New Canadian centre focused on treating the social determinants of health

A new healthcare hub said to be the first of its kind in the country is taking an untraditional approach to providing healthcare to Canadians.

The Canadian Institute for Social Prescribing focuses on how the social factors of health affect patients, and the treatments prescribed aren’t always medications.

“What could happen if your doctor prescribed nature or community or time in a knitting group instead of pills,” said Kate Mulligan, the senior director for the CISP.

“It’s a new way to address some of the social determinants of health, some of the causes of ill health that could be complementary to biomedical approaches. Or an alternative to biomedical approaches where that’s appropriate to you.”

Experts say this approach can also help to alleviate some of the burdens on the stretched healthcare system.

The institute has brought together healthcare providers, community partners and link workers who help to connect patients to services. The hub is centred around social prescribing, prioritizing health equity and community leadership and encouraging collaborations.

Health equity experts say Canada’s current healthcare system doesn’t always consider social determinants of health when treating patients. They say the system should focus on how inequities and disparities impact people’s health outcomes.

“The current medical system only addresses a minimal amount of what’s making us unhealthy. It doesn’t do much for our housing. It doesn’t do much for our sense of loneliness or disconnection. It doesn’t provide food, right, a lot of those other broader things,” said Dr. Kate Mulligan.

“The institute builds on the work of community health centres that have been connecting patients with supports and services, focusing on their health and well-being.”

Dr. Andrew Boozary, the Executive Director of UHN’s Centre for Social Medicine Innovation, said when they talk about social factors, they mean things that drive health outcomes profoundly.

“It’s where people eat, the air they breathe, where they sleep, whether they have housing or not, the sort of jobs they have, and the kind of relationships and connections and supports that are in place,” he said.

For marginalized communities who face barriers in accessing support and services, Dr. Boozary said treating social determinants of health is essential to producing improvements.

“We know from the data and decades of evidence and literature that it’s our most marginalized communities that have been in underserved communities do not get access to the primary care resources do not get access to the same funding for education for social supports from social services,” explained Dr. Boozary.

The way social prescribing works is that a healthcare provider would help assess you for the needs typically addressed within the healthcare system and then refer you to a link worker.

“That’s somebody who has more time and more training to spend with you to co-produce with you what the prescription should be. So have a conversation, really listen, move away from asking what’s the matter with you and start asking what matters to you, and build from there,” explained Mulligan.

For example, if you are experiencing food insecurity, they may be able to provide access to healthy food, or if you are recently bereaved, they could connect you with other people who have lost a loved one.

“These are some of the things that can happen when we take the time to ask about the causes of the causes of our ill health and our unease or ill well-being,” said Dr. Mulligan.

Social prescribing started in the United Kingdom and is now used in over 20 countries.

In Canada, community health centres have for decades incorporated elements of social prescribing in their practice, bridging gaps and creating referral programs that connect patients to the support and services they require.

These community organizations have long acknowledged how social determinants of health impact an individual’s well-being and have created initiatives that address disparities in health.

This summer, the Alliance for Healthier communities, which includes several community health centres, launched the first Black-focused social prescribing project aimed at improving the health of Black communities — an approach grounded in Afrocentric principles of well-being.

Liben Gebremikael, Chief Executive Officer of the Taibu Community Health Centre, associated with the Alliance for Healthier Communities, said he believes this model works.

“We have primary care and community programs as a one-stop shop. But we have not been able to measure and see the connection between the two. The social prescribing model gives us the framework,” said Gebremikael.

The community health centres involved in the two-year project are Black-led. They have various supports and services, including physiotherapy, counselling, mental health and addictions support, diabetes management and many more.

The Alliance for Healthier Communities had previously piloted social prescribing initiatives across 11 health centres in Ontario. Almost 150 providers helped to connect over 1,100 clients to nearly 3,300 social prescriptions, and they saw an immediate impact.

“[There was a] reduction in isolation, better connectivity, increased social activities, even in clinical outcomes. For example, [there was a]reduction in emergency department visits and visits to primary care services. And so people were connected better, feeling good about themselves and things like that, so they were utilizing the services less and less.”

Gebremikael said there was a 14 per cent reduction in emergency department visits.

A final report in 2020 showed the project’s positive impacts on clients, including improving mental well-being and managing different aspects of their health, fewer people feeling lonely, and an increase in the sense of connectedness and belonging.

“If this social prescribing can demonstrate that there is a way of increasing the health and well-being of a marginalized community, I think that could be a huge gain, both from the community’s perspective from service, organization’s perspective and also for the health care system,” said Gebremikael.

He adds that more data on the impacts of social prescribing on community groups need to be collected. This is what community health centres and the Alliance are looking to do in the next two years.

But health equity experts and advocates are also hoping government and policymakers are open to making changes to the healthcare system to address inequities in healthcare across the country.