Could you explain what social prescribing is and how it helps healthcare systems address chronic diseases, mental health challenges and social isolation?

Social prescribing is a supported referral between healthcare and community supports. It helps people identify and address their health-related social needs, with help from health providers and social service providers (formal and informal). These can include food, housing, income, social connectedness and belonging, arts and culture, physical activity, time in nature and more.

You frame social prescribing through two powerful shifts - from 'what's the matter' to 'what matters' and from 'what's wrong' to 'what's strong.' How does this reframing transform our approach to community health?

A strengths-based approach is at the core of health promotion, which is really about empowerment — our power to take more control over our health and the conditions for our health and wellbeing. It aims to foster individual and community self-determination: the ability to make our own healthcare decisions, a sense of purpose and capacity, a feeling of belonging and mattering to others, and ability to give back to others.

That's why social prescribing is so much more than just a "doctor's prescription" for what to do. It's led by the person, who is more than just a patient; they're a community member with much to give, with support from a peer community health worker, often called a link worker or community connector, who helps them to follow through and break down any barriers to participation, from transportation and logistical costs to psychological barriers.

You've highlighted the importance of community and neighborhood-scale leadership (an approach that empowers community organisations to share responsibility for the health of all people in their local neighbourhoods) in health and wellbeing. How can we better support these local interventions to maximise their impact?

By tracking the impacts of social prescribing on people's health outcomes, health experiences, and use of health and community services, we can get a detailed picture of where better investments are needed. I call this "precision community health" - instead of targeting specific genes, we're targeting specific social determinants of health, specific culturally-safe and supportive services, or specific neighbourhoods and postal codes. We need to make sure we have this strong safety net in place and funded by health systems.

As Director of The Canadian Institute for Social Prescribing, you've demonstrated compelling economics in the recent white paper - $4.43 return for every dollar invested and potential savings of millions in healthcare costs. Given these numbers, what's preventing more governments from implementing social prescribing at scale, and what institutional mindsets need to shift to enable this transformation from crisis response to prevention?

Actually, most people in government and health and social institutions are very open to social prescribing once they hear about it. The biggest challenge is spreading the word and demonstrating how easy it is for them to take their first steps. Once that happens, they're usually off to the races because they get such positive feedback from providers and participants, and such good results, that they are on the road to systematisation and quality improvement.

One thing that would help accelerate the process is wellbeing budgeting, something they do in other countries like Aotearoa New Zealand, Wales, Scotland and Finland. It helps governments put the wellbeing of people and planet at the centre of their resource allocation decisions. Such an approach would help us to better consider shared costs and benefits across ministries, departments or even orders of government. The reason is that sometimes the costs are borne by one part of the government or health systems, and the benefits accrue elsewhere. For example, community services and public health might pay for more services but the cost savings go to hospitals in the form of reduced emergency room visits. Wellbeing budgets help us think of the costs and benefits together instead of in silos.

You've outlined a future where older adults are supported by healthy, vibrant community sectors. Since more people are living much longer than before, what fundamental shifts - in policy, healthcare systems, and societal attitudes - need to happen to transform this vision from aspiration to reality over the next 5-10 years?

One thing I like about social prescribing is that we can take small steps that change local practices first, and let our learning experiences inform policy, systems and perspective changes. Feedback loops create the relationships, evidence and momentum we need for more and more positive change. And it just feels good, making people want to do it more and grow and improve the practice.

While there is growing evidence supporting the benefits of social prescribing, what do you think is still missing in terms of evaluating its long-term impact on older adults, particularly in relation to chronic conditions like dementia or depression?

We need more evidence about the details of what works best, for whom, under what circumstances, to ensure we are really advancing health and health equity. That's where the "precision community health" data and evaluation of social prescribing can really help. We also need more research on the role of health promotion and the leadership of people and communities in their own health; sometimes social prescribing research focuses on the technicalities of the referral process and not the transformative relationships and paradigms at work. It always helps to have research about "made in Canada" solutions that demonstrate what works across a range of contexts, geographies and populations in our diverse country. And we need more research about the policies and resources necessary to sustain this work over time.