Social prescription – Why a ‘Wellbeing Script’ can start tomorrow?

We are exploring the concept of a ‘Wellbeing Script’ – how it might work, and most importantly, how it can simplify a referral pathway between clinicians, their patients, and their local Neighbourhood House – those powerhouses of social connection. This opens a world of possibility largely revolved around a referral model bringing patients from disconnection to social connection with positive health impacts. We have discovered many gems and ‘natural social prescribers’ already in our project in the Central Highlands region of Victoria. They are the forward thinkers in medicine who seamlessly practice prevention, as much as preventative and primary care in their daily consultations.

One such gem is Dr Kevin Lee, an endocrinologist and specialist physician who fell in love with Clunes many years ago and continues to practice in this vibrant little community. Dr Lee champions the importance of social and community connection and refers patients in his consultations to a range of health promoting activities not as an extra but a fully integrated part of clinical practice.

Dr. Lee believes it is “simple and day to day practice, you don’t need an extra session just to socially prescribe”. Dr. Lee can share many stories of light social prescribing benefitting his patients. One such patients he recalls presented with obesity (BMI of 37), prediabetes, rheumatoid arthritis, and was wheelchair bound. Dr. Lee noticed that they had an interest in gardening in their backyard. After engaging them with the benefits of horticultural therapy, he had essentially ‘prescribed’ them a course of increased gardening activity which not only increased their dietary fiber intake from their own produce, but over time, they “no longer needed a cane to walk, reversed [their] prediabetes to normal and [could] drive to go back to work [again]”. Her husband was also able to demonstrate his support for her by building raised vegetable boxes and platforms to garden on. In just over six months, they achieved more than 15% weight loss, from 106.9kg to 89.4kg, which is equivalent to a gastric band intervention.

Dr. Lee and Lana de Kort, Clunes Neighbourhood House Manager, have teamed up to imagine what is possible in their community. As a start they have designed and are at present delivering and intensive lifestyle modification program “Weight off my shoulders” with their community. The first program was full upon announcement, we look forward to hearing about the health and wellbeing impact in the future.

Sometimes it is nice to know we can just get on with it – try things, iterate, try again. We don’t need to wait for the perfect system for social prescribing, we can lightly prescribe right now- with the resources available in communities across Victoria, and certainly sign-post pathways for health and wellbeing.

Dr Kevin Lee

Why are we going ‘light’ on social prescribing?

We are often asked in the Wellbeing Scripts project as to why we use the term ‘light’ social prescribing rather than just social prescribing. We have been guided by Kimberlee’s (2015) analysis of a range of existing programs which identified four levels of social prescription: Signposting; and Social Prescribing Light, Medium and Holistic.

Our ‘why’ for a focus on signposting and ‘social prescribing ‘light’, sees a combination of provision of information to patients and community members, and referral between General practice and Neighbourhood Houses (potentially in both directions). Further:

  • It is human-centred in design – created by the people using the system for their context, purpose, and community need
  • It is sustainable– taps into and uses existing capacity and capability, removes us from the searching for funding treadmill
  • Is a ‘Value add’ relationship – there is great value for GPs and Houses in connecting and referring for their community
  • It further unlocks mutual benefit– at a time of great need to socially connect people
  • It is asset based – we go with the energy in the system for greatest likelihood of change and uptake
  • Is place-generated and created – fit for purpose for that community and that GP and NH relationship
  • It has potential for growth– we can learn and iterate, creating solutions that meet the actual needs and opportunities at hand 

As Nicole Battle, CEO Neighbourhood Houses Victoria, puts it “Wellbeing Scripts can be mutualistic with the Neighbourhood Houses being able to refer patients to GPs”.

Put simply we do not want to get too caught up in the enormous size of the effort and resourcing required to shift the health care system to social prescription. This takes time and resources. 

So how might we contribute to this holistic system as it emerges? We aim to demonstrate how bespoke scripts can be developed and used for everyone’s benefit, we do not see the need to wait- rather, we intend for our regions Wellbeing Script to compliment and inform.

Case Study: Central Highlands Prevention Lab

May 2019 – April 2020

The Central Highlands Prevention Lab (the lab) was created in response to the growing public health crisis and its impact on communities across our region, and a compelling groundswell of support for action from regional leaders, government, industry and the local community. The Central Highlands Regional Partnership (CHRP) 2016 General Assembly identified the long-term health outcomes of our populations as a top priority.

Health Futures Australia is partnering with the CHRP and the Department of Health and Human Services under the guidance of the CHRP Health Steering Group.

The lab brings people together to co-design a community-led effort to tackle preventable chronic disease and increase healthy eating and physical activity across our communities by reimagining a healthy future and our community’s investment in prevention.

The lab uses a social innovation approach to guide transformative social change. It brings together leaders from across sectors and across our region to co-design local solutions – new interventions and sustainable investment models – that ready and shift the system towards a new place-based model of community wellbeing for all.

Mini-labs include a place-based Community Lab, a Champions for Change Lab, a Leadership Lab and a Finance and Investment Lab. They are designed to lead targeted change cohorts who are ready to unite and work together to redesign a healthy future.

A 2019 global highlight – a Movement Toward Wellbeing Economies.

This week, as we draw to an end the 2019 calendar year, we take stock and reflect on the last 300 odd days and share some of the #wins in wellbeing that we’re seeing across the globe.

Earlier this year, Nicola Sturgeon, Prime Minister of Scotland stated in her very first TED Talk “…in the world we live in today, with growing divides and inequalities, with disaffection and alienation, it is more important than ever that we ask and find the answers to those questions and promote a vision of society that has well-being, not just wealth, at its very heart.” In her 10 minute talk, Sturgeon outlines that governments can no longer rely on Gross Domestic Product (GDP) as the sole measure of a nation’s success, and that wellbeing markers are needing to be added to create a more conclusive idea of how a country is fairing.

So, what does it look like without GDP determining economic success?

The focus moves to humanity determining economics. Where an equitable distribution of wealth, health and wellbeing while protecting the planet’s resources for future generations and other species is at the forefront of policy and practice.

Reflections from our Prevention Entrepreneurs Alumni

It’s certainly no secret that #healthfuturesaustralia are massive fans of the three powerhouse wellbeing agenda leaders – Katrin Jakobsdottir, Nicola Sturgeon and Jacinda Ardern (#thefutureisfemale) and the work they do to #riseprevention for all. Spurred on by Sturgeon of Scotland, a small group of countries has now formed the Wellbeing Economy Alliance with a goal of pushing wellbeing to the top of its agenda and the cavalry towards the movement is cantering.

Why are we so excited by the wellbeing movement?

Put simply, for HFA, it really boils down to the basic human rights of inclusivity and equity for health and wellbeing for ALL finally becoming a top policy and agenda item. It’s been a long time coming and finally we are seeing momentum towards economic equality. Albeit, not in our nation.

A traditional focus on GDP as a measure of economic performance tends to undervalue quality of life, environmental and social impacts.  It doesn’t acknowledge inequality or lower standards of living. Is there hope? We are now seeing a movement of countries toward a ‘wellbeing economy’ focussed on inclusive growth as the new social indicator of national success. Economic ‘growth’ in this model lies not in the exploitation of natural, social, and human resources but in improving the quality and effectiveness of human-to-human and human-to-ecosystem interactions, supported by appropriate enabling technologies (the Solutions Journal).

HFA aren’t the only fans of the wellbeing movement either. Joseph Stiglitz, Nobel Peace Prize Economist recently wrote “The world is facing three existential crises: a climate crisis, an inequality crisis and a crisis in democracy, yet the accepted ways by which we measure economic performance give absolutely no hint that we might be facing a problem… It is clear that something is fundamentally wrong with the way we assess economic performance and social performance”.

So, what does Stiglitz suggest countries do? Exactly what Sturgeon, Ardern and Jakobsdottir have done – instead of measuring the wrong thing, which Stiglitz suggests means we will do the wrong thing, we need to measure success by measuring humanity.

Reflections from our Prevention Entrepreneurs Alumni

There’s no denying how important metrics are to policy and we certainly acknowledge the complexity of defining wellbeing – this is where we applaud the Canadians, for setting out the powerful measures of health and wellbeing through their index. Not only setting them out but also working toward them. The pursuit of a wellbeing economy (regions and communities) however, calls upon a newfound capability to navigate the future as it emerges and not be wedded to the pursuit of evidence on which to base our decisions as the only guiding light to action. In fact, we can’t let it stop us, McKinnsey’s were very clear on this in their 2015 report Delivering Through Diversity.

When we hear, again, a policy bureaucrat state in the past week that as priority we must base our work on evidence, we need to assert that we are now in the business as public health change agents of inspiring an era of experimentation, rapid iteration and scale.

The new Wellbeing Economy Alliance (WEAll) has been designed and introduced to enable a unified transformation across the globe.  A transformation close to the heart of what HFA stands for – an economy that strengthens social and natural capital while generating human development and wellbeing for all.

Sources:
https://www.fastcompany.com/90435788/a-nobel-winning-economist-says-its-time-to-kill-the-gdp
https://wellbeingeconomy.org/
https://www.thesolutionsjournal.com/article/toward-sustainable-wellbeing-economy/
https://www.mckinsey.com/~/media/McKinsey/Business%20Functions/Organization/Our%20Insights/Delivering%20through%20diversity/Delivering-through-diversity_full-report.ashx

Health and wellbeing for all, or anyone? What’s it going to take?

I feel truly privileged to be a Westpac Social Change Fellow – supporting my not-for-profit and for purpose world and existence now to go forth, learn and do my part in leading and supporting leadership for a better Australia.

 

I have landed in the US – why you might ask? What on earth could I learn from the US when it comes to public and population health? A great deal is my response and experience so far.

At the mid-way point of a 20-day immersion in the US and Canada – I reflect on the emergent messages worthy of thought for our future public and population health effort in Australia. I came to the US because the insights into entrenched and layered complexity, philanthropy and endowment funding, and innovative ways are unsurpassed to the constant expectation that government fund prevention efforts as is the case in Australia – which keeps us on the short-term project funding wheel which simply isn’t working.

Maybe I could glean what it takes to shift this system that is being held in place by the very many who are a part of it – charged with the policy, leadership, research and practice to improve the wellbeing (including me!). It’s no-ones fault – it’s the very nature of systems, try intervening in them and they bounce right back into their usual shape and form. We tend to compete and be set up to do this in Australia -we need to understand this isn’t a zero sum game.

Which brings me to true transformation of the system – but which system?

The food system? The health system? The planning system? Or just the big-whole system impacting our health and wellbeing?

The work of the California Endowment Fund – Building Healthy Communities Program (see www.calendow.org), and the innovative approach to learning and the betterment of public health as real players in the system at CUNY School of Public Health (see http://cuny.is/systemschange), to the market entrepreneurs whose products are entwined with purpose (people and planet benefit – see www.s’well.com Million Bottle Project), to the messages adorning the streets of New York (“It’s time to get back to the way humans ate before industry ruined food”), to participation in the student climate strike in NYC on September 20 – how might we do better in Australia at prevention?

How might we do better in Australia at Prevention?

* Don’t give up on government, still keep at it – good people can work that system, just find them (yes I have just spent almost a decade in government but still have hope)

* I see it’s up to us to show and lead the way, us being the people who live in communities, who are parents, employee or employers, THERE IS NO PREVENTION CAVALRY ON IT’S WAY

* Hitch our wagon to the momentum of climate movement, as the Lancet states climate change, obesity, and under-nutrition are a syndemic – multiple pandemics, highly interrelated – calling on our big thinking on intervening – https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)32822-8.pdf .

* Re-imagine the system, and a sense of the “we” and “us”, together in that system

* Build agile prevention entrepreneurs and changemakers everywhere we can

* Make our work the re-design of the resourcing of the system and work toward this different framing, building numbers and narrators and curators of change.

* And if too hard to re-imagine our system for health and wellbeing – then refuse plastic wherever you go and plant trees whenever and wherever we can, and do it together!

Shelley

The economic system shapes everything – the capabilities of a future impactful “self”

After spending time with the CUNY Public Health team of innovators and entrepreneurs last week in Harlem, NYC I was taken aback by the energy across the school, so vibrant, diverse and engaging. A school wanting to be relevant, contemporary and emergent – able to provide some of the best thinkers, innovators and innovation, and activists in public health possible.

See 2 minute video below from Professor Terry TK Huang, PhD, MPH, MBA. Professor and Chair, Department of Health Policy and Management and Director, Center for Systems and Community Design at CUNY Graduate School of Public Health and Health Policy.

My take out is that our future calls for the following capabilities in population health being:

  • Entrepreneurial
  • Financially and economically, and politically savvy – able to understand how the financial and political system, and economy works:-
  • Agile and adaptive
  • Bold and disruptive
  • Curators and narrators
  • Driven by purpose and social impact
  • Persistent
  • Brokers and negotiators
  • Community organisers and networkers.

This is the only way we will be seated at the table, a table we can no longer be excluded from if health and wellbeing is to be impacted and we have any hope of creating a new social market for health and wellbeing outcomes in Australia.

Shelley Bowen

Health Futures Australia

Extra Resources:

http://cuny.is/systemschange