The concept of social prescribing is growing in affluent nations, driven by an increased awareness of the positive impact that social connections have on overall health. Social prescribing recognizes that health status is influenced not only by medical and biological factors but also by social and environmental factors that can't be addressed by medical care. Social prescribing was initially designed to tackle social determinants of health and systemic inequities (e.g., housing and food insecurity).
Over the years—with the increase in social isolation and loneliness, which was exacerbated by the COVID-19 pandemic—these programs have evolved to focus on social connection. Recognizing the negative impact that social isolation has on physical and mental health, providers increasingly use social prescriptions to connect patients with community-based services to address loneliness and lack of support networks—prevalent issues among older adults.
Social prescriptions commonly include “scripts” for community-oriented activities like park visits, gardening clubs and arts activities such as visiting museums and art galleries. While we appreciate these innovations, we are concerned that—without adaptation to individual circumstances and available resources—social prescribing runs the risk of becoming a benefit most enjoyed by those who have the sociocultural capital and privilege to access them. This could further exacerbate the significant gaps in accessing quality healthcare that already persist in the United States.
Imagine walking into your local pharmacy to fill a blood pressure prescription only to be told it isn’t available. This mirrors the experience of an older adult living in a food desert or an unsafe neighborhood who is advised by her physician to “eat better” or “exercise more.” Such well-meaning guidance quickly becomes a prescription to nowhere, often leaving individuals feeling inadequate and potentially ashamed as they struggle to implement these changes. Likewise, referrals to activities such as health clubs, volunteer work or photography classes—while potentially beneficial—remain out of reach for those without the financial resources, proximity, transportation, physical ability or psychological capacity to participate.
‘Participants share life stories and laughs, forming friendships as they find they aren’t alone in their challenges.’
At Open Source Wellness, a national nonprofit dedicated to advancing health, well-being and human connection, in partnership with healthcare providers and community organizations, we have reimagined social prescribing with a focus on equity, access and inclusion. Our Community as Medicine (CAM; a model developed and trademarked by the nonprofit Open Source Wellness) model is a trauma-informed, culturally relevant health coaching program that delivers practical “behavioral prescriptions” to diverse, transdiagnostic, underserved populations in clinical and community settings.
Typically, a patient’s primary care provider refers them to the 12-week program that brings together groups of 15 to 25 participants in weekly 1–2-hour sessions to learn about and engage in physical activity, healthy eating, social connection, and stress reduction activities, with the support of a health coach trained in the CAM model.
Participants share life stories and laughs, forming friendships as they find they aren’t alone in their challenges. Groups are conducted virtually and in-person, in English and Spanish. Some groups, facilitated with clinical entities (e.g., Federally Qualified Health Centers), include a one-on-one visit with a primary care provider. These “Group Medical Visits” are reimbursable, which supports financial sustainability.
Studies document the benefits of CAM, including reductions in blood pressure; reduced anxiety, depression and social isolation; increased weekly exercise and fruit and vegetable consumption; as well as fewer ER visits. Key to CAM’s success in achieving these outcomes, especially for older adults, is its focus on fostering inclusivity, building intergenerational connections, and supporting personal agency.
Inclusivity
At the core of the CAM social prescription model is the belief that every individual deserves to feel valued. This is particularly important for older adults, who often report feeling marginalized in a society that prioritizes youth and productivity. As a 75-year-old community member shared: “A struggle for me is feeling less relevant. The world seems to be happening in a way that I no longer understand, and I don’t feel as central as I once did.”
‘We strive to empower older adults to succeed on their own terms, reinforcing their independence and autonomy.’
While older adults’ health goals may differ from those of younger individuals, CAM acknowledges the intrinsic worth of each person, focuses on meeting them on their own terms, and fosters genuine human connection to reduce loneliness and isolation. This is crucial, as social isolation is a major contributor to adverse health outcomes among older adults, including cognitive decline and challenges in managing chronic conditions.
Intergenerational Connections
Health coaching for older adults need not be confined to age-specific groups. This can inadvertently deepen the generational separation older adults already experience and exacerbate feelings of isolation. Our intergenerational approach cultivates experiences of value, acceptance and respect, reinforcing inclusivity. It counters age-related stereotypes and fosters a deeper understanding of shared experiences between younger and older participants.
One of our health coaches, Cristian Vasquez, described a CAM group that brought together individuals in their 30s and 40s alongside an older couple in their 70s. The husband had recently experienced a stroke and was unable to participate fully in the activities. Younger participants were inspired by his wife, who continued to dance and engage with life while caring for him. They said they “wanted to keep that kind of health in their life.”
Some older adults may initially feel hesitant about joining groups with younger members, but that reluctance quickly dissipates. As Vasquez said, “In a short time, it becomes a circle of friends—supporting each other, talking openly, and building community.”
Personal Agency
A strong sense of agency—feeling in control of one’s life—is essential for older adults. It motivates self-care and enhances overall well-being. Our approach involves empowering individuals to define and pursue goals that resonate with them so they take control of their health. Rather than positioning themselves as the experts, our health coaches work collaboratively with participants to uncover what matters most.
For instance, a CAM participant might initially join because “my doctor wants me to lose weight.” Through thoughtful dialogue, the health coach may discover that what the individual really wants is “to be able to play with my grandkids.” Through personalized coaching, accountability, and advocacy, our health coaches keep older participants at the center of decisions about their healthcare and help them navigate a fragmented, often overwhelming healthcare system. Ultimately, we strive to empower older adults to succeed on their own terms, reinforcing their independence and autonomy. By supporting participants in building these skills, our goal is for them to sustain these outcomes in the long-term.
Making Social Prescribing More Accessible
While we celebrate the innovative ways social prescribing introduces individuals to parks, museums, art classes and other enriching experiences, we are committed to ensuring that the benefits extend to everyone—especially those without the means or support to access such services. The CAM model of social prescribing focuses on equity. It is designed to enhance participants’ sense of belonging, self-worth and agency, empowering them to make informed decisions about their health.
This is a vital first step toward realizing the promise of social prescribing. To expand our impact, we established the CAM Learning Collaborative (CAMLC) to support clinical and community-based organizations, such as YMCAs, in implementing CAM programs. We are spreading our inclusive model of social prescribing with a vision of empowering every individual to lead a healthier, more connected life.
Elizabeth Markle, PhD, is a licensed psychologist, speaker, writer, researcher and executive director and co-founder of Open Source Wellness. Sally Duplantier, MS, is a gerontologist, health span educator, and a health equity researcher; Michaela Hayes, MHSA, CFRE, GPC, is director of development; both are with Open Source Wellness.
Photo credit: Shutterstock/Tint Media
