A central theme of my columns is that health is determined by a wide range of factors, most of which are not within the realm of the health sector.
Which means that most of the interventions that will help us be healthy are outside the health-care system. One of those interventions, first promoted by the U.K. Department of Health in 2006 and now being developed in England, is social prescribing.
In a report earlier this year, the King’s Fund — a respected independent charity working to improve health and care in England — describes social prescribing as a service that provides a “means of enabling GPs, nurses and other primary-care professionals to refer people to a range of local, non-clinical services.” Given that in the U.K. about one in five patients consult their family physician for what are mainly social problems, it makes sense to refer them to social rather than medical care and support.
In the 1970s, I worked as a family physician in a community health centre with many marginalized and vulnerable people; many of the problems I saw were not medical problems, and could not be solved with medical interventions. The people I saw were precisely the sort of people the King’s Fund suggested are most likely to benefit from social prescribing: Those with “mild or long-term mental-health problems, vulnerable groups, people who are socially isolated, and those who frequently attend either primary or secondary health care.”
The basic idea of social prescribing is simple: Given that a broad range of environmental, social and economic factors affect health, and that many voluntary and community sector organizations are working to support people in these areas, how do we connect people in need to these organizations and their programs?
The types of services that people need, the King’s Fund report notes, include “volunteering, arts activities, group learning, gardening, befriending, cookery, healthy-eating advice and a range of sports.”
Social prescribing involves a primary-care practitioner referring a patient to a “link worker” in the community/social care sector. These workers, who might be paid or volunteers, interview the patient and link them to a suitable community or voluntary-sector program. Some of these programs fall into the area of local governments, involving a variety of recreational activities.
There are two main reasons for undertaking social prescribing: Improving health and reducing costs. So does it work?
There is some evidence that it might, with some studies showing improved health and well-being, and even some reductions in use of primary, emergency and specialty care. But whether or not it is cost-effective remains to be seen, partly because most of the studies have looked only at the experience over 12 months or so, while the benefits are likely to accrue over the longer term.
So while there is emerging evidence that it seems to work, it is too early — and the research to date has been too weak — to give a definitive answer. But there are enough interesting examples and information to suggest it might be worth trying here in B.C., given the new government’s commitment to support and expand community health centres — or what should perhaps be thought of as community health and social-care centres. This provides an opportunity to implement social prescribing, at least on a pilot basis.
There are a few key issues to address. First, social prescribing requires funding and support for the link workers or navigators. Second, the agencies and especially the community organizations and NGOs that provide the services, will likely need increased funding and support to meet the increased demand that can be expected. Third, any implementation needs to be set up with a strong evaluative component, and it needs to be evaluated over several years.
Finally, and perhaps most important, this must be seen as a replacement for, and not an addition to, health-care expenditure. If social prescribing succeeds in reducing demand for health care, the resulting savings have to be transferred out of the health-care system and into the social-care system that is providing these benefits.
After all, much of what determines health lies beyond health care, and funding should reflect that reality.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.