Tia Washington, a 52-year-old mother of three from Dublin, Calif., received a stern warning from her doctor last spring. She said, “If she doesn't get her high blood pressure under control right away, there's a good chance she'll end up in the emergency room.”
He wrote her a prescription for blood pressure medication and recommended that she see a health coach. Mr. Washington reluctantly agreed.
“I didn't want to die,” she said.
To my surprise, the health coach wanted to talk about more than just my vital signs. Ms. Washington found herself confessing that she hated doctors (and medicine). How she tended to take care of her work and her family's needs before her own needs. How her job was causing her “extreme stress.”
Together, they decided that Ms. Washington would attend exercise classes twice a week, see a nurse regularly and receive free fruits and vegetables from the “Food as Medicine” government program.
According to Washington, at the end of the conversation with the health coach, the message was clear: “Tia, watch yourself. You exist.”
Washington's experience is just one example of how a practice called social prescribing is being studied in the United States after being adopted in more than 20 other countries. The term 'social prescription' first became popular in the UK after decades of practice in various forms in the UK. Although there is no universally accepted definition, social prescribing generally improves health by connecting people with non-clinical activities that address underlying issues such as isolation, social stress, and lack of nutritious food. It aims to improve well-being. It plays a key role in influencing who stays healthy and for how long.
For Washington, one of thousands of patients who have received social prescriptions from the nonprofit organization Open Source Wellness, the experience was transformative. She found a less stressful job, started eating healthier, and learned simple ways to move more during the day. After about a year, she was able to completely stop taking her blood pressure medication.
Similar programs are underway elsewhere in the United States. At the Cleveland Clinic, doctors prescribe nature walks, volunteer work, and ballroom dancing to elderly patients. In Newark, the insurance company is partnering with the New Jersey Performing Arts Center to offer patients glassblowing workshops, concerts, and museum exhibits. A Utah nonprofit connects mental health patients with community gardens and helps them participate in other activities that make them feel meaningful. Universities have also begun introducing arts and cultural activities, such as comedy shows and concerts, to students as part of their efforts to address mental health.
The approach has also caught the attention of the New York Fed's community development team, which will bring together experts over the next year to discuss how social prescriptions can help improve well-being in low-income communities.
The process of making referrals is not new to community health professionals and social workers. Social prescribing is different in that it provides a type of accountability coach, known in the UK as a link worker. This coach assesses the client's needs and interests and connects the client with community organizations such as volunteer groups and cultural institutions.
In recent years, the UK's National Health System has hired 1,000 new link workers with the aim of giving social prescribing access to 900,000 people by 2024. But implementing such a plan in the United States, which lacks a socialized health care system, would make the health care system much more complex, experts say.
“It's natural to be skeptical about how far this will go,” said Daniel Eisenberg, a professor of health policy and management at the Fielding School of Public Health at the University of California, Los Angeles. “I think our health care system tends to make very incremental changes, and all the biases built into the system favor medicine and more acute intensive care.”
Experts say social prescribing could keep people from going to emergency rooms for routine complaints, potentially saving billions of dollars and helping health insurance companies pay more. There is a possibility that there will be further incentives to cover the costs.
Horizon Blue Cross Blue Shield, New Jersey's largest health insurance company, is participating in a study investigating whether art prescribing programs improve patients' quality of life and reduce health disparities. Further down the line, the company plans to find out whether its prescriptions can also save money by reducing patients' reliance on the ER for routine medical needs.
Previous research on social prescribing suggests that social prescribing may improve mental health and quality of life and reduce doctor visits and hospitalizations, but many of the studies were small It relies on patient self-reporting and is conducted without a control group.
Jill Sonke, director of research at the University of Florida Medical Arts Center, said the potential benefits have made social prescribing “a really hot topic.” She is working with researchers in the UK to identify all social prescribing programs in the US (there are now more than 30 of them) and find out what works and what doesn't. .
Dr. Sonke said the program is not a panacea and there could be many pitfalls to implementing it more broadly in the United States. For example, if social prescribing isn't available to the uninsured or underinsured, or if people don't feel welcome at referral sites, “the system isn't doing what it's supposed to do.” It will be. she said. “It's really about making health and prevention accessible to everyone,” she added.
In January, Stanford University and Rutgers University-Newark began requiring arts and cultural activities for students as an extension of the schools' mental health services. Rutgers University offers students free access to cultural events in Newark through a partnership with the New Jersey Performing Arts Center. At Stanford, students are introduced to campus events such as concerts, art exhibits, and professional classes, and prescriptions are managed by Art Pharmacy, an Atlanta startup that also offers art prescriptions in Georgia and Massachusetts. .
At both schools, students, including those without mental health issues, can seek referrals from trained staff. Rutgers student leaders can also make introductions.
Christy Maisha, a graduate student studying civil engineering at Stanford University, said she decided to participate because she wanted a break from her intense academic schedule.
“It's not very beneficial to stay in your head space all the time,” she said. “So I was definitely looking for something to get out of that situation.”
Despite some trepidation, Maisha chose to take an improvisational dance class taught by a choreographer. “What am I doing?” she thought as class began.
But she followed her instructor's guidance and used her body, not her head, to contort her torso, limbs, and even her face into new shapes. She said the class symbolized living in the moment, and that she felt liberated from the “planned, predetermined ideas” that often confined her.
“Now that I know it's a really good time, whether I prescribe it or not, I'm more likely to do it,” she said.