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| Community assets? |
Secondly prescribing (and access to resources-whether drugs or gym) is tied up with evidence - the idea that the doctor has the expertise to weigh up the technical evidence and guide your shared decision-making process. Whilst some people might argue that we can 'test' the effectiveness of going to the gym in the same way as a drug (randomised controlled trial) I believe this is the wrong way of looking at 'social interventions' and that a social prescription will never achieve an equal weight of quantitative evidence base as a pharmaceutical prescription. This immediately puts the social on a sloping playing field of evidence (for the doctor practicing 'evidence-based medicine').
An alternative approach, as Michael Marmot might advocate, is as follows: we know people who live in disadvantaged communities have poorer access to greenspace, opportunities to exercise, and hence higher chance of poorer health. The preventative approach (proportionate universalism) would argue for investment in communities - parks, gardens, gyms etc (as chosen and designed by the local community). Social norms, clubs, park runs etc, then encourage people to make use of these resources.
So, I think social prescribing is good - as far as it goes - but a real preventative approach would invest in communities and community assets, rather than the continual focus on the individual.
HI Neil, I too am inpatient about BMJ moderation so this is my response to the blog below. I just came across your reply on twitter. I think my thoughts echo yours.
ReplyDeleteThis is a great discussion to have now. It’s good that we are starting to recognise health as social and develop our practice accordingly. I worked with a practice recently where GPs were frustrated that what they could provide was not what their patients really needed. It was important to them and to most health care staff to know they can make a difference. Social prescribing enables them to do more of that. I had a conversation yesterday with someone who works for a CIC. They have a 30-year history of working with disengaged and hard to reach groups on community projects which make a difference to the individuals and help build the communities they live in. However, the CIC is under threat as the funding streams from local authorities, youth offending schemes and regeneration have disappeared. He had a conversation with a local GP, aware of the impact of the work the CIC does, who wanted to have this option on his prescribing list. However, a further conversation with the practice manager revealed this was not an option, they could only prescribe to funded projects and social prescribing funds have been cascaded down the health route. By trying to deliver a non-traditional approach in a traditional way we are at risk of further limiting the choice of the people we seek to support. We are viewing the issue through our own “health lens” and allocating resources according to our values and agenda. Activists are receiving the message that if they want to do something in their communities they must fund it themselves or rely totally on volunteers. If we are serious about empowering individuals to take responsibility for their own health and supporting communities to provide opportunities for this to happen then we need to give them the power AND the resources to do this. The issue with social prescribing, which is reflected in the language we use is the power and control. Social prescribing is a good start. I hope that as we change the language of this developing practice we can change the attitudes and the behaviours that underpin it too. We just need to do this quickly or the further community assets that are being starved of resources will wither and die.