This article is part of a series exploring the concept of population health, and is based on an interview with Dr. Kate Mulligan, Senior Director, Canadian Institute for Social Prescribing & Advisor, health determinants & knowledge mobilization, Canadian Red Cross, and Assistant Professor at the Dalla Lana School of Public Health, University of Toronto. This series features successful initiatives of health systems that have invested beyond their walls to improve the health of their communities. To visit the population health resource page, click here.
During a routine visit to her doctor, Sarah, a 60-year-old widow, shared that she feels lonely and that she's been housebound for some time. Managing her mental health had become a daily struggle. Her doctor, along with checking up on her medication, referred Sarah to the social prescribing navigator. The navigator met with Sarah, and they made a plan together based on her goals and interests. Along with connecting Sarah to a subsidized meal delivery service and a friendly calls program, the navigator helped Sarah find a community art-making group because they discovered that creating art is something that really brings Sarah joy. Over time and with support, Sarah began to help facilitate the weekly art group, and it has made a significant difference in her life. The connections she found brought a house-bound, socially isolated older adult into a supportive, purposeful, skill-building role in her community, leveraging her passion for art. And now, she is impacting the lives of others.
Sarah's story highlights the merits of social prescribing which holds great promise for patients' health and wellbeing because of its holistic view and acknowledgment of the broader determinants of health. Through social prescribing, healthcare providers and patients co-create solutions that connect patients to local, non-clinical services based on identified social needs. These social prescriptions connect patients to resources aimed at addressing social risk factors such as poverty, loneliness, and housing that are part of the social determinants of health (SDH). As such, social prescribing is viewed as an important way to reduce barriers to health and wellbeing, and ultimately, gaps in population health.
Research is also beginning to look at social prescribing as a way to meet the province's vision for healthcare, especially with respect to improving healthcare workers' experience. That's because social prescribing can help decrease care providers' workload and increase their sense of purpose at work.
It is also an opportunity for government to invest in much-needed system capacity at a fraction of the cost because the supports and services delivered by community and social service providers are less expensive than clinical care. In some cases, they're more appropriate and effective in addressing the root causes of people's medical and psychosocial issues.
The Pandemic's Impact
Before the pandemic, social prescribing was gaining momentum in Ontario. It was named in a number of Ontario Health Team (OHT) applications and is already in place at Community Health Centres (CHCs) and some Family Health Teams (FHTs) across the province. Although COVID-19 slowed some of this momentum, there continues to be strong interest in social prescribing, including from Ontario's Ministry of Health.
While CHCs have been engaged in health promotion for some time, they recently began tracking referrals including the client journey and follow-up through electronic medical records (EMRs). This work was initially undertaken as part of Rx: Community, a pilot research project led by the Alliance for Healthier Communities, which won the first global award for social prescribing in 2019. While the pilot was implemented using existing resources, it emphasized the need for a dedicated staff person to lead this work. With the pilot's demonstrated success, more and more CHCs are adopting these new processes.
FHTs have also been engaged in social prescribing such as the Health Tapestry program run out of the McMaster Department of Family Medicine. Together with the Canadian Red Cross, volunteers are deployed as community connectors or link workers who match patients with community resources. TeamCare is another program where clients of non-team physicians are linked to CHCs for all social prescribing services.
Some international hospitals have also begun adopting social prescribing to promote patients' wellbeing. For example, since October 2019, Singapore's SingHealth Community Hospitals (SCH) started a social prescribing pilot with a small group of wellbeing coordinators, non-clinical staff who work alongside the clinical team to identify and support patients with adverse SDH, putting them at risk of poor outcomes. Upon admission to hospital, patients are screened for risk factors of poor SDH-related outcomes and enrolled in the social prescribing program. Through the program, patients participate in in-house activities that promote wellbeing, such as gardening, exercising, singing, and reading. Just before discharge, they are linked to community care providers to sustain the improvements to their wellbeing. SCH collaborates with key partners such as the Community Network for Seniors (CNS), whose case managers work closely with SCH's wellbeing coordinators to link patients with community partners offering social activities to help re-integrate them back into their own communities. Early evidence is showing improvements in quality-of-life measures as well as reductions in hospital and even primary care utilization. Learn more about SCH's program.
Internationally, countries have been or are adopting social prescribing programs, including Singapore as noted in the above example, Ireland, England, and the U.S. Overall interest in population health and health equity has also increased as a result of the health disparities in our society that were highlighted and exacerbated by the pandemic; social prescribing can make significant contributions towards addressing these disparities. Most recently, the World Health Organization published a toolkit on how to implement social prescribing to help introduce it at the community level.
Potential Next Steps for Ontario
As the system recovers and seeks to rebuild based on lessons learned, social prescribing will be an important tool for OHTs by facilitating connections among community, social service and public health organizations, hospitals, clinicians, and others. Organizations will benefit from beginning or continuing to cultivate trusted relationships with one another by respecting each other's autonomy, competence and what each has to offer. This is a key piece of community-building which is at the core of this work. Partnerships between hospitals and community organizations have addressed SDH for years, leveraging hospital resources and the community's vast experience, expertise and the relationships they've built with local communities.
Social prescribing needs to be considered an integral part of healthcare discussions. Currently, this work has been mainly driven at the grassroots level. During the pandemic, federal leaders have in fact provided some of this support through wage subsidies and by funding community organizations.
The U.K. has one link worker per primary care network and Ontario could consider something similar to this. For example, OHTs can consider having at least one worker dedicated to social prescribing because of its vital role in addressing the SDH and improving population health.
One of the most important innovations for social prescribing is collecting evidence around the pathways for delivering these supports and interventions. There's a lot of research behind the interventions themselves – we know that walking, taking up a hobby and viewing art are healthy. But more data are required to better understand the impact of program delivery and success criteria. Program development and delivery need to be data-informed and leverage community organizations' long-standing knowledge and expertise. Additionally, SDH and equity data need to be primary considerations for data collection given their sizable impact on health outcomes, as well as the use of integrated information systems that can speak to one another to cut across existing siloes.
A Catalyst for Change: Canadian Institute for Social Prescribing
March 11, 2022, marked the launch of the Canadian Institute for Social Prescribing, a national network about social prescribing which is the first of its size outside the U.K. The network brings together big community organizations, such as the United Way, Red Cross, March of Dimes, etc., alongside healthcare and small community organizations to talk about social prescribing in different contexts across Canada and to surface work that's underway as well as success stories.
Because relationships are at the heart of social prescribing, the goal is to cultivate an ethos of cooperation by offering a shared forum for researchers, government organizations, grassroots organizations, and clients who are interested in this work. Many families and their caregivers have expressed the need for these services and the network can serve as a valuable starting point.
The pandemic is a stark reminder that collaboration in healthcare beyond just clinical services is fundamental to patients' and communities' health and wellbeing. Social prescribing offers us a promising way forward.