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Join us for an enlightening conversation with Julia Hotz, journalist and author of The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging. We explore the transformative potential of social prescribing, a practice that shifts patient care from focusing solely on treatment to empowering holistic health and prevention. Discover inspiring stories, including how a simple social prescription changed a patient’s life and sparked a nationwide movement to include social prescribing in medical curricula.
Julia Hotz is a journalist and author of The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging.
She discusses the KevinMD article, “How a group of British medical students fought for social prescribing.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Julia Hotz. She’s a journalist and the author of the book The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging. There’s an excerpt from that book on KevinMD titled “How a Group of British Medical Students Fought for Social Prescribing.” Julia, welcome to the show.
Julia Hotz: Thank you so much for having me, Kevin. Great to be here.
Kevin Pho: So, let’s start by briefly sharing your story and journey.
Julia Hotz: My story and journey, as you mentioned, I am a journalist. I am not a health expert. I am not a health care expert. But boy, during the pandemic, I was really fascinated by so much of the data I was seeing around health, particularly around the loneliness epidemic. I had been in the UK at the time, and there was a statistic suggesting something like one in five people were coming to the doctor for a non-medical, social reason. This creates all kinds of pressure on the health care system.
And so, I started out my journey by investigating: what actually works to reduce loneliness? Why does loneliness have all of these health consequences? I came to find out that loneliness was just the tip of the iceberg. We’ve seen rising rates of lifestyle diseases, anxiety, depression, ADHD, chronic pain, and dementia.
My journey to investigate social prescribing, which is a practice through which health workers are referring their patients to non-medical, community-based activities, is actually a great antidote for this. It turns out that 80 percent of our health is affected by our environment. When we feel connected to our communities, when we feel like we have something to get us out of bed in the morning, when we feel like we have outlets to cope with stress, our health actually does improve.
Kevin Pho: Alright, and the Surgeon General recently highlighted loneliness as an epidemic. I’m interested to hear more about how social prescribing can mitigate some of that. You have an excerpt from your book on KevinMD titled “How a Group of British Medical Students Fought for Social Prescribing.” So, tell us about that excerpt for those who didn’t get a chance to read it.
Julia Hotz: Totally. Well, I’ll just back up a second and say, you know, when you hear about this concept of social prescribing—the act of doctors prescribing an art class or a nature excursion—your first thought as a clinician might be, “OK, that sounds great, but how are they going to have time to do that?” I mean, how are they going to have the resources to do that? Doctors are already so overloaded with the number of things they have to do.
But this excerpt talks about how, actually, in the UK, where this social prescribing movement began, this was a movement from the ground up. It started with a bunch of individual doctors saying, “I know that my patient doesn’t need another medication. I know they don’t need another therapy. I know I don’t need to refer them to a specialist. What they really need are some lifestyle changes.” So, they started prescribing things like cycling groups.
This movement began and grew from the bottom up, but it still wasn’t quite implemented in the health care system. It certainly wasn’t taught in medical schools until a group of British medical students said, “This is the future of medicine. We know that our health is determined by social factors in our environment. We want to start doing this.”
That excerpt describes a scene from the perspective of one of the students who led this revolution. He saw firsthand the story of a woman on 11 medications who had Parkinson’s disease. After getting to know what mattered to her, he prescribed her a salsa class. She went from 11 medications to two medications and started seeing him much less often. Inspired, he fought to start a network of medical students around the country to teach social prescribing.
Spoiler alert: three years into that effort, the NHS—the National Health Service—and the people in charge of the curriculum said, “You win.” They recognized that the next generation of medical professionals wanted this, so they began teaching social prescribing in the curriculum.
Kevin Pho: In terms of examples of social prescribing, you mentioned things like a salsa class. What are some other ways that medical students or physicians can socially prescribe? Are there set courses? What exactly does that formal curriculum teach?
Julia Hotz: I think it’s important to note that it really depends on where you are. Social prescribing exists now in 32 countries, but let’s stick with the UK example because that’s where it has had the most uptake. A social prescription could look like joining a cycling group, participating in a sea swimming course, or connecting someone to a volunteering opportunity.
In the UK, it’s often not just the primary care provider doing the social prescribing. They enlist what’s called a “link worker.” This position serves as an intermediary between the medical professional and the community. The link worker takes the time to get to know the patient—what matters to them, what gets them out of bed in the morning, or even what they loved doing as a child but haven’t done in years.
For example, Kevin, if you were my patient, I’d ask you questions like, “What are you curious about in your neighborhood? What kinds of activities would you like to try?” Then the link worker matches that information to what’s available locally. Maybe it’s cooking classes, maybe it’s job help if you’re seeking employment. Social prescriptions are tailored to the individual and guided by evidence.
For instance, if someone is experiencing depression or is at risk of obesity, I might prescribe movement-related activities because exercise improves metabolic health, boosts serotonin production, and releases endorphins. If someone is struggling with anxiety, I might prescribe art classes as a coping mechanism. It really depends on the person’s needs and interests.
Kevin Pho: In your excerpt, you talk about the shift in focus from “what’s the matter with you” to “what matters to you.” Talk about that distinction and why it’s important.
Julia Hotz: That shift really sticks with people. It’s great that today there’s less stigma around discussing health, especially mental health. But it’s tempting to see everything through the lens of a diagnosis: “I can’t do this because I have anxiety,” or “This is my depression talking.”
What social prescribing does is acknowledge those struggles while emphasizing that they are not the whole story. Health workers ask patients, “When in your life do you feel least depressed? When do you feel most focused or least anxious?” By understanding the broader story of the patient, they can help them feel better more often.
This approach really works. For example, I interviewed a patient with severe anxiety, panic disorder, agoraphobia, and social anxiety. He told me that while therapy and medication helped, he started seeing everything through the lens of his anxiety. But when he was prescribed activities like book discussions and concerts—things he loved—his anxiety went to the back burner. This shift can also encourage healthier lifestyles for patients by focusing on their interests and helping them stick to positive changes.
Kevin Pho: You mentioned that the genesis of this movement was in the UK. Are there any initiatives in the United States that formally implement social prescribing?
Julia Hotz: Yes, there are. Believe it or not—and this might surprise your audience—there are insurers in the United States now covering social prescriptions. For example, in New Jersey, Horizon Blue Cross Blue Shield covers up to six months of arts prescriptions for patients at risk of overspending on their insurance. This is part of a partnership with arts organizations like the New Jersey Performing Arts Center.
That’s just one example, but there are other grassroots and statewide initiatives. While we don’t yet have a national program like the UK, there is significant momentum. For instance, there’s a group called Social Prescribing USA, which is a coalition of doctors, social workers, and community leaders working to mainstream this practice by 2035. There’s also growing interest in prescribing nature. You’ve likely had guests on your podcast who talk about the benefits of nature and park prescriptions. These efforts are starting to take shape in a more formalized way.
Kevin Pho: Tell us about the spectrum of responses from patients. I imagine some people come in expecting a traditional prescription and are surprised to be prescribed something like a salsa class or an art class. What kinds of reactions have you seen?
Julia Hotz: Definitely, and I get it—if I went to my doctor for chronic headaches and they prescribed an art class, my first reaction might be, “Wait, what about my headache?” Patients might initially think they can just join a class on their own, but it’s important to note that social prescribing doesn’t work that way.
It’s not a replacement for traditional treatments, but rather a complementary approach. If a patient needs medication, they’ll still receive it. Social prescriptions come into play when medication alone isn’t enough, or when a patient’s lifestyle is contributing to their condition.
Doctors also explain the science behind these prescriptions. For example, migraines and headaches are often linked to stress, and there’s robust evidence that activities like art or spending time in nature can reduce stress, lower cortisol levels, and improve overall well-being. Patients are often more receptive when they understand the evidence and see that the prescription is personalized for them.
Social prescribing also involves active listening and collaboration. Sometimes it’s a link worker or social worker—not just the doctor—who helps patients explore what matters to them. This ensures that the prescription aligns with their interests and long-term health goals.
Kevin Pho: Let’s dive into some of the evidence. You’ve mentioned a few conditions already, but what are some specific diagnoses that are effectively treated with social prescribing?
Julia Hotz: Sure. Let’s continue with the example of nature and its impact on attention-related disorders, particularly ADHD. ADHD symptoms often include inattention and difficulty focusing. Decades of research show that spending time in nature significantly improves attention and focus.
One study found that children with ADHD who spent just 20 minutes in a natural setting experienced benefits comparable to taking Ritalin. Similarly, adults who walk for an hour in a natural environment report improved mood, lower blood pressure, and reduced cortisol levels. These findings are supported by measurable data, such as blood and urine samples.
Another area where social prescribing is effective is mental health. Activities like art classes help patients cope with anxiety and depression by providing creative outlets. Movement-based prescriptions, like dance or cycling, improve metabolic health, reduce stress, and elevate mood. Social connections, such as volunteering or group activities, foster a sense of belonging and purpose, which are critical for mental and physical well-being.
The book goes into detail about the science behind these interventions and how they address a wide range of conditions, from chronic pain to loneliness.
Kevin Pho: Your excerpt comes from your book, The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging. Tell us about the audience for this book and some of the key messages you hope they take away.
Julia Hotz: The book is primarily written for a general audience—people who may be struggling with their own health challenges or know someone who is. It’s also for those who feel a sense of disconnection or malaise since the pandemic.
The first part of the book focuses on patient stories, exploring how these non-medical interventions have transformed lives. The second part is aimed at healthcare professionals, policymakers, and medical educators. It provides a blueprint for integrating social prescribing into healthcare systems, sharing lessons from 32 countries that have implemented it successfully.
The key messages are that social prescribing is not a new concept—it builds on the idea that health is influenced by our environment and social connections. This practice unifies approaches like integrative medicine, lifestyle medicine, and holistic health, offering a tangible framework to make them accessible and actionable.
I hope readers come away with a sense of hope. Social prescribing shows us that we can address some of the most pressing health challenges of our time by reconnecting people with their communities and their passions. It’s a practical, evidence-based solution with the power to transform healthcare.
Kevin Pho: The book is called The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging. Julia, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Julia Hotz: Thank you so much, Kevin. It was great to be here.
