Kate Mulligan used to have a hard time convincing people how bad loneliness was for our health. But the pandemic changed that.
“During COVID-19, many people experienced social isolation for the first time,” says Mulligan, an assistant professor in social and behavioural health sciences at the Dalla Lana School of Public Health. “It used to be a very tough sell for me to explain what a strong determinant of health it was — and now people know about it from their own experiences.
“There’s good evidence out there that social isolation has impacts on physical health similar to smoking 15 cigarettes a day,” she says. “It increases stroke risk; it impacts many physical health factors that are deeply intertwined with mental health. We sometimes talk about physical and mental health separately, but they’re very rarely separable.”
Even in post-pandemic times, social isolation still contributes to health problems in our society — as do other social ills, such as income and food insecurity and literacy. To counter such problems, Mulligan has become one of Canada’s foremost advocates of social prescribing, which seeks to improve people’s health and well-being by strengthening community connections and personal agency.
In addition to — or instead of — medication, a person accessing social prescribing might instead be offered exercise classes, volunteering opportunities, or support groups by their health care provider. To facilitate this process, professionals known as link workers develop relationships with patients, and seek out activities that are personalized for them.
This past April, Mulligan taught a Multidisciplinary Urban Graduate Seminar (MUGS) entitled Social Prescribing in the City. Offered in partnership between Dalla Lana and the School of Cities, the seminar saw graduate students from different disciplines working together to discuss social solutions to various health-related problems faced by people in Toronto.
Over the course of the week, the group went to the U of T Scarborough campus, where they connected with nature and participated in a drumming circle. They also visited the Bentway, a mixed-use public space under the city’s Gardiner Expressway; went to a presentation offered by jack.org, which specializes in youth mental health; and learned how St. Michael’s hospital is using social prescribing in its work with older adults.
“I genuinely enjoyed the course,” says Karen Khan, who is completing her master’s degree in planning through the Department of Geography & Planning, the School of Graduate Studies and the Faculty of Arts & Science.
“As a planning student, my main research focus has always been housing, particularly the homelessness crisis that we’re dealing with. The solution to this issue is usually described very technically: we need to build homes.
“That’s true of course, but no one really talks about what the struggle of being unhoused is actually like for people. Along with housing, people also need safe spaces, a sense of community, and available activities to improve their sense of well-being.”
Mulligan first became interested in social prescribing when she worked for the Alliance for Healthier Communities, a membership organization that supports community health centres (CHCs) in Ontario.
About seven years ago, she and her colleagues received funding to pilot social prescribing for CHC patients.
“We found that the CHCs were co-housing different kinds of services, such as community development, health promotion and clinical primary care. But there wasn’t a direct referral from the doctor, for example, to the yoga class or the community kitchen or the food bank down the hall. So we tried it out.
“We were in 11 different community health centres, and the results were just incredible. We saw a 49 per cent reduction in self-reported loneliness. We saw healthcare providers saying people were coming in less often, and that they were showing improved health and well-being. And this was just after about nine months.”
The biomedical gaze asks: what’s the matter with you? Social prescribing switches that to the strengths-based health promotion gaze, and asks: what matters to you? It’s about shifting away from an impersonal, service-based health system that’s under a ton of strain, to one that shows you matter. And that makes a big difference.
Mulligan realized that social prescribing would be helpful not only to the five per cent of Ontario residents accessing care through CHCs, but to the population at large. “And so that’s why I started up the Canadian Institute for Social Prescribing in 2022,” she says. “We’ve really just continued to grow from there.”
With a background in global health, Valentina De Leon is now completing a master’s degree in public policy at the Munk School of Global Affairs & Public Policy in the Faculty of Arts & Science. This summer, she is completing an internship focused on older adults with the Waltons Trust, a Canadian grantmaking foundation with a belief in social prescribing.
Studying alongside others from her own field and others, De Leon appreciated the multidisciplinary nature of Social Prescribing in the City. “I thought it was quite brilliant to do it that way, especially because social prescribing requires the integration of people from different disciplines,” she says. “So it only makes sense to have that be reflected in the classroom. We were able to share a lot of ideas, and gain perspectives we never would have known about otherwise.”
This year, Dalla Lana postdoctoral researcher Nicole D’Souza is conducting a tri-campus pilot project on social prescribing at U of T with the support of a grant from the Social Sciences and Humanities Research Council. It will be the first time social prescribing has been implemented at a Canadian university.
“The biomedical gaze asks: what’s the matter with you? Social prescribing switches that to the strengths-based health promotion gaze, and asks: what matters to you?” Mulligan says. “It’s about shifting away from an impersonal, service-based health system that’s under a ton of strain, to one that shows you matter. And that makes a big difference.”