Finish Line: The quiet rise of "prescribing connection"
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Your doctor's new prescription might be for a fishing rod, or other goods or services you won't find at a pharmacy.
The big picture: With the rise of "social prescribing," physicians are sending patients to choirs, art studios, walking clubs and lakesides. Overstretched health systems and a worsening loneliness epidemic are forcing a hard look at how social interventions can improve mental and physical health.
- "The hope is that the care might not merely help address crises such as hospital waitlists and overreliance on prescription medications, but also tackle broader problems including social isolation," Andrew Dickson writes for Bloomberg (gift link).
- The term can encompass anything from programs that connect people with access to affordable produce to prescriptions to paint or volunteer.
Zoom in: The U.K. has been leading the charge globally. The National Health Service (NHS) has offered social prescribing since 2019, as part of a $6 billion primary care expansion.
- That push has produced more than 5.5 million referrals in England over five years — far exceeding the original 900,000 target.
- Social prescribing started in impoverished areas to help people with complex medical needs who also faced social and economic obstacles. The most common prescriptions still are for housing advice and debt counseling.
- But nature activities and arts engagement are also common, according to the umbrella organization National Academy for Social Prescribing.
Case in point: A small nonprofit in Kent, England — Cast a Thought — has hosted more than 280 participants on fishing outings funded by a mix of NHS and charitable support.
- Participants may arrive with all types of overlapping conditions, including PTSD, depression, hypertension and chronic obstructive pulmonary disease (COPD).
The evidence of real health benefits of social prescribing is promising.
- A large English cohort study cited by University College London's Daisy Fancourt found that people who engage in creative activities at least monthly are roughly half as likely to develop depression.
- A 2020 global meta-analysis found that surgical patients who listened to music used fewer opioids and reported less pain.
- Yes, but: "There are plenty of myths," Fancourt cautions to Bloomberg. And it's hard to establish an evidence base to justify paying for such services because "success" can be subjective, and there's no control group to measure outcomes against.
Smaller efforts are spreading elsewhere:
- The Netherlands has offered "wellbeing prescriptions" for more than 15 years, subsidizing activities like cycling clubs, museum visits and tai chi.
- U.S. pilot programs are running in some states, including California, Florida and Massachusetts. Nonprofit Social Prescribing USA is aiming for nationwide access to services like art or music therapy, dance classes and outdoor activities for every American by 2035.
Between the lines: Even placebo effects of going out for that hike count, according to Social Prescribing USA co-founder Dr. Alan Siegel.
- "Most of the healing happens in the 80% of people's lives that has nothing to do with health clinics and hospitals," Siegel told Bloomberg.
By the numbers: The U.S. population above age 85 is projected to more than triple from 6 million in 2020 to 19 million by 2060, dramatically increasing chronic disease burden.
- The World Health Organization projects a global shortage of around 11 million health care workers by 2030.
The bottom line: Less overcrowding at hospitals or reliance on prescription drugs is laudable. But some of social prescribing is about returning to our roots and finding nonclinical causes of ill health: "The Greeks realized these things thousands of years ago," Fancourt says.
- If one day out fishing leads to one less pang of loneliness, we'll call it a win.
