Social Prescribing: Emperor’s New Clothes or Paradigm Shift?

If you want to live a long and healthy life have good genes, be able (rich enough) to live in a healthy environment, have “good” health behaviours and access good healthcare – not too much and not too little.

Timely, effective healthcare makes a difference but is only part of the picture. We have long known that alongside healthy lifestyle choices the wider determinants of health: clean air, good housing, social capital, employment or at least a role that gives a feeling of usefulness; all contribute to health, wellbeing and the ability to recover or live well with illnesses.

We cannot yet change our genes. As a GP I used to sometimes joke with patients that I should write a prescription that said “take a break”, “have a holiday” or even “win the lottery”. Convalescence was once widely prescribed and accessed as part of healthcare, but I wonder how much difference my letters made, for example requesting rehousing for a child with asthma in a house that was not damp and mouldy. Perhaps the letters even did some harm, reinforcing helplessness, hopelessness or (even worse) offering false hope?

I found advocating a “healthy lifestyle” challenging too. Although I used motivational interviewing techniques and recognised the importance of people being ready and supported to change, I often found that those people with the most to benefit from behaviour change were those most savagely trapped in unhelpful and maladaptive health behaviours, often facing huge barriers to changing their lifestyles and with little or chaotic systems of support for the behaviour change that could release so much health potential.

Critics of “social prescribing” can point to the lack of an agreed definition for what social prescribing actually is, absence of evidence for its effectiveness and will point out that addressing the wider determinants of health is not new, indeed is central to some healthcare vocations, for example occupational therapy. My own objections centre on the potential power asymmetry between “prescriber” and the recipient of the “social prescription”. Access to clean air, worthwhile role and adequate housing is a right, not something that you should go to the health service or doctor for.

There is understandable cynicism too that looking to social prescribing to fill a widening gap between funded healthcare provision and the escalating needs of our ageing population is either a sticking plaster or, worse, an attempt to distract from adequate resourcing of healthcare. But wait a minute, if social prescribing is about taking a positive approach (some will say an asset-based approach) to our problems then we need to embrace this movement, recognising its long history and rich tradition.

With individuals this means taking a personal activation approach: asking what matters to people, empowering people to make positive change, generating and widening opportunities for change that people themselves help identify from their own lived experience of what makes a difference.

Within our communities it means harnessing the power of all of our health assets: not just schools, libraries, public sector bodies but hobby groups, faith groups and community sports clubs; to play a role in helping our population overcome loneliness, become more active and eat more healthily.

Across the wider system, it means engaging with politicians, sports governing bodies, business to become socially active and more responsible for shaping a healthier environment.

Can social prescribing do all this? I don’t know. International Mixed Ability Sports are not social prescribers….but we might just be somewhere where people with a “social prescription” to take more exercise get that prescription “filled out”. We might be social dispensers.

By taking an asset-based approach and working with a group of participants who have historically been excluded from sports, IMAS can be a catalyst for wider change to build a more inclusive society.

IMAS works with individuals, giving them a voice to demand equal participation and empowering individuals to be able to make healthier choices.

IMAS works with community sports clubs, recognising grass root amateur community sports clubs as potential health assets. We help club explore barriers to widening participation, recognise benefits, helping clubs change to become more inclusive in a way that is sustainable in the long term.

IMAS works with sports governing bodies national and internationally to develop a supportive environment to facilitate culture change in sport and community sports clubs. We also work with politicians and businesses to widen the impact of inclusion using the mixed ability sports approach. IMAS has worked with healthcare professionals in training and as part of their continuing professional development, using resources coproduced and delivered by participants to show the potential impact of an inclusive approach to sports and the wider benefits.

Find out more by visiting our website and signing up to the IMAS Manifesto.

www.mixedabilitysports.org

Dr. Mark Purvis