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Medicalising Poverty Is Not the Answer

Government plans to have doctors prescribe things like heating and fresh food to patients only treat the symptoms of a bigger social ill: poverty.

Doctor sitting at desk and writing a prescription for her patient. (demaerre / Getty Images)

In August last year, Liz Truss’ government drafted policy plans to enable GPs and other healthcare professionals to prescribe heating for their most vulnerable patients, including by paying part of their energy bills. Prior to the grip of the cost of living crisis, research indicated that poorly heated homes cost NHS England approximately £860 million a year, and take as many as 9,700 lives.

Despite being met with anger from the British Medical Association alongside members of the Opposition, the government implemented the policy in Gloucestershire. Widely reported as having a positive impact, it’s been expanded to 150 households in the NHS Gloucestershire area, as well as homes in Teesside and Aberdeen. In the latter two, invited people—those with cold-sensitive and respiratory health conditions who are struggling with rising costs—can have their energy bills paid through the Warm Home Prescription scheme.

This isn’t the first intervention of its kind. At other times, there have been proposals that doctors should be able to prescribe basics like fruit and vegetables, exercise, social activities, and financial advice. Most recently, the Telegraph announced potential government plans to station job coaches in GP surgeries. These ideas fall broadly under the umbrella of social prescribing or community referral, which is a way of linking patients with non-medical or non-clinical sources of support grounded in their communities—activities which might include art therapy, exercise groups, or emotional support. Social prescribing is promoted as an effective response to social issues that affect our general health and wellbeing, like unemployment or housing problems.

In many ways, these interventions are positive. On the most basic level, it’s good that the Warm Home scheme enables people to live in a warm house. It’s also good that social prescriptions centre the betterment of our health within our communities, and place prevention above cure. But at the same time, some risk only addressing the symptoms of a broader social ill: poverty.

In recent years wages in Britain have undergone the longest stagnation since the Napoleonic wars. Cuts to social security and public services mean people across the country have been stripped of their ability to afford the basics like good food and a warm home. We know that living without those things makes people sick: cold, damp homes can contribute to circulatory and respiratory problems; poor nutrition has been linked to higher rates of asthma, diabetes, and arthritis, not to mention depression.

At the same time, this cost of living crisis—which is exacerbating the consequences of those cuts and that stagnation—has arrived at a point when underfunding, understaffing and privatisation in the NHS has hamstrung its ability to deliver its universal aims. GPs and other health practitioners—who would be tasked with prescribing warm homes—are already overwhelmed with long waiting lists and a workforce crisis. Healthcare workers are likely the first to point to the social and financial determinants of many of the health problems with which they deal—but as Dr David Wrigley, BMA England GP committee deputy chair, put it, GPs ‘do not have the time or the skills to do the work of the welfare system’, particularly a welfare system that recent governments have made systemic efforts to slice up.

With so many facing poverty, the better alternative is obvious: accessible and high-quality public housing, capped energy costs, affordable healthy food, well-funded schools (with universal free school meals), liveable social security payments, and better working conditions with rates of pay that enable people to get everything they need. Genuinely addressing the deliberately siloed approaches to health, social care, and housing—as just three examples—would mean the health consequences of a cold home are automatically protected against, and programmes like the Warm Home Prescription scheme would not need to exist.

There is another dimension to this, too, which is that of empowering people to demand that their homes are made safe and their wages liveable by removing the restrictions that currently exist—and are in the process of being expanded—on organising and protest. People should not be beholden to bad landlords and bad bosses that treat their health as disposable. The prescriptive method, by contrast, keeps people in a passive role in the political choices that so drastically affect their lives, and does nothing to dismantle the power dynamics—like energy companies raking in millions while rinsing their customers—that are contributing so much to the development of ill-health in the first place.

The framework of social prescribing recognises that we access health as socially located individuals, which is in many ways a step forward from individualistic approaches to health that have previously dominated. Covid made it impossible for even this government to ignore the role that financial insecurity, bad workplace conditions, overcrowded homes and the like play in poor health. But it will be evidence of a flaw in that thinking if we allow things like networks of community support, space and time to enjoy leisure and exercise, decent housing and food, and basic warmth to be turned into medicines to be prescribed, rather than recognising them as the fundamental pillars of a decent life—and ours by right.