuing kids one after the other. And right about that time, your friend swims to shore and steps out and starts walking away, you know, looking as if you're about to get left alone. You say, hey, where are you going? I can't save all these kids by myself.

and your friend says, I'm going upstream to tackle the guy who's throwing all these kids in the river. And I remember that parable, which is pretty well known in the realm of public health, it contains essentially the moral of this book, which is that again and again in different sectors of the economy, in our personal lives, in our work, we get stuck in this cycle of reacting to things. You know, we're always dealing with emergencies, we're responding to fires that break out, but we're never getting upstream to deal with the systemic issues that beget these problems that we spend all of our times chasing. And so that was the original seed of that word upstream. Upstream concept makes sense, but downstream work is rewarded more. It's more tangible. And this is a

problem you bring up in the book as well. It's really hard to prove that prevention is actually effective. And we can get into a little bit more detail on that in a bit. But how do we prove what did not happen is kind of the big question about upstream, what do you call them, interventions or problem solving. It's really hard to get people on board because you have to prove that that effort is what resulted in something not happening. Exactly right. And in fact, this revelation was shared with me by a deputy chief of police years ago. And he had this thought experiment that I thought captured this issue so well. He said, imagine two different police officers who go downtown during the morning commute when things are crazy. And one of them stations herself at a really busy intersection

where cars are always rushing through. There's a lot of accidents. And just by making her presence visible, she makes people kind of slow down, get more cautious, and we avoid accidents. So that's Officer 1. And then Officer 2 goes to a different part of downtown where there is a prohibited right turn signal. And she hides around the corner. And when drivers try to sneakily make that right turn, she jumps out, pulls them over, gives them a ticket. And the deputy chief said, which of these officers is doing more to protect public safety? And he said, for sure, it's the first officer. But if you ask which of these officers is getting rewarded, which of them is getting promoted, which of them is getting praised, it's the second one. Because she comes back with this stack full of tickets. That's the evidence of her work. That's the downstream work. You wait until the problem happens and then you do something about it. And when that's the case, it's very tangible. You know, when there's a child drowning in the river and you rescue them, you're a hero. And the evidence of your heroism is right in front of you. But if you think about that other officer who hung out at the busy intersection, how does she prove she did anything?

There was somebody going to work that morning who, in an alternate reality where she wasn't there, would have been in an accident. They would have gone to the hospital. They don't know that, nor does the officer know who she helped. So there is an answer to this, and the answer is data. You know, so we could collect such careful data at this intersection that hopefully we could track the number of accidents before police intervention, the number afterwards. And if we're lucky, we'd make enough of a difference where we could see a downtick in the data.

But notice that even in that scenario, all we're really seeing change is there's a spreadsheet somewhere where some numbers went down, as a result of our action. We still don't know who we helped. We still can't point to any specific individuals. And this is something that's characteristic of a lot of upstream work is it can be kind of maddeningly ambiguous. It's like even when we know we're doing amazing things, we still can't track it all the way through to the human beings who were helped. The burglary example is interesting. In crime prevention, it completely makes sense. Also in diseases, we did a show a few weeks back with Dennis Carroll, who is an expert on influenza, and he mentioned that the best way to

get ahead of a pandemic, and this is, it's interesting because we released this, I think, in February, which if you're listening to this in a few years, this is February 2020, so this is right before COVID-19 decimated the rest of the world here. So he said, what we need to be doing is preventing diseases upstream. He even used that term. He said, in the animals before they spread to humans, Because by the time things spread to humans, it's too late to mitigate a lot of the damage, especially novel viruses that do a lot of damage are highly infectious. He even said recently that we almost got lucky with COVID because it's not as deadly as something like a novel strain of influenza would be or a novel strain of some other type

of disease could be to humans. Things could be even more infectious, more fatal. And so preventing these in the animals before they spread to humans is the key. but the problem is nobody wants to spend a billion dollars testing ducks, you know, in finding out if ducks have some new flu, or ducks, geese, whatever it is. But the problem is they fly all over the world, maybe not ducks, but geese, they fly all over the world, they poop everywhere, those molecules and those kind of bacteria viruses are being consumed and spreading to other animals all over the world, all over North America

anyway, because of migration patterns. But nobody wants to say, hey, you know what, we need to fund the heck out of these researchers who are looking for novel diseases and birds because it could get to humans. Even if, let's say they found COVID before, nobody would be like, thank God, you know what that disease would have done? Because someone would have gone, yeah, we never would have gotten that. Or we would have gotten it in a few people and, you know, they would have either been quarantined or isolated or we'd have come up with some sort of treatment.

It would have been fine. Nobody would really know about this. Well, it's almost like we have to learn our lesson the hard way, but then we don't learn that lesson and then go, well, you know what? We need prevention now. That doesn't seem to be happening. And the particularly frustrating thing about COVID is we've had some dry runs in recent years. I mean, just in very recent history.

SARS and MERS. Exactly right. Ebola outbreak. I mean, you would think there would be some red flags in a lot of places. And I should say, to be fair to the public health community, they were saying exactly what we should do. I mean, the frustrating thing about this epidemic is there's a lot of problems in life that are unexpected and unforeseen and were left where we have no choice but to react. And then there are other problems that are perhaps low probability, but imminently foreseeable,

exactly like this pandemic. It might have come in two more years or 20 more years, but virtually everybody who's looked at pandemic says there's a big one coming. And it wasn't a mystery what we needed to do to prepare. But the thing that happens is when you're dealing with something that might happen, it always seems to get squeezed out and pushed aside by something that is happening at the moment, even if it's of lesser significance. You know, it's like the old Stephen Covey thing about the urgent versus the important. The urgent always drives out the important. And so our policy makers

and the people who have the purse strings that could have been investing in the sort of public health infrastructure we needed to be effective in fighting this, it's like one decoy after another, one red herring after another where we're chasing the emergency of the day and we're neglecting the thing that could well be, you know, a civilization threatening event. You mentioned in the book that you never run out of room upstream, and this is kind of subtly brilliant, because right now, using COVID as an example, we're stuck trying to figure out how we can rush a vaccine through faster than any vaccine in human history, right, that could have tons of side effects or other problems with it. In the meantime, hundreds of thousands of people, and that's

if we're lucky, only hundreds of thousands of people are going to die from this or be severely, severely injured for the rest of their lives. And we have a very small window for this to not get even more out of control. And even then, there's no guarantees. But upstream, you can kind of go back as far as you want. Can you give us a little bit of an example on this? You gave an example with crime. Tell us how we never run out of room upstream. I think this is a great point for people to assimilate here. Yeah. So the example that I shared in the book is a true example of my parents' home was burglarized a few years ago. They were out for a walk in the neighborhood. And while they were out, A couple of burglars kicked in, their backdoor came in, stole a couple of iPhones and some jewelry and some cash, and then left, and they were never caught by the police.

So that's a situation where you've got a failure of downstream response. The problem happened, and it wasn't addressed and it wasn't punished. If you start thinking upstream, what you'll notice is upstream is not like a destination. Like we've got to get upstream. It's more like a direction. And so you could think in terms of seconds upstream. Like imagine that at the moment they kicked in the back door, there was some just ear-splitting alarm that went off. Maybe that would have been enough to deter them.

You could imagine hours before if they had noticed there were a lot of police cars kind of patrolling the neighborhood. Maybe they would have thought better of what they were doing. If you think in terms of months before, maybe these were repeat offenders. Maybe they'd already actually clocked some time in jail for burglary. And if so, there have been some experiments showing that, Certain kinds of behavioral therapy can stop the cycle of recidivism and actually, you know, get people back on the straight and narrow. So maybe had one of these burglars or both of them, you know, been involved with that, maybe they would have changed their trajectory. And then you can keep going back and back and back to years before, even decades before.

So, you know, could you imagine an intervention decades before this break-in at my parents' house that would have prevented it? And the answer is yes. there's a guy named Richard Trimbley, who's a sociologist that studied aggression in young kids, especially boys. And what he's done over the course of his career is he's essentially gone further and further upstream. He started his career working with people in prisons. And then he started studying teenagers. And then he started studying elementary school kids where you're already starting to see the early signs of aggression that later manifest as criminal activity. And Trimbley now has convinced himself that the best time to prevent future aggressive activity is when the future,

quote unquote, criminal is in his mother's womb, that there are a lot of factors as early as during a pregnancy that correlate with aggression downstream, factors like maternal depression and poverty, substance abuse, and other kinds of deprivation, all of which are changeable, right? And some of his studies he's got going on now, the question is, if we support at-risk first-time young mothers, if we build some cushion around them, if we help them, you know, can we forestall some of these downstream consequences? And so that to me is the significance of why I love this term upstream so much better than other terms that are used a lot like preventive or proactive, because I think it helps us stretch our thinking that there are ways to

prevent something seconds before it happens and there are ways to prevent something decades before it happens. It's not that one is always better than the other. It's just a way of reminding ourselves. We have a lot more options and a lot more agency than perhaps is obvious. We move mountains to clean up after hurricanes, well, at least in the first world. It's tsunamis and hurricanes, but we do virtually nothing to prevent disasters even when we are able to do so. And I know hurricanes is kind of a rough example because it's hard to prevent hurricanes outside of extreme geoengineering. But I find it interesting that we will dedicate billions or even, I guess in the case of COVID-19, trillions of dollars to cleaning up after something when preventing it would have been a fraction of a percent of the cost.

Like I think we can all kind of agree right now that testing animals for novel viruses and making sure that people in our countries are not eating them or they're not being congregated in certain places or that when we find these types of viruses, we actually might even figure out a vaccine. for the animals and stamp it out there, that would have cost potentially hundreds of millions, if not billions of dollars, which is about one, maybe less than 1% of what it's costing just in the United States and economic damages. And you see these kind of just gross separations between the investments we avoided and the consequences of not making those investments again and again, even outside of pandemics. Like in the book, I talk about the preparation for Hurricane Katrina. and I learned something I had never learned, you know, kind of living through Katrina in the news and as we all did, having that moment of national disgrace when we saw how things were handled so poorly. But I learned something that changed my mind a little bit. So about a year before Katrina happened, there was exactly the kind of upstream preparation that we would have wished for. FEMA, working with an outside contractor, created a simulation of a major catastrophic hurricane hitting New Orleans. This was something that was on.

everybody's radar. It's just like the pandemic situation where people have been warning for years, pandemic is going to hit. It may well be a coronavirus. They were saying the same thing about New Orleans. One of the worst things that could happen because of New Orleans geography is if a major hurricane hit there. So they did something about it. They created this simulation called Hurricane Pam in New Orleans. They brought together all of the relevant players, the local state agencies, the state, the federal. They had the police force there. They had public health people. They had government people. they had private citizens, and they were all working together under this simulation of this fictitious Hurricane Pam that turned out to be eerily similar to the real Hurricane Katrina the hit. And so this was kind of a marvel of upstream work. And so the obvious question is, well, what the hell? If they were practicing this hurricane a year prior, why was it so awful when Katrina hit? And part of the answer is this. This Hurricane Pam simulation was envisioned as the first in a bunch of preparations. And according to some reporters who were working on a book at the time, FEMA said no to

travel expenses that amounted to about $15,000. And of course, when the real Katrina hit a year later, the rebuilding in the Gulf Coast area costs more than $62 billion. So we penny pinch when it comes to $15,000 in travel costs. And then, you know, when the hurricane hits, we think nothing of spending 62 billion to rebuild. And you see this kind of crazy disjunction again and again where the old saying is an ounce of prevention is worth a pound of cure. But we don't live that way. And it's a lot worse than that. It's like an ounce of prevention is often worth a ton of cure. 15,000 to 62 billion is many, many, many orders of magnitude. And yet we said no to that. You're listening to the Jordan Harbinger show. We'll be right back. Thanks for listening and supporting the show. And to learn

more and get links to all the great discounts you just heard from our amazing sponsors, visit Jordan Harbinger.com slash deals. Don't forget, we have a worksheet for today's episode so you can make sure you solidify your understanding of the key takeaways. That link is in the show notes at Jordan Harbinger.com slash podcast. If you'd like some tips on how to subscribe to the show, just go to Jordan Harbinger.com.com slash subscribe. Subscribing to the show is absolutely free. It just means that you get all of the latest episodes downloaded automatically to your podcast player so you don't miss a single thing. And now back to the show. Healthcare in the USA is another example here.

We're really probably the best in the world at treating ailments. I mean, you hear about people flying in from all corners of the world to, in fact, you hear about when there's controversy, like some crazy dictator or something is flying to the United States to get treatment for cancer or something along those lines or somebody in a royal family somewhere flies to us and you think, what the heck? This is a person has tens of billions of dollars and they're flying all the way here to get treated for something. I guess that you really can't do better anywhere else.

So we're the best at treating ailments, but we're really, really bad at preventing them. And you just need only look around at the leading causes of death in the United States, things like obesity that are completely preventable. Why doesn't the United States just do what countries like Norway do? What's going on here? And tell us what Norway does, because I just blew that intro there, that lead. Yeah, so what's interesting about health care spending in the U.S. is we always hear that health care is more expensive in the U.S.

That's what we kind of know from the media. And that's certainly true, by the way. If you just look at healthcare spending per capita, we are far and away, the outlier. But it's actually a more interesting and nuanced story than that. So if you were to distinguish downstream health care spending, so that's you get sick, you have a disease, you break a leg, you've got to go get treated, you know, downstream is after the problem has happened. If you think of that as a bucket of spending, and then if you think about upstream health care as a different bucket of spending, where upstream health care is about making you a healthy person. And so that might be everything from, you know, ensuring you've got clean air to giving you adequate transportation and parks to play in,

giving you a good education, you know, all these things that are a little bit distant from your health, but that make you a healthier person and that reduce your stress and reduce downstream consequences. So if you think of those two buckets, the average ratio of upstream health spending to downstream health spending in developed countries. It's about two or three dollars spent upstream for every dollar spent downstream. So most nations spend a lot more upstream. The U.S. is the outlier. We spend about one to one.

And so the consequences of that are predictable. Number one, if you've got something like heart disease or cancer or some major ailment, we have some of the best specialists in the world. And as you said, that's why we've got Saudi princes flying to Houston in Boston to get their health care because we excel at downstream spending, especially as some of the most complicated and serious disorders. But if you ask, where would you be most likely to raise healthy children? I mean, the U.S. really isn't even on the map.

And yet many of these choices are just that. They're choices. It's not like there's some law of nature that says we have to prioritize downstream over upstream. And in talking to health care leaders, even people within the system, I think are starting to wake up to this and realize that this is unsustainable. You know, we can't just have a system that only kicks into action when someone already has a chronic disease like asthma or diabetes. And sometimes there's just outright absurdities. Like I talked to a guy named Patrick Conway,

who used to be the administrator of CMS, which is Medicare and Medicaid, he told me, you know, we won't think anything of spending $40,000 a year for the price of insulin, but we'll balk at paying $1,000 to try to prevent someone from getting diabetes. And those are the kind of trade-offs, I think we've got to get a lot smarter about. And just as a little ray of hope here, I think that a lot of the incentives that were baked into the Affordable Care Act actually nudge us a little bit in that direction. Like, there are starting to be ways that doctors and health systems are incentivized to try to keep people from developing ailments rather than simply treating them once they happen. Now, who's going to pay for all the things that don't happen?

Actually, the better question is probably, how do we decide who's going to pay for all the things that don't happen? Because look, health care, we're thinking, well, of course, maybe that's on you. Maybe you have to pay for that, or maybe there are government programs or something like that. But when it comes to some more complicated issues, maybe disaster preparation, well, okay, do we have the health care system pay for that? Because disasters, they have people who get injured. Well, or is this, no, no, look, we got to have the people who construct levies in these areas. They're the ones who have to pay for that. that's a county level. Well, wait a minute, it's going to disproportionately affect certain cities.

Should those cities then pay more for that? Or if we're talking about educational issues, is it the school system that pays for that? Or do we have to take our own destiny into our own hands here in certain ways? How do we decide where to allocate those? Because obviously, multiple parties have, there's multiple shareholders in this, right? It's not just about you being more healthy. Sure, in an ideal world, we would all take care of our own health care, maybe, or it would all just be handled by the government, depending on what your politics are on this issue. But the truth is there's a stakeholder

just about everywhere, right? Because the education system suffers if somebody's absent all the time. The economy suffers if somebody can't work. But you suffer if you're unhealthy. Like how do we divide those costs and then split them up? Yeah, it's an incredibly complicated issue.

And I think we can capture all this under the umbrella question, who will pay for what does not happen? Right. The essence of prevention. I want to say, first of all, that it's not like this is some unanswerable question. People answer this question all the time. And in fact, all of us that have ever gotten an oil change on our car, we've answered that question, right? You get an oil change, not for any instant payoff, but because you're willing to pay 60 bucks today to prevent, you know, a breakdown down the road. That's classic upstream thinking. What you notice, though, is it starts to get very, very complicated in especially like the social domain. One example I give in the book is about there's this program. called the Nurse Family Partnership. I mean, it's an excellent program that is designed to match at-risk first-time moms, kind of like that Richard Trimbley stuff I was talking about earlier.

Like, could we protect at-risk mothers to avoid downstream consequences? This program is designed just for that. So if you're, you know, a 17-year-old first-time mom, low-income, single, first baby, they'll match a nurse with you to kind of show you the ropes. And this program has proven again and again, just astonishing results and things ranging from maternal health to child safety to reducing mother smoking, reducing infant mortality, and on and on. One study estimated that for every dollar we spend as a society on NFP will earn about $6.50 return, which is no matter how hardcore of a finance person you are, that's a good return. We'll take that. And yet, it's really hard to get this program funded. And the reason is, because if you look at where that $6.50 return

comes from, it's complicated, right? So if you reduce preterm births, that's going to save money for Medicaid, which would have paid for the more intensive care that was needed for those babies, had they been born preterm. And if you reduce criminal offenses downstream, well, that's going to save money in the justice system. And if you reduce SNAP payments, which is one of the outcomes of the program, that's going to save money for the federal agriculture department, which is what fund SNAP or what used to be called food stamps. And so the point is that if you find someone, Let's say you found like a local health system to pay for NFP. They would have to pay the upfront money, which is about $10,000 per woman served.

But then you start to see these returns accruing to lots of different accounts, some to the criminal justice system, some to the agriculture department, some to Medicaid, some to the health system. And it's what's called the wrong pocket problem. And that's to say that the person footing the bill for NFP is only receiving a trickle of the returns and the returns are splintered out across a number of different parties. So like when you pay for the oil chains for your car, there's one pocket. You pay the 60 bucks for the oil chains and you recoup the downstream savings from having a more functional vehicle.

But in things like this nurse family partnership, it's much, much more complicated. Now, I will say everywhere there's a complicated problem, there's probably also a complicated solution. And so there are solutions to these things, including in the healthcare system. Like these days, there are a lot of health systems they're using what's called the integrated model like Kaiser Permanente in California, where probably where you live where you're listening to this if you're in the U.S., you're in a fee-for-service area where people get paid when you get sick and come in for help. So the cash register doesn't ring until something goes wrong and you go to the doctor. But with Kaiser Permanente, it's very different. They get paid based on the number of patients in their network. They just get a flat fee per year, whether or not you come to the doctor or not, which kind of

flips the incentives, right? Because all of a sudden, what they want to do is keep you healthy, because the less treatment they have to provide to you, the more profitable it is. And so you're starting to see experiments like that where we're trying to figure out as a society, how do you align pockets? You know, how do you avoid the wrong pocket problem and figure out ways to give people incentives to do upstream work rather than downstream? and where we're still very, very early in this.

I mean, it's the first ending of this kind of work, but it's just fascinating to see it changing. We see this work when there's one big stakeholder, right? Like, you had some pretty interesting sports science about re-injury prevention and the NBA. You want to take us through that? Because it's like if the benefit is clear enough, the profit motive is there,

the power center can be located with the incentives aligned, then we can easily take action upstream. This would be like hurting cats with the government in many ways, but with the NBA, they're doing almost like science fiction level injury analysis and re-injury prevention analysis. This is a fascinating story about a guy named Marcus Elliott. So his backstory was he's an MD that decided to get into sports training, which is not a very common path. But he joined the New England Patriots back in 1999, and he had been asked to join.

The Patriots had a rash of hamstring injuries to key players, and it had just kind of thrown the team for a loop. And so they brought in Elliott. He had a very different perspective on injuries than most trainers at the time. So the general mindset, I would say, in that era was football is a tough game. It's a violent game. People are going to get hurt. That's just the way it is. And so there was a kind of fatalism about it.

Well, you had some hamstring injuries. That's just the luck of the draw. But Elliott thought that most injuries were actually the result of poor or improper training. that a lot of times what triggers a hamstring injury is muscle imbalances or over-strengthening the wrong muscle groups. And so when he came in, he took positions that were particularly prone to hamstring injuries like wide receivers. And he would do almost like a muscle strength inventory top to bottom just to figure out kind of what your condition was and look for things like an imbalance and strength between your left and right hamstring, which is a warning flag for injury. And he would triage and, you know, kind of group the wide receivers in highest risk for injury, moderate risk for injury, and low risk.

And for the high risk, he would do this intensive, you know, one-off training program for each receiver, totally different depending on their specific needs. As a result of this work that he does, the Patriots go from having 22 hamstring injuries the year before he arrives to three afterwards. And that makes believers of people. And this is an example of something that I call problem blindness, which is to say it's really hard to solve or prevent a problem if people don't see it as a problem or code it as a problem. So like that attitude in the NFL that, well, it's a violent game. People are going to get hurt. That's problem blindness. And when we have problem blindness, it kind of makes the possibility of a solution more remote because we're not even seeing that we're encountering something that is subject to change.

And then somebody like Marcus Elliott comes in, he sees through the problem blindness and he shows us, hey, this is fixable. We do have influence here. We can make a difference. And these days, Marcus Elliott has his own sports training agency. It's called a P3. You should check this out online if you like this kind of stuff. Just Google Marcus Elliott and P3. And there's some videos there that will blow your mind where it's almost like an MRI for like professional athletes where they'll do this. super sophisticated video analysis of like the way someone jumps and the way that they land and the way that they pivot. And they can detect things at the early stage that are fixable that could lead to really bad, even career-ending injuries down the road. You know, Marcus Elliott was telling me that there are certain kinds of rotation in the knee that they see that's highly associated with knee injuries. And so when they catch that early, they can kind of retrain the athlete. Okay, you see when you land, you're doing this thing that's causing this torque that's not healthy, we need to kind of rewire the way that you land after a rebound or whatever. And so that's a classic

example, right, of how you can come into a situation where the reactions are always downstream. You know, your athlete gets injured. You want to get the best trainers. You want to get the best recovery to get them back up to speed. But a lot of those things that you were treating as emergencies to be solved could have been prevented with the right work. Problem blindness, this seems like it's everywhere. How do we then reverse this. You gave the example of racism, actually, in the book, which I thought was an interesting example. The point I'm making in the book is that we habituate to our environments for better or worse. And so problem blindness, you know, in the case of the NFL, you know, we were dealing

with professional athletes who were accustomed to the risk of injury. You know, everybody was an adult kind of knowing what they were getting into. In other situations that we can habituate to things that are terrible. Like, I just, some research on sexual harassment in the workplace in the 60s and 70s. And not to suggest we've solved sexual harassment today, there's still plenty of it in the workplace. But it was normalized to such an extent that there were some observers at the time who actually kind of encourage women to just roll with it. Jeez. I want to read you this quote. This is from Helen Gurley Brown, who was the editor of Cosmopolitan magazine for a lot of years. I could not believe that this was a real

quote somebody wrote down. This is from 1964. A married. man usually likes attractive, approving females around him whom he may or may not think of as sex objects. You'll never get me to say this is wrong. He may not be planning to bag you for his collection, but only trying to ascertain your basic attitude toward men. One little Miss Priss who thinks hemlock is preferable to sin, even when it isn't her sin, can spoil a man's pleasure in his work. An attractive girl textile executive says, I'd rather have a man making a good healthy pass at me anytime rather than having him cutting my work to ribbons. Oh, wow. It's like she's got sexual Stockholm syndrome, you know what I mean? And so that's an

example of how problem blindness can seep in and really become a destructive force where the problem is so ubiquitous that we kind of lose the ability to see it. And one of the things that's kind of stuck in my brain like, what do you call it when a song is stuck in your head, an earworm? This is like an idea worm or something. But I can. keep thinking, like, what is it that we're living with in this era that 50 years from now, people will just mock us for being such idiots, you know, the way that I just did with this quote. And I think we probably got some guesses because there's a lot of stuff in the news every day. But chances are there's a lot of stuff that we're blind to that it's going to take the next

generation to kind of shake us by the collar and say, hey, you really messed that up. Another problem we run into here is we impose sanctions or maybe we should say requirements on upstream interventions that would never apply to downstream interventions. So someone eating terribly is going to get bypass surgery. But if they want to go to the gym and get a trainer to help any of this, they would never cover, like, we're not going to pay for your trainer. That's ridiculous. Go to the gym, your damn self and stop eating so much. And then 20 years later, the guy's getting quadruple bypass surgery and it's costing hundreds of thousands of dollars. And then he's out of work. You know, he's on disability for the rest of his life or something like that. That is 10 to 100 times the

cost of hiring a personal trainer for the two decades prior, right, and a nutritionist, I would imagine. Absolutely right. And in fact, it's kind of become this perverse thing where we're used to evaluating prevention in terms of cost savings. And I think I know how this much have happened. Like, if you're trying to get a program funded, like there's something called the Diabetes Prevention Program that has been proven successful in taking people who are what's called pre-diabetic, kind of at the cusp of diabetes, and putting them through this lifestyle program that actually prevents them from developing diabetes. I mean, it's amazing that we have a program that has been proven to do that, and yet it's like pulling teeth to get it funded. And so if you've got

a program like that and you're trying to build allies and you're trying to attract support, one of the most powerful arguments you can make is, hey, not only is it going to keep people healthier, it's going to save money. So I think what was originally just like a sales tool, like, I'm going to add that to my PowerPoint presentation that, you know, it saves us money, and that's another good factor. It's almost become a requirement these days where a lot of people judge prevention programs based on the requirement that they save money. And what I'm saying is that is lunacy. The reason why we should be preventing asthma and preventing pandemics and preventing even smaller problems like customer dissatisfaction is not necessarily because it saves

it money, but just because it's the right thing to do. And like in the example you gave of the quadruple bypass, there's nobody in the health system. When that guy comes wheeling in to the ER, There's nobody who's going to take a moment and say, all right, if we do this bypass, is it going to save us money in the long run for this guy's care? I mean, obviously, he's just going to get the bypass because he needs the bypass. But all of a sudden, when we start talking about like a program to provide food to poor children, all these economists roll out of the woodwork saying, well, is it going to save us money? What if we just thought about the payoff of providing food to hungry children? So anyway, that's my little rant on this absurdity that's come out in upstream work. It's not that I think it's irrelevant.

Obviously, we would love for all prevention programs to save money. That's a wonderful thing. We should always care about cost-benefit analysis. The point is just it shouldn't be a constraint. There's no law that says for a prevention program to be worth doing, it has to save us some coin. You're listening to The Jordan Harbinger Show. We'll be right back after this. Thank you for listening and supporting the show.

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Yeah, that's a good point. We can also take into consideration the idea that it might save lives, which might be kind of important too. Depends on our goals as a country. And we've solved big problems like this before, right? We put fluoride in the water to help build healthy teeth. So it's not like this is something that's novel to society where we start thinking about preventing things. You know, this happens all the time. It's just that we seem to apply it selectively in ways that don't totally make sense.

Yeah. In fact, if you want to send a thank you letter to someone, send it to public health officials. Here's a stunning statistic. In 1900, the average life expectancy for a child born in America was 47.3 years. And by 2000, the last month. life expectancy was 76.8 years. We basically bought an extra 30 years of life. I've done a bunch of stuff in my life that I'm proud of, and I suspect everyone listening has too, but none of us have extended human life expectancy by 30 years. I mean, talk about a massive achievement. And if you

look under the hood at what exactly caused that, what you see again and again and again is successful public health efforts, things like better hygiene, why. water systems, vaccines, you know, better care for pregnant mothers and on and on and on. And it's like you can track a lot of that success back to upstream interventions to make people healthier and to prevent bad things from happening. So to your point, we have a huge track record of successful upstream interventions. I think sometimes we just allow ourselves to be distracted by the problems of the day and we forget our own success. At some point, technology, will bring the cost of a lot of these things way down.

Maybe not in humans as much right away, but you give the example of elevators and other cool kind of internet of things, devices that will measure tiny changes to predict maintenance. Give us the elevator spiel, because this was, the elevator example, I should say, versus the elevator pitch, because it really does sound like

it's a stroke of genius that probably isn't that hard to implement. This kind of blew my mind. I mean, I'm geeky enough to appreciate this, But most major elevator companies these days have what they call smart elevators, where there's a bunch of data that's being collected just about the normal usage of the elevator, their noise, their speed, their temperature, and things like that. They're getting beam to the cloud, invisible to you, you know, just writing to get to the fourth floor. And based on past data, they've started to be able to draw conclusions from certain diagnostics. like, you know, I quote this one guy who said, normally it takes a certain amount of time for the doors to close.

Maybe it's five seconds. And then over time, you start to see, oh, it's ticking up to 5.1 seconds and then 5.2. And nobody that's riding the elevator would ever in a million years notice that. But what that might tell you if you're an elevator expert is something's kind of getting gumbed up. And it's slowing down. You need to get in there and lubricate the system. And that way, you can show up and just, you know, add some lube to the elevator. doors, which is a trivial maintenance thing, and not wait until six months down the road when the doors don't open and passengers are stuck and it's on the local news. And that's a good example of the kind of thing that's going to become easier and easier with technology is we'll be able

to deploy these sensors that give us information that can then be analyzed with smart intelligence to help us act more quickly than we would have otherwise. I actually talked to this guy who was a sewer expert. This didn't make it in the book, but I just thought it was fascinating. And he said, He's got this technology that you can put in city sewers that will give you early warning when you might have an overflow situation on your hands, which needless to say would be something you would want to be coming. I don't care how much it costs. Get it in there. And so again and again in our world, you see that these sensors that we can install in the environment can feed back information to us and help us prevent catastrophe. Sometimes, though, our prevention can end up with unintended consequences, and this is fascinating. The cobra effect, this is a real example from, where is it, India?

I should put an asterisk on the word real. So I tried very hard to figure out. This story kind of smells like an urban legend to me, but... Like an apocryphal. It's a real fake example of something that could have happened, and if it did happen in real life, it maybe would have happened in India. How's that? It sounds kind of sort of plausible, but I don't think I'd want to take my name on it.

Got it. I actually heard this story on the Freakonomics podcast. We'll blame them if it's wrong. I'm fine with that. So the story is that back in the days when Britain ruled India, there was an administrator that was worried about the cobras in Delhi. There were a bunch of cobras around an obvious public health hazard. And so this guy had an ingenious idea.

Aha, I'll put a bounty on cobras. You know, bring me the head of cobras and you'll get some cash. And it works. People start bringing in cobras. you know, in bulk. But then there are some entrepreneurial types in India who think, hmm, I get money if I bring in dead cobras. So they start farming cobras for the sake of turning in the cobra skins that they get a bounty for. And so all of a sudden you have these cobra farms, you know, just basically manufacturing cobras at scale. And so the administrators

catch on to that and they take back the bounty scheme. And then you've got these farms full of cobras that aren't worth anything anymore. And so what did the farmers do? They let them go. And so this noble effort to reduce the number of cobras in India yielded more cobras. And that's an example of something called the cobra effect. And my favorite provable example of the cobra effect is something that I suspect a lot of people listening have experienced at work, which has to do with the craze for open offices. You know, so many big firms these days have moved to these open floor plans and, you know, Let's do away with cubicles. And I think the intent here is partly noble and partly shrewd.

The noble part is, hey, let's do away with the cubicle world, you know, like we see an office space. I think the shrewd part is, can we pack people in a little bit tighter to save some money on real estate? Regardless, the obvious thing that you would conclude is if you put people closer together, you tear it on the walls between them, what are you going to get? You're going to get more face-to-face conversation. It just has to happen. Well, there's a couple of Harvard scholars who studied this in two Fortune 500 companies, and they used, this is kind of just a geeky sidebar, they used this technology called a sociometric badge to actually put real data against this. So their employees for weeks wore these essentially lanyards that had monitoring devices on them that measured who they talked to and for how long.

There was nothing super creepy about it, that nothing was being recorded. what they wanted to know was just who's talking and how much and how does it change once we move to the open floor plan environment. And the conclusions were about as stark as you ever get in a study like this. As soon as the employees moved to the open office floor plan, face-to-face interactions plunged by about 70%. Oh, my God. It basically just stopped face-to-face interactions. And meanwhile, the use of email and messaging apps spiked. So there's the COBRA effect again, right?

When you put people closer together so they'll talk more, they end up talking less. That's interesting. I wonder, can we attribute that to the open office space or is it really just, hey, we have slack now, so I never need to talk to you again? I think it's more likely the open office because these were so proximate in time. Like the before and after that I'm talking about, it was just like weeks apart, not months or years. So it was the same people, the same core software, and then they move into this environment and all of a sudden their behavior changes. That's interesting. I would love to see a study done about this that's not in Silicon Valley, because I have a feeling that Silicon Valley folks, we may skew a little bit towards, oh, do I have to talk to another human? Oh, look, open office space doesn't matter, still going to email. I would like to see this in kind of like normal people businesses, businesses that employ normal folks that are not engineers and things like that. Although I guess, look, Silicon Valley, we still have marketing folks and PR and HR. So it's probably valid. I just,

like to think that we're not that antisocial as humans, but I guess, you know, I have no data for that anymore. Well, if you think about, like, being on a subway or being on a plane, like even most of the extroverts in the world are probably not likely to, even though they're sandwiched really close to another person, it doesn't mean they're going to talk more. I think we all just have this core craving for some degree of privacy. And even if we're sandwiched really close together, it just makes us more fanatical about, you know, avoiding eye contact and putting on our headphones and that sort of thing. In closing here, what can we do? I mean, I'm not going to single-handedly change the health care system. I'm not going to necessarily be able to do a lot of upstream systems

changes for things like homelessness. And yes, there's the whole like, do your part type situation. But what can I do to make, let's be real, everyone listening to this is like, how do I apply this to myself or my own business or my own life or my own family, leave the public health stuff to public health officials? What can I do with this information? Totally fair question. And I should say, you know, even though it's fun to talk about pandemics and Hurricane Katrina and these kind of huge social things, I mean, this is fundamentally a book about organizations and people. And there's a lot in it that is useful today. So I'll give you an example at the other end of the spectrum. I talked to this guy named Rich Marisa, who had this ongoing spat with his wife, or maybe Spats overstating it. But they had this little thing that they always bickered about. And it was the hallway light. So Rich was going in and out of the house, a bunch often, you know, to take the dog out and he would flip the hallway light on on his way out and then he'd come back in and he'd forget to turn it off. And that just irritated his wife. And so that was their little thing that they argued about. And then one day, Rich realizes, oh my God,

I can fix this like forever. He goes to Home Depot. He buys this thing called a light switch timer where you just replace your light switch faceplate with this other thing that has buttons for like five minutes, 10 minutes, 15 minutes. And now when he goes outside, he presses the 10 minute button. The light lights up. He comes back in. Even if he forgets, the light just turns itself off. And they never have to argue about this again for the rest of their marriage. And that to me is kind of symbolic of what it means to go upstream in our own lives, you know, leaving aside pandemics and hurricanes, is try to figure out what kinds of problems or even irritants, not even like major life problems, but just things that bug you, that are

buging you again and again and again. For me, it was, I'm usually working in coffee shops, not anymore, unfortunately, because of the virus, but, you know, I wrote most of the books with Chip in coffee shops, and so I was always schlepping a laptop back and forth and pulling out a power cord, plugging it in, putting it back in the bag, going back to my office, re-plugging it in. And so just shuffling power cords was like one of those small day-to-day irritants that I had just, just put up with for years. I mean, thousands of times I had done this until one day in the course of researching this book, that's what it took for me to click in. I might be able to do something about this. I just bought two different power cords. And one of them lives in my backpack forever. And one of

them is permanently affixed to my desktop. So when I come back to my office, you know, I can just plug it right in. It's in exactly the right spot. And I think that the moral of this story is we are so adaptable as people. You know, early we talked about how easily we habituate to things, sometimes good, sometimes bad, that we can actually just adapt to dealing with problems that we could well have solved. And to me, that's kind of a hopeful message, because it says with just a little bit of intentionality and maybe a little bit of extra effort in the short term, we can get out of that habit of constantly dealing with irritants and just stamp them out altogether. We are a hero for fixing that whole chord problem, huh? Yes. I know a nation of millions is looking to me for inspiration

after that one. Yeah, the guy who figured out how to turn the light off. But it really is, it's simpler than we think. And I think a lot of issues really does come down to like using our own psychology against ourselves. It kind of goes down to even financial advice, right? Like the idea where people go, I can't budget, I can't save money. And then someone comes up with a brilliant idea to have it automatically deducted from your paycheck and put into a separate account that you can't access and suddenly people have retirement funds. Exactly. It's like, well, this is how we prevent certain things. Sometimes the biggest problem is our own habits, our own issues, and we have to figure out a workaround for that and that workaround usually comes upstream.

Well said. Thank you very much for doing the show, Dan. I really appreciate it. Thank you, Jordan. Great to be back with you. Always fun talking to Dan. You know, some stuff that didn't make it to the show was that we should be looking for systems change. Don't combat the results. Change the system that creates those results. That might sound obvious once again, but this is something we're terrible at, generally. Look at homelessness, for example, or even crime. Are we trying to prevent crime by making sure kids have a place to go and they have good role models? I mean, yes, but barely. We're certainly throwing a hell of a lot more resources towards law enforcement and the justice system. I don't think anybody's going to argue with that. Another concept I found interesting that

we didn't quite have time for, poverty and scarcity actually reduces cognitive capacity. People who are poor and underslept and don't have enough, it slows their upstream thinking. You end up doing something called tunneling. This is where you're only reacting. You're not preventing. You're just trying to get the next obstacle that's in front of you out of the way. And you hear about this concept a lot when people describe it, people who are paycheck to paycheck and say things like, as if I could do this maintenance on my car.

I have to work to make sure that I can just put hand-to-mouth food in my kids' bellies. You hear about this a lot with single parents. So it's easy to be all judging and think I would do this and this and this. One, you're not in their shoes, but especially the idea that it can actually reduce their cognitive capacity, which makes sense. You're stressed out, you're not getting enough sleep and you have bad nutrition. That's not going to help you prevent things. It's not going to help you with your upstream thinking or even your problem solving for that matter. And last but not least, something I found a little interesting because of my social engineering background.

There's a lot of upstream prevention of social engineering attacks that's possible now. So there's software that creates these phishing emails, you know, where it's like, hey, this is Angie from accounting. I need you to log in to the company intranet and do something, something with your paycheck, and you end up putting in bank details on like a fake website that looks like something your company would have created. They're doing these phishing simulations where there's software that will email your whole company internally with a fake link, tractsi, who's clicked on it, who entered what information,

and then you can bring those people into a training. That is a good idea because when they tested this, a huge number, like one third of certain companies would click on a fishing email, log in with their company email and password, and like enter bank details on this site that is fake. Now imagine if a criminal got access to that information and not the security company you hired. That is genius. I love that idea. But obviously more important than we thought, it's not just your parents clicking on those fishing emails anymore, right? Big thank you to Dan Heath.

The book title is upstream. Links to Dan Stuff will be in our website in the show notes. Please use the website if you buy books that you hear about on the show. It helps support the show. Also in the show notes, there are worksheets for each episode so you can review what you learned here from Dan Heath. We also now have transcripts for each episode, and those can be found in the show notes as well.

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