For more than 30 years, Frank Frost worked as a long-distance truck driver, ferrying industrial chemicals across the United Kingdom.
"I worked away from home six days a week, working up to 12-15 hours a day," says Frost, now 76. "My only exercise was looking for a fast food outlet in the evening when I'd parked up."
He gained weight and was diagnosed with Type 2 diabetes in his 50s. His doctors put him on insulin injections and told him to lose weight and move more.
"When l, like most people, failed, they made me feel weak and worthless," says Frost.
Then, Frost met a doctor with a completely different approach — one that changed his life.
"He asked me what mattered to me, which I'd never been asked before by a doctor," says Frost. "I told him that I wanted to live long enough to see my grandkids grow up."
The doctor also asked Frost about things he enjoyed doing as a kid and discovered he used to love riding a bike. He gave him a prescription for a 10-week cycling course called Pedal Ready for adults getting back into cycling.
"I hadn't been on a bike for almost 50 years until I started cycling again," says Frost.
What Frost's doctor had done was give him a social prescription, says journalist Julia Hotz, who's written about Frost's experience in her new book The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging.
It's the idea of health professionals "literally prescribing you a community activity or resource the same way they'd prescribe you pills or therapies," she explains. The prescriptions include exercise, art, music, exposure to nature and volunteering, which are known to have enormous benefits to physical and mental health.
And it all starts with "flipping the script from what's the matter with you to focusing on what matters to you," Hotz says. "What are your activities that you love? What gets you out of bed in the morning?"
Frost's prescription helped him make friends after years in a solitary profession.
And it helped him lose 100 pounds, get his diabetes under control and go off insulin. He says he still bikes with friends he made through the biking class. They call themselves the "Chain Gang," and members look after each other.
"We're all of a certain age," says Frost. " We don't leave anybody. It's changed my life."
Tapping into lifestyle's role in health
Social prescriptions are not intended to replace pills or therapies, says Hotz, but to complement them.
Chronic diseases such as diabetes, heart disease and cancer are now the leading cause of death worldwide. And decades of research has shown that adopting healthy habits can stave them off.
For instance, social connection lifts our mood and benefits health overall — and friends can hold people accountable when building new, healthy habits. Time in nature can reduce stress, says Hotz. Studies also show that exercise can ease depression and anxiety and boost cardiovascular health. And music and arts are known to be therapeutic for people with mental and behavioral disorders.
Health care providers in about 30 countries are doing social prescribing to address symptoms of Type 2 diabetes, chronic pain, dementia, attention deficit hyperactivity disorder, anxiety and depression, among others, Hotz says. And a growing number of providers — around 250 so far — in the United States are starting to use them, too, according to Social Prescribing USA, a nonprofit organization advocating for this approach.
"Social prescribing, really has the promise and the research to back it up to change health care in ways that would be healing for all of us," says Dr. Alan Siegel, a family physician at Kaiser Permanente in Oakland, Calif., and executive director of Social Prescribing USA.
The National Health Service in the U.K. has incorporated social prescribing, covering the cost of hiring caseworkers to connect patients to the right community group. Most prescribers in the U.S. partner with community organizations offering group activities.
But in some instances, health insurers help cover related costs. For example, Horizon Blue Cross Blue Shield has partnered with the New Jersey Performing Arts Center to connect high utilizers of the health system to arts and culture programs in the community.
Health and cost benefits
Studies in the U.K., which routinely uses social prescribing, show that not only does it improve health, it also saves money.
"There's a reduction in emergency room visits, in repeat visits to primary care providers, and that over time generates a pretty significant return on investment," Hotz says.
Health care systems are increasingly recognizing that "it's cheaper for them to cover 10 weeks of Zumba classes than it is to cover, for example, high blood pressure medication over the course of a lifetime, or GLP agonists over the course of a lifetime," she adds.
A report on social prescribing in Canada found that for older adults, there was nearly $300 million cost saving from lower hospitalizations, emergency calls and visits to the ER due to fewer falls. Among youth, they found a 14% increase in lifetime earnings for youth ages 15-17 struggling with anxiety and depression.
Art Pharmacy, a Georgia-based program that collaborates with health systems, insurers and universities to connect patients with cultural activities, reports that more than two-thirds of people participating saw improved mental health, and a reduction in ER visits.
Doctors at the Center for Geriatric Medicine at the Cleveland Clinic have found social prescribing especially valuable for seniors, says Dr. Ardeshir Hashmi, chief of geriatrics.
They now regularly ask patients questions like: "What was your career in? Who else is at home? Do you have friends? Do you have family? What do you enjoy doing and are you still doing those things?"
Hashmi has had patients who want to be more connected to nature, or want to resume being a member of a book club, or engage in creating art, or in volunteering.
His patients have seen "significant improvement" in levels of loneliness, he says, as well as in symptoms of depression, anxiety and memory problems.
What lights you up? Find a prescription for yourself
Anyone interested in social prescribing can check out a map on Social Prescribing USA's website for a list of organizations and health systems that are doing this in some capacity.
The kinds of programs listed include Walk with a Doc, an organization hosting walks with doctors in communities in 54 states and territories. It's aimed at helping people embrace walking together for health.
And if you're not seeing something in your area, try asking your doctor for help, even if they aren't familiar with social prescribing, suggests Hashmi.
He suggests asking your doctor questions like, "Is there a community you can connect me with? This is what matters most to me in my life. I've lost that at some point over time. Are there other patients that you know of that you could connect me with? Is there a community organization that you know of?"
And if your doctor is unable to help you, Hotz suggests turning to the internet to look for community organizations already doing what you are seeking, whether it's hiking, drawing, singing, swimming, volunteering with kids, or spending time with friends.
"There's a ton of options to choose from, a lot of options at local libraries, local parks departments, a ton of groups trying to make social prescriptions free or low cost to people," she says.
The key, Hotz says, is asking yourself the right questions before you start looking for a community organization to join.
For example, "What lights you up in the morning? If you had two more hours in the week, what would you spend it doing? What was an activity you loved to do as a kid but haven't had a chance to do since?" she says.
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