Dr. Ardeshir Hashmi remembers the first time he offered his patient a prescription that didn’t come in a pill bottle.
His story began 10 years ago when he was a geriatrician at Massachusetts General Hospital, where he’d been seeing “Ruth”—a 93-year-old who came to the emergency department every 2 weeks, usually by ambulance, with chest pains and anxiety. Hashmi’s units typically responded by conducting clinical procedures, like X-rays and blood tests. “Everyone thought, ‘Oh my god, it’s something with her heart and her blood vessels,’ ” he explained.
But then, Hashmi noticed something: Ruth’s symptoms subsided almost as soon as medical professionals attended to her. And then, when he asked about her backstory, he learned her chest pains began when her grandson left for college. Beyond being her primary source of social connection, Ruth’s grandson also was her transportation to other sources of social connection, like ballroom dance lessons.
That’s when Hashmi had an idea for a different kind of medicine: a prescription for Ruth to rejoin ballroom dance lessons, with help from a geriatric case manager to drive her there.
“Wouldn’t you know it, all of [Ruth’s] emergency room visits disappeared,” said Hashmi, who now works as chair of geriatric innovation at The Cleveland Clinic. “It was just as simple as that.”
Hashmi’s “social prescription” responds to the way an estimated 80% of health outcomes are driven by social factors in a person’s environment, such as access to transportation and the closeness of friendships, while only 16% are related to clinical care.
Social prescribing is a way to connect a person to what matters to them, instead of just treating what’s the matter with them.
Studies find these unmet social needs harm our health and our healthcare. Not only does loneliness increase a person’s risk of depression, anxiety, dementia, stroke and premature death, but it also can increase a patient’s reliance upon primary care and the emergency room. In the United Kingdom, the National Health Service (NHS) estimates 1 in 5 doctors’ appointments are made for purely social reasons.
Social prescribing emerged as a response to this—a way to connect a person to what matters to them, instead of just treating what’s the matter with them. And helping more people create their own health solutions puts less pressure on the healthcare system, said Bev Taylor, a former community development worker who in 2015 joined NHS England.
“My dad had just died, and he’d been a really lonely, working-class man. He would not think to join a community group, but I reckoned that if the doctor had introduced him, he would have loved it,” Taylor said.
In partnership with community organizations, Taylor helped the NHS organize social prescribing pilots around the country. Doctors like Mohan Sekeram in South London immediately understood the need. “When you’ve only got 10 minutes with [a patient], you end up looking at the medical aspect, because that’s what we’re trained at doing, and often the patient doesn’t get the treatment they need, we don’t give them the treatment they deserve, and they come back a few weeks later.”
Many others agreed; one survey found 59% of doctors agreed social prescribing would reduce their workload. But it wasn’t until 2018, when the U.K. established a Minister of Loneliness, and 2019, when the NHS formally integrated social prescribing into its long-term plan, that social prescribing became easier for them to practice.
One of the plan’s key provisions included the equivalent of about $560 million (translated from pounds) to establish link workers—health professionals who serve as a “link” between the doctor, the patient, and the community organization. Instead of 10 minutes with a patient, link workers have up to an hour with them and have more time to get to know which local community organizations could best address patients’ interests.
The NHS’ investment in social prescribing paid off. The most recent data finds healthcare practices have significantly reduced the number of doctors’ appointments (up to 50%) and emergency room visits (up to 66%), and can also deliver up to 2 to 8 times return on investment.
It’s also effective for conditions beyond loneliness. While reporting The Connection Cure, the first book on the science and spread of social prescribing, I saw how social prescriptions could help treat symptoms from many types of lifestyle and psychological illnesses, particularly the most common conditions older adults face. When Frank—an ex-truck driver diagnosed with type 2 diabetes—was given a social prescription for a 10-week cycling course, he lost 40 pounds, came off his insulin, and made lifelong friends.
Recently, CMS approved waivers in Arizona, California, New Mexico and Oregon to cover dance and music therapy.
When Marianne —a polyglot struggling with dementia—was referred to a farm-based daycare program, she found relief from her cognitive decline, and opportunities to socialize. When Akeela—an empty nester mother with a severe back injury— was prescribed a spot to volunteer at a children’s charity, she found that it helped curb the intensity and duration of her pain.
“Thank you for giving us our mom back.”
The potential for social prescribing in the United States is enormous, too. One in 3 Americans (33%) experience chronic loneliness. Six in 10 Americans have at least 1 chronic disease, while 4 in 10 have at least 2. Fifty percent of U.S. adults also will be diagnosed with a mental illness at some point in their lifetime.
The appetite is there, too. One survey found most patients wish their doctors would focus more on the social drivers of health, and support social prescriptions becoming a regular part of healthcare. And clinicians agree; a survey of more than 1,500 physicians found 95% agreed their patients’ health outcomes were affected by at least one social determinant of health.
And yet, that same survey found 87% of physicians wish they had both more time and ability to address their patients’ social needs. Instead, given time and resource shortages, most physicians have little choice but to prescribe surgeries and pills. Today, nearly 7 in 10 Americans take prescription drugs, and almost half of Americans older than age 65 take 5 or more medications.
Despite the infrastructure and cultural challenges in the United States, social prescribing is growing, and groups like Social Prescribing USA are helping to document it. Recently, the Centers for Medicare & Medicaid Services approved waivers in Arizona, California, New Mexico and Oregon to cover dance and music therapy. New York similarly amended the state’s Medicaid waiver to connect beneficiaries to nutritional and housing support. Leaders in New Jersey, California and Vermont have partnered with insurers to prescribe art and nature.
This growth is built on the success of early social prescribing programs in the United States. One of the first began at the Department of Veterans’ Affairs—where social workers screen patients for their loneliness levels, and “prescribe” them weekly phone calls with a volunteer. At least 83% of participants in that social prescription program, called the Compassionate Contact Corps, report the weekly calls made them feel less lonely, and 77% reported it improved their well-being across the board.
Another began at Massachusetts Cultural Council, whose first 2021 social-prescribing pilot saw widespread support not only from patients, but also physicians, who shared how delighted they were to be able to “prescribe beauty in someone’s life.”
That’s also true for Hashmi, who is currently expanding social prescribing at the Cleveland Clinic, in partnership with the Holden Arboretum. Beyond helping patients, he said social prescribing helps him practice the kind of medicine he has always wanted to practice. And to remind him of that mission, he keeps the card Ruth’s kids sent him on his desk: “Thank you for giving us our mom back.”
Julia Hotz is a solutions-focused journalist and author of The Connection Cure—the first book on the science, stories, and spread of social prescribing. She has been invited to advise health and community organizations, teach in medical schools, deliver talks at TEDx, university symposiums, international conferences and more. She proudly serves on the board of Walk with a Doc, and as an advisor to Social Prescribing USA.
