Public Health and indeed a nations public health system has often been a measure of a country’s liveability, compassion and effective government. It’s the decisions, plans and actions that define a direction and care of the population that dictate how desirable a location may be for a population and for those looking for better quality of life. A public health system can make a huge difference to a nations output, GDP and productivity as well as it’s national wealth. A good public health system can save a government large amounts of money as fewer people are needing funded public health institutions to monitor and treat illness and disease.
Comparing public health systems is akin to inviting all the elders of a dysfunctional family to the dinner table. Each person will advocate that theirs is better, more robust, more compassionate and more appropriate for the population. It can result in heated discussion, debates and literal verbal smackdowns when ‘nationalists’ come to defend various public health policies and structures. Honestly, it’s about a population having ACCESS to health care in the case that they DO need it.
Australia sits pretty well above the OECD (Order of Economic Co-Operation and Development) average for many of the main indicators of health services, life expectancy, access to health services and long term care. We are in a good position in this country. But many GP’s are finding that there is a need to address the over burdened influx of patients needs and demands as the industry begins to see a downturn in GP’s and more graduates moving into specialist roles. This also cites the reduction in medicare payments for GP’s and the increasing pressure on privately owned practices to remain financially viable in private, family orientated practices.
Enter the concept of Preventive medicine over Emergency care. Encouraging the greater population to take more control of their actions that can influence their health and the need to use the Public Health System. One of the discussion points that is gaining momentum in Australia is how much social support or community based institutions can influence and assist with the increasing load of maintaining and even monitoring health.
Social Prescription is a relatively new concept that originated in Great Britain and is fast making it’s way around the globe as a means of dealing with easing the strain on our National Public Health Systems. The concept of Social Prescription is connecting people in their local community with health advocating activities such as sporting groups or creative art groups that promote social connectedness and positive health actions. It has been referred to as Non Medical Referral or Community Referral which gives you an inkling of the type of service that this provides. Loneliness and social isolation are precursors to poor health indicators and also mortality (Brigham Young University - Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review Published 2015) Figures ranging from 30% in the UK to 50% in the US of people who lack social contact have higher rates of mortality than those connected to good social actions.
“Social prescribing acknowledges that individual health is largely determined by a wide range of social, economic and environmental features, thus offering holistic support that is person-centred and tailored to individual needs. It involves the creation of referral pathways to the “third sector” (local non-clinical voluntary services and community groups) that enable health care professionals to refer patients or clients to a link worker in order to codesign a non-clinical social prescription to improve their health and wellbeing. ”
To combat these indicators, intervention is aimed at addressing the issues of isolation in an effort to get people involved in the best possible activities that will not only build good strong bonds within the community, but also getting people active and involved in positive, life-affirming activities. These systems have been operating in the NHS of the UK for years, dating back to the 1990’s and institutions such as the Bromley by Bow Centre in East Longon being cited as the first reference of this type of Non Medical referral system operating as early as 1984. The idea is that issues that can be traced to a lack of social connectedness can be ‘referred’ to a community based operation in an effort to prevent these issues from becoming a strain on the public health system. There is evidence to suggest that 20% of all GP visits are for social issues primarily and that if we can redirect these issues to within the local community themselves, or even addressing the precursors to these conditions then that will have a flow on effect that downgrades the need for the public health system to address the consequences.
As an example, diabetes patients present with issues that can be addressed by social connectedness. Understanding how to cook effectively, taking some regular exercise and making lifestyle changes are cited as the best way to deal with Type 2 Diabetes. A community based centre that is linked to local groups can put people in touch with cooking classes, light exercise classes, walking groups and even art therapy groups that get people moving and being involved in activities that help influence Body Mass Indicators and such, can make a huge difference to how someone with Diabetes might be able to take more control and feel supported. Having that constant social interaction also plays a role in monitoring someone’s health. When they are involved in groups regularly, that continuous contact can be a factor in recognising when things might not be going to plan and a person starts to ‘not attend’ as their health is deteriorating or someone at the group may identify ill health before it becomes a larger issue. This is but a single simplistic example of how Social Prescribing can make a difference to someone’s health.
Dr Charlotte Hespe, chairwoman of the NSW/ACT branch of the Royal Australian College of General Practitioners, says that this type of intervention needs to be happening more in Australia and she wants to see more general adopting of these types of principles in an effort to help support the general health system. As she says, “the conversation is long overdue”. This is supported by Professor Alex Haslam who is leading Australia’s investigation in to the importance of social indicators in relation to health. “Although research shows that lack of social integration and support are the most important determinants of mortality, we found that people tend to see them as among the least important,” Professor Haslam said.
In Australia we are yet to pick up the baton on identifying these factors as potential elements in the quest for better health. It’s a cultural shift and change that needs support and recognition in the Australian conversations and GP’s are jumping on board. Pilot studies are beginning in Australia to try and better facilitate the implementation of these new strategies and the movement is gaining momentum as GP’s begin to cite that they are overtaxed and over burdened with issues that perhaps lie more in social policy than health policy.
It’s the concept of Preventative roles over Emergency roles. Addressing the issues that contribute to poor health situations and addressing them in the pre-emptive roles that society can influence so that the end result is a reduced load on our public health system. Support for these types of support services and making them more widely available in Australia is fast becoming a catch cry of professionals in the field and could be a game changer in the way that we deal with health issues and health factors.
The one thing this discussion does support is that we need to maintain social connections. Getting out and being with others and having those support networks in place so that when and if the time comes, we have others that are happy to help in times of need and provide essential services such as delivering supplies to our door if we are in social isolation lock down. A timely reminder of the importance of remaining socially connected in the current situation. Social distancing yes -but don’t separate from your fellows and friends. Keep those connections in place.
