We all know health is more than just the conditions we have and the medicines we take. MedShadow writes frequently that eating well, sleeping well, exercising, socializing, and reducing stress can go a long way to preventing illnesses and minimizing symptoms of a wide range of conditions such as anxiety, lupus and irritable bowel. Doctors have known this for a long time, but it isn’t something they can actually prescribe for their patients… or is it? Let me introduce you to social prescribing.
MedShadow spoke with Julia Hotz, a solutions-focused journalist who is currently traveling the world reporting and collecting stories about doctors who prescribe all kinds of social supports for their patients, ranging from fresh food to volunteering, for her upcoming book, The Social Prescription, which will be published by Simon & Schuster in 2024.
MedShadow: What is social prescribing?
Hotz: Social prescribing is a way for doctors and other health workers to connect patients with medicine that addresses their social determinants of health. It turns out up to 80% of our health is determined by social factors – tangible things like access to healthy food, a safe home, stable finances, and also intangible things, like a community we can belong to and friends we can depend on.
People without those social supports tend to have worse physical and mental health, so social prescribing steps in by filling those gaps. Some doctors prescribe tangible things — fresh food, housing assistance, even help with their patients’ heating bills. In my book, we follow doctors offering social prescriptions that address intangible things — like gaps in community and friendship. So, that’s everything from cycling groups to art discussion clubs to volunteer opportunities.
The doctor who came up with social prescribing has a great tagline: instead of asking “what’s the matter with you?” they ask patients “what matters to you?”
MedShadow: How did you first learn about social prescribing?
Hotz: I first learned about social prescribing when I was a graduate student at the University of Cambridge. This was in 2018. It was the same year that Britain appointed a Minister of Loneliness, so I was really interested in that because it wasn’t really clear how policymakers would address loneliness — which was starting to become a big public health issue.
I wanted to design my graduate school research to actually hear from people who were lonely about what it’s been like for them, what the minister could do to make it easier. I did these sort of focus groups and found out that the way to stop loneliness is really simple: You give people opportunities to meaningfully connect with one another. And it was through the focus groups that I actually believe I first heard the term social prescribing, which I’ve followed closely since.
MedShadow: What might a social prescription look like? What conditions could it help with?
Hotz: Just as there is a very wide variety of social prescriptions (in the book, I cover social prescriptions that revolve around movement, nature, art, service work, and conversations), there is a wide variety of conditions it can help with, too. Loneliness is the one people think of right away, but social prescribing has also been associated with improvements in depression, anxiety, PTSD, ADHD, as well as more physically presenting conditions like diabetes, dementia, Parkinson’s, and chronic pain.
Even before social prescribing came to be, a good deal of research shows this; exercise, for example, has been found to help people with depression. Nature can be really restorative for people with anxiety. Art can be especially healing for people with trauma and cognitive disorders.
MedShadow: Is there evidence that social prescribing can reduce the need for medications in any specific situations?
Hotz: There’s definitely evidence that social prescribing can reduce the need for medications in specific situations. Although, I will say that a lot of studies don’t look at that, and researchers and doctors don’t necessarily want to frame social prescribing as a replacement for medication.
Certainly, there are patients who get both social prescriptions and pharmaceutical prescriptions. But, there are instances in which a patient might be given a social prescription which would negate their need for other kinds of medication.
For instance, in my book we follow this retired truck driver named Frank who had been struggling with diabetes. He was told he would be on insulin for the rest of his life. A doctor and his team prescribed Frank a spot in a cycling confidence course, where many others in the group also have diabetes or other health problems, and through being accountable to cycle with that group, and through making friends with the fellow cyclists, Frank was actually able to come off of insulin.
It can also do the same for mental health. We also follow a researcher named Amanda who had been struggling with very severe depression. She’d just moved to a new town, and didn’t know anyone, and faced a whole load of other challenging social circumstances like divorce and grief. She had been put on the highest dose of antidepressants. But after her social prescription from a mental health nurse, which was for a sea swimming course, Amanda makes all of these new friends, finds an activity she loves, and is able to go from the maximum dose to the minimum dose of antidepressants.
MedShadow: In reporting on social prescribing, has anything really surprised you? Any stories really stuck out to you?
Hotz: Those two stories are among the ones that have surprised me (we follow eight others in the book). But I would say I’ve also been very surprised by the evidence, not just ‘Wow, social prescribing is so powerful that it can actually reduce the need for medication in patients,’ but also by other bits of evidence around the return on investment for health care systems at large.
In England, where healthcare is paid for by the government, some studies find social prescribing saves money in the long run because people end up relying on their doctor less. They require fewer appointments, fewer follow-ups. They end up using fewer health resources.
Other studies associate social prescribing with fewer trips to their primary care office and even to the emergency room, since socially prescribed patients tend to learn to manage their own health, they’re also able to prevent health emergencies before they happen.
MedShadow: What should patients know about social prescribing? Any helpful tips for patients whose healthcare providers might not be experts on it yet?
Hotz: There’s a great organization called Social Prescribing USA that’s trying to make social prescribing available to every American by 2035. But as we wait for social prescribing to be an option for more of us, I would say that people should integrate the takeaways of social prescribing into their own lives.
For example, many of us know that we feel good when we move our bodies, or we get out into nature, or we interact with a piece of really meaningful art, or we volunteer, or we have a meaningful conversation. We also know that it feels really good to spend time with people we care about.
I think, especially since COVID, so many of us have become so accustomed to staying inside, just ourselves and our screens. We know intuitively that that’s not good for us. That’s not what we’ve evolved to do. And so I would say whether or not people have social prescribing available to them at the doctor’s office, they can harness the power of it in their own lives in the meantime.
