
The Case for Social Prescribing
In the spring of 2024, my then-nine-year-old daughter, Orla, had emergency neurosurgery in Toronto—twice—for a sudden brain infection. She received months of world-class hospital care that included teams of neurosurgery and infectious-disease specialists, round-the-clock observation and nursing, high-tech MRIs and custom prosthetics, and we never received a bill. That’s what Canadian health care is known for.
But just as important was the social care that helped Orla regain her love of life after losing—and then working to regain—control over the left side of her body. She got access to therapeutic clowns, an accessible garden, therapy dogs, music, playtime with friends and an in-hospital school. Some of her inpatient friends even received help with essentials like food, housing, counselling and family income. In their hospital rooms, each child had a whiteboard where they and their families wrote and drew under the prompt, “What matters to me?” This helped them turn the page from “What’s the matter with me?”—the question that dominated their acute care. Almost invariably, family, friends and fun topped the lists, laying the groundwork for the rehabilitation team to deliver personalized, holistic care. For Orla, the team helped her set—and meet—goals that were beyond our wildest dreams when she was at her sickest; participate in a “MasterChef” food fundraiser with other patients; play ball hockey with Toronto’s pro women’s hockey team, the Sceptres; and take a family visit to the Haliburton wolf sanctuary. I’ve been a health science and policy researcher for two decades, but it was Orla’s experience that showed me the importance of integrating social care into our health outcomes.
Decades of research support the fact that providing community support is part of health care. Social determinants account for up to 80 per cent of our health, far more than any single medical intervention. Food, housing and financial security are prerequisites for well-being, while connection and activities help people thrive. Social bonds cut the risk of dementia by half and cut heart disease and stroke by 30 per cent. They also boost survival rates by 50 per cent. They strengthen our immune systems, regulate our nervous systems and hormones, reduce mental health stressors and foster healthy behaviours like eating well and staying active. The benefits go beyond individuals: coming together prepares us to collectively face the challenges life throws at us, whether that’s wildfires, floods, political polarization, pandemics, economic turmoil or even brain infections like Orla’s.
Canada has cutting-edge medical technology for acute care, like Orla’s brain surgeries and hospitalizations. Yet less than 10 per cent of health budgets go to addressing social determinants of health. Instead, Canada has outsourced this crucial work to unpaid caregivers and community organizations, failing to adequately recognize, let alone remunerate, their contributions. Even though we see our health system struggling before our eyes, our health policy remains tethered to last century’s model and focused on the same three health system costs: doctors, hospitals and prescription drugs.
There is an alternative. Introduced by the U.K. in 2019, social prescribing connects patients to community services that improve their health. Instead of writing prescriptions for pills, doctors can prescribe social activities for a patient. A prescription might suggest a free pass to a museum or park, a community health worker to help you fill out forms for housing and income support, or a support group for people who share a common experience and understand your struggles. It could even be a weekly visit to fill your bird feeder and share a cup of tea. In my experience, the intervention often centres on something poignant and affordable that health professionals might never have considered without asking patients what matters to them: a fishing rod and a fishing buddy, a board game with a prescription for the family to play together—even a chance to attend summer camp.
By including these activities in our health records, we can see precisely how social interventions shape health experiences, outcomes and service use. Take green prescribing in the U.K.—referrals to nature-based group activities like walking, gardening and conservation work. A recent multi-year evaluation revealed that participants’ anxiety levels fell by 29 per cent, happiness went up by 42 per cent and feelings that life was worthwhile rose by 45 per cent. Social prescribing shifts the focus from patients as passive recipients of care to people as active agents of change. That’s why it’s so transformative. In a health system often burdened by bureaucracy and stretched to its limits, it empowers patients to make their own decisions, build their skills, give back to others as active volunteers and feel that they matter and belong. The practice has quickly spread: there are now practical applications of it in more than 30 countries, mostly by word of mouth between practitioners, community members and researchers.
In Canada, social prescribing is already being practised locally in every province. But for now, it’s largely limited to individual efforts by doctors. Most patients and clinicians still don’t know they can ask for it or make it happen in their own communities. Social prescribing still needs to be formalized and integrated into medical training. These gaps inspired me to launch the Canadian Institute for Social Prescribing, or CISP, in 2022. I wanted to grow the practice, advocate for supportive policies and learn what works best. Just two years later, in B.C., the Ministry of Health started funding workers to join small organizations and help older adults access housekeeping help and activities at community centres. In Ontario, Black-focused social prescribing at community health centres connects people to things like youth sports, mentorship by business leaders and barbershops known for their expertise in Black hair. Online resources help too: in Quebec, a website called Clic Social helps health-care providers find out what services are available. Across the country, the online PaRx program lets doctors make referrals to parks and nature.
Doctors and health-care providers can write referrals, but they’re often too overwhelmed with meeting patients’ medical needs to prioritize their social ones, or they don’t know how to help. A simpler and more empowering model is for them to refer patients to peer community health workers—referred to as “link workers” in the U.K. and “community connectors” in parts of Canada. These individuals, deeply embedded in their communities, have the skills—and, crucially, the time—to build trust, listen and guide participants through their health journeys. They also act as bridges between organizations. Often, health and social institutions can reassign existing staff or volunteers to this role to get things started.
Social prescribing is not yet widely known enough to be a universal part of our health system—but it should be. We need to spread the word and train and support local people to start social prescribing in their communities. At CISP, we have link worker training tools and a nationwide community where peers can share inspiration and guidance. We’re focused on the next generation of health-care professionals, too. We’ve developed a teaching guide for college and university teachers and a national student-led social prescribing collaborative. We’re also working with medical schools to update their curricula.
By allocating federal funds directly to community service providers or earmarking federal-provincial health transfers for social prescribing, we can build the local self-reliance we need for stable, sustainable and impactful social prescribing across the country. For just $100 million a year—or around 0.03 per cent of Canada’s $372-billion health-care spending—we could start with one locally employed link worker for every 40,000 patients in Canada, about the ratio used in the U.K. For a little more, we could hire thousands more link workers and build in evaluation tools to make sure that we funnel health and social-service investments to where they are most needed and most effective. Canada’s health-care system is under immense pressure, but social prescribing is remarkably efficient at turning deficits into assets: a recent KPMG Canada study showed that with every dollar invested in social prescribing, we gain $4.43 from improved well-being and reduced costs on the health-care system. What’s more, social prescribing reconnects health care providers with a sense of purpose and builds volunteerism and community pride in having strong, innovative and locally grown initiatives in our own backyards.
It shouldn’t take a medical emergency like Orla’s—or the resources of a hospital—for us to access the benefit of social prescribing. Many of us feel a harmful sense of isolation in our daily lives and our health-care experiences, especially if we encounter discrimination or indifference. Instead of recovering in the darkness of our bedrooms and in cold, sterile emergency departments, with a bit of a boost we can get outside and breathe some fresh air with friends, volunteer to help others, or find a hobby that gives us a sense of flow. That’s healing.
Almost a year later, Orla has regained much of her mobility, along with a new sense of purpose, agency and belonging that she didn’t have before her brain injury. While her journey will be lifelong, Orla’s experience shows why social supports should be a routine part of clinical care. Making it happen is simple, cost-effective and sustainable. And it is well within our reach.
Kate Mulligan is an assistant professor at the Dalla Lana School of Public Health at the University of Toronto and is the scientific director at the Canadian Institute for Social Prescribing.