Global Health Organization
The Global Health Organization at Columbia University Irving Medical Center is a free organization for students that aims to promote interdisciplinary collaboration in the field of global (international) health through extracurricular, academic, and community-oriented activities. Our organization includes members from the Vagelos College of Physicians and Surgeons, College of Dental Medicine, School of Nursing, and Mailman School of Public Health. Throughout the year, we host events to broaden awareness of global health issues, career opportunities, and international experiences for health sciences students.
For more information about our upcoming events, email firstname.lastname@example.org.
For updates from Columbia's Global Surgery Student Association (GSSA) chapter, follow @ColumbiaGssa on Twitter.
Global Health Organization Events
The following events were previously hosted by the Global Health Organization.
Residency Panel: Medical students networked with residents and received advice on how to go about working in international health settings. This event was designed to demonstrate the wide breadth of specialties applicable to international health.
Hunger Banquet: Attendees were split in different income groups (high, middle, and low) and were served a proportional quality and quantity of food relative to their income level. A faculty member in nutrition spoke about the challenges and opportunities in addressing undernutrition and food availability problems on a global level.
World AIDS Day: A panel of experts in the field of international HIV/AIDS spoke about the history of the epidemic, recent developments in the field, and the potential for the creation of vaccinations and other treatment and prevention options.
International Summer Experiences Panel: First-year medical students gained advice from second-year medical students on how they went about planning, funding, and executing their international summer experiences.
CUIMC Student and Faculty Meet-and-Greet Event: Over 175 students and faculty members from all schools at the medical center dined together and engaged in discussion of international health efforts on campus.
We have also collaborated with various other student groups at the medical center to put on myriad events, such as film screenings, guest speakers, topical group discussions, and training sessions.
Social Prescribing: Bridging Gaps in Biomedical Care
Published on 07/12/2023
By the GHO Executive Committee
Imagine walking into your doctor’s office at your most vulnerable and walking out with a prescription for museum-going, gardening, housing, or financial support… it likely wouldn’t align with your expectation of the doctor's order. What if we told you the scenario you just pictured has transitioned into reality? As part of an innovative initiative in England, this novel idea materialised into a widespread resource provided to patients across the country. What is more, it attracted the attention of over 20 countries across the globe. They called it “social prescribing.” But what is this social prescribing? Richard Barry Crawford, graduate student in Nutrition at the Vagelos College of Physicians and Surgeons, Advocacy Chair of the Global Health Organisation, and recent intern at the National Academy for Social Prescribing, attended the 2023 SP Show at the Southbank Centre in London, England and shares his analysis.
What is SP?
In recent decades, a pattern of demographic changes across the world (i.e. ageing populations) combined with widening gaps in the workforce (i.e. understaffing) and rising levels of burnout have caused increased pressures on health systems and unsustainable demand of health services. Seven million patients have been placed on a waitlist for elective surgeries in England alone, according to the NHSE. Yet, this phenomenon has spread worldwide and is due to firm beliefs in operating under a sick-care model, namely delivering for biomedical needs without truly catering for psychosocial ones. The COVID-19 pandemic spotlighted what a healthcare system already under-pressure looks like, causing pre-existing health inequalities to resurface to the light of day. Specifically, research from England has demonstrated how problematic this may prove, as 1 in 4 doctor’s appointments in the UK are booked for purely social reasons. For such individuals, whose needs extend far beyond pills and procedures and are related to social isolation, loneliness, mental health problems, financial issues, or practical support (e.g. housing), clinicians have fallen short of being able to support them. With the added pressure of 10-minute limits to patient appointments in general practice which is widely prevalent across the world (average time across world) -- clinicians are hardly able to scratch the surface, diagnosing and labelling patients, but falling short from understanding what truly matters to them and the root cause of the health issue, which is what SP truly is about.
The predictable breaking point marked winter 2022 with doctor and nurse strikes, further straining already-scarce resources. Consequently, healthcare systems force doctors to wait until we fall ill before allowing access to healthcare. And even when we do seek care, our treatment often consists of surgeries, procedures, and pharmaceutics without addressing the root cause. In essence, our existing sick-care model functions akin to a repair shop instead of adopting a preventive approach. Yet, consumers want convenient, affordable, more efficient, and personalised care. Moreover, 80% of patient health depends on social determinants of health, British epidemiologist Sir Michael Marmot says. In short, the status quo is not sustainable, begging the question: what is the antidote to this unsustainable sick-care?
The aforementioned pressures have encouraged English academics, policymakers, and clinicians to develop a healthcare model seeking to address patients’ bio-psycho-social needs: social prescribing was born. Initially formalised as health policy in England, the rapidly growing, preventive health model consists in either a clinical or non-clinical professional referring people with unmet social needs to a social prescriber, or “link worker” to meet with patients. They identify meaningful goals, co-create social prescriptions to relevant services, connect patients to community resources, provide motivational support and even co-attend activities. These resources seek to address material needs (food, transportation, finances, legal, housing, digital inclusion) through the promotion of particular health behaviours (diet, exercise, smoking cessation, chronic disease management, mental health counselling) and socio-emotional prescriptions (social connections, nature exposure, cultural activities, arts and crafts, volunteering and community engagement). Thus, it’s important to note that – contrary to popular belief – these social prescriptions do extend beyond art and museums. What SP truly is about, is improving general health and wellbeing in a holistic manner, supporting those most in need.
The question remains, why do we need a link worker in this dynamic? Patients may often feel too uneasy to confide in healthcare workers key elements of their backgrounds that may well be the root cause of their poor health. Yet, withholding such information from their providers hampers their ability to focus the health intervention on the true problem. Link workers bridge this gap by providing patients with the most valuable resource of all: available time. That very ability to invest in each patient more than doctors and clinicians can, allows social prescribers to refocus the conversation from what’s the matter with the patient to what matters to the patient. That step, right there, is the health intervention where the building of rapport and trust with the individual begins. Quality time (30 min-1h/patient) is spent to map out the issues at hand, drawing connections with community resources, and co-designing concrete plans of action using skills such as motivational interviewing. This link worker-facilitated process also helps avoid signposting, the practice of merely telling the patient what they should do and expecting them to comply without following up on them. As patients take baby steps toward their social prescription, link workers accompany them so far as to join the first few sessions to increase their likelihood of long-term adherence.
The English SP Model
In 2018, England implemented a national strategy to reimburse one ‘link worker’ for every primary care network in the country, extending access to more than 2.5 million individuals over 5 years. In just the first trimester of 2023, the NHS added over 1,000 new link workers to alleviate winter pressures by decreasing new admission to emergency rooms.
How does SP look in practice? During his trip across the pond, Crawford had the pleasure of visiting the renowned Bromley-by-Bow Centre, known historically as one of the birthplaces of SP in England. There, he met Leila – a social prescriber and manager of a team comprising link workers specialised in a wide range of domains, from financial support to mental health to children and young people. On a normal day of work, Leila would take a referral from the family doctor whose needs go beyond biomedicine, spend an hour with patients co-designing a plan of action, and connect them with the activities of choice within the community around BB. Back at the Southbank Centre, the largest artistic venue in Europe where the SP Show took place, Crawford was introduced to successful UK SP pilots that have been unravelled in the group. Examples include the English National Opera (ENO)-Imperial College Healthcare NHS Trust partnership to implement an integrated six week pilot singing programme called the ENO Breathe Project. Opera singers support those recovering from COVID-19 and offering tools for self-management, particularly with regards to posture, breath and anxiety; the Queen Elizabeth Hall Roof Garden, a rooftop garden maintained by volunteers from Grounded EcoTherapy – a group that offers people dealing with issues like homelessness and addiction help through horticulture.
Global interest and recognition
Versions of the SP workforce tailored to resonate with the local culture and population have existed globally (e.g. community workers in Canada, seikatsu shien in Japan, or ASHA workers in India). Even though customising titles in each country makes for easier local buy-in, the absence of standardisation can stand in the way of comparison between SP workforces within a country and internationally. Now, systemically integrated SP is spreading beyond English borders and is being piloted in over 25 countries across the globe, including Singapore, Canada, Portugal, and even the US, to cite a few. To keep track of all the globally conducted work in progress, the National Academy for Social Prescribing has assembled SP Around the World Map – a series of case studies from piloting countries with varying levels of maturity in SP implementation. It is precisely because of these varying levels of maturity that government officials and private partners from these countries and across societal sectors have gathered in London for International SP Day on March 9, 2023 to dive deeper into what SP consists of as well as into how to formally integrate it into their institutions. Their long-term vision is to modernise their national models of healthcare, as they seek to adapt to demographic change and increases in multiple morbidities.
Still, as mentioned previously, some countries are more mature along the process than others. Crawford spoke Nicola Evans from the Welsh Government, who revealed that Wales has outlined five priorities to formalise SP:
Establish a common understanding of the SP model
Explain the concept
Generate a glossary of terms
Build a competency framework for link workers and social prescribers
Commission guidance by clusters of general practitioners and partnerships with activity sectors
Set national standards for activities and other concrete social prescriptions
Standardise public health measures and the core data set collected by the government used to assess impact
As more countries are hungry for SP structure and action items, these points may well serve as directing pillars of systemic implementation across the globe.
An American implementation?
Most relevantly to us, what could SP look like right here at home? It’s worthy to note that a number of doctors have informally applied activities to care in order to prevent spikes in anxiety or other manageable conditions that land patients in the emergency room. Examples include life story clubs (an outlet for seniors to talk about their lives), nature walks, walks with a doctor, and expressive arts training programs. Positive results for patients hold promise, but the concept faces particular challenges in the US. Social prescriptions here have largely focused on connecting patients to resources for basic material needs, given significant socioeconomic inequalities and a weaker public social safety net. For one, the U.S. does not have a national health service, which makes implementation and scaling up more difficult. Programs must focus on issues affecting marginalised people to counter systemic biases known to create health inequities. Convincing insurers to reimburse for such programs constitutes another hurdle to overcome.
Beyond existing pilots, the social prescribing network in the US advances the movements in more ways than one. As a future doctor, Richard hopes to be able to use SP as part of his wider clinical acumen by the time he is qualified. “This will only happen if medical education is updated with such innovative concepts and ideas that reflect the importance of fully embedding social determinants of health in the curriculum and tackling social inequalities,” he reflects. He believes this can begin with peer-teaching amongst students as part of a newly established student champion scheme across the US, which recognises that our health goes beyond pills and procedures.
To this end, in March 2023, Richard launched the national U.S. Social Prescribing (SP) Student Movement across 50+ university campuses, reaching academia across educational levels (from high school students to professors), in partnership with colleagues at Harvard College, SP USA, and the UK medical community. The following month, Richard organised the first-ever WHO-supported NYC SP Conference at the Columbia University Medical Centre which included attendees such as a senior advisor to the NYC Mayor, the Associate Director of Policy and Health at the Office of the U.S. Surgeon General, the Head of Arts Programming at NYC Health + Hospitals, Director of National Research and Impact at One Nation/One Project, emissaries of the Columbia VP&S Office of Medical Education, Professors of Psychiatry and Neurology at Columbia VP&S, among other state, community, and industry leaders. The Conference was composed of a morning session for Columbia students to come learn about SP history, its model of systemic shift, and implementation work from industry leaders catalysing the movement, and an afternoon session compiling American SP stakeholders and industry leaders from different NYC sectors to exchange expertise, raise awareness about existing projects/proven and envisioned benefits, and define specific next steps in our subsequent call to action. In the aftermath, Richard led a team of graduate and undergraduate students from Columbia, Harvard, Johns Hopkins, and University of Florida in drafting a formal report for purposes of journalistic and academic publication, synthesising major proposals developed during the NYC SPS Conference for implementation across various societal sectors.
As a young student, Richard feels passionate about social prescribing and hopes for its spread across the US.