Social Prescribing as Strategic Infrastructure: Unlocking Community Capacity for Sustainable Healthcare When Institutions Reach Their Limits.

Canada's healthcare system is approaching structural limits: nearly $400 billion in annual spending, while nearly one in five Canadians is without a regular healthcare provider, emergency departments overflow and health inequities persist that universal coverage alone cannot resolve. This paper argues that social prescribing, a structured referral system connecting people to community resources through trained link workers, offers not merely an additional program but a paradigm shift. By making visible the economic and social value of community-based health work, social prescribing functions as a strategic catalyst for an enabling state model of healthcare: one that redirects public investment toward the community infrastructure where health is actually produced. This paper traces Canada's health system through three historical paradigms: the nation state, the welfare state and the emerging enabling state. It shows how social prescribing bridges the transition, with modelling suggesting a potential return of $4.43 for every dollar invested while building resilience against the compounding disruptions of climate change, trade instability and geopolitical uncertainty. Drawing on Canadian pilots, international evidence and cross-sectoral economic analysis, the paper offers recommendations for community organizations and governments to recognize, resource and protect the resilient future that Canadian communities are already building.