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Municipal governments across the Global North are increasingly becoming key actors in shaping urban food and agriculture policy. In the City of Toronto, recent aspirational policies, such as the provincial Local Food Act and the municipal Toronto Agricultural Program, created new opportunities to shape a healthier food system. We sought municipal perspectives on the question of “How might urban agriculture policy and programs be better supported to promote equity and health?” Analysis of findings from semistructured key informant interviews with municipal staff and policy-makers (n=18) illustrated broad support for generating better quantifiable evidence of the impacts of urban agriculture on economic development and employment, health and health equity, land use and production, and partnerships and policies. Place-specific economic and equity data emerged as particularly pressing priorities. At the same time, they sought better approaches to the potential risks involved in urban agriculture. Key informants also shared their views on the use of health impact assessment research to make a case for urban agriculture to a range of stakeholders; to manage real and perceived risks; and to move beyond enabling policies to empower new investments and procedural changes that would facilitate urban agriculture expansion in the city. The results informed the evolving praxis agenda for urban agriculture at the intersections of population health, environmental sustainability, and urban governance

IntroductionWith the social prescribing movement gaining traction globally, there is a need for an agreed definition of social prescribing. There are two types of definitions – conceptual and operational, meaning agreement on both types of definitions is needed.ObjectiveThe aim of this study was to establish internationally accepted conceptual and operational definitions of social prescribing.DesignA three-round Delphi study was conducted.MethodsConsensus was defineda priorias ≥80% agreement. In Round 1, participants were asked to list key elements that are essential to the conceptual definition of social prescribing and to provide corresponding statements that operationalize each of the key elements. In Round 2, participants were asked to rate their agreement with items from the first round for inclusion in the conceptual and/or operational definitions of social prescribing. Based on the findings from this round, the conceptual and operational definitions of social prescribing were developed, including long and short versions of the conceptual definition. In Round 3, participants were asked to rate their agreement with the conceptual and operational definitions of social prescribing.ParticipantsThis study involved an international, multidisciplinary panel of experts. The expert panel (n=48) represented 26 different countries across five continents, numerous expert groups, and a variety of years of experience with social prescribing, with the average being 5 years (range = 1-20 years).ResultsAfter three rounds, internationally accepted conceptual and operational definitions of social prescribing were established. The definitions were transformed into the Common Understanding of Social Prescribing (CUSP) conceptual framework.ConclusionThis foundational work offers a common thread – a shared sense of what social prescribing is, which may be woven into social prescribing research, policy, and practice to foster common understanding of this concept.STRENGTHS AND LIMITATIONS OF THIS STUDYStrengths of this study include the consensus method that was chosen, the diversity and size of the expert panel, and the fact that consensus was defineda priorias ≥80% agreementLimitations of this study include the fact that only those who could speak, read, and write English were eligible to participate in this study, the attrition of the expert panel, and the fact that the expert panel did not reach 100% agreement on the definitions

Background Social isolation and loneliness affect one in four older adults in many regions around the world. Social isolation and loneliness are shown to be associated with declines in physical and mental health. Intersecting social determinants of health influence both the risk of being socially isolated and lonely as well as the access and uptake of interventions. Our objective is to evaluate what evidence is available within systematic reviews on how to mitigate inequities in access to and effectiveness of interventions. Methods We performed an overview of reviews following methods of the Cochrane Handbook for Overviews of Reviews. We selected systematic reviews of effectiveness of interventions aimed at mitigating social isolation and loneliness in older adults (aged 60 or above) published in the last 10 years. In addition, we assessed all primary studies from the most recent systematic review with a broad intervention focus. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus in collaboration with a librarian scientist. We used a structured framework called PROGRESS-Plus to assess the reporting and consideration of equity. PROGRESS-Plus stands for place of residence, race/ethnicity/culture/language, occupation, gender or sex, religion, education, socioeconomic status (SES), social capital, while “plus” stands for additional factors associated with discrimination and exclusion such as age, disability, and sexual orientation. We assessed whether PROGRESS-Plus factors were reported in description of the population, examination of differential effects, or discussion of applicability or limitations. Results We identified and assessed 17 eligible systematic reviews. We assessed all 23 primary studies from the most recent systematic review with a broad intervention focus. All systematic reviews and primary studies described the population by one or more PROGRESS-Plus factor, most commonly across place of residence and age, respectively. None of the reviews and five primary studies examined differential effects across one or more PROGRESS-Plus dimension. Nine reviews and four primary studies discussed applicability or limitations of their findings by at least one PROGRESS-Plus factor. Conclusions Although we know that social isolation and loneliness are worse for the poorest and most socially disadvantaged older adults, the existing evidence base lacks details on how to tailor interventions for these socially disadvantaged older people.

Purpose This is a study protocol to co-create with knowledge users a core outcome set focused on middle-aged and older adults (40 years+) for use in social prescribing research. Methods We will follow the Core Outcome Measures in Effectiveness Trials (COMET) guide and use modified Delphi methods, including collating outcomes reported in social prescribing publications, online surveys, and discussion with our team to finalize the core outcome set. We intentionally center this work on people who deliver and receive social prescribing and include methods to evaluate collaboration. Our three-part process includes: (1) identifying published systematic reviews on social prescribing for adults to extract reported outcomes; and (2) up to three rounds of online surveys to rate the importance of outcomes for social prescribing. For this part, we will invite people (n = 240) who represent the population experienced in social prescribing, including researchers, members of social prescribing organizations, and people who receive social prescribing and their caregivers. Finally, we will (3) convene a virtual team meeting to discuss and rank the findings and finalize the core outcome set and our knowledge mobilization plan. Conclusion To our knowledge, this is the first study designed to use a modified Delphi method to co-create core outcomes for social prescribing. Development of a core outcome set contributes to improved knowledge synthesis via consistency in measures and terminology. We aim to develop guidance for future research, and specifically on the use of core outcomes for social prescribing at the person/patient, provider, program, and societal-level.

A growing body of evidence demonstrates that digital inclusion mediates access to other social determinants of health – directly, through access to and literacy in technologies or services, and indirectly, by supporting people’s capacity to participate fully and equitably in civic and cultural life online. Novel approaches to community-led participatory journalism, in which people from equity-deserving communities are supported to tell their own stories, suggest promising practices for online civic engagement as an emerging approach to promoting health though digital inclusion.

ObjectiveSocial prescribing is a person-centred model of care with emphases on lessening the impact of unmet social needs, supporting the delivery of personalised care, and reducing non-medical resource use in the primary care setting. The purpose of this systematic review was to synthesise the effect of social prescribing for older adults within primary care.DesignWe followed standard systematic review guidelines, including protocol registration, screening studies (title/abstract and full text) and assessing the study quality.Eligibility and information sourcesWe searched multiple online databases for studies that included older adults 60+ years (group mean age), an intervention defined and called social prescribing (or social prescription) via health provider referrals to non-medical services, and quantitative physical and psychosocial outcomes and/or health resource use. We included experimental and observational studies from all years and languages and conducted a narrative synthesis. The date of the last search was 24 March 2022.ResultsWe screened 406 citations (after removing duplicates) and included seven studies. All studies except one were before–after design without a control group, and all except one study was conducted in the UK. Studies included 12–159 participants (baseline), there were more women than men, the group mean (SD) age was 76.1 (4.0) years and data collection (baseline to final) occurred on average 19.4 (14.0) weeks apart. Social prescribing referrals came from health and social providers. Studies had considerable risk of bias, programme implementation details were missing, and for studies that reported data (n=6) on average only 66% of participants completed studies (per-protocol). There were some positive effects of social prescribing on physical and psychosocial outcomes (eg, social participation, well-being). Findings varied for health resource use. These results may change with new evidence.ConclusionsThere were few peer-reviewed studies available for social prescribing and older adults. Next steps for social prescribing should include co-creating initiatives with providers, older people and communities to identify meaningful outcomes, and feasible and robust methods for uptake of the prescription and community programmes. This should be considered in advance or in parallel with determining its effectiveness for meaningful outcomes at multiple levels (person, provider and programme).

BackgroundSocial prescribing (SP) assists patients to engage in social activities and connect to community supports as part of a holistic approach to primary care.Rx: Community was a SP project, which was implemented within 11 community health centres (CHCs) situated across Ontario, Canada.AimTo explore how SP as a process facilitates positive outcomes for patients.Design & settingQualitative methods were used. Eighteen focus groups were conducted at CHCs or by video-conferencing, and involved 88 patients. In addition, eight in-depth telephone interviews were undertaken.MethodInterviews and focus groups were transcribed verbatim, and analysed thematically using a theoretical framework based on self-determination theory (SDT).ResultsParticipants who had received social prescriptions described SP as an empathetic process that respects their needs and interests. SP facilitated the patient’s voice in their care, helped patients to develop skills in addressing needs important to them, and fostered trusting relationships with staff and other participants. Patients reported their social support networks were expanded, and they had improved mental health and ability in self-management of chronic conditions. Patients who became involved in SP as voluntary 'health champions' reported this was a positive experience and they gained a sense of purpose by giving back to their communities in ways that felt meaningful for them.ConclusionSP produced positive outcomes for patients, and it fits well within the community health centre model of primary care. Future research should examine the impact on health outcomes and examine the return on investment of developing and implementing SP programmes.

> R.E. consulte son medecin de famille pour plusieurs raisons. Elle fait de l’hypertension et a des malaises typiques d’un trouble d’anxiete generalisee avec humeur depressive. Son medecin de famille sait qu’elle est mere monoparentale de 3 jeunes enfants et qu’elle aimerait bien

> R.E. presents to her family physician with several concerns. She has high blood pressure and illness suggestive of generalized anxiety disorder with depressed mood. R.E.’s family physician understands that R.E. is a sole parent for 3 young children: “I wish I could get out of the house or book

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the 'Beyond the Building Blocks' framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs. publishersversion published

Purpose For over 40 years, Canadian and international bodies have endorsed comprehensive primary health care (PHC), yet very little work has been done to describe how services and programs are delivered within these organizations. Because health equity is now of greater interest to policy makers and the public, it is important to describe an evidence-informed framework for the delivery of integrated and equitable PHC. The purpose of this paper is to describe the development of a “Model of Health and Well-being” (MHWB) that provides a roadmap to the delivery of PHC in a successful network of community-governed PHC organizations in Ontario, Canada. Design/methodology/approach The MHWB was developed through an iterative process that involved members of community-governed PHC organizations in Ontario and key stakeholders. This included literature review and consultation to ensure that the model was evidence informed and reflected actual practice. Findings The MHWB has three guiding principles: highest quality health and well-being for people and communities; health equity and social justice; and community vitality and belonging. In addition, there are eight attributes that describe how services are provided. There is a reasonable evidence base underpinning the all principles and attributes. Originality/value As comprehensive, equitable PHC organizations become increasingly recognized as critical parts of the health care system, it is important to have a means to describe their approach to care and the values that drive their care. The MHWB provides a blueprint for comprehensive PHC as delivered by over 100 Community Governed Primary Health Care (CGPHC) organizations in Ontario. All CGPHC organizations have endorsed, adopted and operationalized this model as a guide for optimum care delivery.

Municipal governments across the Global North are increasingly becoming key actors in shaping urban food and agriculture policy. In the City of Toronto, recent aspirational policies, such as the provincial Local Food Act and the municipal Toronto Agricultural Program, created new opportunities to shape a healthier food system. We sought municipal perspectives on the question of “How might urban agriculture policy and programs be better supported to promote equity and health?” Analysis of findings from semistructured key informant interviews with municipal staff and policy-makers (n=18) illustrated broad support for generating better quantifiable evidence of the impacts of urban agriculture on economic development and employment, health and health equity, land use and production, and partnerships and policies. Place-specific economic and equity data emerged as particularly pressing priorities. At the same time, they sought better approaches to the potential risks involved in urban agriculture. Key informants also shared their views on the use of health impact assessment research to make a case for urban agriculture to a range of stake­holders; to manage real and perceived risks; and to move beyond enabling policies to empower new investments and procedural changes that would facilitate urban agriculture expansion in the city. The results informed the evolving praxis agenda for urban agriculture at the intersections of population health, environmental sustainability, and urban governance.

Assess the consumer nutrition environment in midsize to large supermarkets by supermarket type and area-level socioeconomic variables.Cross-sectional census of 257 supermarkets using the Toronto Nutrition Environment Measures Survey in Stores.Toronto, Canada.Availability; price and linear shelf space of fruits and vegetables vs energy-dense snack foods by supermarket type; after-tax, low-income measure; and neighborhood improvement area.Multivariate linear regression.There was a high availability of fruits (7.7 of 8) and vegetables (9.5 of 11). There was similar linear shelf space for fruits and vegetables vs energy-dense snack foods (ratio, 1.1 m). Adjusted fruit prices were lowest in quintiles 1 (β = -$1.30; P = .008), 2 (β = -$1.41; P = .005), and 3 (β = -$1.89; P .001) vs quintile 5 (lowest percentage of people living with low income) and in ethnic (β = -$3.47; P .001) and discount stores (β = -$5.64; P .001) vs conventional. Adjusted vegetable prices were lowest in quintiles 2 (β = -$1.87; P = .04), 3 (β = -$1.78; P = .03), and 4 (β = -$2.65; P = .001) vs quintile 5 and in ethnic (β = -$7.10; P .001) and discount (β = -$5.49; P .001) stores. They were highest in other (β = + $3.08; P = .003) vs conventional stores. Adjusted soda and chips prices were lower in discount (β = -$1.16; P .001) and higher in other stores (β = + $0.67; P .001) vs conventional.Findings do not indicate inequities in shelf space, availability, or price across diverse neighborhoods. Practitioners can use findings to help consumers navigate supermarkets to make healthy choices.

This study critically analyzed the operationalization and materialization of globally hegemonic dengue fever discourse at the local level in the city of Putrajaya, Malaysia. Textual analysis of the World Health Organization's First report on neglected tropical diseases (NTDs) (2010) identified three discursive strategies in the WHO's effort to set the agenda for research and action on neglected diseases: the nomination of dengue fever as a disease of the impoverished and voiceless other; the predication of neglected disease status on environmental and behavioural uncleanliness; and the framing of so-called ‘pro-poor’ neglected tropical disease discourse as a new paradigm under which targeting these othered people, behaviours and environments is a key strategy for NTD management and control. Further analysis of the transcripts of 14 key informant interviews conducted with experts in public health, governance and urban development in Putrajaya found that discursive links between dengue and poverty contribut...