Relationships: The Future of Healthcare
Healthcare is transforming. We are at the cusp of something new. It hasn’t hit the US yet. It’s just starting in Great Britain. Doctors will begin prescribing you to spend time with people, called “Social Prescribing.” Yes, this may sound crazy. But it’s real. And it may be the key to your grandmother living longer, your colleague combatting meaninglessness, or helping a friend out of depression. Future generations will think about health differently. This post outlines the evolution of our healthcare system to understand how we developed this radical and innovative solution.
Healthcare changed dramatically in the past two centuries — from home remedies in the 1700s to rigorously trained doctors in the late 1800s. The early 1900s birthed public health efforts, and the latter part of the century brought emphasis to diet, exercise and mental health. The new millennium focused on the “social determinants of health”: how work conditions, pollution, discrimination, and other societal factors affect our health. You can read my comprehensive summary of the evolution of US healthcare here.
Yet something has been missing. The missing link is relational health.
Let’s trace its origin. The 1990s witnessed an explosion of neuroscience research. The invention of MRIs and Pet scans created deeper understanding of the brain. Neuroscientist Gary Bernston noticed an unusual phenomena. Why did some illnesses become symptomatic in social situations? (Think of cold sore herpes showing up before prom). He partnered with social scientist John Cacioppo. They created a new field: social neuroscience. Social neuroscience merged the latest in psychology, sociology, neurology, and immunology. The scientists observed that loneliness and stressful social situations were correlated with bad health outcomes. But questions remained:
- Was this correlative or causal?
- Was there a genetic basis?
- Are relationships truly causal to health?
The science is now in: the negative health impact of loneliness is comparable to obesity or smoking 15 cigarettes a day. Today, the Coronavirus pandemic is further isolating us. We’ve seen mental health decline and virtual Telehealth slots fill up. The former US Surgeon General attributes loneliness as a major cause of the opioid epidemic, and research out of Stanford found that relationships can lift people from addiction. We cannot ignore loneliness. Doctors cannot ignore it. Or else we risk trillions in medical costs and millions of lives lost. The evidence is clear. Social relationships are a key new health category.
How do we address it?
Social Prescribing is a promising approach.
This new medical practice emerged in Great Britain. General practitioners in the UK can now prescribe patients to engage in social activity. Patients get connected with a “community link worker” to create a custom social plan. Patients are sent to volunteer in local schools, join a local card game club, help out in a garden, or partake in a hobby group. Community is their medicine.
This flagship initiative is part of sweeping changes happening in Great Britain. In 2018, the Prime Minister appointed a Minister of Loneliness. Their commission issued £11.5 million to fund 120 organizations. Some grantees focus on creating infrastructure for social prescribing. Other grantees are public health focused, creating “friendly benches” for chatting, and keeping public transit open later for at-risk groups. You can see the list of fund grantees here as well as the award winners of the best social prescribing organizations. Beyond the government, organizations such as the Social Prescribing Network, Ways to Wellness and Befriending Network are paving the way for Social Prescribing to become more mainstream. Other countries are taking note. Australia, Canada, Japan, and Netherlands are also adopting the social prescribing practice.
Will these initiatives work? The most recent batch of research on loneliness interventions was published between 2005–2015, before the loneliness epidemic. In 2011, SCIE synthesized 39 British loneliness interventions into a report. The most effective interventions were befriending services and using 1:1 Community Navigators (a “community link”). The longitudinal studies in the SCIE analysis showed that social group interventions increased survival rates in older folks.
As for Social Prescribing, an early UK meta-analysis shows promising results: average decrease in primary care by 28%, average decreases in accident and emergency visits (A&E) by 24%. Secondary care referrals dropped in two studies (55% past 12mo and 64% past 18mo), yet one study showed doubling of secondary care mental health referrals. Social prescribing seems to have mixed economic results, leaning towards positive bottom-line impact on UK practices. There is room for more robust evidence; Many studies are not randomized controlled trials (RCTs) or peer reviewed and all face the inherent challenges of conducting research on such a complex intervention.
Will social prescribing and other interventions take off in the US?
After talking with leaders in the space, I’m convinced that now is the perfect moment for Social Prescribing to take hold in America. There is a public zeitgeist around exploring solutions to loneliness, and the technology + science + policy is in place to support this inspiring new practice.
I am planning a US grassroots physician movement, exploring a prospective pilot study, and inaugural US social prescribing conference in collaboration with academics Harvard, Stanford, University of Michigan, the UK movement’s originators, as well as reps from hospitals, Carnegie Hall, and the NIH. Message me if you’d like to be involved: socialprescribingusa@gmail.com
In the meantime, here 8 ways society can mobilize to strengthen relationships — and ultimately increase our collective health.
