The link between loneliness and inactivity is well documented, and within this intersection lies an emerging practice known as ‘social prescribing’. What can podiatrists do to help people who are lonely, particularly if it comes in the way of movement or exercise opportunities?
The loneliness epidemic has been cited in recent press reports and media statements, with the UK and Japan appointing Loneliness Ministers. Loneliness is also mentioned as a key factor within the social determinants of health (SDH).
According to the World Health Organization (WHO), SDH are ”…the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces (CSDH 2008).” Or put even more plainly by WHO, the “Non medical factors that can influence health outcomes.”
As podiatrists and other health practitioners would have experienced, loneliness can impede a patient’s ability to follow treatment advice or even book a return appointment. Or conversely, it can result in multiple appointments being sought by a patient when in fact, physical treatment may not always be required.
There is a difference between being lonely and socially isolated. It is possible to be surrounded by people – loved ones, work colleagues and so forth – and yet still feel lonely. This excerpt by the AHP Workforce explains this in more detail: “Social isolation is determined by the quality and quantity of social relationships, whereas loneliness is a person’s subjective feelings about these relationships. Combined, social isolation and loneliness are closely linked to the social determinants of health (SDH).”
Now that the link between loneliness and the social determinants of health is clear, what is the solution, if any, for a podiatrist when treating a patient who is experiencing loneliness? The solution is not necessarily simple; given constraints on time and resources – and variables around the patient’s mindset. Nonetheless, there is a pathway to consider called ‘social prescribing’.
What is social prescribing? You may have already come across this concept, given it is increasingly profiled in recent news reports. Larter, an active consultancy in this space, offers the following definition.
“‘Social Prescribing’ is a means to enable health professionals to refer patients to local, non-clinical services and supports. In other words, it is non-medical prescribing that improves health and wellbeing. Examples include community referral to social or physical activities; to a community group; or to learning and skills development activities. A social prescribing program usually involves a clinician connecting the patient/client to a ‘link worker’(also known as ‘community connector’ or ‘navigator’) who works to facilitate the social prescription.”
The Consumers Health Forum of Australia offers a similar description.
“Social prescribing is the practice where health professionals, including GPs, have the resources and infrastructure to link patients with social services – or even social groups – in a bid to address the social determinants contributing to poor health and stave off the epidemic of loneliness and social isolation. A GP may, for example, suggest a patient join a local running group to enjoy the benefits of exercise and interaction.”
It is interesting to note the parallels between the social determinants of health and social prescribing. Social determinants of health – as stated by the WHO above – are, “Non medical factors that can influence health outcomes.” Likewise, the role of social prescribing is described above as, “Non-medical prescribing that improves health and wellbeing.”
The benefits of social prescribing are clear, with increasing data available to support the healthcare benefits. Numerous trials are already underway in Australia and overseas. (See list at the end of this article).
Social prescribing can benefit patients by offering an often-low-cost way for the patient to become more mobile and active while being more socially connected; in a meaningful way that helps to combat loneliness.
This approach doesn’t necessarily need to add undue time or effort on the patient’s part during patient consultations. In fact, there is a range of high impact / low effort ways to integrate social prescribing themes into practice, which are explored further on.
Many podiatrists recommend patients join local sporting or community groups and, in doing so, already practice elements of social prescribing without perhaps being aware of this term. In fact, reports show that most health professionals already undertake some form of social prescribing.
However, there are different degrees of social prescribing, with the ideal pathway described further below (Section C). That said, any in-road into social prescribing is arguably positive within itself.
Given the workforce pressures that podiatrists face, the key is to be able to provide social prescribing in a way that doesn’t place further pressure on a podiatrist’s individual resources and capacity. Yet the concept of social prescribing can be as simple or as comprehensive as a podiatrist wishes it to be, via any of the following pathways.
While by no means exhaustive, below are some ideas for podiatrists to consider exploring.
a. High impact / low effort methods
At its most essential level, if a podiatrist senses that a patient is lonely or socially isolated, they may wish to refer them to local organised groups or community-based activities; to simultaneously increase their activity levels and mobility.
Whether this is made as a formal referral – to an identified contact in an established group – or as a passing suggestion made to the patient, it depends on the podiatrist’s capacity and individual situation, amongst other factors. This approach could be as simple as suggesting a patient join:
These kinds of interactions not only help to address loneliness while improving mobility and activity, but they also support a much larger preventative health care picture; one that aligns with the United Nations’ sustainable development goals.
b. High impact / passive methods
Short of making direct referrals to a range of community groups, such as the above examples, more passive examples in this emerging space could include:
c. Integrated methods
In perhaps its most ideal scenario, social prescribing would consist of the following three elements, according to the AHP Workforce:
“A social prescription should include these key components:
When a link-worker is unavailable, allied health professionals (especially those working in private practice) may need to use their creative skills and phone. Too busy? Could a practice manager take on that role? Accessing a link-worker should be achievable so long as the referral is made to an appropriate community organisation.”
This article won’t explore this concept in detail, but at its core, a link worker is described in this research excerpt as follows:
“A non-health or social care professional based in primary care practices or community and/or voluntary organisations, who support access to a range of community-based resources and supports for health and social care.”
In an ideal scenario, a podiatrist or other health professional would benefit from the support of a link worker when offering a social prescription to a patient. Yet this requires action at a national and systemic level. The role of a link worker – and the policy levers, training and resourcing required to enable this role – is certainly complex with overseas examples deserving closer investigation.
Groups such as Ending Loneliness Together and the Australian Social Prescribing Institute of Research and Education (ASPIRE) are working on these goals, with a global conference taking place in Sydney in June 2024.
Amongst other goals, ASPIRE is also reported to be: “…calling on the Federal Government to commit to social prescribing as a part of a broader strategy to address the social determinants of health, saying it should be the principal funder of a national expansion, which could tie in with efforts to strengthen and modernise Medicare.”
What can a podiatrist do right now to help ease the loneliness pandemic whilst encouraging your patients to be more active and mobile? Particularly when cast against the backdrop of an already overstretched workforce?
Apart from sharing this article with your networks to help raise further awareness, the answer partly lies in considering the above high impact / low effort ways for you to integrate social prescribing into your day-to-day practice.
It is a potential win-win – and the start of a much bigger conversation that is gaining traction in Australia’s wider health landscape.
NEXT MONTH: In Part 2: What advocacy efforts are taking place in this space to agitate for Government change?
If you are feeling lonely or down, APodA members can always contact our Member Assistance Program for confidential support and advice. Please also refer to recent articles which address the issue of mental health, the loneliness pandemic, social connection and support for members.
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