A mile in your own shoes


Thirty years ago, I ran an outdoor education charity in Brighton. Young people, mostly from very disadvantaged backgrounds, came with us on day trips and camps to have a go at rock climbing, canoeing and building bivouacs. On one such trip, a group of blind and partially sighted teenagers were working their way through a series of tunnels and gulleys at a rock outcrop near Tunbridge Wells. We had paired each member of the group with a sighted volunteer. We figured the partially sighted and blind children would need help. Halfway into the tour, I was waiting for the first sighted volunteer to come through a particularly twisty tunnel, with their visually impaired companion following behind. I waited longer; there was no sign of either of them. Eventually I heard a voice, calling out instructions: "slide your hand down to the right…turn your shoulder.." and then a face appeared. It was Sean, a boy of 14, blind since birth due to optical nerve atrophy. Cool as you like he explained that David, his volunteer companion, had taken fright at the prospect of the tunnel so he (Sean) had offered to lead instead.

Bias, unconscious or otherwise, is everywhere. Our own judgments and beliefs, combined with systemic imbalances in power and wealth, drive a system that, well-intentioned or not, creates a culture of passive receiving. It's at odds with what most people really want. It rides roughshod over our dignity and denies our self-determination. This just makes us feel worse and leaves those who are trying to help us nonplussed about why it's not working. There is a simple answer.

Only we are experts in where our own shoes pinch and, as far as humanly possible, our dignity demands that our expertise is recognised and we have a choice, a say and a hand in putting things right for ourselves. Empowered individuals and communities are not subjected to the stigma of handouts; there are better ways to reduce need, such as recognising and investing in assets. Sean's confidence in the rock tunnel and his ability to navigate confined spaces were assets that meant he became the helper, not the helped.

So where does social prescribing come in to this picture? Social prescribing done well results in communities that are able to make the most of what they have. In a healthy community, we are connected to useful, enjoyable, health-enhancing activities and services. But more than that, we have a say and a hand in how things work. We are the 'doers' and not just the 'receivers'. A truly inclusive service leaves no asset unused.

We are obsessed with outcomes and perhaps rightly so. Austere cuts in public service funding and the ever-broadening gap in social and health inequalities, demand that we get even better results for ever dwindling resources. We have to make practical decisions about how we divide those resources up to meet the costs of service delivery, community capacity building and outcome measurement. Get the community working how we want it, with sustained services and people from all backgrounds valued and involved, and all the other benefits and outcomes will flow.

Young people tell us they want somewhere to go that is safe and, on their doorstep, something fun and rewarding to do and someone friendly to show them how. Communities tell us they want spaces that are clean for young people to play in, activities to counter stress and isolation, help with basic needs and a stronger say in what happens around them. Commissioners tell us they want help with tackling social inequalities, helping hands for the hardest pressed communities and healthier, fairer, safer places for young people to grow up in.

Young people, communities and commissioners all want the same things: local action, for and by local people. That's social prescribing, by any other name.

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Wednesday, 19 June 2024
Royal College of Medicine

5th International Social Prescribing Conference

19th & 20th June 2024