social prescribing: the next step for equitable healthcare

the data are in : people living with racism, low incomes and crowded housing are most affected by the covid-19 pandemic. the attention it has drawn to these inequities has healthcare providers re-examining their practices with respect to virtual care, active outreach and health equity.

however, many are not sure what to do next. in addition to structural and policy changes, patients and healthcare practitioners need a straightforward, practice-based solution to help them take immediate action that can address health and social needs in real time. they need supportive structures that enable them to use both covid-19 testing and routine healthcare visits as opportunities to collect vital  sociodemographic data  and to screen and refer people for access to food, housing, income supports, culturally safe supports and community connection. they need social prescribing, a way to integrate health care with community and social services to support people’s immediate social needs.

in february,  the alliance for healthier communities  and the  association of family health teams of ontario  argued that it was time for healthcare practitioners to take on  social prescribing , a strengths-based referral program that empowers patients and healthcare providers to use health appointments as opportunities to connect with the community. when patients experience social isolation or other social needs, healthcare practitioners can use social prescriptions to connect them to a link worker, who then works hand in hand with patients to connect them with the appropriate supports and services.

in march, the alliance released the early results of ontario’s  first major social prescribing intervention study  that demonstrated a 49 per cent reduction in loneliness amongst participants and more than 80 per cent support amongst healthcare providers engaged in taking action on the social determinants of health. we were hopeful that the provincial government would invest in social prescribing in its march 2020 budget.

a month later, we were locked down under covid-19. mainstream populations encountered firsthand the  health impacts of social isolation  while  disparities in canada’s covid-19 cases  and the global black lives matter movement made intersecting social determinants of health front-page news. more people saw that we can only protect everyone when everyone is protected: seniors in long-term care, retirement homes and at home whose health worsened under isolation; women and children at risk of gender-based violence who found themselves cut off from social supports; working people removed from meaningful, income-generating livelihoods; those already pushed to the margins and living without adequate food or safe and secure housing; black, indigenous and racialized people who experience discrimination in healthcare and beyond.

in canada, governments at all levels responded to the disruptive isolation of covid-19 lockdowns with a range of measures ranging from income supports to efforts to bridge the digital divide for students disconnected from their schools. the federal government’s allocation of  $350 million for community responses to covid-19  and similar initiatives by provincial and local governments demonstrated the recognition that it is community, as much as any infection control measure or economic support, that gets us through. at the same time,  grassroots “care-mongering”  and  neighbourhood-level mutual aid  provided heartening examples of the capacity people and communities possess to keep one another healthy and well.

they also tailored supports to specific communities at high risk of covid-19 or of the side effects of lockdown. taibu chc created a “ taibu together”  helpline for toronto’s african, caribbean and black communities; humber river family health team (fht) conducted telephone outreach to assess social determinants of health and domestic safety; norwest chc created emergency boxes to deliver harm reduction kits for isolated clients who use drugs; niagara chc’s queer youth collective used instagram to create a safe online gathering space; central lambton and delhi fhts worked directly with migrant workers to deliver trusted health and social care; anishnawbe health brought out a mobile healing rv to provide health and social support to indigenous people experiencing homelessness in toronto.