Social prescribing beyond social prescriptions: moving social prescribing from commodification to co-creation

Purpose This paper aims to challenge the prevailing focus on “social prescriptions” in social prescribing research and practice and argue for a broader understanding of “social prescribing” as a process of co-creation that prioritizes relationships, community engagement and self-determination. Design/methodology/approach Rather than presenting new empirical data, this paper draws upon key concepts from public health, sociology and political ecology to offer a novel theoretical lens through which to understand and implement social prescribing, critically examining the limitations of framing social prescribing primarily through the lens of “social determinants of health.” Findings We argue that a narrow focus on “social prescriptions” over processes of “social prescribing,” like a narrow focus on “social determinants of health” over complex and intersecting “processes of determination in health,” can lead to a commodification of interventions, reinforce power imbalances and neglect the crucial role of community engagement and self-determination. We propose a place-based, person-centred, politically aware approach that emphasizes the dynamic interplay of people, power and place in shaping health outcomes. Research limitations/implications This conceptual paper primarily focuses on theoretical challenges to existing social prescribing frameworks. Further research is needed to connect this framework with the existing empirical evidence and real-world practice of social prescribing, investigate the nuances of power dynamics within social prescribing initiatives and explore the feasibility of implementing alternative approaches in diverse contexts. Practical implications The paper advocates for a shift away from simply “prescribing” social activities and toward a more collaborative, co-creative approach to social prescribing. In practice, this means that social prescribers consider prioritizing relationships: building trust and fostering strong relationships between patients, link workers and community organizations; focusing on self-determination: empowering individuals and communities to actively participate in shaping their own health pathways; adopting a “political ecology of health” framework: considering the dynamic interplay of people, power and place in shaping health outcomes and implementing culturally safe and trauma-informed practices: addressing existing power imbalances and potential harms within healthcare. Social implications By emphasizing co-creation and self-determination, the proposed approach to social prescribing has the potential to reduce health inequities by better addressing the social and political roots of health disparities, empower marginalized communities by ensuring their voices are heard and their needs are met in a culturally safe manner, strengthen community connections by fostering a sense of belonging and mattering and promote social justice by challenging existing power structures and advocating for more equitable social and environmental conditions. Originality/value This paper challenges the dominant focus on “social prescriptions” by focusing on processes of “social prescribing.” It introduces a political ecology of health framework that provides a more nuanced understanding of the dynamic processes that shape health. This framework emphasizes co-creation, self-determination and community engagement and highlights the importance of relationships and power dynamics in social prescribing. The paper advocates for a more equitable and transformative approach that emphasizes community leadership and strengths and better addresses the social and political roots of health inequities.