Original ArticlesCritical Interactionism: An Upstream-Downstream Approach to Health Care ReformMartins, Diane Cocozza PhD, RN; Burbank, Patricia M. DNSc, RNAuthor Information College of Nursing, University of Rhode Island, Kingston, Rhode Island. Correspondence: Diane Cocozza Martins, PhD, RN, College of Nursing, University of Rhode Island, 2 Heathman Rd, Kingston, RI 0288 (firstname.lastname@example.org). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Advances in Nursing Science: October/December 2011 - Volume 34 - Issue 4 - p 315–329 doi: 10.1097/ANS.0b013e3182356c19 Buy SDC Metrics Abstract Currently, per capita health care expenditures in the United States are more than 20% higher than any other country in the world and more than twice the average expenditure for European countries, yet the United States ranks 37th in life expectancy. Clearly, the health care system is not succeeding in improving the health of the US population with its focus on illness care for individuals. A new theoretical approach, critical interactionism, combines symbolic interactionism and critical social theory to provide a guide for addressing health care problems from both an upstream and downstream approach. Concepts of meaning from symbolic interactionism and emancipation from critical perspective move across system levels to inform and reform health care for individuals, organizations, and societies. This provides a powerful approach for health care reform, moving back and forth between the micro and macro levels. Areas of application to nursing practice with several examples (patients with obesity; patients who are lesbian, gay, bisexual, and transgender; workplace bullying and errors), nursing education, and research are also discussed. © 2011 Lippincott Williams & Wilkins, Inc.