Social prescribing is a term and concept we are hearing more and more, not just in healthcare environments but from community-based organizations, patients and the public. But the term is not new, and it is not unique to the United States. Social prescribing has been widespread in the United Kingdom since 2018 and is active in 32 countries around the world.
Social prescribing means connecting people to activities, groups and support that improve their health and well-being. These often include a range of social services, the arts, nature, volunteerism, movement, companionship and community-building. While there has been an attempt to address social determinants of health across the United States in healthcare systems and their associated electronic medical record systems, the idea of a “prescription” to address these is relatively new.
Social prescribing can be informal—and is something many clinicians have probably done for decades without recognizing that they are social prescribing. In writing this article, Dr. Perissinotto recalled how as a new young physician and faculty member interested in social connection, she would engage her patients who were experiencing loneliness in conversations around what would help them feel more connected. Often, these conversations led to individualized solutions—everything from finding new Bridge partners, seeking a new companion, or using the Friendship Line or Well-Connected-Español, both phone-based support programs for older adults. There are advantages of having a “link worker,” who has more time to meet with a patient and co-create the individual’s prescription to a specific program.
The common denominator in the U.K.’s and Europe’s successful social prescribing initiatives is a single-payer health system.
While any of these activities are part of what is meant by social prescribing, there is also a more formalized way of socially prescribing at scale. This type of social prescribing program has now been extended to 74 Veteran’s Administrations through the Compassionate Contact Corps.
Massachusetts also has a statewide program that includes a hypertension study at the Brigham and Women’s Hospital in Boston, which provides arts prescriptions through the arts-prescribing company, Art Pharmacy (featured elsewhere in this issue). Another example, Project Connection, has adapted the U.K. model, using “link workers” to connect people who have received trauma-informed therapy to community-based organizations in the arts and nature.
Because of the mixed picture of whether healthcare providers are informally or formally socially prescribing, it is harder to quantify how broadly social prescribing is occurring in the United States, but momentum is growing. Social Prescribing USA, the national advocacy organization, is working on a mapping project for social prescribing programs in the United States. It leads a Community of Practice (250 people involved in implementing social prescribing in their respective institutions) and a Health Professional Champions group (designed to educate and empower health professionals to advocate for social prescribing and increase awareness) that helps implement programs nationwide.
At UCSF, the Social Connection and Aging Lab, in partnership with the RRF Foundation for Aging (formerly the Retirement Research Foundation), is developing and studying a tool to more accurately socially prescribe to address loneliness and isolation. The hope is that a standardized tool will help streamline processes, which will enable better identification of root causes for loneliness and isolation (and other social determinants of health) and thus be able to prescribe more accurately—in essence, a different type of precision medicine.
What’s Holding Up U.S. Adoption of Social Prescribing?
Standardized processes or better identifying formal vs. informal social prescribing may not be the only keys to broader acceptance of social prescribing in the United States. If we look at the unique features of the U.K.’s and many of Europe’s successful social prescribing initiatives, we see that the common denominator is a single-payer healthcare system. In a single payer system, the insurer can concentrate on preventive care and long-term benefits as the patient is usually with them for the long run. In the United States, patients generally stay with one insurer for an average of two years.
For the United States to embrace social prescribing, we will need to see more successful implementation and examples of success—and success would have to be measured not just in terms of uptake and patient satisfaction but presumably in improved healthcare outcomes and reduced healthcare costs.
This also means we will need ongoing implementation research that looks at economic outcomes, including return on investment (ROI), which many private and commercial payors will want to see. Thus far in the United States, various payment models are being explored, including those paid for by commercial health insurance companies, a for-profit business model called Art Pharmacy, Medicaid, and through philanthropy.
Outcomes research has been completed in the United States, with different interventions showing improvements in mental health, loneliness and chronic disease. But healthcare economic data such as ROI are still needed before more widespread adaptation happens. If this data mimics that in the U.K., Canada and Australia, with ROIs of $3–$7 for every dollar spent, the healthcare industry would be the most likely payor for these services, along with Medicaid and Medicare.
Thus, having national leaders such as Social Prescribing USA lead advocacy and dissemination, and The Foundation for Social Connection (which brings together scientific experts in social connection) to lead the science and research, will be critical for success.
Despite the evolving healthcare landscape and current cuts affecting our public health infrastructure and the research enterprise across the country, there is reason to be hopeful.
One private insurer, Horizon Blue Cross Blue Shield, partners with the New Jersey Performing Arts Center to address high-utilizing patients and hopefully to curb costs. With their initial success, they have recently received a $150,000 grant from the National Endowment for the Arts.
In states with certified Peers and Medicaid-reimbursement for Peer Services, Peers have the potential to be used as a tool for addressing loneliness and isolation, and could be “prescribed” by clinicians or healthcare teams. Other healthcare systems and insurers are forming partnerships with organizations to provide social prescribing in the arts, nature and social connection.
Social prescribing is here to stay in the United States. What is less clear is how this will unfold, which programs will be most successful, and what elements will be needed to succeed in public and private sectors and the ever-evolving American healthcare system.
Alan Siegel, MD, is executive director of Social Prescribing USA in San Francisco. Carla Perissinotto, MD, MHS, is professor of medicine in the UCSF School of Medicine.
Photo caption: An older woman walks along a street in Japan.
Photo credit: Shutterstock/AlmostViralDesign
