For the last several years, reporter Julia Hotz has been tracking a developing trend in medicine.
More and more, doctors are recommending things like hobbies and group activities as a complement to traditional treatments for mental health issues.
It’s called “social prescribing,” and Hotz wrote a book about it last year called “The Connection Cure.” Hotz joined The Show to talk about it.
Full conversation
JULIA HOTZ: A social prescription is any non-medical, community-based resource or activity that aims to improve your health by strengthening your connection. So, that could mean an art class, it could mean cycling lessons, it could also mean support with rent or nutritious food.
SAM DINGMAN: These are prescriptions that you might not necessarily get from like your primary care physician, but if I'm not mistaken, the argument that you're making is that these are just as relevant as, say, a medicinal solution.
HOTZ: Absolutely. And actually, I mean, I was surprised to learn this — that more primary care physicians are doing this. Sometimes it doesn't come directly from them, sometimes it comes from somebody on their team, such as a social worker or in the UK, a position they created called a link worker. But absolutely, that's the kind of idea behind calling it a social prescription. It's not just a recommendation to exercise more or — really helpful, — be less stressed. It's actually a healthcare referral in a specific course or activity.
DINGMAN: What got you thinking about this?
HOTZ: I started researching this during COVID when, you know, back then the headline was really about loneliness. How we were all so lonely, we were all so stressed. And I'd learned throughout this that the UK had been doing something really interesting. First of all, they appointed a minister of loneliness. They said, “We know that loneliness has all these public health consequences. Some studies suggest its consequences are equivalent to smoking 15 cigarettes a day.” So, the UK with its nationalized health care system, said, “OK, this is a problem, this is costing us money. We're gonna appoint some national resources to do something.” And that is sort of one of the ways that social prescribing was born there.
But as I wrote this book, I realized that actually it's not just loneliness. Social prescribing is being used to help treat everything from things like depression and anxiety to ADHD, chronic pain, Type 2 diabetes. It's the way that actually 80% of our health is determined by what's in our environment.
DINGMAN: Eighty-percent. That is a massive number. [LAUGHS]
HOTZ: It is, and I always say you'd think if 80% of our health is determined by our environment, you'd think 80% of our medicine would be. We've heard for a long time that lifestyle drives so much of the chronic disease burden, particularly in America. The big new idea here is saying, “Let's actually make it as easy as possible to do something about that, and let's also use the power of other people to get us there.” In other words, instead of just, “Hey, Sam, you should exercise more,” it's, “Hey, Sam, I'm gonna prescribe you a cycling class that meets on Tuesdays after work, because I know you've always loved cycling, and I'm going to give you a bike, too.”

DINGMAN: Yeah, OK, so that there's, there's a lot to that difference. I mean, for one thing, you know, saying: “You should work out more,” you know, could be received in a sort of shaming sort of way. But the way that you framed it seems more like an invitation.
HOTZ: That's right. It is this idea that health should be fun. You know, health isn't just about treating the symptoms of disease. It's also about linking us to environments that make doing healthy things more fun. And this comes back to the beginning, you know, it's not just loneliness and stress. We're also seeing rising rates of anxiety, depression, ADHD, chronic pain, Type 2 diabetes, dementia. All of these things are related, and it has to do with the fact that the way we're encouraged to live these, you know, lives largely alone, in our apartments — we can get any sort of survival needed we met without leaving our homes. Social prescribing is saying: “This is not how we're meant to live.”
DINGMAN: So, as I understand it, there are five, kind of, core elements to that. Tell us what those are.
HOTZ: That's right. So when I reported this book, I found that most often social prescriptions were for activities involving movement, nature, art, service and belonging. This is how we survived as a species, at one point. Like, movement wasn't optional. If we wanted food, we had to move our bodies. If we wanted —
DINGMAN: We had to chase something down and catch it. [LAUGHS]
HOTZ: Right. If we wanted to survive and compete with the bears and, you know, the threats in our environment, we had to be able to understand nature. And most importantly, we had to be able to do this with other people. So, that's why you see that mutual aid systems date back. It's why you see storytelling and cave painting, and this sort of tendency to want to make meaning from our lives, was an essential part of this, too. And social prescribing is about saying, “Let's reconnect us to those things.” The whole tagline is, “Instead of just treating what's the matter with us, let's reconnect ourselves to what matters to us.”
DINGMAN: So I would have to imagine that in addition to getting those of us who may need a social prescription on board with this idea. There is also a need to get doctors and medical professionals thinking this way. I mean, from what you're saying, it sounds like that is happening in some parts of the world, but what does that look like in the U.S. right now?
HOTZ: Yeah, this is, I think, where the big challenge lies ahead. It's not so controversial to say that art's good for us, exercise is good for us, nature is good for us. And if you're like me, you're thinking, “Oh, is my insurer gonna pay for a social prescription? I mean, really, I can barely get them to cover my therapy."
DINGMAN: Right.
HOTZ: Well, here's the case. You might have heard that some insurance companies are now, for example, covering gym memberships. And their logic is, “OK, if we could cover, let's say, a $100-a-month gym membership, and that's going to lead a person to become more active and become less reliant on medication and expensive therapies down the line. And this is actually a pretty good investment for us.”
Well, now more insurers are using that same logic with all kinds of social prescriptions, including art prescriptions, including actually, as of last month, in your backyard at the University of Arizona. Where, you know, the campus has partnered with this incredible organization, Art Pharmacy, that's working to link students with art prescriptions in their community. We've heard of in Massachusetts, where arts prescribing is really big, it looks like visits to museums. In New Jersey, where I come from, it's looked like glass blowing workshops.
DINGMAN: So, obviously there are also conditions people are dealing with that do require major clinical care. I could imagine there being some tension in the conversations that come up around this about wanting to make sure that that doesn't get lost. Is that a fair characterization?
HOTZ: I think that that's absolutely ... the instinctual reaction when you hear social prescribing, you think, “Is this an alternative to medicine?” And what we'd say is absolutely not. And lots of stories in the book are about social prescribing being a compliment to other kinds of medicine and therapies.
A lot of the people I spoke with were really helped by traditional pharmaceutical medication, were really helped by things like cognitive behavioral therapy. But I think what, you know, physicians and therapists alike would say is that what we do in the doctor's office or the therapist chair can only take you so far. And that's where social prescriptions can be really key. Not to take any options off the menu, but just to put another one on.