The word "fable" dates to the 14th century. According to Merriam-Webster, a fable is "a fictitious narrative or statement, a legendary story of supernatural happenings or a narration intended to enforce a useful truth." Sometimes, the latter case is "one in which animals speak and act like human beings." The last part of the definition does not apply to a fable I included in my first book more than a quarter of a century ago, the Rodale edition of High Level Wellness: An Alternative to Doctors, Drugs and Disease; the other parts do apply. The fable was also included in the Bantam edition of this book (1979) and the updated and revised 10-year anniversary version published by Ten Speed Press in 1986.
Around 1975, I was a mid-career urban planner and health care administrator studying for a doctorate in public health in the San Francisco Bay Area. I was well aware of the waste in the medical system -- the planning organization I headed was charged to moderate unnecessary spending in health care facilities, mostly hospitals. I knew enough about the wellness concept to realize that billions could be saved if a way could be found to inform and motivate people to take better care of themselves. If people were guided to adopt and sustain greater responsibility for their health, they would not get sick so much and then much of the cost of expensive hospitals and other medical accoutrements would be saved. The Upstream/Downstream fable seemed a way to make that point in a simple but memorable, understandable way. Here is the fable I wrote, as it appeared in the original Rodale edition of High Level Wellness.
It was many years ago that villagers in Downstream recall spotting the first body in the river. Some old timers remember how Spartan were the facilities and procedures for managing that short of thing. Sometimes, they say, it would take hours to pull 10 people from the river, and even then only a few would survive.
Though the number of victims in the river has increased greatly in recent years, the good folks of Downstream have responded admirably to the challenge. Their rescue system is clearly second to none: most people discovered in the swirling waters are reached within twenty minutes, many in less than ten. Only a small number drown each day before help arrives -- a big improvement from the way it used to be.
Talk to the people of Downstream and they'll speak with pride about the new hospital by the edge of the waters, the flotilla of rescue boats ready for service at a moment's notice, the comprehensive health plans for coordinating all the manpower involved, and the large number of highly trained and dedicated swimmers always ready to risk their lives to save victims from the raging currents. Sure it costs a lot but, say the Downstreamers, what else can decent people do except to provide whatever is necessary when human lives are at stake.
Oh, a few people in Downstream have raised the question now and again, but most folks show little interest in what's happening Upstream. It seems there's so much to do to help those in the river that nobody's got time to check how all those bodies are getting there in the first place. That's the way things are, sometimes.
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