Social Prescribing Student Movement Framework by WHIS Inspire

SOCIAL PRESCRIBING INTERNATIONAL STUDENT MOVEMENT FRAMEWORK The opportunity exists to empower young students and future healthcare professionals across the world to develop healthy communities through principles of Social Prescribing, Personalised Care, and Sustainable Development Goals.

FOREWORD Dr Bogdan Chiva Giurca, Chair and Founder, Social Prescribing Champion Scheme, Development Lead, Global Alliance for Social Prescribing

The one-size-fits-all approach to health and care has been dismissed in light of complex unmet patient needs and expectations. With one in four patient consultations in the UK visiting their doctor for purely social reasons, the medical model alone falls short of delivering the excellent care that our patients need and that healthcare professionals strive to deliver. Our future doctors are being taught to react to disease, to cater for the already sick and to follow algorithms which rarely apply in their day-to-day jobs as clinicians. Acute care is crucial and must continue, but it is unsustainable given rising staff shortages and changing demographics: The number of people aged 60 and over are set to double by 2050, not to mention the health inequalities exposed by the COVID-19 pandemic and the longterm effects of the virus on the wider economy

Social Prescribing Student Movement Framework

In a world operating beyond the pandemic, the question becomes:

How do we move away from a system just focused on treating illness towards one that is based on promoting well-being and preventing ill health?

The Social Prescribing model (and Person-Centred Care more widely) has been developed to complement and work alongside the medical model to address unmet needs. Moreover, social prescribing has the potential to play a key role in tackling the social determinants of health, estimated to account for approximately 80% of the modifiable factors contributing to health outcomes for a population. This document serves as a call for action for students, academics, and clinicians world-wide, to unite and challenge the pathogenic approach to health, in an attempt to explore health promotion and health creation through principles of social prescribing, personalised care, and sustainable development goals. We believe long term change can only occur by driving forward a shift in values and beliefs amongst the future generation of clinicians and healthcare professionals. The students of today represent the healthcare professionals of tomorrow and must be equipped with the necessary tools to navigate ever-changing demographics.

“The international student framework provides us with the opportunity to share best practice, knowledge and wisdom to support the future leaders of good health & wellbeing.” Gareth Presch, CEO, World Health Innovation Summit, Expert SDG3/4 UNGSII, Member of Pope Francis COVID19 Vatican Commission - Group 2 Looking to the Future

Social Prescribing Student Movement Framework

SDG3 GOOD HEALTH & WELLBEING We believe the opportunity exists to establish a new healthcare model that creates value based on prevention, early intervention and using different types of resources. This approach will enable people and communities to thrive and improve their health and wellbeing, support the existing health services, and create new and meaningful jobs, all while supporting the implementation of the UN’s 17 sustainable development goals.

Who’s Involved? This international framework has been put together by the NHS Social Prescribing Student Champion Scheme with support from Global Social Prescribing Alliance, National Academy for Social Prescribing, WHIS, UNGSII Foundation, Social Prescribing Network, the College of Medicine and Integrated Health, the Social Prescribing Student Collective of Australia, the Social Prescribing Student Collective of Japan, Harvard Global Health Institute, and the Portugal Social Prescribing Student Champion Scheme. A list of our authors and contributors can be found at the end of this document.

“The movement set up by students represents a true medical education revolution led with passion and enthusiasm by young leaders across the world” - Dr Michael Dixon, Chair of the College of Medicine and Medical Adviser to HRH Prince of Wales

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OUR FRAMEWORK CONTENTS The social movement behind social prescribing that has been generated by students passionate to improve health and wellbeing continues to grow rapidly, and this framework will enable even more people to get involved in the work to transform lives

”

- James Sanderson, Director of Personalised Care NHS England, CEO of the National Academy for Social Prescribing

Social Prescribing Student Movement Framework

OUR MISSION To establish a global network of student champions dedicated to the advancement of social prescribing through promotion, collaboration, and innovation

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Social Prescribing Student Movement Framework

This document has been authored by a team of enthusiastic students, doctors, academics, and healthcare professionals including: Sonia Epstein, Rachel Chen, Sai Ramesh, Dr Joel Chilaka, and Dr Bogdan Chiva Giurca. We would like to express our gratitude to our many contributors including: Lavinia, Dr Michael Dixon, Bev Taylor, James Sanderson, Sian, Grace, Jasmine, Wentin, Daisy, Leah.

THE VISION To support students worldwide in driving forward a reform in medical education, one that promotes patient involvement and tackles social determinants of ill-health through principles of social prescribing and personalised care.

1 2

Introduction Pages: 1 – 6 • • •

How to Start a Social Prescribing Student Champion Programme in Your Own Country Pages: 7 – 24 • • •

3 4

Who is this document for? Summary Overview: A Seven-Point Checklist for Starting a Social Prescribing Student Champion Programme.

Seven-Point Checklist Case study: UK Champion Scheme International Partners

Further Reading Pages: 25 – 30 • • •

Principles of Social Prescribing Origins Evidence

Resources Pages: 31 – 32

Social Prescribing Student Movement Framework

This document is addressed toward students, young healthcare professionals, young community leaders, and their clinical and academic colleagues seeking to lead institutional, local and national efforts to make social prescribing a priority among the next generation of healthcare leaders. Students from all health-related professions, including those training to be doctors, nurses, occupational and physical therapists, social and community health workers, and many others are crucial for building a global movement for social prescribing. This document aims to: • Explain what social prescribing is and clarify the role of social prescribers • Outline the impact of social prescribing and the opportunity it brings to people, society, the economy and healthcare system • Help students and colleagues plan how they can build local social prescribing movements from within their universities, communities, and advocacy networks and access the resources they need • Connect passionate students, academics, and community members from across different regions to collaborate and bolster their impact • Develop student champions and build a global alliance of students committed to promoting and implementing social prescribing. This framework has been put together by members of the Global Social Prescribing Alliance. The Global Social Prescribing Alliance (GSPA) is a group of worldwide partners who recognise that what keeps us well is more than medicine. The Alliance’s work supports the implementation of UN Sustainable Development Goal 3: “Good health and wellbeing”.

WHO IS THIS DOCUMENT FOR?

SUMMARY WHAT IS SOCIAL PRESCRIBING Social prescribing provides a framework through which all local agencies (including, but not limited to clinicians) can refer patients to non-clinical, community-based services that promote health and wellbeing via a ‘Link Worker’. Link workers give people time, focus on what matters to the person using a personalised care approach, and connect people to community groups and agencies that will support their health and wellbeing. This emphasises a truly bio-psycho-social approach to health, instead of a purely biomedical approach.

Social Prescribing Student Movement Framework

In most models of social prescribing, a healthcare professional refers a patient to a social prescriber (often referred to as ‘Link Worker’), who engages in face-to-face conversations with the patient in order to understand their needs. Together they co-design a personalized approach to care that complements their biomedical prescriptions. These “social prescriptions” can be activities provided by the voluntary and community sector, from financial support and professional counseling to artistic or physical activities that build community connections.

• • • •

Gain a sense of belonging to a community Peer support Reduce loneliness Improve mental and physical health

•

Relieve pressure on primary care clinicians, emergency departments, and in-patient wards Promote significant financial savings

On the healthcare service & economy •

On society and community • • •

Those who can benefit from social prescribing might: • • • •

Be living with one or more long term health conditions Need help with money, legal and practical issues Be recovering from or impacted by COVID-19 Need help to be more physically active, to connect with others, to overcome loneliness or isolation Need support with their mental health

WHAT IS THE IMPACT OF SOCIAL PRESCRIBING On people

WHO CAN BENEFIT FROM SOCIAL PRESCRIBING

Create stronger, inclusive communities Empower individuals Develop new groups and community activities

•

Social Prescribing Student Movement Framework

WHAT ARE THE ROLES OF STUDENTS & YOUNG HEALTHCARE PROFESSIONALS

With one in four patients in the UK visiting their doctor for purely social reasons, it is clear that comprehensive health care requires more than a biomedical approach. For this group of patients, social prescribing could ensure a truly biopsychosocial treatment plan. Equipping students and young healthcare professionals with the tools and an understanding of personalized, holistic care enables them to challenge existing conceptions of health and to promote wellness proactively rather than to respond to illness when it appears. Beyond practicing principles of social prescribing themselves, they are best placed to question the health systems they will inherit and can apply a fresh perspective on medical education, the doctor-patient relationship, and what truly constitutes health.

Students are educated, informed, and passionate—they have the platform and the drive to demand systematic change in a healthcare landscape that desperately needs to adapt to the pressing 21st century needs. Through the establishment of Student Social Prescribing Champions across the globe, we can build a network and a movement for more holistic, collaborative healthcare together.

ENGAGING STUDENTS: THE SOCIAL PRESCRIBING CHAMPION SCHEME The Social Prescribing Champion Scheme was established in 2017 to engage the next generation of healthcare professionals in promoting social prescribing. The Scheme is now a multi-centre national project led by young healthcare professionals and healthcare students representing all UK medical schools, with support from key national organisations including NHS England, The National Academy for Social Prescribing, The College of Medicine and Integrated Health, The Social Prescribing Network, Personalised Care Institute, Arts4Dementia, and several others.

Since its establishment, it has recruited thousands of medical and Allied Health Profession (AHP) students from all over the United Kingdom to spread awareness of social prescribing through teaching and focusing on aspects of lifestyle medicine that can improve person-centred care. There are now up to three champions in nearly all of the 35+ medical schools within the UK and the movement is expanding globally.

OVERVIEW: A SEVEN-POINT CHECKLIST FOR STARTING A NATIONAL SOCIAL PRESCRIBING STUDENT CHAMPION PROGRAMME WITHIN YOUR OWN COUNTRY

i vii

ii 7 STEPS TO DEVELOPING A STUDENT CHAMPION PROGRAMME

vi v i Familiarise yourself with the concept and model of social prescribing

ii Reflect on your country or region’s healthcare system

v Get in touch with our team via spschemeinternational@gmail.com

iii

iii Consider where iv Ask yourself: Who social prescribing might join me in fits within your own setting up this clinical or healthcare movement? education

vi Set up an Introductory vii Launch your Social Prescribing country’s Social Webinar in your country Prescribing Champion or region Programme

Social Prescribing Student Movement Framework

HOW TO START A NATIONAL SOCIAL PRESCRIBING CHAMPION PROGRAMME WITHIN YOUR OWN COUNTRY A SEVEN-POINT CHECKLIST

i. FAMILIARISE YOURSELF WITH THE CONCEPT AND MODEL OF SOCIAL PRESCRIBING The foundational elements of social prescribing have been outlined by numerous resources beyond this document. These include the Global Social Prescribing Playbook from the Global Social Prescribing Alliance, group of worldwide partners dedicated to the advancement of social prescribing through promotion, collaboration and innovation. The King’s Fund, an independent UK charitable organization, has collated a series of studies that point toward the benefit of social prescribing. The Asset-Based Health Inquiry from London Southbank University delves further into the utility of social prescribing.

Social Prescribing Student Movement Framework

You can also learn about social prescribing from a general practitioner’s perspective and a patient’s perspective. Additional resources are available at the end of this framework document.

ii. REFLECT ON YOUR COUNTRY OR REGION’S HEALTHCARE SYSTEM No uniform model for social prescribing exists — and there shouldn’t be one. Social prescribing can only be successful if it bridges the existing healthcare system with the community it seeks to serve. Social prescribing may take different forms depending on the particular challenges and opportunities present within a particular region. Start by asking yourself: Is healthcare in your country paid for and provided by the government, or do private organizations provide medical services and insurance? Is out-of-pocket spending on healthcare a major burden? What robust community and voluntary resources exist?

It can be helpful to think locally: What are the social determinants of health that most impact the community around you? These may include access to housing, green spaces, healthy food, or opportunities to exercise. What stakeholders — both clinical and non-clinical — might be able to collaborate with you in targeting them through a social prescribing model? What support is already offered for building community health, and does the healthcare system in your country offer any similar programmes to social prescribing? How are healthcare professionals in your country currently seeking to address the psychosocial aspects of health?

Social Prescribing Student Movement Framework

iii. CONSIDER WHERE SOCIAL PRESCRIBING FITS WITHIN YOUR OWN CLINICAL OR HEALTHCARE EDUCATION Even if the infrastructure for social prescribing does not yet exist, the concepts upon which it is based may be part of your training as a healthcare professional. A “biopsychosocial model” of health emphasizes that wellbeing is shaped holistically, through the convergence of biological, psychological, and socioenvironmental factors often referred to as the social determinants of health. Health equity and person-centered care are both fundamental tenets of social prescribing. Are lectures on the social determinants of health, preventative care, or shared decision making with patients included in your curriculum? Do any of your professors have a particular interest in the biopsychosocial model of health or health equity? Engaging with professors or other institutional partners who are already committed to these principles may be helpful in building a local network for advancing social prescribing.

iv. ASK YOURFELF: WHO MIGHT JOIN ME IN SETTING UP THIS MOVEMENT? If you’re a student, young clinician, or young academic, think of your colleagues, both in your school and outside of it. Consider which lecturers, clinical colleagues, mentors, and professors may be interested in the principles behind social prescribing. Would any of them be interested in being part of this movement? How many places can you reach across the country?

Social Prescribing Student Movement Framework

If you’re a senior academic, think of your students and younger colleagues. Who among them might be passionate about driving social prescribing forward? Brainstorm which academic institutions, universities, professional or academic societies, and organizations may be viable partners. Having committed collaborators in different geographic locations can potentially spread awareness about social prescribing more rapidly. Once you get in touch with our team, we are happy to provide you with materials that may be helpful in reaching out to potentially interested students or colleagues.

v. GET IN TOUCH WITH OUR TEAM The U.K. Social Prescribing Champion Scheme and the Global Social Prescribing Alliance are here to support you with resources, guidance, and a platform to start your movement. Contact us and let us know what we can do to help. If desired, we can set up a scoping and planning meeting where a member of our team will be able to help, as well as match you with a student champion mentor in the U.K. who can offer advice and a wider network of support.

Get in touch with our team via spschemeinternational@gmail.com

Social Prescribing Student Movement Framework

GLOBAL SOCIAL PRESCRIBING CHAMPION BUDDY-UP PROGRAMME As social prescribing gains traction around the world, the students involved in driving the movement forward have begun to form an international student-led coalition. The buddy-up programme provides direct support to student interest groups joining the global student social prescribing movement by providing mentorship from experienced student champions. By working and learning together, we can introduce social prescribing to areas where it is relatively unknown and expand our network of support and collaborators. In the early stages of the buddy-up programme, members of the UK Social Prescribing Champion Scheme will serve as mentors. However, as student movements in other countries develop, champions from any country can apply to mentor and share their learning. Using their personal experiences in hosting educational events, producing research, and supporting local champions, mentors can guide new interest groups through launching their own campaigns. Please reach out to us at spschemeinternational@gmail.com if you are interested in participating in the programme.

Social Prescribing Student Movement Framework

vi. SET UP AN INTRODUCTORY SOCIAL PRESCRIBING WEBINAR IN YOUR COUNTRY OR REGION

Webinars are an excellent method of introducing social prescribing to a new audience and gauging interest. Our team is here to provide social media support, posters, and technology assistance, as well as potential discussion topics and materials to share during your talk. Your webinar can be hosted on the World Health Innovation Summit platform which has been set up in collaboration with the United Nations and the World Health Organization. This will therefore amplify your voice and help you reach a larger audience. International Social Prescribing Day, held each March, is an opportune moment to rally around the cause of social prescribing and celebrate the thousands of programmes established to maintain the health of local communities. One example of a successful introductory webinar can be found here.

Building Momentum Around an Online Event Before your event, create a simple registration form to capture the audience joining you and to allow dissemination of further information after the webinar. While doing so, please be conscious of following data protection regulations and of storing the webinar participants’ data safely. After your event, create and send a follow-up form as an opportunity for students to express their interest in getting involved further. These contacts will be useful resources when recruiting a core leadership team and student champions across your country.

Social Prescribing Student Movement Framework

vii. LAUNCH YOUR COUNTRY’S SOCIAL PRESCRIBING CHAMPION PROGRAMME Through contacting classmates, colleagues, and interested participants of your event, assemble a core leadership team. This team can involve both students and mentors, all of whom work together to decide which partners, collaborators, and senior leaders can become involved at this stage and in the future. Establish roles and responsibilities for team members. If you need a model for group organization, feel free to consult the U.K. Student Champion Scheme Model described in the following pages. As a team, create short-term goals and a long-term vision to which team members can help hold each other accountable, and set these goals to a timeline — but remember to start small and allow for slow development! Healthy, stable systems will be more impactful in the long run. With the help of our resources, develop your country’s logo and apply it to branding and recruiting materials. Establishing an online presence is another great way to formally announce your presence—a Twitter account is a good place to start, as there is a welcoming community of social prescribing advocates on Twitter already. Coordinate the launch of your movement with a few simple events that people can join to learn more about social prescribing. Encourage those you may know at other universities to attend and begin thinking about whether they might want to start their own local programme.

If you need help reaching an online audience or finding speakers for events, please reach out to us! We are happy to help you at every stage of this process. As your movement grows, update the world through social media and other chains of communication so we can celebrate milestones together.

WHAT OUR STUDENT MOVEMENT LOOKS LIKE: THE UK SOCIAL PRESCRIBING CHAMPION SCHEME The UK Social Prescribing Champion Scheme was established in 2017 with support from several national organisations including NHS England, the College of Medicine and Integrated Health, the Social Prescribing Network. It is now a multi-centre national project organised and led by thousands of students and clinicians representing academic institutions and hospitals across the UK.

Social Prescribing Student Movement Framework

There are now up to three champions in nearly all of the 35+ medical schools within the UK, with movements taking off in Portugal, Japan, the USA, Australia and elsewhere.

The core aims of the UK Social Prescribing Champion Scheme •

•

Providing resources for the development of Social Prescribing Student Champions across the world, such as through this international framework Establishing a student movement focused on health creation and disease prevention by using a personalised care approach and the principles of social prescribing Challenging medical education in countries where “doctor-knows-best” approaches are still dominant

The core values of the UK Social Prescribing Champion Scheme • • • •

Adequate education for the future generation of doctors Patient involvement: co-design, co-creation, and collaboration in treatment Allowing patients to live their best possible life by focusing on a biopsychosocial and preventive approach to health and wellbeing Empowering the generation of today’s students who will eventually become tomorrow’s healthcare professionals

Social Prescribing Student Movement Framework

THE UK SOCIAL PRESCRIBING CHAMPION SCHEME MODEL When establishing a new Student Champion Programme, adaptations to individual countries and cultures will likely be required. However, below are some principles and tips that have worked in the United Kingdom Scheme which may be useful in other countries.

RECRUITMENT STRATEGIES In establishing the UK Student Champion Scheme, an important first step was to establish a core leadership team, which included roles such as Lead, Social Media Lead, and Secretary as listed in the diagram above. To recruit these leaders, the UK programme relied on a number of strategies, such as:

Social Prescribing Student Movement Framework

Spreading the word through formal and informal networks Word of mouth tended to be the most effective means of recruitment, as students involved in the programme inspired their friends at other medical schools to join. Champions asked medical schools directly to advertise social prescribing to their students, and requested nominations for students who might be interested in leading.

2 Preparing literature & resource materials to formalize the organization Publicity materials distributed online and across campuses can attract interest. Documents explain the principles and impact of social prescribing for potentially interested students. An email address and social media accounts, such as a Twitter account for the programme, centralize communication and establish an online presence.

Using Social Media Effectively Social media and online tools have helped expand the reach of the movement. The UK Student Champion Scheme has used countdowns to events on Twitter, feature spotlights of family doctors and local community groups, and theme-based content relating education, art and music, or physical activities to social prescribing.

3 Starting small and building up over time The UK programme began with only a handful of dedicated students who took on larger roles as time progressed, with regional leads advancing to core leadership positions. Thus the process of new champions growing increasingly involved and experienced, taking on more responsibilities, and inspiring their classmates and colleagues to join, became a sustainable cycle of recruitment and coleadership that built up steadily over multiple years. Since its founding in 2017, the UK Student Champion Scheme has been able to obtain funding from the NHS, the College of Medicine and Integrated Health, and others to compensate students for their commitment to the student movement.

Social Prescribing Student Movement Framework

GET IN TOUCH To request examples of these materials and make contact with a current member of the UK Student Champion Scheme, please email

spschemeinternational@gmail.com.

Organizing and Recruiting Student Champions Below is a diagram of the structure of recruitment and responsibilities used in the UK for the Student Champion Scheme:

Key Responsibilities

Mentor and encourage student champions. A point of contact and support to help spreaad the world about SP.

Core Team

Lead Vice-Lead Academic Lead Social Media Lead International Lead Conference Lead Secretary

Key Responsibilities

Oversee the scheme and mentor regional leads. Provide support for all students on the scheme.

Regional Leads Team Regional lead for each area of the UK responsible for a number of medical schools

Organise events to spread the word about SP to peers. Network with local SP and personalised care initiatives.

Student Champions Medical Students and Allied Health Professional Students at UK Universities

Key Responsibilities

WHAT STUDENT CHAMPIONS CAN DO

Social Prescribing Student Movement Framework

Student champions at UK medical and allied health profession schools raise the profile of social prescribing in many ways. They have hosted a number of successful talks at their universities about social prescribing. These talks can put social prescribing in the larger context of social determinants of health and lifestyle medicine; they can be a single lecture-style event for a larger group (20+ students), or a series of discussions for smaller audiences of under 10 students. In the past, some students have incorporated their talks into a conference or within a local university society (e.g. ‘MedSoc’) or widely within a national association of medical students such as the Australian Medical Students’ Association. By connecting with medical societies, departments of primary or preventive care, or local community organizations, student champions can further centralize a social prescribing programme within an institution, while also laying the groundwork to build invaluable connections with important stakeholders. Student champions can also conduct research into the existing knowledge of social prescribing, social determinants of health, and personalised care amongst university students. This can be achieved by distributing surveys locally and nationally. Results from such surveys can inform practical means of incorporating the aforementioned concepts into the undergraduate and postgraduate curricula for medical and healthcare students. There are also opportunities for student champions to produce and publish research in this quickly growing field.

Social Prescribing Student Movement Framework

ACTIVITIES & EVENTS The UK programme has held a number of events to raise awareness, such as the Annual National Conference for Social Prescribing, an online webinar series, and local events.

In finding partners, collaborators, and speakers for events, the UK Programme approached: • •

• • •

Medical societies and student unions like MEDSOC, which helped them promote events and reach medical students Local and voluntary and tertiary organizations such as Pathways from Homelessness and Diversity and Ability, which give talks related to social prescribing General practitioners and family doctors, who often already practice social prescribing or value similar principles in their work Medical schools and institutions, which can give their official support or even collaborate on curriculum development Government officials at the local and national level, who may be able to push policies promoting social prescribing

INTERNATIONAL PARTNERS STUDENT CHAMPION PROGRAMMES AROUND THE WORLD

Social Prescribing Student Movement Framework

UPDATES FROM STUDENT MOVEMENTS AROUND THE WORLD AUSTRALIA

SINGAPORE

Our efforts to create a Social Prescribing Champion Programme in Australia began with a proposal to the Australian Medical Students’ Association (AMSA), which agreed to come on board and lead a national, coordinated effort to educate students about social prescribing and advocate for its inclusion in Australian healthcare. In order to gather interested students and to introduce people to the concept of social prescribing, we co-hosted a webinar in March 2021 with the UK NHS Social Prescribing Champions Programme, along with the University of Melbourne School of Population and Global Health. Following the webinar we recruited 10 medical students from Universities around Australia and have named the group the Social Prescribing Student Collective. We have developed educational materials, a database of local organisations working within social prescribing, and hosted our first webinar introducing students to the language and practice of social prescribing. AMSA has also passed a Social Prescribing Policy, which will form the basis of AMSA’s future advocacy in this space.

Singapore has started social prescribing in an inpatient setting within SingHealth Community Hospitals in late 2019, and has had early results that are encouraging and affirms the need to address social determinants of health before elderly patients return back to the community. Social prescribing has also recently started within the primary care outpatient setting through SingHealth Polyclinics.

We hope to support these efforts and others through our advocacy, outlined in this national policy document developed by the AMSA. Follow our progress on Facebook and Instagram, and don’t hesitate to reach out to socialprescribing@amsa.org.au

FACEBOOK

INSTAGRAM

We are encouraged by the person-centred approach that social prescribing advocates for, its focus on the health of populations and its crosssector partnerships and collaborations for better outcomes. Social prescribing reminds us that medicine cannot be practised in a vacuum. We have just started to establish a local network of student leaders passionate about social prescribing, one that comprises student members of diverse international backgrounds, consolidating global health and public health expertise on various fronts. Our SIG also seeks to engage fellow advocates on international platforms to learn how to adapt and improve our initiative, collaborate with existing healthcare institutions and primary care teams to achieve sustainable involvement in teaching and promotion of social prescribing within the local context, and empower the next generation of youths to be social prescribing champions by tapping onto post-secondary educational institutions and community groups. For more information, please reach out to: school@singhealthch.com.sg

Social Prescribing Student Movement Framework

USA

JAPAN

With a growing understanding of the role of psychological and social factors on patient wellbeing, various institutions in the United States have taken steps to complement biomedical approaches by adopting social prescribing principles into their health systems. Medical education has implemented interdisciplinary modules in public health, preventive medicine, medical humanities, and arts. A central aim of the US Social Prescribing Champion Program is to engage non-premedical students, including those with interests in economics, government, the humanities, social entrepreneurship and health equity.

Here in Japan, our social prescribing student collective started during the spring of 2021. We first reached out to the managing members of a social impact organization called the Hult Prize Foundation for support, and we plan to reach out to other student organizations such as TEDx at Sophia University in Tokyo.

To gain traction in the United States, where patients must navigate a complex healthcare system supported by federal, state, and private stakeholders, social prescribing will require collaboration across different sectors. Developing a cohesive movement driven by students, young professionals, researchers, and healthcare workers from diverse fields can help shift cultural perceptions of health and medicine from purely biomedical and reactive to holistic and proactive. Complementing the initiatives in place, students and alumni of universities including Columbia, Duke, Harvard, and Stanford have formed a national interest group centered on tackling the social determinants of ill-health by promoting social prescribing and principles underlying it in the U.S. healthcare and medical education systems. The geographically diverse and interdisciplinary team will congregate for a fall 2021 webinar to raise the profile of social prescribing. The Harvard Global Health Institute (HGHI), in partnership with the UK’s National Academy of Social Prescribing, is supporting the early work of these students with a platform and network for collaboration, and students at Harvard College are planning to host a multi-disciplinary conference about mobilizing communities to respond to the social determinants of health.

Our plan is to host a webinar for university students across Japan, including but not limited to students at Sophia, Waseda, and Tokyo Universities, with the goal of creating an interactive and memorable experience that will inspire Japanese students to join the movement for social prescribing. Right now, we are still discussing whether to create a national interest network or a non-profit organization, and our main task at hand is translating foundational resources about the principles of social prescribing from English to Japanese. This work of translation has been our biggest challenge yet, because the balance between clarity and impact is crucial. Cultural and linguistic barriers further complicate the critical work of networking and gathering an audience for our webinar. Since social prescribing is such a new and foreign concept in Japan, it can be difficult for students to resonate with it without the right language or examples. As a result, we are currently targeting Japanese universities that are particularly familiar with English. However, despite these challenges, we have faith that social prescribing can inspire students universally and we are excited to get to work.

PORTUGAL Social Prescribing has been an integral part of the Portuguese healthcare system since 2018. However, following the success of the UK NHS Social Prescribing Champions Programme, we were inspired to create a similar programme in Portugal to recruit medical students as advocates of social prescribing. We launched the programme in May 2021 to attract interest from potential Champions, and hope to inform the future generation of medical graduates about social prescribing and its significance within the Portuguese community. We also aim to establish a research group that can evaluate the outcomes of social prescribing and contribute to an ever-growing evidence base that will, hopefully, inform future practice. For more information, please reach out to: saudepublica@aefml.pt

Social Prescribing Student Movement Framework

FURTHER READING

Social Prescribing has the ability to transform patients into people by focusing on what matters to them, their whole needs and strengths, not just their biomedical ones that need ‘fixing’.

THE PRINCIPLES OF SOCIAL PRESCRIBING What would it look like for the healthcare system to see a patient as a whole person, beyond a medical diagnosis? What if, along with medication, doctors and nurse practitioners were empowered to prescribe housing and financial wellbeing advice, dance or sports lessons, volunteer opportunities, single-parent groups, and connections to bereavement networks? What if, in addition to providing care for those already experiencing disease, we also actively sought to prevent ill-health and target its social determinants? This is the vision behind social prescribing, which is now a national policy within the UK’s National Healthcare Service.

Social Prescribing Student Movement Framework

Financial stability, opportunities for connectedness, and access to good food and health-promoting activities all impact a person’s overall wellbeing. This asset-based approach to health goes beyond treating illnesses. It recognises people as not just patients with needs, but as community members with gifts to share. It starts with patients’ strengths, not their weaknesses. There is no “one-size-fits-all” model for social prescribing, with countries around the world beginning to integrate it into their healthcare systems. Movements are taking off in Canada, Portugal, the Netherlands, Australia and elsewhere. In the UK, social prescribing is driven by the expertise of “link workers”, who are embedded in primary care network multi-disciplinary teams supported by national investment. Social prescribing link workers engage in face-to-face conversations with patients in order to understand their needs, working together to co-design a personalized healthcare approach that extends beyond biomedical care. While the term “social prescribing link worker” is used across England, other regions developing their own social prescribing programmes have used different titles for the individuals filling this role, among them community connector, wellbeing advisor, and health advisor, depending on local preference. The English Social Prescribing model is outlined in more detail here.

Social Prescribing Student Movement Framework

ORIGINS OF THE SOCIAL PRESCRIBING MOVEMENT The ideas behind social prescribing are ancient, but incorporating them into existing structures of primary care has been an ongoing effort of the last century. In the UK, social prescribing is often dated back to the “Peckham Experiment” in South London (1926-1950). This was a physician-run health centre that aimed to improve the health of patients by giving them access to activities such as physical exercise, swimming, games, workshops and a café producing nutritious food and whose activities were organised by the patients themselves. In 1984, the Bromley by Bow Centre in East London was founded to offer welfare advice and employment to support young people. Other communitybased organizations, with the expertise of a social prescriber at their core, have continued to emerge. A turning-point occurred in 2014 when the National Health Service laid out its Five Year Forward View, emphasizing the importance of preventive and community-based medicine and citing the positive impact of social prescribing programmes. The NHS’s 2019 Long-Term Plan committed to help build the infrastructure for social prescribing by incorporating it into its comprehensive model of personalised care. In October of 2019, the National Academy for Social Prescribing was launched as an independent charity in the UK with funding from numerous partner organizations. It supports the NHS’s 2019 targets of making social prescribing accessible to every GP practice across England and referring at least 900,000 people to social prescribing by 2024. This is the biggest investment in social prescribing by any national health system, and legitimises communitybased activities and support alongside medical treatment as part of personalised care. As of the fall of 2020, the NHS reported that more than 1,200 link workers were in post.

PARTNERS & COLLABORATORS UK examples include several national organisations including NHS England and Improvement, National Academy for Social Prescribing, the College of Medicine and Integrated Health, the Social Prescribing Network, Personalised Care Institute, the Royal College for General Practitioners, Arts4Dementia and several community / voluntary care sector organisations as well as academic institutions and universities.

SOCIAL PRESCRIBING IN ACTION The Bromley by Bow Centre (BBBC) in London is a pioneering charity that combines a neighbourhood hub for community engagement with a medical practice and research center, offering a tailored support pathway for patients’ needs. For instance, a patient struggling with dietary conditions could be referred to a community link worker who will support patient involvement in cooking classes and relevant education to supplement a medical prescription. This approach, led by the link worker, relies on shared-decision making based on what truly matters to the patient. It also creates a social network in which people can support and encourage each other. The BBBC serves people in one of London’s most deprived areas, by recognising the social factors that impact health.

Social Prescribing Student Movement Framework

EVIDENCE FOR SOCIAL PRESCRIBING As more social prescribing programmes are established, the opportunity to observe their impact widens. A growing body of evidence demonstrates improvements in mental health and general wellbeing with participation in social prescribing programmes. A study of a pilot in Rotherham that connects people with over 20 voluntary and community organisations showed that after six months, there were reductions in use of National Health Services among 161 patients referred to the programme. These included a 21 percent reduction in Accident and Emergency attendances, 9 percent reduction in outpatient appointments, and 29 percent reduction in inpatient admissions. A programme in Shropshire reported statistically significant improvements in measures of wellbeing and loneliness, with a 40 percent reduction in general practitioner consultations among participants compared to a control group. Whether these changes are directly a result of social prescribing is still unclear, and requires further evaluation. Small-scale studies such as these have generated encouraging results, but weaknesses in the evidence base still remain. Many studies focus on individual interventions rather than the social prescribing model, do not have a control group, rely on qualitative evidence, or are otherwise limited in their scope and replicability. Determining the cost-effectiveness and resource implications of social prescribing is particularly difficult, and may require a long-term approach. There is good reason to believe that social prescribing can deliver benefits for some people, and with the growth of new programmes supported by fierce advocates, its impact can be evaluated, refined, and delivered.

4 © National Academy for Social Prescribing 2021 © World Health Innovation Summit 2021 Designed, edited and organised by Joshua Entwistle, Emily Dodd and Gareth Presch – World Health Innovation Summit

FURTHER RESOURCES, READING & MARERIALS: Creative Health – All Party Parliamentary Group report. http://www.artshealthandwellbeing.org.uk/

Healthy London Partnership (2018), What is Social Prescribing? https://www.healthylondon.org/our-work/personalised_care/ social-prescribing/

NHS England (2018), Comprehensive model of personalised care. https://www.england.nhs.uk/personalisedcare/comprehensivemodel-of-personalised-care/

NHS England (2019), Social prescribing link workers: Reference guide for primary care networks. https://www.england.nhs.uk/publication/social-prescribing-linkworkers/

Healthy London Partnership (2017), Social prescribing: Steps towards implementing self care.

NHS England (2019), What is personalised care?

https://www.healthylondon.org/resource/social-prescribingsteps-towards-implementing-self-care/

https://www.england.nhs.uk/personalisedcare/what-ispersonalised-care/

USEFUL RESOURCES 1. NHS England (2020), Social prescribing and community-based support summary guide. https://www.england.nhs.uk/wp-content/uploads/2020/06/socialprescribing-summary-guide-updated-june-20.pdf

2. Personalised Care Institute (2020), Accredited Learning, https://www.personalisedcareinstitute.org.uk/mod/page/view. php?id=32

3. NHS England (2019), Social prescribing link worker welcome pack. https://www.england.nhs.uk/publication/social-prescribing-linkworker-welcome-pack/

4. Dayson, C. and Bashir, N. (2014), The social and economic impact of the Rotherham Social Prescribing Pilot. Sheffield: Sheffield Hallam University: https://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/ social-economic-impact-rotherham.pdf

5. Polley, M. et al. (2017), A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications. London: University of Westminster 6. Alliance for Healthier Communities (2020), Rx: Community - Social Prescribing in Ontario https://www.allianceon.org/Social-Prescribing

7. World Health Organisation (2021), Health is a State of Absence of Disease, https://www.who.int/about/who-we-are/ constitution#:~:text=Health%20is%20a%20state%20 of,absence%20of%20disease%20or%20infirmity

8. Fries, C.J. (2020), Healing Health Care: From Sick Care Towards Salutogenic Healing Systems: National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099730/

9. NHS England (2019), Personalised Care. https://www.england.nhs.uk/personalised-health-and-care/

32 10. NHS England (2020), Green social prescribing. https://www.england.nhs.uk/personalisedcare/social-prescribing/ green-social-prescribing/

11. NHS England (2020), Social Prescribing Summary, https://www.england.nhs.uk/wp-content/uploads/2020/06/socialprescribing-summary-guide-updated-june-20.pdf

12. The Scottish Government (2017), Delivering the new GMS contract in Scotland Memorandum of understanding. https://www.gov.scot/binaries/content/documents/govscot/ publications/correspondence/2017/11/delivering-the-newgms-contract-in-scotland-memorandum-of-understanding/ documents/delivering-gms-contract-in-scotland---memorandumof-understanding/delivering-gms-contract-in-scotland--memorandum-of-understanding/govscot%3Adocument/ Delivering%2BGMS%2Bcontract%2Bin%2BScotland%2B%2BMemorandum%2Bof%2Bunderstanding.pdf

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16. SingHealth Community Hospitals (2021), Digital Social Prescribing. SingHealth Group. https://www.singhealth.com.sg/news/defining-med/digital-socialprescribing

17. Alliance for Healthier Communities (2020), Rx: Community - Social Prescribing in Ontario. https://www.allianceon.org/Social-Prescribing

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Polley, M. et al. (2017), Making Sense of Social Prescribing: University of Westminster.

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https://westminsterresearch.westminster.ac.uk/item/q1v77/ making-sense-of-socialprescribing

http://www.rcgp.org.uk/policy/general-practice-forward-view/ spotlight-on-the-10-high-impact-actions.aspx

Presch, G. et al., (2020), Intellectual Capital in the Digital Economy: Routledge.

The British Academy (2021), The COVID Decade: understanding the long-term societal impacts of COVID-19.

https://www.taylorfrancis.com/chapters/ edit/10.4324/9780429285882-4/world-health-innovation-summitwhis-platform-sustainable-development-gareth-presch-francescadal-mas-daniele-piccolo-maksim-sinik-lorenzo-cobianchi

https://www.thebritishacademy.ac.uk/publications/covid-decadeunderstanding-the-long-term-societal-impacts-of-covid-19/

Presch, G. et al., (2020), The World Health Innovation Summit (WHIS) platform for sustainable development. From the digital economy to knowledge in the healthcare sector: Routledge.

https://www.kingsfund.org.uk/publications/social-prescribing

https://www.researchgate.net/publication/336749206_ The_World_Health_Innovation_Summit_WHIS_platform_for_ sustainable_development_From_the_digital_economy_to_ knowledge_in_the_healthcare_sector

http://www.theworkfoundation.com/wpcontent/ uploads/2017/02/412_Social_prescribing.pdf

The King’s Fund (2017), What is social prescribing? The Work Foundation, Lancaster University (2017), Social prescribing: a pathway to work?

www.gspalliance.com SOCIAL PRESCRIBING STUDENT MOVEMENT FRAMEWORK The opportunity exists to create a sustainable health and social care model that generates value, creating new and meaningful jobs while implementing SDG3. We are deeply grateful and thankful to our authors, contributors and collaborators. Thank you for helping us shape this document and more widely, thank you for empowering the future generation of healthcare professionals.

Authors & Contributors:

For any further

Rachel Chen – Global Health Student, Harvard University (*) information, or if you Sonia Epstein – Global Health Student, Harvard University (*) would like to set up Sai Ramesh – Keele Medical Student your own ‘Champion Dr Joel Chilaka – Junior Doctor, NHS England Schemes’. Please contact Lavinia Porter – Swansea Medical Student us through: Rania Fernandes – Dundee Medical Student Bogdan.Giurca@ Grace Newman – Univ of Melbourne Medical Student nasp.info Jasmine Davis – President-elect (2022) Australian Medical Student Association (AMSA) Sian Slade – MPH Alumni, Univ of Melbourne (AU) Daniel Morse – Social Prescribing Network Lead, USA Varshini Odayar – Global Health Student, Harvard University Taiki Yamamoto – Sophia University Student, Liberal Arts Major, Japan Asuka Sakagami – Aichi University Medical Student, Japan Dr Kheng Hock Lee – Director, Office of Community Engagement & Education, SingHealth Community Hospitals, Singapore Adeline Kwan – Senior Manager, Office of Community Engagement & Education, SingHealth Community Hospitals, Singapore Daisy Kirtley – Exeter Medical Student and SP Student Champion Scheme Lead Wentin Chen – Birmingham Medical Student and SP Student Champion Scheme Social Media Lead Dr Lucia Lazzereschi – Junior Doctor, NHS England Dr Aimee Dowek – Junior Doctor, NHS England Dr Cristiano Figuerido – General Practitioner and SP Lead Portugal Leah Crabtree – Southampton Medical Student Gareth Presch – CEO and Founder World Health Innovation Summit Beverly Taylor – Director of Operations, National Academy for Social Prescribing Nicola Gitsham – Head of Social Prescribing at NHSE&I James Sanderson – CEO National Academy for Social Prescribing and Personalised Care Director NHSE&I Dr Kate Mulligan – Assistant Professor, Dalla Lana School of Public Health, University of Toronto Dr Michael Dixon – Chair of the College of Medicine UK Dr Bogdan Chiva Giurca – Development Lead, Global Social Prescribing Alliance (**)

(*) Main author(s) (**) Main supervisor and main correspondent Contact: Bogdan.Giurca@nasp.info