“What is health? For me, it’s having the capacity to think and having the capacity to do things on my own or with the help of others,” says Janet Rodriguez, a disability justice advocate who lives with visible and invisible disabilities.
“It’s everything from being able to go to a party, go grocery shopping or clean my house. Even though I’m in pain, if I can manage it and have satisfaction in the things I do, that is health.”
As a patient of St. Michael’s Academic Family Health Team and a lived experience expert advisor to its Social Determinants of Health Committee, Rodriguez is deeply involved in disability justice work. For her, if health goes beyond how well our body parts function to include our mental wellness, emotional stability and ability to engage in social relationships and community life, it’s clear that health care should do the same.
Proponents of the social prescribing — or social interventions — movement agree. “Social prescribing is about expanding our understanding of what family medicine is and what health is,” says Dr. Gary Bloch, a family physician who has long championed the integration of social determinants of health into frontline primary care.
“Family medicine is a relationship-based specialty, so we develop a deep understanding of the complexities of our patients' lives. This holistic view of health — where social, mental and physical aspects are interconnected — helps us understand and support what health really means to our patients," says the Department of Family and Community Medicine faculty member.
Social prescribing as a term was coined in the United Kingdom in the 1990s, alluding to efforts by health team members to refer patients to non-clinical services. While free museum visits and national park passes have attracted public attention, the core of social prescribing focuses on connecting patients to community programs and resources such as social benefits or disability supports.
“This is work that family physicians have been doing for decades,” says Dr. Dominik Nowak, a family doctor at Women’s College Hospital, DFCM faculty member and president of the Ontario Medical Association.
“We do it because it is part of being a ‘good doctor’ and we know our patients need the support, but it often seems like something that is outside the system. When you name it, you can make it systemic and start to put supports around it.”
On the east side of downtown Toronto, Dr. Bloch and the St. Michael's Academic Family Health Team are starting to make these systemic changes with programs including the SEED (Support, Equity, Empowerment and Dignity) for seniors initiative.
Launched in 2023, SEED focuses on isolated older adults in the St. Jamestown, Regent Park, Moss Park and St. Lawrence neighbourhoods, which have a high proportion of seniors living alone and in poverty.
The program relies on community health workers, who build partnerships and map out community resources, and link workers, who develop relationships with individual clients to understand their needs and connect them with appropriate services.
“As a link worker, my job is to get to know my clients, understand their goals and co-design a plan with them,” says Sandesh Basnet, a link worker with the SEED program.
“One person might want to be able to go swimming or do a cooking class or become more tech savvy. But not everyone is ready for that right away. Some of our clients don’t leave their apartments, so we work on building their confidence about going outside, even if it is just down to the lobby or across the street for a coffee.”
In the program’s first months, from January to September 2024, SEED’s two link workers saw about 80 clients in the community. But with almost 50,000 patients associated with the family health team, the need far outstrips supply.
“When you get older, every day can be a struggle. You look at your calendar and it is all medical appointments and not a lot else. And that’s the reality,” says Barbara Center, a St. Jamestown resident and SEED community advisory committee member. “Those of us who aren't living on the edge or are managing OK, we have a responsibility to those who need help and services. I live alone. I've been lonely. I've been depressed. I came to this program because I felt I had experiences to share.”
While not all clinics will have the benefit of link workers on staff, Dr. Bloch and the team hope to build a network of programs, resources and educational curricula to nurture a health workforce that understands, values and can implement social interventions.
A significant inaugural step is the first Canadian social prescribing resource for primary care providers, launched in October 2023 in collaboration with the Centre for Effective Practice, Alliance for Healthier Communities, Canadian Institute for Social Prescribing and St. Michael’s Academic Family Health Team.
The resource, which has been accessed over 4,000 times, is intended for family physicians and others wanting to practise social prescribing in a more formalized way. It is complemented by a new, interactive, web-based training module.
“People look at doctors and see that our power isn’t just around medications, it’s about relationships and how we connect people to broader health,” says Dr. Nowak, co-clinical lead for the resource. “Social prescribing has been around a long time, but its importance has flown under the radar. These projects are part of a movement helping change that.”
