Social Prescribing for Health care providers: An interview with Julia Hotz, Author of The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging
An Interview with Julia Hotz
Before our upcoming chat (link) with Julia Hotz, we had the pleasure of discussing all things social prescribing with the author of the forthcoming book The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging.
Julia is a solutions-focused journalist based in New York City whose stories have appeared in publications from the New York Times to Scientific American.
The Connection Cure, a blend of science writing, storytelling, and investigative journalism, chronicles her journey across the planet through 30 countries, gathering first-hand stories on how social prescribing and the enormous impact it has on health and well-being.
Ivory and I (Lis) will be hosting a FREE virtual event on June 2nd, 2024 with Julia that will be geared towards those of us working in healthcare, clinical settings, public health and/or research.
Have a question for Julia before our talk? Ask it here.
THE INTERVIEW
Lis: How would you describe social prescribing?
Julia: Social prescribing is a practice through which doctors, therapists, and other kinds of health workers literally prescribe their patients’ non-medical community resources and activities the same way they’d prescribe pills and individual therapies.
People usually click into what social prescriptions are when I list some examples: art classes, cycling groups, gardening gigs, community potluck dinners -- these are the obvious kinds.
But social prescriptions can also include nutritious food, housing support, legal aid, and cash.
That’s because of a simple fact -- one well known to most health workers, especially occupational therapists: up to 80% of our health is socially determined by factors in our environments. We need access to the basics -- a safe home, a stable job, protection from violence and discrimination. And we need access to sources of joy, meaning, and relationships: people we can call in a crisis, a reason to get out of bed in the morning, hobbies that help us cope with the stress of being human (especially a human today, when record numbers of us report feeling stressed, lonely, and pessimistic about the future.)
Ancient philosophers, Indigenous thinkers, holistic medical experts, positive psychologists, and all kinds of public, community and allied health professionals have been preaching versions of this idea for decades. Social prescribing gives health workers a unifying practice to do something about it. Instead of asking, “What’s the matter with you?” they ask a version of “What matters to you?” and prescribe their patient some local resource or activity connected to that answer.
It’s important to note that social prescribing doesn’t seek to replace other options in health care, like pharmaceutical prescriptions and individual therapies. It seeks to complement them. Instead of treating sickness, I think social prescribing is really about making it easier for people to access their own lasting wellness.
Lis: How does social prescribing intersect with other fields, such as allied health, public health, community development, and mental health?
Julia: I see all of these fields are very connected to social prescribing. They, too, “treat” the social determinants of health. They, too, seek to prevent health problems in the first place, often by bolstering community connections. And some workers within these fields have been doing social prescribing for years, even without calling it that.
I think the name “social prescribing” -- and the fact that nearly thirty countries are adopting it -- gives this work a unifying thread and specific practice. And the more we can trade templates on best practices in social prescribing, the more we can lift the whole of these fields, and help more patients achieve lasting health.
Lis: From your experience, how does this concept vary depending on where you are in the world?
Julia: All around the world, and especially after the pandemic, lifestyle diseases, mental illnesses, and loneliness have been on the rise. We haven’t really talked about why, but I think a lot of it has to do with the way humans are not evolutionarily-wired to live in the conditions modern society demands of them.
(Interviewer Note: According to the Surgeon General’s report, social isolation increases the risk of premature death by 29 percent. It’s equivalent to the impact of smoking 15 cigarettes per day. Loneliness increases the risk of heart disease, stroke and dementia, as well as other serious medical conditions. 1
Julia (continued): So, on one hand, there’s a universal call to action: to address the problem of the modern and universal stressors in our environment by reconnecting people to age-old sources of joy and meaning in their environment, like movement, nature, art, service, and belonging.
On the other hand, each country has a different cultural context and unique health care pressure points through which these stressors are occurring. That’s why social prescribing looks so unique in each country. In Singapore and South Korea, for instance, social prescribing is typically about addressing the health concerns and social isolation issues of their rapidly aging population.
While I was there, some of the social prescriptions I saw included chair yoga, tea making, gardening, and “variety shows.” But in Canada and Australia -- both of which are big countries -- social prescribing is about addressing health inequities at the local level, and some of the most promising models are happening through community health centers.
At Rexdale Community Health Centre in Toronto, for instance, I saw how this goal being addressed through their Black Social Prescribing Project -- a means to provide holistic, culturally-affirming social prescriptions, like dance circles and cooking classes, based on Afrocentric healing principles (My book tells the story of a woman who went to a play about a Caribbean barbershop as part of her social prescription).
In other words, just as social prescribing asks patients to reflect on “what matters to them”, health care systems are designing models based on what matters to them and their constituents, too.
Lis: What challenges or barriers exist in the widespread adoption of social prescribing? Any ideas on how they can be addressed?
To actually make social prescribing mainstream, I write in the book that we have to talk about some “unsexy logistics”: “Funding social prescriptions. Tracking them. Training health workers to offer them. Helping community groups deliver them. Getting insurance companies to get on board with them. Getting Big Pharma to get out of the way of them. Getting our already overburdened and under resourced health care systems to integrate them.”
This gets especially challenging in the United States, where we’re dealing with deep healthcare disparities. More and more people can’t afford or access therapy. Some can’t afford or access health insurance for primary care, either. Both lead to patients relying on the emergency room, which can create even more costs for those patients.
One study of 42 million ER visits found one in five insured patients were at risk of a “catastrophic health expenditure” -- health care costs exceeding 40% of the patients’ income. It’s a vicious cycle of diagnose-treat-repeat. 2
Social prescribing can address these issues of health disparities by treating the root cause of the problem. For instance, at Cincinnati Children’s Hospital, doctors are prescribing legal aid , which can both clear the root cause of chronic health conditions and in turn, according to one study, reduce hospitalizations by 38%.
So, I think addressing these barriers in health care starts with showing how social prescribing can have a return on investment (in the UK, for instance, some evidence suggests social prescribing schemes can deliver between £2.14 and £8.56 for every £1 invested).
That’s an incentive for insurance companies, too. If social prescribing can prevent potentially expensive health problems down the line, it’s a sound investment from an economic perspective. This is why many insurance companies now cover gym memberships, for instance. The same logic applies with social prescribing, and is one reason why Horizon Blue Cross Blue Shield of New Jersey invested in a first-of-its-kind ArtsRx pilot covering art prescriptions for their member patients at risk of overspending on their insurance, and for Rutgers University students.
Lis: What examples of successful social prescribing programs or initiatives have you encountered during your work?
Julia: Beyond the successes in health care, my favorite examples come from before-and-after stories of patients’ health. The book takes you around the world to tell these stories in-depth, but among others, you’ll meet Khuyen -- an aspiring novelist with PTSD and anxiety whose prescribed art workshop helps her tell a new story around her trauma, and cope.
You'll meet Akeela --a caring mom with chronic back pain whose prescribed volunteer gig at children’s charity helps her reconnect to her sense of purpose, and feel she can better manage her pain, too.
You’ll meet Jonas -- a history buff who’d been suffering from agoraphobia and panic disorder until ‘culture vitamins’ --organized group trips to local concerts and museum exhibits -- gives him courage to step outside of his comfort zone, and help him get out of his own head.
You’ll meet Amanda -- a passionate researcher struggling with deep depression whose prescribed sea swimming group helped her reduce her antidepressants and helped her “life become bright again.”
Julia’s book, The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging, published by Simon & Schuster, is available for pre-order here.
Connect with Julia @hotzthoughts on Instagram, TikTok, or visit her websites The Connection Cure and Julia Hotz.