Patricia G. Butterfield, PhD, RN, FAAN

Year First Published – 2017

Major Concepts

1. Health determinants, including . the categories of environmental-spatial,
   economic-resources, cultural-ideologic, and opportunity-potential;
2. Population life-course trajectory;
3. Health inequities;
4. Upstream actions;
5. Health-promoting systems;
6. Target of system change (inclusive of 7 categories ranging from paradigms/beliefs to subsystem elements); and
7. Point of inflection. (Butterfield, 2017, p. 4-5)

Typology

Conceptual model

Brief Description

The model is designed for practice at a population level, including organizational or geographically defined populations. It is a process model that focuses on both the “what” and “when” of upstream interventions that focus on system-level changes that can improve the health of a population. The goal is to reduce inequities by intervening early and broadly at the level where determinants of health take shape. Upstream actions include strengthening prevention services, delivering care in novel ways, honoring grassroots wisdom, and/or broadening care to include health determinants

Primary Sources

Butterfield, P. G. (2017). Thinking Upstream: A 25-Year Retrospective and Conceptual Model Aimed at Reducing Health Inequities. ANS. Advances in nursing science, 40(1), 2–11. http://dx.doi.org/10.1097/ANS.0000000000000161

Butterfield, P. G. (2002). Upstream Reflections on Environmental Health: An Abbreviated History and Framework for Action. ANS. Advances in nursing science, 25, 32–49.

Butterfield, P. G. (2001). Thinking upstream: conceptualizing health from a population perspective. Community Health Nursing: Promoting the Health of Aggregates. Toronto, Ontario, Canada: Saunders, 69–82.

Butterfield, P. G. (1990). Thinking upstream: nurturing a conceptual understanding of the societal context of health behavior. ANS. Advances in nursing science, 12(2), 1–8. https://www.ncbi.nlm.nih.gov/pubmed/2105688

About the Author

Patricia G. Butterfield 

Dr. Butterfield’s experience includes: 1) leadership roles on descriptive, analytic epidemiology, and RCT studies addressing environmental health issues, 2) participation in invited roles at NIH, EPA, and IOM, and 3) serving as the Director of the Occupational and Environmental Health Nursing Program at the University of Washington. Dr. Butterfield served on EPA’s Federal Advisory Committee and is an alumnus of the Robert Wood Johnson Executive Nurse Fellows Program. As Dean of Nursing at Washington State University (2007-2014), Dr. Butterfield guided a transformation of the College’s research culture yielding a commensurate seven-fold increase in grant/contract revenue. She served as principal investigator on an R01 addressing a public health nursing intervention aimed at reducing household environmental health risks to rural low-income children. (from https://medicine.wsu.edu/about/leadership-mission/administration/patricia-butterfield-ph-d-rn/)