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Building on first-hand project experience, it demonstrates how the conceptual framework of PDSR can serve as a tool for mapping out institutions and actors for identifying investment and reform needs, rather than randomly mixing and matching upstream and downstream interventions.
Other studies support this in highlighting that downstream interventions rarely reduce inequalities and may widen them.
Furthermore, Lorenc et al. explicitly concluded that "downstream" interventions actually worsen health inequalities [ 82].
In this situation, upstream approaches (e.g., larviciding, personal protection) discount the attributable benefit of downstream interventions (e.g., adulticiding).
It also reflects the focus to date on downstream interventions that rely on educating individuals to improve public health [ 30].
In addition, downstream interventions arising from the HEADS-UP process may impact multiple wards, regardless of their participation in HEADS-UP.
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"The law is an extremely expensive downstream intervention compared to potential demand-side initiatives in prevention, treatment, and harm reduction".
Instead the model's dynamic nature where transmission, host infectiousness and host immunity are intimately linked, changing over time, allows downstream intervention impacts to evolve during the simulation.
These recommendations reflect the rationale of the rating scheme and encourage upstream over downstream intervention efforts, first emphasizing material factors, then process, with human interface intervention recommended only as a temporary stopgap measure.
Downstream intervention using nucleotide precursors could potentially circumvent a scenario in which folic acid cannot ameliorate some FOCM-related neural tube defects owing to defects in the intervening enzymes required to metabolize folic acid.
The amyloid hypothesis and its appealing simplicity in the framework of overproduction versus reduced clearance, and the identification of some of the genes responsible for these processes, opens the door for genetic or downstream intervention to prevent the onset of the disease.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com