Equity in Social Prescribing: Who Is Reached, Who Is Missed, and Why It Matters for Viet Nam

Equity in Social Prescribing: Who Is Reached, Who Is Missed, and Why It Matters for Viet Nam

Social prescribing is often discussed as a way to respond to social and practical factors that influence health and well-being. Someone may be experiencing loneliness, financial difficulty, limited opportunities for physical activity, social isolation, caregiving pressure or another challenge that clinical care alone cannot resolve. Connecting that person with appropriate community support may help, but an important question sits behind that promise: who is actually able to benefit?

A social prescribing pathway can exist, community resources can be available and referrals can be made, yet some people may still be less likely to hear about the pathway, be offered it, make contact, reach the service, participate or remain engaged long enough to benefit. The World Health Organization describes health equity as the absence of unfair and avoidable or remediable differences in health among population groups. In social prescribing, this means looking beyond whether a service is technically available and asking whether people have a fair opportunity to access and benefit from it.[1,2]

This matters particularly for Viet Nam. Formalized social prescribing remains at an early stage, and the published evidence specific to Viet Nam is still very limited. It would therefore be premature to claim that we already know which groups are being systematically reached or missed. A more responsible approach is to build equity into early implementation, learn where barriers actually occur and adjust the pathway before those barriers become embedded.

Key Points

Equity in social prescribing does not mean giving everyone the same referral or ensuring that every population group receives the same number of referrals. It means creating a fair opportunity for people to understand the pathway, access support that is relevant to them and participate in ways that are realistic for their circumstances. Inequity can arise before a referral is offered, between an offer and referral, between referral and contact, or after someone reaches a community resource.

International evidence suggests that cost, transport, caring responsibilities, time, disability, digital access, language, literacy, confidence, cultural fit and uneven community infrastructure can all affect engagement. Referral routes also matter, because healthcare-based and community-based routes may reach different populations. For Viet Nam, these findings should inform what we look for, not be treated as proof that the same patterns already exist here.

Equity is not the same as treating everyone identically

Equal access can sound fair. Everyone receives the same information, follows the same referral process and is given the same list of community activities. In practice, however, identical processes can produce very different opportunities.

Consider two people who are both interested in a community exercise program. One lives nearby, has flexible working hours, owns a smartphone and can comfortably afford the fee. The other lives farther away, depends on public transport, works irregular shifts and has caregiving responsibilities at home. Both may technically have access to the same program, but their realistic ability to participate is very different.

The same issue appears with digital registration, physical accessibility, opening hours, language and cost. A pathway designed around people who find services easy to navigate can unintentionally work best for those who already have more time, mobility, information or financial resources.

A 2026 global scoping review of 115 peer-reviewed empirical social prescribing studies identified recurring barriers including socioeconomic hardship, transport difficulties, limited digital access, caring responsibilities, limited time, literacy and language challenges, cultural mismatch, fluctuating health and low confidence.[3] The review raised concerns about an “inverse care” effect, where people with greater social and structural needs may have more difficulty accessing or sustaining engagement unless programs deliberately reduce those barriers.

Equity therefore does not mean that everyone needs social prescribing. Some people will not need it, some will decline it, and others may prefer another form of support. A person-centered approach should respect those choices. The more useful question is whether people for whom social prescribing may be relevant have a fair opportunity to understand, access and benefit from it.

Equity can be lost at several points in the pathway

It is tempting to assess equity by looking at a referral list and asking whether different groups are represented. That is useful, but referral is only one point in a much longer pathway.

Someone may never hear about social prescribing. They may see a healthcare professional but never be offered it. They may be offered it but decide not to proceed. They may accept a referral but never make contact with the person or organization providing support. They may make contact but find the activity unaffordable, inaccessible or unsuitable. They may attend once but not return, or participate regularly without receiving support that meaningfully addresses what matters to them.

Recent evidence illustrates why these stages need to be distinguished. A 2026 population-based study using English primary care records from more than 12 million patients found that approximately 4% had been recorded as being offered a social prescribing referral, and 77.7% of those were subsequently recorded as referred. Women, older adults, people living in less deprived areas and people with multiple long-term conditions had higher odds of being offered social prescribing. Among people who had already been offered it, however, older age groups had lower odds of being referred.[4]

These findings should not be transferred directly to Viet Nam. England has a mature national social prescribing infrastructure, a particular primary care model and a large social prescribing workforce. The study is valuable here because it demonstrates a methodological point: looking only at who was ultimately referred can hide differences that occurred earlier in the pathway.

A separate UK study analyzed 160,128 unique people referred to social prescribing, representing more than 200,000 social prescribing cases. Approximately nine in ten cases had at least one contact with a link worker, but only 38.3% had at least one intervention prescribed.[5] The reasons for that difference were not fully established, and the authors cautioned that absence of a recorded intervention does not necessarily mean failure. Nevertheless, the finding reinforces an important distinction: referral, contact and participation are not the same outcome.

Referral routes may also shape who enters the pathway. In the same UK study, most referrals in England, Wales and Scotland came through medical routes, while non-medical routes such as self-referral, schools and community or voluntary organizations reached some groups differently. Younger adults, men, people in more deprived areas and some ethnic minority populations were reached more equitably through non-medical routes.[5]

This does not mean Viet Nam should copy the British referral model or immediately create open referral routes everywhere. It suggests something more fundamental: social prescribing should not assume that healthcare is the only place where health-related social needs can be recognized. Depending on the model and local context, social services, community organizations and other trusted actors may eventually have a role, provided that responsibilities, governance and information-sharing arrangements are clear.

Trust is part of this equation as well. A person may respond differently to an unfamiliar service than to an introduction from someone they know and trust. A multinational co-creation study published in September 2026 emphasized flexible, individualized communication throughout referral, linking and community participation. Participants also preferred community opportunities to be connected with their own interests rather than assigned simply because they belonged to a particular demographic group.[6] Designing for difference is therefore important, but it should not become stereotyping.

Barriers overlap, and community infrastructure matters

Equity is rarely explained by one characteristic. An older adult may also live alone, have limited mobility and lack confidence using digital technology. A person with a disability may also have limited income and live far from an accessible activity. A caregiver may be financially comfortable but have almost no time to participate. A worker may be interested in an activity but unable to attend because it operates only during working hours.

These circumstances overlap, which is why labels such as “older,” “low income,” “disabled” or “ethnic minority” tell us relatively little about what a particular person actually needs. The 2026 multinational study on social prescribing for people in vulnerable situations makes a similar point, proposing that vulnerability should be understood as individualized and contextual rather than automatically attributed to membership of a population group.[6]

Sometimes the main barrier is not the referral process at all. A person can receive excellent person-centered support and still have nowhere appropriate to go. Community resources are unevenly distributed. One neighborhood may have affordable exercise groups, parks, cultural activities, volunteer opportunities and active community organizations, while another may have few options. Rural or remote areas may involve long travel distances, while urban areas may offer more activities but still present significant barriers related to cost, time, transport or navigation.

The 2026 global review identified limited community-sector capacity, unstable provision, transport gaps, cultural inappropriateness, digital exclusion and uneven access to local resources among important implementation constraints.[3] A 2026 Western Pacific review similarly found substantial variation in how social prescribing and related interventions are organized across the region, with resource constraints and inconsistent referral systems among recurring challenges.[7]

Digital tools can help maintain directories, communicate availability and support coordination, but digital convenience should not quietly become a condition of access. A person should not need a recent smartphone, reliable internet connection or confidence completing online forms simply to participate in community life. Where appropriate, digital communication can sit alongside telephone contact, in-person support and assistance from trusted people or organizations.

There is also a broader limit to what social prescribing can achieve. It can help someone navigate available support or build community connection, but it cannot by itself correct poverty, inadequate housing, poor transport or a lack of community infrastructure. The World Health Organization's work on social determinants of health equity emphasizes that health inequities are shaped by the wider distribution of resources, opportunities and power.[2] Social prescribing should therefore complement, not substitute for, wider social, public health and community development responses.

This matters because equity problems can become unintended harms. A 2026 global umbrella review identified plausible equity harms associated with unequal provision, delivery and access to social prescribing, alongside potential psychological, group or social, and opportunity harms.[8] The review did not establish how commonly such harms occur, so these should be understood as potential risks rather than proven routine outcomes. The practical lesson is that good intentions alone do not guarantee equitable implementation.

What equity means in the Vietnamese context

Viet Nam should not import a ready-made list of “underserved social prescribing populations” from another health system. We do not yet have enough Vietnamese social prescribing research to determine who is systematically reached, who is missed or which referral model would produce the most equitable outcomes.

The 2026 scoping review of social prescribing and related interventions in the Western Pacific Region identified 42 peer-reviewed studies across the region, with only one study from Viet Nam.[7] This very limited evidence base is one reason international findings should be used as questions for Vietnamese implementation rather than assumptions about Vietnamese populations.

At the same time, Viet Nam has broader health-system experience showing why equity needs attention. World Health Organization work in Viet Nam highlights the importance of equitable health financing and access, particularly for people in vulnerable circumstances, ethnic minority communities and people living in remote, mountainous, border and island areas.[9] The World Health Organization's regional framework for reaching the unreached also emphasizes inclusive primary healthcare, community participation, local adaptation, socioeconomic barriers and data-informed decision-making.[10]

For social prescribing, this points to circumstances that should be considered during pilots and early implementation. Cost may influence participation for people with limited disposable income. Distance and transport may become particularly important outside major urban areas. Language and cultural relevance may matter in some communities. Fixed daytime activities may be difficult for workers or caregivers. People who are socially isolated may also be less likely to discover opportunities through ordinary community networks. Digital-only pathways may exclude people with limited connectivity or confidence using technology.

These are implementation considerations, not evidence that every person in these groups needs social prescribing or is currently being excluded from it. That distinction is essential. Equity should lead to better questions and better design, not assumptions about individuals based on demographic categories.

Accessibility for people with disabilities also has a clear legal and rights dimension in Viet Nam. The current consolidated text of the Law on Persons with Disabilities, issued as Consolidated Document No. 24/VBHN-VPQH on 26 February 2026, maintains provisions recognizing the rights of people with disabilities to participate equally in social activities, live independently and integrate into the community, and access public facilities, transportation, information technology, cultural and sporting services and other appropriate services.[11]

For a social prescribing pathway, this means that saying an activity is “open to everyone” is not enough. Can a person physically enter and move through the venue? Can they understand and use the information provided? Can they participate meaningfully once they arrive? Is appropriate assistance available where needed? Accessibility needs to be understood through the real experience of participation, not only through an organization's stated eligibility criteria.

Measure equity, but do not collect data simply because it may be useful

One of the weaknesses in the international evidence is that equity is often discussed more confidently than it is measured. A 2024 study of social prescribing services in England found inconsistencies in demographic data collection and substantial gaps in information about referral sources, outcomes and wider determinants of health. The authors argued that understanding equity requires looking at who accesses social prescribing, how they access it and what outcomes they experience.[12]

For Viet Nam, early pilots should therefore collect enough information to understand whether important differences are emerging, but this does not justify collecting every possible demographic or social variable. More data are not automatically better data.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/ND-CP have been in effect since 1 January 2026.[13,14] Information collected for equity monitoring may constitute personal data and, depending on the information involved, may also engage requirements applicable to sensitive personal data. Organizations should therefore determine in advance what information is genuinely necessary, the purpose for which it is collected, the applicable legal basis and consent requirements, who may access it, how it will be protected and how long it should be retained.

For population-level evaluation, reporting can often rely on aggregated information or other methods that reduce identifiability where appropriate and legally compliant. The objective should be to understand whether the pathway is working equitably without collecting or circulating more identifiable personal information than the purpose requires. Equity monitoring should not become a justification for unnecessary data collection.

The measures themselves also need to follow the pathway rather than stopping at referral counts. Programs should ask who was offered social prescribing, who accepted or declined, who made contact, who actually participated and who stopped participating. When participation does not occur, it is useful to understand why. Was the activity full? Was transport difficult? Was it too expensive? Did the timing not work? Was the person uncomfortable with the activity? Was the resource simply not appropriate?

Those questions provide far more useful information than labeling everyone who does not participate as “non-engaged.”

Building equity into social prescribing in Viet Nam

The best time to think about equity is before a pathway becomes large. Once referral habits, digital systems and partnerships are established, inequities can become harder to recognize and more difficult to redesign.

Early implementation in Viet Nam should therefore examine the entire pathway. Referral numbers matter, but so do offer rates, acceptance, successful connection, participation, participant experience and reasons for disengagement. Data should be interpreted alongside what community organizations and participants say is happening in practice.

Resource mapping also needs an equity lens. A directory containing fifty community activities can appear impressive, but if almost all are concentrated in one part of a city, require payment or operate only during working hours, the number of listings tells us very little about equitable access. What matters is whether the network offers realistic options for different people and circumstances.

Community partners can provide valuable insight here. They often know who regularly attends, who rarely appears, what barriers participants describe, when activities are becoming unaffordable or inaccessible and where local gaps exist. People using the pathway, including those who decline or disengage, should also have opportunities to explain what made participation easier or harder.

This approach is consistent with the World Health Organization's broader Western Pacific framework for reaching people who are not adequately served, which emphasizes local adaptation, community participation and data-informed action rather than assuming that one model will work everywhere.[10]

For Viet Nam, an equitable social prescribing model is therefore unlikely to begin with a national list of “priority populations” and a predetermined intervention for each group. A stronger starting point is to learn locally, identify where barriers actually occur, involve communities in understanding them and adjust the pathway accordingly.

Key Takeaway

Social prescribing has the potential to connect people with forms of support that conventional healthcare may not provide, but being community-based or person-centered does not automatically make a pathway equitable. People can be missed before a referral is offered, between an offer and referral, between referral and contact, or between participation and meaningful benefit.

Some of the people facing the greatest social challenges may also face the greatest practical barriers to accessing community support. Cost, transport, time, caring responsibilities, disability, language, digital access, confidence and the absence of suitable community resources can all influence whether a referral becomes a real connection.

For Viet Nam, the evidence is not yet strong enough to say exactly who social prescribing is reaching or missing. That uncertainty is not a reason to delay thinking about equity. It is a reason to build equity into early implementation and evaluation from the beginning.

The objective should not be to give everyone the same service or achieve identical referral rates across demographic groups. Nor should people be assigned activities based on assumptions about their age, disability, income, ethnicity or other characteristics.

A more useful question is: Does a person for whom social prescribing may be relevant have a fair opportunity to understand it, access it, choose support that matters to them, participate in it and benefit from it?

When the answer is no, the next question should not simply be, “Why did this person fail to engage?” We should also ask, “What in the pathway, the community or the wider environment made engagement difficult?”

That is where an equity approach to social prescribing begins.

References

1. World Health Organization Regional Office for the Western Pacific. Health equity and its determinants in the Western Pacific Region. Manila: World Health Organization Regional Office for the Western Pacific; 2020.

2. World Health Organization. World report on social determinants of health equity. Geneva: World Health Organization; 2025. ISBN 978-92-4-010758-8.

3. Kisa A, Kisa S. Models, implementation, and reported outcomes of social prescribing interventions: a scoping review. Frontiers in Public Health. 2026;14:1871347. doi:10.3389/fpubh.2026.1871347.

4. Agboraw E, Wilding A, Munford L, Sutton M, Wilson P. Inequalities in referrals to social prescribing from primary care in England: a retrospective observational study. PLOS ONE. 2026;21(6):e0350842. doi:10.1371/journal.pone.0350842.

5. Bu F, Hayes D, Burton A, Fancourt D. Equal, equitable or exacerbating inequalities: patterns and predictors of social prescribing referrals in 160 128 UK patients. British Journal of Psychiatry. 2025;226(2):91-99. doi:10.1192/bjp.2024.141.

6. Rasmussen LG, Oeser P, Baggio S, et al. Adapting social prescribing to groups in vulnerable situations: a multi-national co-creation study. BMC Public Health. Published online 11 September 2026. doi:10.1186/s12889-026-29275-z.

7. Lwin KS, Wong MSJ, Tan MH, et al. Organization and implementation of social prescribing in the Western Pacific Region: a scoping review. The Lancet Regional Health - Western Pacific. 2026;67:101714. doi:10.1016/j.lanwpc.2025.101714.

8. Cooper M, Okeowo D, Bennett L, et al. Potential harms of social prescribing: a global umbrella review and dark logic model. BMJ Open. 2026;16(5):e108998. doi:10.1136/bmjopen-2025-108998.

9. World Health Organization Viet Nam. Strategic priority 1: Health system strengthening. WHO Viet Nam. Accessed 25 September 2026.

10. World Health Organization Regional Office for the Western Pacific. Regional framework for reaching the unreached in the Western Pacific (2022-2030). Manila: World Health Organization Regional Office for the Western Pacific; 2023.

11. Office of the National Assembly of Viet Nam. Consolidated Document No. 24/VBHN-VPQH consolidating the Law on Persons with Disabilities. 26 February 2026.

12. Khan K, Tierney S, Owen G. Applying an equity lens to social prescribing. Journal of Public Health. 2024;46(3):458-462. doi:10.1093/pubmed/fdae105.

13. National Assembly of the Socialist Republic of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. 26 June 2025. Effective 1 January 2026.

14. Government of Viet Nam. Decree No. 356/2025/ND-CP detailing certain provisions and measures for implementation of the Law on Personal Data Protection. 31 December 2025. Effective 1 January 2026.

Article Information

Published: 25 September 2026
Last reviewed: 25 September 2026
Publisher: Social Prescribing Vietnam

Disclaimer

This article is provided for educational and informational purposes. It does not constitute medical advice, clinical guidance, legal advice or official policy. Evidence on equity in social prescribing continues to evolve and remains limited in Viet Nam. International findings should not be assumed to apply directly to Vietnamese populations, communities or health and social care settings. References to particular populations or circumstances are intended to identify potential barriers that may warrant attention during implementation, not to imply that all individuals within those groups are disadvantaged, require social prescribing or are currently being excluded from it. Organizations developing social prescribing pathways should determine the applicable Vietnamese legal, professional, accessibility and personal data protection requirements for their specific activities before implementation.