Mission possible: how pharmacists are taking action on social determinants of health

This article is reprinted from CFP’s 2025 Changing Face of Pharmacy report, mailed to more than 14,000 community pharmacies in Canada in November 2025. A pdf version is also available.

Avery,* a pharmacy student, was momentarily struck speechless.

After explaining to a patient how to store their new medication, the patient thanked Avery and then leaned closer to quietly add, “But I live in my car. How can I store it, living in my car?”

That was Avery’s first experience with a social determinant of health (SDoH). Unfortunately, as all pharmacists well know, it won’t be their last.

SDoHs are non-medical factors that can significantly influence health outcomes. In addition to economic stability, SDoHs include education, physical environment and social context (e.g., culture, race). Income stability is perhaps the biggest SDoH to affect access to health care, evidenced by the significant amount of time pharmacy teams spend, every day, helping patients secure coverage from drug plans and find lower-cost alternatives.

Research studies have shown that 70 to 90% of health outcomes are dependent on socioeconomic and environmental factors. ^1,2 In other words, “social determinants have a greater impact on health than actual healthcare delivery,” says Lee.

But the big question is, how can community pharmacists, family physicians and other healthcare providers do more to address SDoHs when they already struggle to keep up with current workloads?

The good news is the answers may be coming sooner than you think.

The first multi-site implementation of a validated screening tool for SDoHs is currently underway in pharmacies in Newfoundland and Labrador as part of a research project led by Lee and funded by the Canadian Foundation for Pharmacy. And a structured pathway that enables healthcare providers to link patients to social care services—one model is called social prescribing—is gaining momentum, and government funding, across Canada.

For Hussein, the inevitability of social prescribing comes down to two irrefutable facts. First, “clinical outcomes will never be achieved if we don’t address underlying social problems,” he says. Second, most pharmacies’ current efforts to address SDoHs, while well-intentioned, are unsustainable and ultimately fall short.

“The old way is to build your own network of contacts in the community. That’s labour-intensive and hit-and-miss. The new way is social prescribing. I am doing it today. Any pharmacy can do it,” says Hussein.

A global movement

The 2008 report by the World Health Organization’s Commission on Social Determinants of Health triggered much discussion among member countries. “It made it clear that it doesn’t make sense as a society that we pour money into expensive hospitalizations when we could be doing so much more upstream. And it would be better for the person, and better for communities,” says Pinto.

Subsequent economic analyses, including research by Upstream Lab, confirmed that SDoHs are the biggest common denominator among the highest-cost users of healthcare systems. “If we want to bend the cost curve, we need to think about how we can tackle things like housing, food security, income security,” summarizes Pinto.

Canada was among the Commission’s country partners to commit to making progress on SDoHs to improve health equity. So was the United Kingdom, which formally implemented social prescribing as part of primary care in 2019 (whereby family physicians could refer patients to “social prescribing link workers”). A 2023 scoping review of 19 studies confirmed that the U.K. program had a positive economic impact, including reductions in health service usage. ³

Back in Canada, the Public Health Agency of Canada established the Canadian Council on Social Determinants of Health in 2015. In 2022, it funded the Canadian Network for Health in All Policies, which is working with governments, Indigenous groups, universities and not-for-profit organizations to take an intersectoral approach to improve health equity.

“The federal government has really been advocating that the provinces take the health-in-all-policies approach. So when they’re developing roadway infrastructure, how does it promote healthy cities? How does it promote walking? We’re seeing that health-in-all language used more by provincial governments,” observes Lee.

SDoHs are front and centre in Lee’s home province of Newfoundland and Labrador. Health Accord NL, a 10-year initiative launched by the provincial government in 2022, has two main objectives:

• Awareness of and intervention in the social factors that influence health.
• Balance of community-based and hospital-based services.

The Health Accord’s 10 action items to address SDoHs include updated education programs for healthcare and social care providers.

Other provincial governments are in various stages of taking more action on SDoHs. For example, Ontario Health released a framework and resources guide in October 2024, developed with Ontario Health Teams in mind. The B.C. government is developing a “value set… to assist any B.C. health system provider to identify, capture, maintain, and understand SDOH[s].”

The Canadian Institute for Social Prescribing was established in 2022, anchored by the Canadian Red Cross and funded by two private foundations. Its mission is to build bridges between health and social sectors by connecting healthcare providers, community leaders, researchers, funders and international partners to share practices, build evidence and influence policy.

To that end, the Institute enlisted Hussein to conduct an environmental scan of SDoH topics in pharmacy curricula as well as interview pharmacy leaders on potential strategies to strengthen pharmacists’ capacity for social prescribing. The findings and recommendations are summarized in a poster presentation completed early this year.

Upstream Lab is also one of four facilitator organizations behind Deep End Canada, a resource-sharing network and advocacy organization launched in 2024. It joins Deep End networks already established in eight other countries, including Scotland, Japan and Australia.

To start, Deep End Canada’s members are primary care sites focussed on reducing health inequities by addressing SDoHs, “but it’s meant to go beyond that and certainly could include pharmacies and other healthcare teams,” says Pinto.

In the pharmacy world, 2022 updates to the National Association of Pharmacy Regulatory Authorities’ model standards of practice include a call for pharmacy professionals to “recognize and consider the impact of social determinants of health on individual, community, and public health and wellness.”

Similarly in the U.S., the Joint Commission of Pharmacy Practitioners updated its Pharmacists’ Patient Care Process in May 2025 and embedded SDoHs into four of the five steps of the process, including SDoH screening and data collection, assessment, and planning and implementing a care plan.

The SPARK tool

How can pharmacies better integrate SDoHs into daily practice, ideally in a way that improves workflow and saves staff time? A screening tool is the first building block for a structured pathway—which is where the SPARK (Screening for Poverty And Related social determinants to improve Knowledge of and links to resources) tool comes in.

Originally developed in 2011 by a collaboration of hospitals and a public health organization in Toronto, Ontario, the tool was mainly used by a handful of primary care clinics in the province. In 2021, Upstream Lab received funding from the Canadian Institutes for Health Research to refine and validate the tool by interviewing Canadians in four provinces. The result is “a simple yet comprehensive and inclusive, 18-question tool,” concludes the research study.⁴

Upstream Lab is now actively recruiting healthcare teams, including community pharmacies, to implement the SPARK tool. The SPARK RPh study, led by Lee with Pinto as one of the co-investigators, is evaluating its implementation in seven community pharmacies in Newfoundland and Labrador. Analysis of the aggregate data will also determine the most common social needs of patients—and help advocacy bodies make the case for long-term government funding, notes Lee.

When doing medication reviews or assessments for common conditions, pharmacists in the SPARK RPh study ask patients if they’d like to answer the tool’s questions as well as fill out a survey for researchers. Almost all are agreeing to participate, says Lesley,* a pharmacy manager at one of the participating pharmacies, adding that a supporting script helps pharmacists explain the reasons for the tool and its questions.

Lesley recently helped a long-time patient, a retiree with limited literacy skills and mobility issues. “Reading and apprehension are a struggle for him, and we had to go through the questions slowly, but it seemed like he was doing well,” Lesley recalls.

Then one week later, while picking up his blister packs, he reopened the conversation. “He said he thought about it some more and was wondering if there was any support out there to help him take care of his house,” says Lesley, who gave him the contact information for a social worker who would determine if he qualified for government-subsidized assistance.

For Lesley, one of the tool’s biggest benefits is its ability to deepen relationships, as it did in this case. “The questions opened a new line of communication and he got to know me a little bit more. He came back with his own questions, which was great.”

The tool helps normalize the conversation that health is as much about social needs as it is biological, adds Lee. Furthermore, during public consultations that informed the rollout of the study, people shared that they’d like to see the SPARK tool become a self-populated questionnaire they could readily access and update on their own. “They would like to have this data shared with all their healthcare providers. They don’t want to be asked the same questions by multiple providers.”

Lee envisions the day when the SPARK tool is integrated into provincial electronic health records. “It needs to be part of how we approach caring for people. And the data will help governments figure out where the needs are in communities.”

A referral pathway

Currently when pharmacists come across patients impacted by SDoHs, they may give patients contact information for social services, and hope the patient will take the next step. Or some go to the extreme of helping patients themselves, whether by filling tax returns or finding temporary housing.

What if healthcare providers could refer patients to someone trained in addressing SDoHs? That person would proactively reach out to the patient and work with them to develop a plan, which would include follow-ups and documentation. The term social prescribing is commonly used to describe this referral pathway, and several models are unfolding in Canada.

In Kingston, Ontario, Hussein is currently trying to help a 16-year-old who comes into the pharmacy to pick up harm-reduction supplies. “He is pretty much homeless, and you can see he is hungry. I always tell him, if you need food, I can help you. I can refer you to the centre here.”

By “centre” Hussein means the Kingston Community Health Centre, which employs a link worker (also known as connectors or navigators) trained in SDoHs and the development of care plans that are “co-created” with the patient. “We are working on a protocol to formalize this into a proper digital pathway, with referral forms and a feedback loop that enables us at the pharmacy to know the outcomes of our referrals,” says Hussein.

Social prescribing streamlines the healthcare provider’s role to that of identifying patients with social needs, without having to spend time on addressing those needs. While government funding is currently focussed on the link workers, Hussein foresees the day when pharmacies and other healthcare providers will be able to bill for their referrals. “Our role as identifiers is key, and my partnership with the Centre enables me to focus my time on that,” says Hussein.

To get started, Hussein recommends pharmacies check out the Social Prescribing Initiatives map of the Canadian Institute for Social Prescribing. More than 90 community health centres and other community program providers are on the map so far, ready to receive referrals from family health teams and other healthcare providers. While most are concentrated in B.C., Alberta and Ontario, sites in other provinces are slowly emerging.

If a pharmacy’s local community health centre is not on the map, Hussein encourages his peers to set the wheels in motion by reaching out to the organization. The Canadian Institute for Social Prescribing and Ontario’s Alliance for Healthier Communities are two excellent resources to help community organizations become active in social prescribing, he adds.

Another approach is to employ someone dedicated to addressing SDoHs onsite, bypassing the need to partner with a community health centre (although the onsite person may work with the centre). “That requires a certain level of volume,” says Pinto. “We’re doing a trial now of a community health worker in a primary care clinic who is providing short-term navigation to assist people. That type of follow-up is key, as a lot of systems for social supports are hard to navigate.”

The position does not need to be full-time, and government funding is a possibility. Sarah Kozusko, co-owner of Queen City Wellness Pharmacy in Regina, Saskatchewan, successfully lobbied for funding to employ an onsite social worker for two days a week.

Federal funding enables Upstream Lab to pursue a wide array of pilot projects that reduce health inequities—and to mobilize knowledge among policymakers at all levels of government. “We often work with different ministries to keep them up to date on what they can be doing to address SDoHs. The SPARK tool is a good example of that,” says Pinto.

Momentum is building, Pinto says, and all healthcare teams have a key role to play. “Our mission is to integrate social interventions into our work at multiple levels. It is doable. Our vision is a health and social care system that is truly tackling social factors alongside the biological.”

Interested in using the SPARK tool?

Developed by Upstream Lab, implementation of the SPARK tool is tied to ongoing research funded by the Canadian Institutes of Health Research. To access the online version of the tool, as well as supporting materials and resources, healthcare teams are asked to complete a survey and agree to be contacted for follow-ups on the tool’s adoption.

A print version of the tool, in English and French, is immediately available in pdf format, which pharmacy teams can scan once completed to add to the patient’s record.

Summary of resources

• Social prescribing in pharmacies: What is it, does it work and what does it mean for Canadian pharmacies?” Hussein T, et al. CPJ, December 2023
• “Transforming Health Equity: Why Pharmacy is Key to Social Prescribing.” YouTube webinar, CASCADES Canada, June 2025
• Upstream Lab, including SPARK (Screening for Poverty And Related social determinants to improve Knowledge of and links to resources) screening tool
• Canadian Institute for Social Prescribing, including “Social Prescribing in Canada: 2025 report“
• Alliance for Healthier Communities, including social prescribing training modules
• “Ontario Health’s Social Determinants of Health Framework… A Paradigm Shift,” a framework and resource guide
• Pharmacy Quality Alliance Social Determinants of Health Resource Guide (US)

References

1. Marmot M, Allen J. Social determinants of health equity. Am J Public Health. 2014;104 (Suppl 4):S517-S519.
2. Hood CM, et al. County health rankings: relationships between determinant factors and health outcomes. Am J Prev Med. 2016 Feb;50(2):129-35.
3. Polly M, et al. Building the economic case for social prescribing. National Academy for Social Prescribing. 2023 Oct.
4. Adekoya I, et al. Screening for poverty and related social determinants to improve knowledge of and links to resources (SPARK): development and cognitive testing of a tool for primary care. BMC Prim Care. 2023 Nov;24:247.