Enhancing linkages across health and community sectors is the task at hand, and it is not an easy one. I thank everyone for being here. My overview for today will be as follows: first, I would like to acknowledge that I am joining you from the unceded territories of the Musqueam people, and I have had the opportunity to be in the presence of many elders. Their prayer has had a profound effect on the conversations we have. Cultural humility is what they have taught me, that I can both receive and give, and that we are all part of a community. I would like to share some of that gift with you through my words.
Next, I will briefly introduce myself, today's objectives, and then present a scenario. I will present three views on social prescribing from a scholar who has written in a way that is both accessible and impactful. Finally, I will talk about how social prescribing can be practical, and then we will have our own discussion on the case and ask what community is, what we could do differently from what is being tried now.
A little about myself: I thank Andrea for the invitation and suggestion. I became interested in this topic because as a town planner working in a big city, I realized that we could design better communities to meet the needs of seniors who may be new to the cities. My fellowship is funded by the Canada Mortgage and Housing Corporation and the Canadian Institute of Health Research and is focused on Urban housing and health. Urban planners and people from housing have different perspectives on what is important and it can be hard for these two worlds to communicate.
Our objectives today are to introduce and invite discussions on social prescribing, its rationales, and challenges. I hope to broaden our political imagination and understand that "political" does not refer to electoral politics, but instead refers to our everyday relationships and the people we see as equal or different from us. Our goal is to rethink and enhance the scope and possibilities of social prescribing intervention.
Starting in neoliberal UK, social prescribing aims to address health problems beyond just prescribing medication. Social connectors, who can be anyone from neighbors to police officers, are trained to help connect individuals with community resources, such as dance classes and self-management programs for conditions like cancer and diabetes. The reason for the interest of policy makers today varies. Some see it as a way to help people who suffer more, some see it as a way to teach people how to take care of themselves, and some see it as a way to restore person-centered care. These three perspectives on social prescribing led to different approaches (Calderón‐Larrañaga et al., 2022).
A challenge of the first approach is social and economic segregation. The fact of the matter is that the lives of marginalized people may be unknown to many policy makers. Critical scholars thus advocate for person-centered care as a way to deconstruct our idea of otherness, instead of attempting to address complex social and political determinants of health with social prescribing, especially given a lack of communication between health and community sectors. The voices and perspectives of seniors need to be amplified for real change to occur.
Instead of viewing social prescribing as a simple solution to address social inequality, scholars recommend focusing on person-centered care and recognizing how difficult it is.
Instead of viewing social prescribing as a simple solution to address social inequality, scholars recommend focusing on person-centered care and recognizing how difficult it is (Calderón‐Larrañaga et al., 2022). Despite decades of talk about community health centers, some areas still face the same challenges in implementing these solutions. There are barriers, such as the lack of funding for community organizations to update the directory of services, and difficulty tracking and reporting on referrals to community organizations. The patient medical home uses electronic medical records to plan for patient needs, but there is currently no way to track if the referral is appropriate. Social prescribing, when properly implemented, should help with these issues. Clients should feel a sense of support and community.
Implementation can vary greatly from place to place. Burnaby and Vancouver have different approaches, and this is due to differences in jurisdiction. A rural community in the UK has involved the postal service in their efforts, with mail carriers checking in on their clients. Implementation can be problematic when health professionals are often overworked and funding shortage signals different valuation of doctors and community-based professionals. It's important to be aware of these differences and to work together to find a solution that works for everyone.
Pictured: Dr Gan acknowledged by MLA Michael Lee for contributing to the South Vancouver Seniors Network Webinar in October 2022 at a recent event.
The General Practice Service Committee of BC is leading the way by introducing Link Workers in Primary Care Networks (PCNs), but more needs to be done to break down sectoral silos. PCNs bring together family clinics to coordinate and provide resources, including assigning a link worker to each network to provide person-centered care and direct individuals to the right resources. The hope is that the GP can focus on diagnosis and patient relationships while accessing an array of clinical supports and services outside the practice.
There have been success stories with this approach, but social workers are often not given enough resources or respect to do this work effectively. In Scotland, they focused on the social and political determinants of health, especially in poor areas and for people with long-term chronic conditions (Wildman et al., 2019). After a year or two of the Link Worker program, people reported highly personalized service and gradual, holistic changes in areas beyond health. The paper also highlights both the positive and negative aspects and raises questions about long-term continuity. For example, social workers may not receive adequate recognition or respect from the medical system, which can lead to burnout.
Neoliberalism affects not only the health system but also the community sector, with underfunding leading to difficulties for seniors’ programs. It's also important to have open and honest conversations and to adopt a reflexive mindset about ourselves in the process. The key to addressing many of these problems is more than having a Link Worker available. Wildman and colleagues (2019) touched on the importance of personalized service and the availability of suitable and accessible volunteering services. A social worker can help connect people. The community, including neighborhood houses, faith groups, community centers, and community associations, must be prepared to support individuals, including those with complex psychosocial needs.
Acknowledgement This webinar was hosted by South Vancouver Seniors Network in October 2022. The summary was drafted by ChatGPT based on an auto-generated transcript. Dr Gan is grateful for the robust discussions and inputs from participants. Please view a recording of the webinar here: https://youtu.be/Cb70Dj-Q794
References
• Calderón‐Larrañaga, S., Greenhalgh, T., Finer, S., & Clinch, M. (2022). What does the literature mean by social prescribing? A critical review using discourse analysis. Sociology of Health & Illness, 44(4-5), 848-868. • Gan, D. R. Y. (2022, October 20). Social prescribing: Enhancing linkages across health and community sectors [Webinar]. South Vancouver Seniors Network. https://youtu.be/Cb70Dj-Q794 • GP Services Committee (2018). Integrated System of Care: patient medical homes and primary care networks. https://gpscbc.ca/what-we-do/system-change/primary-care-networks • Mackenzie, M., Skivington, K., & Fergie, G. (2020). “The state they're in”: Unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities. Social science & medicine, 256, 113047. • Wildman, J. M., Moffatt, S., Steer, M., Laing, K., Penn, L., & O’Brien, N. (2019). Service-users’ perspectives of link worker social prescribing: a qualitative follow-up study. BMC public health, 19(1), 1-12.