{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:05Z","timestamp":1782366485746,"version":"3.54.5"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Despite rising investment in health and social services, loneliness, mental distress, and social disconnection continue to worsen across high-income countries. This pattern suggests the challenge may not lie solely in insufficient provision, but in how systems conceptualize people and value. Within increasingly individualized and consumption-oriented contexts, people are often positioned as recipients of services rather than contributors to social and civic life, with value reduced to economic or service-based metrics rather than relational and civic contributions.<\/jats:p>\n                  <jats:p>These assumptions shape system design, giving rise to two recurring patterns of failure. In ethical abandonment, systems retreat into markets and transactions, positioning people as consumers without preserving conditions for meaningful agency or contribution. In ethical overreach, systems use prescriptive, behavioral, or medicalised approaches that substitute institutional control for personal authorship, positioning people as objects to be optimized. Although these approaches appear opposed, both deny that people can matter to others beyond their consumption of support, undermining reciprocity, eroding shared life, and driving system expansion.<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Contributory reciprocity<\/jats:italic>\n                    is proposed as an alternative ethical orientation, recognizing people as potential contributors to shared life, not merely recipients of support. It partitions responsibility: systems secure real opportunity and preserve civic space; individuals retain authorship over engagement. The framework maintains expectation, rather than obligation, that people can create value for others, rejecting the drift toward lives organized around consumption alone.\n                  <\/jats:p>\n                  <jats:p>Social prescribing is examined as a practice through which contributory reciprocity can be enacted. When practiced as invitation rather than prescription, it renders opportunities visible, lowers barriers to entry, and returns authorship to individuals. When reduced to behavioral direction or commodified experience, it risks reproducing the consumption-oriented logic it seeks to address. Actionable recommendations are provided across system design, commissioning, evaluation, and policy development, emphasizing opportunity over activity delivery, relational work, and distinguishing invitation from uptake.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1797875","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:31:06Z","timestamp":1782365466000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Abandonment or overreach: the ethical failures of health and social systems and the need for contributory reciprocity"],"prefix":"10.3389","volume":"14","author":[{"given":"J. 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