What can and should be done to change the paradigm of a healthcare system that is predominantly based on a patient care model and does not focus on people and their potential?
The Covid-19 pandemic, which exposed the fragility of health systems and increased inequality also showed that when governments, societies and individuals make a concerted effort they can achieve extraordinary results, in high quality health care even in extremely difficult circumstances, mobilising the resilience of people and whole communities.
In the spirit of 'no one left behind', the ultimate goal of sustainable development, the Alliance for Social Prescribing has warned that traditional approaches to health and well-being may no longer be sufficient in our post-pandemic world. Urgent action is therefore needed to improve health and well-being, and access to care and education, to reduce inequality and stimulate economic growth, address climate change and work towards environmental sustainability.
In 2022, the National Academy for Social Prescribing, the World Health Organisation (WHO), the World Health Innovation Summit (WHIS) and the UNGSII Foundation published and promoted the Global Social Prescribing Alliance Playbook, a resource to spread good practices for improving the health and wellbeing of people and communities, sustaining health services and creating new job opportunities, with a view to social, economic and healthcare sustainability.
What is social responsibility and social prescribing?
The Global Social Prescribing Alliance creates partnerships based on networking care and support systems, combined with arts and social activities provided by local areas, people and communities. The strength of social prescribing is changing the mindset to focus on people and their potential, rather than thinking of them as patients, concentrating on what matters in their lives, on their values and strengths.
The Global Social Prescribing Alliance Playbook offers a new model of health care based on prevention, early intervention and employing different types of resources to support the 17 UN development goals.
The playbook explains what social prescribing is and defines the roles (i.e. the professional figures) needed for an effective system. It aims to support policy makers, voluntary organisations and society in planning action with communities, to increase activities and services in the arts, sport, voluntary and social work and more. It helps to define and measure the impact that social prescribing can have on people's lives, on the economy and as part of the health care system. It also offers support and useful tools for self-assessment, monitoring and measuring the impacts of social prescribing.
Relational and social support for the community
We can assess the social impact of the prescribing system on individuals and communities. There are many factors that influence a sense of belonging, relational and social support, reducing loneliness, improving mental and physical health, increasing inclusion, empowering people and promoting proactivity in communities.
In the health service, it decreases hospitalisations, emergency room visits and requests for medical tests, with spin-offs for economic investments.
Relational and social support for the community
We can assess the social impact of the prescribing system on individuals and communities. There are many factors that influence a sense of belonging, relational and social support, reducing loneliness, improving mental and physical health, increasing inclusion, empowering people and promoting proactivity in communities.
In the health service, it decreases hospitalisations, emergency room visits and requests for medical tests, with spin-offs for economic investments.
Seven steps for effective implementation
The document suggests the way forward for effective action.
1) Developing social prescribing at a local level: it is vital that all local partners work together to build resources and services, through a strengths-based approach, by identifying and understanding major problems to be addressed together with the community and by mapping people and resources.
2) Developing and supporting local communities and groups: social prescribing should be co-produced with the community, involving the people most at risk, voluntary organisations, religious groups, minorities and social enterprises. Local organisations and community networks deeply rooted in the local area should become part of the dialogue and relationship with the health system. Doctors and social and health services, who are in charge of social prescribing must be able to receive information from the local communities about the services offered in their areas. This needs continuous financial support for volunteer groups and organisations working in the communities.
3) The centrality of professional figures: Link Workers: These are the professionals who connect the various actors in the local prescribing system, as part of a multidisciplinary team that includes GPs. They are recruited for their relational, communication and empathy skills and they work in the local area to listen to people, understand their needs and recommend the appropriate services integrated in the prescribing circuit.
4) Shared planning with people: The social prescribing paradigm is deeply rooted in customised care and in co-design and management that involves people and communities.
5) Professional training: this should also be available through accredited pathways. Link workers should also have access to regular clinical supervision to support their professional well-being.
6) Ensuring clinical engagement and involvement: all care professionals must have training programmes to increase awareness of the role that social prescribing can play in reducing social inequality and to learn about the benefits of the biopsychosocial care model.
7) Measuring impact: Systems for measuring and self-assessing impact provide evidence and spread awareness of the potential of a customised approach to healthcare. The UK health service has developed the Social Prescribing Common Outcomes Framework to offer practical support in collecting data within the prescribing system.
In general, the current health care system is predominantly based on caring for the sick. As if to say, ‘this is a system that waits until we get ill and then takes action’. According to the Global Social Prescribing Alliance, "today's 'doctor-centred' culture has led to the mistaken belief that consuming formal health services leads to the increased health for the population".
In our modern post-pandemic society, the paradigm must be reversed. Not only does health mean the absence of disease, but the health revolution needs to be based on a vision of health as a resource for everyday life.
By Catterina Seia and Sara Uboldi
Sara Uboldi, researcher CCW-Cultural Welfare Centre, research fellow ISPC-CNR, PhD Humanities University of Modena and Reggio Emilia
