Social Prescribing USA was so excited about the publication of Julia Hotz’s new book, The Connection Cure, the first U.S. book on social prescribing, that we asked her some questions about her new book. Please see our interview with her below:
What made you want to write a book about social prescribing?
At first, as a journalist and academia dropout, I was really interested in social prescribing for its potential to tackle epidemics of loneliness. Based on the name, I thought social prescribing was about boosting social connection, and helping people find friendships.
But when I actually began reporting on it, I realized loneliness was just the canary in the coal mine, and that social prescribing was so much more than that. I realized social prescribing had the potential to help with all kinds of health issues that our environments (i.e. “social determinants”) can influence, from chronic pain to asthma. And especially during the pandemic, when we were reading about all kinds of shortages in healthcare and seeing health problems in our loved ones and ourselves, I wanted to investigate this cool new idea — one that could potentially alleviate pressures on health care and improve population health at large.
So, after I wrote a feature about social prescribing for WIRED UK, an editor reached out and said I should write a book about it. And I did! (And then, spoiler alert, as you’ll learn in Part 3, I realized that there was a more personal reason why I wanted to write this book.)
What did you learn more about social prescribing in writing the book?
SO MUCH. Related to above, I’d say that I learned how this practice is relevant not only for loneliness, but for depression disorders, ADHD, addiction, trauma, anxiety disorders, chronic pain, type 2 diabetes, dementia, and all kinds of health issues that poverty can compound, like asthma.
I learned that the ideas behind social prescribing have existed for millennia, and have continued to independently blossom around the world. It was only relatively recently that our healthcare systems began to see sickness as biomedical, not biopsychosocial, and began to focus on the symptoms, instead of the root cause (The reasons, which the book goes through, involve a pretty wild ride through history.)
Maybe most important for the everyday reader, I learned social prescribing doesn’t just help people who are sick. I learned it’s a model we can all use when we’re not feeling well — sad, distracted, worried, frustrated, alone.
What do you think it will take for the U.S. to embrace social prescribing as it is around the World?
I think it starts with acknowledging that social prescribing in the US probably won’t look like it does around the world, because of our size, our widely-felt inequities, our mostly private insurance system, and our pressures on the health workers.
So I don’t think it’s a simple copy and paste job. But I do think we can borrow different ideas from models around the world to make it work in the US, and part 2 of the book gets into this. For instance, in the UK — the birthplace of social prescribing, which is dealing with similar pressures in the field, we can leverage the success they’ve had in demonstrating social prescribing reduces pressure on the system. Some of the most rigorous evidence fro the UK suggests social prescribing can reduce emergency room visits, the number of hospitalizations, and the number of doctors appointments, and can also deliver between a 2 to 8x return on investment. And thanks to models like the first-of-its-kind ArtsRx pilot from Horizon Blue Cross Blue Shield of New Jersey, I think we’re already seeing in the US how social prescribing can work in a private insurance system; if a patient’s social prescription treats or prevents their underlying health issue, and leads them to require less medication and therapy down the line, then that’s a sound investment for a private insurer (this is one reason why more private insurers are covering patients’ gym memberships.)
What are some of your favorite social prescribing programs both around the World and at home?
This feels like asking to pick a favorite child!
One that I love telling people about is this “green care farm” in Norway, called Impulssenter (named for our “impulse” to serve with others). It’s unique in that it’s designed for people with dementia to come together, enjoy meals together, walk around the premises, and, yes!, actually help out with tasks on the farm — from feeding cows to harvesting chicken eggs. I definitely had my own preconceived notions about what people with dementia can and can’t do anymore, and this care farm totally defied my stereotypes; it allowed me to really see the magic that can happen when we see people not for what’s the matter with them, but for what matters to them.
One that I love in the US comes from the VA and their Compassionate Contact Corps program, which connects veterans struggling with loneliness to virtual companions for weekly phone calls with volunteers. Last week, there was a great New York Times article on loneliness that recommended people join a group and cut back on social media. But in the comment section, I noticed frustrated questions about how lonely people could “join” a group and cut back on social media if they can’t leave their house, and social media is their only social lifeline. This program anticipates that barrier, and provides a way for veterans struggling with loneliness to have meaningful 1:1 connections with volunteers. over the phone. Then, some volunteers form such a strong bond that they go and visit their veterans in person (spoiler alert: that was the case for the volunteer-veteran pair I profile in my book).
What do you want your book to accomplish for the field?
Much like most of our systems, health care in the US seems pretty bleak right now. As we’re seeing rising mental and physical health caseloads, rising costs, and rising inequities, we’re also seeing fewer health workers joining the field, and that many of the health workers left are dealing with burnout or moral injury — a phenomenon in which “someone engages in, fails to prevent, or witnesses acts that conflict with their values or beliefs.”
I want this book to show the field that there’s an antidote to all of these problems in social prescribing. I want this book to help the field realize that there’s a reason why 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 same idea for years. What’s changing now is that there’s a growing grassroots movement to do something about it, and a growing pool of practical resources to help the field add social prescribing to their menu of options.
Who do you want to most read the book?
Hmmm, does “everyone” count?!
A specific person who comes to mind is Vivek Murthy, our U.S Surgeon General. His advocacy and activism around addressing the health harms of loneliness has led to a hugely important cultural conversation. And though his work touches on social prescribing, I think he’d be thrilled to see just how impactful his work has been, and how it’s led people to design social prescribing programs that go beyond just treating loneliness, and actually help create health for everyone.
What has made you so passionate about social prescribing? / or What do you want readers to most get/learn from reading your book?
This brings us full circle with question 1, but I think I’ve become so passionate about social prescribing because I see now that this isn’t just a cool big new idea for health care; this is a life-changing mindset shift around what health is for all of us, including me.
Like lots of fellow Americans, I grew up believing that “diagnose-treat-repeat” was the only way to do health care. And it’s easy to see why: our earliest health care experiences confirm it; when we get strep throat, for instance, we go to the doctor who runs a test and prescribes us an antibiotic. But we know lifestyle and mental illnesses don’t follow this model as neatly, in part because we haven’t done a great job at treating them at the population level (this is why we don’t have epidemics of strep throat, for instance).
In my lifetime, there’s been a great conversation to destigmatize those more complicated diagnoses. But even so, I think there’s still an idea that a diagnosis is something you have (just look at the language of it: “I have depression, I have ADHD.”) Similarly, I always imagined “treatment” for those diagnoses as being limited to therapy and medication, and that getting coverage for those treatments– in our uniquely American maze of EPOs and PPOs and insurance acronyms — was kind of a gamble.
I didn’t realize how steeped I was in this symptom-focused mindset, and how much it affected my understanding of my own health, until I saw an alternative in social prescribing. Instead of believing symptoms of our diagnoses to be like life sentences, I started seeing how our environments can affect those symptoms, for better or for worse. Because of how we evolved, I learned how environments that allow us to move, spend time in nature, create and consume art, serve our communities, and feel a sense of belonging with our neighbors can actually treat those symptoms, and that there’s science to support this. But most of all, I learned that those medicines — movement, nature, art, service, and belonging — are really gateway drugs to help us become more present, more attuned to the sources of joy, meaning, and relationships all around us.
So, I want readers of this book to have that same realization. I want them to see sickness as not just a “diagnosis” that gets treated through healthcare. I want them to think about health as being something they can create for themselves, and with other people.
More on Julia’s book can be found at www.socialprescribing.co