Social determinants of health (SDH) are non-medical factors that have an impact on one's health. The World Health Organisation (WHO) defines these as “the conditions in which people are born, grow, live, work and age” and “the fundamental drivers of these conditions.”

Research shows that social determinants may be more crucial than lifestyle in affecting health. SDH account for between 30-55% of health outcomes. For example, there is a variation of 18 years in life expectancy between high and low-income countries.

Primary healthcare professionals often do not have the time or expertise to address these aspects of wellbeing. Yet, social prescribing has the potential to do so.

Social prescribing enables healthcare providers to refer patients to local community services. These forms of support target non-clinical factors like housing, loneliness, and financial difficulties.

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‍What are social determinants of health?

Five key groups constitute as social determinants of health:

1. Economic stability

This includes employment opportunities and the cost of living. No regular source of income and poverty can harm a person’s health.

2. Education access and quality

This includes language and literacy skills. Educational attainment has a long-term impact on employment and wellbeing.

3. Healthcare access and quality

This includes health insurance coverage and health literacy. Less obvious issues are access to nutritious foods and opportunities for physical activity.

4. Neighbourhood and built environment

This includes safe housing, environment and well-connected transportation. Neighbourhood crime and violence are key problems to consider here.

5. Social and community context

This includes cohesion and participation within a community. Racism and discrimination at the workplace and in everyday life impede forming connections.

Decision-making processes, policies, social norms and structures all determine SDH. In turn, SDH are responsible for health inequities within and between countries.

In the UK, the gap between the richest and poorest has continued to widen over the last decade. Those in areas of social deprivation are more prone to physical and mental illnesses. According to WHO, the lower the socioeconomic status, the worse a person’s overall health.

For one, poverty limits access to healthy foods and safe surroundings in which to thrive. Unstable housing and low income are often linked to substandard education. Children growing up in more deprived areas suffer such disadvantages throughout their lives. These have a severe impact on their physical and mental wellbeing long into adulthood.

In England, only a third of children eligible for free school meals do well at GCSEs. This is in contrast to almost two-thirds of pupils who are not eligible for free school meals.

SDH not only affects individual and population health but also health equity. As a result, promoting healthier choices alone will not end health disparities. Action at the national, local and individual levels is necessary to bring about change.

This, of course, entails fair access to quality healthcare. Yet, working beyond healthcare to address social determinants takes equal importance. This is where social prescribing may step in.

What role can social prescribing play?

Social prescribing is a non-medical prescribing service that can improve overall health and wellbeing. This typically involves a clinician who connects patients to a link worker. Link workers then work with clients to find non-medical solutions to non-medical factors. What this may look like in practice varies across individuals and their needs.

For instance, employment advice may be part of a client's personalised care plan. Income and employment are two of the most important determinants of wellbeing. Unemployment has been decreasing in England. However, the proportion in most deprived areas is more than double that of least deprived areas.

Access to good employment has a positive impact on physical and mental health. To tackle the lack thereof, a link worker addresses their clients' key priorities and co-develops a plan to target these. Social prescribing can be an effective approach to individual placement and support.

Social and community context can impact one's language skills and/or self-confidence. This can be due to a lack of social capital, i.e. resources attained through connections. By identifying such factors, link workers support their clients with goal-setting.

Link workers may refer clients to employment advisors. Employment advisors provide support to seek, gain, and keep quality jobs. They also mediate between employers and employees to address expectations and problems. This then improves job retention and social capital.

Poor health is not always a result of personal lifestyle choices. Factors outside of one's control are often the cause of health inequities. Social prescribing has the potential to address these factors. It offers a sustainable ecosystem that embodies healthcare beyond just medical care.

Social prescribers put in the time with clients that healthcare professionals lack. They draw on local resources to support clients. In doing so, they also address structural inequities at the individual level. This can reach the community and national levels in the long run.

What is the evidence for social prescribing and SDH?

While social prescribing is a compelling model, evidence lags on its implementation and impact on SDH. Reasons include methodology and the focus on individual case studies.

Regardless, its prospects remain promising. A study by Nottingham Trent University reported that healthcare providers recognised social prescribing as a potential solution to address social factors of wellbeing among patients. Patients also valued the different social relationships they created through social prescribing. An increase in community belonging and reduced loneliness were the two main outcomes cited.

The relationship between social determinants and health are often cyclical. In this line, social prescribing is more than an alternative form of support. Rather, it complements the medical model. It tackles the paradox that people seek medical care for social needs. Through a practical route of person-centred care, it has the potential to address social determinants of health.