Social prescribing is health care’s cure for loneliness and social isolation. What better time to consider it?
In April, when this article was written, the world was grappling with the COVID-19 pandemic.
Our governments were imposing various measures to slow its spread, including asking us to limit excursions outside the home and practise physical distancing. Writing an article about social-prescribing — in which health-care providers refer patients to non-clinical, community-based activities to improve their health and well-being — at a time when we are being asked to stay home seems counter-intuitive.
However, self-isolation and physical distancing are presenting mental-health challenges for many, including feelings of loneliness and social isolation. Staying connected is at the heart of social prescribing and, now more than ever, we need to maintain our connection to our networks and communities, even if that means adapting the ways in which we do so.
Social prescribing’s role
Social prescribing is increasingly seen as the next step in improving and better integrating health systems around the world because it provides an evidence-informed pathway to better co-ordinate health and social care. It recognizes that a person’s health is determined by a variety of social, economic and environmental factors. Income, education, housing, nutrition, relationships and self-confidence are just some of the factors, also known as social determinants of health, that play a vital role in a person’s physical, mental and social well-being. Research indicates that between 80 and 90 per cent of a person’s health outcomes are driven by social determinants of health.
Social prescribing enables the health-care system to see and treat patients in a holistic way instead of focusing solely on their medical diagnosis. It offers a non-clinical way to improve people’s health and well-being while also allowing them to take greater control of their health. Social prescribing complements clinical treatments and enables health-care providers to refer patients to such activities as cooking classes, dance lessons, volunteering or peer support groups to enhance their well-being through increased physical activity, healthier food and greater social contact.
Canada’s loneliness and social isolation problem
In recent years, research has identified the crucial role that social connectedness plays in ensuring physical and mental health. Loneliness and social isolation cause serious harm and are increasingly seen as major health threats. In 2017, Ontario’s chief medical officer of health noted in his annual report that “people with a weak sense of community belonging are more likely to be in the top five per cent of users of health-care services; this accounts for more than 50 per cent of total health-care spending… costs that could be reduced if these individuals were part of connected communities.” Many other health officials across the country echo his position.
This is concerning given how disconnected our society has become. A 2019 Angus Reid report found that a third of people in Canada are lonely, and about 23 per cent of those people — close to nine million — are socially isolated. Of those nine million, less than half feel a connection to their community and about one in 10 feels “very satisfied” with their lives. Notably, members of this group are more likely to have lower incomes and a high school education or less. They are more likely to be single or living alone, and be part of a minority group. Even amongst those who are moderately connected, nearly 66 per cent of Canadians would like to spend more time with family and friends and only one third of people are “very satisfied” with their lives.
Implementing social prescribing in Canada
There are several models for social prescribing, but most involve a health-care provider referring a patient to a navigator, often called a link worker, who “fills” the prescription by working with the individual to connect them to the most appropriate supports in the community.
Rx: Community, Canada’s first social-prescribing pilot program, was launched in Ontario in May 2018, using 11 of the province’s community health centres. It ran until December 2019. The results of the pilot, which were detailed in a report released in March 2020, show that participants experienced improvements to their mental health, decreased loneliness and a greater sense of connectedness and belonging. Health-care providers saw improvements in their patients’ well-being and were better able to connect patients to social supports, thanks to the presence of link workers who enabled deeper integration between clinical care and social supports.
The pilot confirms what many in the health- and social-care professions know intuitively: people are healthier when they are connected to social and community supports and when they are empowered to play a meaningful role in their own health and the well-being of their community.