Health-ing the System: Gareth Presch on Prevention Finance & Social Prescribing

In this episode of the Health-ing Podcast, hosts Thomas Plochg and Ushma Issar speak with Gareth Presch, CEO and Founder of the World Health Innovation Summit and leader of the Global Social Prescribing Alliance, about what it really takes to shift health systems from disease management to prevention-and why capital, not just good intentions, is the bottleneck. Gareth shares his journey from public service in Ireland-including senior roles across the health sector and leading the statutory National Hemophilia Council after the contaminated blood tragedy-to building global platforms that connect governments, communities, and investors. His core message is simple but disruptive: health systems are excellent at acute and disease care, but they spend roughly 97% of budgets on managing illness, leaving massive untapped opportunity (and necessity) for prevention. A central theme is social prescribing as a practical, scalable entry point into the “new paradigm.” Gareth explains how link workers embedded in primary care can address social determinants of health with far more time than a GP appointment allows-and how outcome-based approaches can make these models financially compelling (e.g., savings multiples per pound invested). He describes prevention as “not soft” at all: it requires serious capital, workforce planning, and new infrastructure. The conversation goes deep on why the system resists change-until external pressure forces it. Gareth argues that waitlists, workforce shortages, and economic drag from ill health will eventually make prevention unavoidable at the ballot box. But speed is the challenge: investors want scale (often €/$50M+ ticket sizes), while prevention innovations often remain fragmented. His solution is a city-to-region model: build local ecosystems, aggregate projects to reach investable scale, and use philanthropic and family office capital as early “seed” funding before attracting pension funds and institutional investors. Thomas and Ushma explore the tension between traditional “reductionist” evidence models and complexity-based systems thinking. Gareth responds with a pragmatic view: health systems already measure everything, and prevention impact can be demonstrated-especially when linked to real costs like emergency visits, long-term treatment, and lost productivity. The harder part is translating evidence into bankable structures-learning investor language, fund mechanics, underwriting, blended finance, and outcome contracts-without losing ethical direction and public benefit. Ultimately, Gareth reframes “health-ing” as both a personal and systemic capability: empowering people and communities, while building the financial and institutional architecture to make prevention the default. The episode closes with a clear call: the ROI for prevention is everywhere; the next step is execution-designing ethical, investable models that deliver health equity at scale.