Abstract
Social prescribing, characterised by a link worker connecting patients with local groups and services, is currently being widely implemented in the UK. Taking clients' experiences of a social prescribing intervention in the North of England between November 2019 and July 2020 as its focus, this paper employs ethnographic methods to explore the complex social contexts in which social prescribing is delivered. Building on Bourdieusian approaches to class, we concentrate on four case studies to offer a theoretically-grounded analysis which attends to the relationship between everyday contexts and the classed processes by which health capital may be accrued. By following clients' experiences and trajectories through shifting positions across time - often entailing moments of tension and disjuncture - we explore how processes of classed inequality relate to engagement in the social prescribing intervention. Our results show how structural contexts, and relatedly the possession of capital, shape clients' priorities to invest in the cultural health capital offered by the intervention. Importantly, while inequalities shaped participants’ capacity to engage with the intervention, all participants recognised the value of the health capital on offer. We conclude by arguing that inequalities cannot be tackled through focusing on the individual in the delivery of personalised care and therefore offer a counter narrative to socio-political assumptions that social prescribing reduces health inequalities. Crucially, we argue that such assumptions wrongly presuppose that people are homogenously disposed to engaging in their future health.
Highlights
Social prescribing is a topic of growing policy, practice, academic and political interest
The visit triggered a diagnosis of Type 2 Diabetes (T2D), six months sickness leave, and a referral into talking therapies and the social prescribing intervention, which in turn referred him to the gym and nutrition classes
The intervention worked for all of the participants we report on here - even Eddie who was able to utilise social prescribing to access the foodbank
Summary
Social prescribing is a topic of growing policy, practice, academic and political interest. Ranging from active signposting through to more intensive approaches, social prescribing typically involves a non-medical link worker/facilitator who addresses patients’ personalised support needs (Howarth and Donovan, 2019). This is often through ‘co-producing’ a personalised plan followed by referrals into relevant voluntary and community sector activities, local authority or health services (Wildman et al, 2019; Frostick and Bertolli, 2019). Identi ed as playing a key role in the delivery of the NHS Model of Personalised Care, the aim is that by 202 /2 over 900,000 people in England will be referred into social prescribing (NHS England, 2019c) It is increasingly framed as part of a broader commitment to reducing health inequalities (NHS England, 2019a, 2019b, 2019c). A 10-year review of The Marmot Report (Marmot et al, 2020) observed that health inequalities are increasing in the UK and called for more research into how social prescribing might affect health inequalities
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