CM 272: Julia Hotz on the Connection Cure
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This book packages the story of social prescribing in stories about the power of movement and nature and art and service and belonging. But those five things are really just gateway drugs for us to be more present in the world. Welcome to Curious Minds at Work. I'm your host, Gail Allen. Each day, millions of doctors write prescriptions for drugs intended to help their patients.

But what if many of our modern health ailments, like depression, anxiety, chronic pain, would benefit as much, if not more, from a social prescription? These are questions Julia Hotz set out to answer.

Julia is the author of the book, The Connection Cure, The Prescription Power of Movement, Nature, Art, Service, and Belonging. By sharing research findings, as well as people's stories from around the world, we get to see a whole other side of medicine. After reading her book, I'm more convinced than ever that we need to make time for doing things we enjoy with other people.

Before we start, one quick ask. If you like the podcast, please take a moment to leave a rating on iTunes or wherever you subscribe. Your feedback sends a strong signal to people looking for their next podcast.

And now here's my interview with Julia Hotz. Julia Hotz, welcome to the podcast. It is great to have you on. Thank you so much, Gail. So great to finally meet you. You point out in your book how social prescribing has become an important tool for medical doctors. So to begin, what is social prescribing? So social prescribing gets its name from the social determinants of health.

This is the idea that actually up to 80% of our health is determined by social factors in our environment, such as where we live, how we live, what kind of outlets we have to cope with stress. And social prescribing refers to the idea that because so much of our health is determined by these social factors, our medicine should be too.

So a social prescription then is for any non-medical resource or activity in your community that aims to improve your health and your connections. So it's everything from fresh produce prescriptions to cycling groups and art classes.

To make this more concrete, let's share an example. Let's start with the one in the book that you call the movement prescription. And it involves Frank working with his doctor, Ollie Hart. Can you share that story?

So Frank, like many of us, lived a pretty sedentary lifestyle. His happened to be extra sedentary. He was a truck driver. And so he spent most of his days sitting. By the time he got home, he was so exhausted, didn't have time to exercise, kind of just sat on the couch, wasn't motivated to eat healthy foods. And he lives what I call this sort of work, sleep, eat, repeat lifestyle.

And at some point during this, Frank begins to gain weight. He also begins to develop type 2 diabetes, which is not always but often associated with being overweight.

And for most of his life, Frank, when he would go to the doctor, he would sort of go in with his head down because doctors would wag their fingers and say, you should eat healthier, Frank. And they would prescribe him insulin and they told him he was going to be on insulin for the rest of his life.

And Frank was really discouraged. He didn't think he had much of a choice about, you know, his prescription or his type 2 diabetes until he meets this doctor who, as you say, Ollie Hart, who turns things around for him. And that's because Ollie starts with the perennial question of social prescribing, which is asking not what's the matter with you, but what matters to you.

And what I mean by that is Ollie actually came to find out that Frank used to love to ride his bike as a kid. He actually had a lot of potential and interest in being active again. He just didn't know, like many of us, where to begin. Ollie says to Frank, I'm going to help you get off your insulin because I see that's really important to you. And I'm going to actually prescribe you this cycling course and

And so that's what Ollie does for Frank. He writes him a social prescription to join his local cycling course. It's targeted at adults over 50 who literally sort of relearn how to ride a bicycle as an adult. They meet every Tuesday at 10 a.m. Each week they learn something new about biking.

The course is about eight to 10 weeks. And what's really amazing is that through this, Frank not only falls in love with biking again, but he makes all of these friends. And even after the course ended, Frank was motivated to continue cycling with these friends. Lo and behold, he loses the weight. He is able to come off his insulin. And more importantly, he feels healthier than he's felt in years.

It's so interesting as I was reading the book and you talk about this, you know, these social prescriptions are often just sort of the beginning, the entry point to all of these other benefits, these friendships, these reliances, these accountability buddies. It's pretty incredible. Yeah, right. That's just it, Gail. And, you know, I think a lot of us say, okay, sure, I know I should ride my bike more or I know I should go out and be social, but

For many of us, we don't know where to begin. And for many of us, I think it takes a doctor's orders at least to start.

to help us find a group that actually does this, a time where they meet weekly, as you say, accountability buddies to actually hold them accountable, to keep showing up and more importantly, to make it fun. You know, your medicine should be fun. Your health should be fun. And that's one of my favorite things about Frank's story and social prescribing as a whole is that people really,

really honored what the movement is all about. They focused on what mattered to them. And through that focus, they were able to sort of create their own health.

Julia, I love how you talk about essentially getting permission because one of the things that I know I've personally experienced is, you know, I've had a doctor, you know, every once in a while say, you know, you love exercise, you work out a lot, but you mentioned that you're tired. What did you take off? And having a doctor ask that, talk to me about, you know, giving me permission, it does help you take a step back and say, oh, I can give myself that. Yeah.

And I really think that one of the things that struck me about social prescribing is you're right. Doctors are giving people permission to prioritize their social health.

That's exactly it, Gail. And I'm sure this resonates for a lot of your listeners in the workplace. We work so hard and we're sort of of two minds. We love our work and we want to work hard. And at the same time, leaning too much into that can be toxic. It can create stress and stress can create all kinds of health problems. And

What I love about social prescribing is it says, you know, both things can be true. Like you can continue to work hard, but instead of just saying, you know, hey, take it easy or take more breaks or have some balance, it's actually giving you sort of a pathway to do that. You know, most of us, when we're asked about our, uh,

Our moments of awe, to quote one of your previous guests, or our moments of joy, or when we look back on our lives, you know, what are we most grateful for?

they will be moments of intense connection. So I think social prescribing is about bridging that gap and actually inviting healthcare to create a pathway for us to do the things that we know we should be doing and that can create more of our health and to live with that balance beyond just an aspiration, but an actual practice. You write in your book that this is not new science. It's actually grounded in old science. Can you share some of that history?

The opening chapter of the book actually talks about this fictitious patient, John, who you come to find out the doctors, quote unquote doctors, who come and see him are real ancient doctors. Hippocrates, Razzes of Persia, Buddha, a teacher, you know, all of them had these ideas about the ways that our environments influence our health.

And some of them even wrote social prescriptions, you know, evidence of ancient Greek doctors prescribing music. Eastern and holistic medicine talks a lot about mindfulness and sort of cultivating a sense of connection to other people and yourself. So this is not new technology.

or a new thought by any means. And in fact, the ideas of social prescribing have long been baked into other modern practices, which you might know as lifestyle medicine or holistic medicine or integrative medicine. I think social prescribing is about unifying all of those and saying, okay, this

Those have often, unfortunately, been sort of seen as fringes on the healthcare system, right? Like there's mainstream medicine and then there's like alternative medicine. Social prescribing is saying, actually, these ideas should be mainstream. And because it should be mainstream, let's get more of primary care doctors involved. Let's get more insurers involved.

Let's not make it so that you have to go to a quote unquote specialist doctor to be able to enjoy these age old revered benefits of movement, nature, art, service and belonging, which the opening chapter also talks about as being very essential to how we evolved, right?

We evolved to be in nature. We evolved to move our bodies. We evolved to seek belonging and share stories and serve with other people. And so, yeah, social prescribing is just a new form of bringing us back to these very old ideas.

Julia, what are some of the highlights of how we've gotten to a place where we need social prescriptions? What shifts have we seen over time that have gotten us here? Because you're calling out the fact that this goes way back. Sure. You know, I think that there's a lot of pressure points on our healthcare system right now that are calling for sort of a new or expanded understanding of medicine and

One is just that the current options we have, medication, individual therapy, these can be great. These work for some people sometimes, but they don't work for all people all of the time. And that is why, for example, I use the example in the book of the epidemics. When you hear the word epidemic, nobody's talking about an epidemic of strep throat.

People are talking about epidemics of depression and addiction, ADHD, loneliness, things that unfortunately have not been entirely solved by medication or therapy, whether it's because that medication or therapy is ineffective for some people.

It's also not available to some people, whether that's because of, you know, cost barriers or a third really important pressure point is the lack of health care workers who can deliver this. You know, there was just a great article in The New York Times this weekend about why fewer people are going into primary care homes.

We've also seen shortages in therapists, shortages in social workers, shortages in the number of new medical school residents. And so, again,

I define it in the book as we've long had a system of diagnose, treat, repeat. You go to the doctor, you get a diagnosis, you get treated, boom, you do the same thing the next time you get sick. But if this really worked for all sicknesses, for all of us all the time, then we would be collectively much healthier than we are. And so I think we need medicine to take into account that some of these symptoms that we're seeing are

are a product of our environments. And if that's true, then maybe the solution is also in our environments through social prescriptions. Let's talk more about that environmental piece. You tell the story of Heather. She's a woman who's living with a great deal of stress and it's impacting her health negatively. She's given the advice to stress less, but at least at first, not a lot of instruction on how to do it. Then she's given a nature prescription.

What is that? What did it do for her? Heather, like I'm sure many of your listeners, felt like she had this endless to-do list. You know, she worked three jobs and it actually led to physical symptoms, right? She'd try to go to bed at night and all she could think about was her to-do list. She would get these heart palpitations. She developed insomnia. And as you point out, she went to her doctor and her doctor said, okay, it sounds like you're stressed. Just stop being stressed.

Um, but you know, Heather says, how do you stop being stressed if your life is stressful? And so what, um, what the doctor then does for Heather, um, is actually prescribes her an eight week course in nature, um, through run through a local nonprofit here in the United States called come alive outside. Um,

And what the prescription was, was to enjoy quote unquote, joyful group outdoor experiences. And when I went to visit Heather and set it on this nature prescription, it was, you know, not like going on a five mile hike and having a really physically rigorous nature experience, but actually just sort of sitting in nature, walking,

observing its quiet wonders, listening to nature poetry by the late Mary Oliver, writing their own nature poems, and then going on a quiet, peaceful nature walk in the local park.

And, you know, this is supported by so much evidence suggesting that nature has this unique power on our attention, as many of your other guests have talked about. There's something unique about the way nature can capture our attention without taxing it.

many, many studies showing that when we enter nature, you know, we reduce our cortisol production, we calm down, our moods improve, we ruminate less. The part of the brain that's associated with rumination, there's less activity in it. We experience more awe. And then what it does actually is it allows us to be better at judging our stressors. So effectively we feel less stressed and

And this was certainly true for Heather. You know, she, she comes away from this prescription and she says, listen, I can't, it's true. My life is stressful. I can't change everything that's on my to-do list.

But when I feel really overwhelmed, I know now that I can just take some time for myself outside. I can look up at the clouds like I used to do. And actually taking time to do this isn't, you know, a waste of time. It's not getting in the way of my to-do list. It's actually making me better and more focused at tackling it afterwards.

It's almost like it gives us more perspective. That's right. That's right. Exactly. Nature gives us perspective on the things that really matter to us. And ask anyone who's been for a walk outside or gotten some sunshine, gone for a hike, gone for a swim. Very few people will say that they feel worse or more stressed after, right? Everyone kind of says that they feel

And I think what better really comes down to is, as you know, your great guest, Dr. Keltner puts it, you've taken yourself out of your head for a little bit. You've put yourself into some great awe inspiring environment and you do, you walk away with more perspective.

You write about Japan and forest bathing. And did you actually go and experience forest bathing yourself? I did. I did. Tell us about that. Yeah.

Yeah, so forest bathing was this thing I read about and I couldn't believe it. It has a really interesting origin story of, lo and behold, stress, the buzzword of the hour. Epidemics of stress cropping up in the 1970s and 80s in Japan, which was a time in which the economy –

grew exponentially. The GDP went up, people were working harder, longer hours. The historians called it the Japanese economic miracle.

But the dark side of that was that more and more people were getting sick from stress-related diseases, more heart disease, very tragically, more suicide. They even had a new term to describe this called karoshi, meaning death by overwork, or even worse, karujitsu, suicide by overwork.

And so the Japanese government was, of course, mortified by this and had tried all sorts of things, you know, tried to pass limits on working hours. That didn't work. People just dodged them. And then finally tried a different approach and said, kind of like Heather, Heather ultimately realized is, listen, we can't change the environment of this stressful work environment.

But we can change the environment after hours. And one, you know, environment that's been especially revered in Japanese Shinto and Buddhist tradition is that of forests. And so the Japanese government invests in what they called Shinrin-yoku, literally translates to forest bathing, right?

Not taking off your clothes, as I learned when I did it, but actually just going to a forest with a Shinrin-yoku guide and immersing in it with all five senses.

And when I went to do this, and so, you know, spoiler alert, they do this. And at first, it's just this really popular campaign. But then scientists actually went in and studied the blood, urine, saliva of super stressed out workers who had gone forest bathing and found that they were

lowered their cortisol production, increased their natural killer cell production, which was really helpful in fighting cancer. They anecdotally were less stressed, improved their moods.

So I was really curious about this. I try it for myself and I try it because I am someone maybe like some of your listeners who has a really hard time just like sitting still. I know that I should probably be doing this more, but the second, like if I'm on a work retreat and somebody tells me to meditate, I'm like,

You know, we're going to do a 10 minute guided meditation. I think, okay, that's 10 minutes I have to like think about that email I'm going to write, which is terrible. It's exactly the opposite of what you should be doing. But so for me to really have that sort of quieting of the mind, the quieting of the stress.

I needed to put myself in a different environment. And when I went to, you know, for my forest bathing experience at Okutama Forest Therapy Base, just outside of Tokyo, I

I finally have that meditation experience I've never had before. You know, it's just these two hours of being guided and really being asked to pay attention with all five senses. You know, look for things on the trees, look for interesting things along the path, listen to the sounds of the forest, smell the different elements of the forest, and

Max, my guide, even has me taste the forest by giving me this tea that was created from one of the plants there to touch. It was really, really magical. And I write in the book that

I, as every journalist, I think you want to be able to tell your reader about everything you were experiencing in that moment. But because I had genuinely had this meditative forest bathing experience, I couldn't do that. I was really focused on being present in a way that I haven't been able to in the past.

And what's really exciting is that even though this practice started in Japan, it's actually spread all around the world, including the United States. You could go for a guided forest therapy experience

Or I think that you could try to get some of those benefits by really intentionally immersing yourself in even a park or some local nature preserve. I think it's just about the intention too. Having the guide helps, being in Japan is beautiful, but there are ways that I think the everyday reader who maybe can't go to Japan can still access some of those therapeutic benefits as well.

In this interview, Julia Hotch shares how social connection can set us on a path toward health and healing. If you'd like to learn more about the power of social connection, check out episode 259 of Curious Minds at Work with Jeffrey Cohen, author of the book Belonging, The Science of Creating Connection and Bridging Divides. Jeff talks about the health impact of loneliness and steps we can take to address it.

For me, what I've always been curious about is the nature of the change process, how people change and how we can cultivate positive change as educators and as parents and as managers. Now let's get back to my interview with Julia Hotz. You also write about the connection between art and health. And I wanted to ask, why art? What does it give us? Yeah, that's a great question. And I think...

That can be its own book. That probably is its own book. In fact, there's a great new book out called Your Brain on Art, which is all about sort of the neuroscientific benefits of art and

But I asked myself that same question too, right? Because it's like not totally clear why we evolved to create and consume art. Like nature, okay, pretty obvious. Moving our body, of course. Even like being with other people, we know that was an evolutionary advantage, right?

But art was really interesting. I got some clarity on this by speaking with experts in this space, you know, art therapists, social workers, experts in the art who will tell you that this is really also sort of like nature, a forum to shift your perspective, right?

So, you know, art therapy, that's another discipline that's been around for a really long time, particularly in the space of trauma. It especially became popular after World War II and, you know, veterans were reporting trauma, trauma meaning literally translating to a wound or

Um, so in other words, people who had experienced these tremendously painful events and were impacted by them in some way. And so what art therapists and other practitioners of arts for health will tell you is that art can uniquely serve us when our words can't. In other words, we can't express the depth of our pain, um,

Art can kind of serve as that third medium to help us. And I tell two stories in that chapter, one about a woman named Kuhn who had experienced a lot of trauma in her life, a lot of abuse, and genuinely was kind of scared to try art because she grew up with this really abusive mother who sort of made her feel like

Like she was never good enough. She could never do anything right. And I think like many of us, when we try art, you know, we say, oh, I'm not going to be any good. What if I mess it up? And what she learns from this creativity workshop prescription, as it's called, is

is that it's really not about producing something good. It's about getting lost in the experience of creating the art. It's almost about letting this almost sixth intuitive sense guide you and let you feel things that you didn't know you felt, that words alone might not have reached in you.

And so for Kuhn, who had gone from being severely depressed and anxious, out of the workplace, PTSD, she finds that art helps her express herself and try new things and build the confidence that she never got to build in her childhood. And also play again. You know, a lot of social prescribing is really about having the experience to play as an adult.

So I think art can help us connect with our own story, whether we're the ones who are creating it or as in the second social prescription of a man named Jonas, can help us see ourselves in other people's stories.

And so just to quickly recap Jonas's story, he had been struggling with anxiety. He was having panic attacks. He was also out of the workplace. He gets prescribed something called culture vitamins where, you know, kind of similar to the other programs, multiple weeks long group of, you know, eight to 12 other people and

He's taken through these art and culture experiences in his city. He goes to the museum, he goes to a concert, and his favorite one actually is this shared reading prescription at the library. What he finds through reading, which, you know, stories, I would argue, are a form of art, is

What he finds through this shared reading experience is that he can take real comfort in listening to other people's stories. He can sometimes see himself in the story of a character who's maybe facing their anxiety. And this is why there's a whole field called bibliotherapy that demonstrates how

Reading, especially to children with anxiety about a character who is going through some challenging circumstance can actually be tremendously effective for reducing their anxiety and improving their mental health.

And I just think that both stories speak to this universal need to sometimes reconnect with ourselves by connecting with the stories of other people and sort of taking comfort in the fact that other people have been through this thing. I can get through it too. That's really, really helpful. And I'm glad you brought up the bibliotherapy aspect because I think there are folks who will say just how powerful it was for them to get involved in, let's say, a book club.

Yes, exactly. And that's what this was. This shared reading was effectively like a book club. And I think kind of like nature, reading a book can sometimes create a real sense of awe in us. It can take us out of our own head, immerse us in the stories and scenery and lives of these characters.

And not only does that temporarily take us away from our own sort of rumination and problems of the self, as Dr. Keltner would say, but it also allows us to take comfort in the resolution of others' stories. And I found that's really effective for me. Like when I'm feeling really upset, really sad, really angry, really anxious, I'm

I often find that, you know, listening to really emotive music or watching a film or reading a great book can really help me. Even though the characters are not real, it feels like they are. And I feel a sense of connection and kinship with them.

I so agree. It also makes me think that your work is coming out at this time and we've got Robert Putnam who wrote Bowling Alone. His work is coming back into popularity again because of this worry about people not joining things, disconnected, loneliness. And I feel like

A huge part of it is what it gives you as an individual, what it gives you as an individual operating within a group where you are getting something from the art, let's say in a book club, but you're also getting something from the fact that people have different opinions. Like the book club that I'm in, there's 20 people in the book club, there's 20 different perspectives. We disagree, we argue, and then we all go out for dinner. You know what I mean? It's this really fun way of reminding ourselves that

It's okay to disagree. And then we figure it out and we get along because we've built these relationships with each other. And so I just see what you're talking about is, again, such a fantastic entry point.

to what we need as a way to stay connected to each other, even with disagreement. I've seen, I've seen folks be so helpful to each other as a result of being part of a book club, getting to know each other and, you know, saying, yeah, I'll pick you up from the airport. And I think these kinds of experiences that you're talking about, almost having a prescription to find ways to be connected to others in cities, I think it's just increasingly important. Oh, I love that so much. I love that you found that in your book club, um,

so much to unpack there. You know, number one, I think it's great because as you point out with Robert Putnam talks a lot about the decline of social capital and having actual spaces where we can connect, you know, that's so important. And I think it's important, at least for me and maybe for some introverts that are listening right now, like the thought of going to a space where it's like, all right, let's connect. You know, everyone talk amongst yourselves is like,

really scary. But what's beautiful about a book club and a lot of these social prescriptions is that you're actually bonding over this like shared thing, this shared activity, this shared interest. And the research, um, suggests that that is key to creating a sense of belonging. It's key to creating a sense of ultimately companionship

And that, I think, when you have that base of, okay, wow, we can discuss about both things we have in common and things we disagree on.

What we're actually doing there is we're learning about ourselves through that practice. And there's a great researcher who I quote in the book, Dr. Arthur Aaron, who says that when we do this, when we have this deep connection with another person who we agree with, we disagree with, it can actually help affirm who we are. He says a companion is a confidant that affirms who we are. And when we have that companionship,

That is such a gift. That is when we say, okay, this is somebody I can call at 3 a.m. in a crisis. I can ask them to pick me up from the airport. These are the things

potentially life-saving connections that we have in our lives. And it's just been so interesting to me that only until recently are we treating companionship as this truly medicinal thing because every bit of evidence we have from evolution says that we also needed these, you know, tight connections. And I think it's so beautiful that for you through your book club, others through social prescriptions are finding that.

So I want to talk about this piece because in some ways I feel like it's connected. Serving others has also been shown to improve people's health. And, you know, I think when you're part of a group, it's hard to be part of a group and not in some ways end up being in service. But then there are ways we can deliberately be in service. Talk about that aspect.

It's hard to believe because, you know, you might be reading a lot of headlines right now that lead us to believe, oh my gosh, humans are terrible and selfish and, you know, narcissistic, whatever. But actually, a lot of evidence suggests that humans at the end of the day are pretty generous. And this was actually something we evolved to be. Like, it was...

very beneficial for you to cooperate with the group, to share your resources, to serve others so they'll serve you. And it's not surprising to me that you read a lot of research suggesting that something as simple as volunteering, sort of a standard way we think about service, has been shown to increase our longevity,

It's associated with improved moods, reduced depression, reduced stress.

Having a sense of purpose is associated with also a longer lifespan. Again, that makes a lot of sense because this is something we evolved to do and how we evolved to be in the world. And so how we see this playing out in the real world is in a couple of ways. I talk, for example, about this woman named Akilah who had this debilitating back pain and

And it was especially, you know, it was physically painful, of course, but it ended up being psychologically very painful as well because that back pain ultimately forced Akilah to give up her job, which she absolutely loved as a caretaker at a hospital.

you know, and she was a real caretaker. I mean, she was on her feet all day, pushing patients around, lifting them up out of beds. Ultimately, she couldn't do it anymore. It was also devastating because her two children, whom she'd, you know, grown up taking care of, had recently left the house. And so suddenly Akilah finds herself in this position of having cared for others her whole life

to being bed bound with nothing and nobody to take care of. And like most doctors we've seen, well-meaning doctors, they looked at Akilah and they said, you know, you need to rest. Clearly you're in so much pain. You just need to take some time off, take some time for yourself, rest. Don't worry about anyone else or anything. But for Akilah, this was torture because she had built her whole identity and her life around caring for other people.

So long story short, she tries a lot of different forms of medication and therapy. Nothing's working for her until she finally links up with this health worker named Joanne, who really listens to her, kind of gets her read, figures out what matters to her, figures out that Akilah, what she's really missing in her life is something or someone to care for.

And what she then did, her health worker, Joanne, was prescribed Akilah a volunteer gig at this children's health charity where Akilah wouldn't have to be on her feet all day, but would be able to answer phones and talk to the parents of children with complex medical needs, help them feel better, help them get what they needed. It was a form of caregiving without actually taxing her body, right?

Akilah says that this more than any other prescription is what actually made her feel better. She still deals with back pain, but by having something that got her out of bed in the morning, by feeling purposeful and useful and like she was doing something that honored who she was in this world, a caregiver, it almost distracted her, she says, from her back pain. And it made her feel less depressed, less anxious, less ruminative, less

And so I think that really speaks, Akilah's an extreme example because again, she was particularly drawn to caregiving. But I think all of us have that tendency on some level. We have to feel like we have a sense of purpose.

And it might not look like literally volunteering, but often it does. Often we do structure our working lives, or at least our working lives, around some cause that we feel drawn to, some way of serving other people. Social prescribing began in the UK, and I don't think a lot of us know that. How did it start? How long ago did it start?

The word social prescribing is a bit contested and its official origin is a little bit unclear, but it seems to have started in the 1980s when the UK, which is different from the US in that they have a national health care service. They have a taxpayer funded public system.

It began in the 1980s when that system was really starting to show some weaknesses. You had people coming to the doctor for issues that were primarily social or economically determined issues.

I tell this one story of somebody who was coming to the doctor every Friday night because he was so lonely. Actually, sorry, it wasn't the doctor. It was the hospital. He was coming to the hospital every Friday night. And when the doctor asked him why, he said, it's obvious because I need social company. If I were alone every weekend, I don't know what I'd do with myself.

Lots of stories like that contributing to a pressure problem we still see today on the NHS. People coming to the doctor for non-medical reasons, which leads people who legitimately do need medical care to not be able to get it.

And so this was all happening in the background. And, you know, you had some really innovative pioneering doctors ultimately trying to do, you know, social prescribing, the examples we've just heard about on a small scale, prescribing people local resources and activities to address their non-medical needs. And you had a lot of people actually doing this independently and

And then in 2018 in the UK, some people might remember this headline of them establishing a national minister of loneliness. This was done in response to this epidemic of loneliness that we're hearing about all over the world. Also in response to the death of a politician, Joe Cox, who was really passionate about loneliness.

And it was sort of like magical timing 2018 because you had this minister of loneliness. You had a commitment from the government to embed a strategy in their national health care plan to reduce loneliness.

And you had these different examples of social prescribing cropping up all over the country. That story I just told about Akilah and Joanne, that was one of them. That was a really early example of social prescribing popping up in a city organically.

And so what the UK did ultimately in 2019 was formalize this. They said, we're going to invest in social prescribing. We're going to invest in the creation of this position called the link worker. Link worker is someone like Joanne who sort of serves as a sort of link between the doctor and the community. That way, when a doctor comes and sees a patient who might have some non-medical issues, they could just say, okay, I'm

I'm going to pass you on to the link worker who can have some time to really get to know you, what matters to you, and who also has knowledge of what sort of activities, resources, services are in the community.

Sure enough, the UK found that this was a really effective investment. The number of people going to the GP decreased in places where social prescribing was implemented. The number of emergency room visits decreased by about 28%.

The link worker actually saved the practice money because, again, think about that lonely Friday night repeat visitor. That person through a link worker would no longer be coming to the hospital. They would be connected to other people in their community.

And, you know, I don't want to be too, too, too like rosy about it because there have been a lot of challenges implementing it in the UK and elsewhere. It's increasingly starting to come to the United States. Ultimately, it makes a lot of sense, like investing in non-medical prescriptions for people with non-medical needs who are taxing our health care system and

is a really good idea no matter what kind of healthcare system you have. So let's talk about that. You alluded to it's coming to the US. We are a very large country. We are a country that does not have a national system, state by state. We have got the diagnose, treat, repeat approach that you discuss.

Where do you see us headed with this? Where do you see inroads? You told us a story already of a person in Vermont who was able to access a nature prescription. What do you see as possible for us? And you've got your finger on the pulse. You go to so many of the cutting-edge conferences in this space. Talk to us about that. Sure. Well, I'll admit for all of the reasons that you mentioned, I was really skeptical about social prescribing in the U.S. You know, I thought this would be a book where

Okay. I go and I report on how it's working in the UK and all this. And then I try to like make the case that this has to happen in other places, but never the US, right? Because of all the things you say, we have big pharma, we have tremendous health inequities. We're the only nation of this size where a substantial proportion of people don't have health insurance. Right.

We have all these shortages in providers. We have this epidemic of what's called moral injury, like health workers in the field feeling increasingly demoralized by it, like they can't make good choices for their patients. And so I was really skeptical.

But here's the thing. Doctors are amazing and therapists are amazing. And in spite of these limited resources and these cultural barriers, they ultimately do want to do what's best for their patients. And so, yes, we have this national system. But when I tell the story of what's worked for social prescribing in the U.S.,

We have a lot of stories of really innovative individual doctors and therapists and their teams coming up with innovative ways to address small slices of this. So some of them look like, for example, in Boston, there's been a tremendous movement to – it began in Boston but has now spread to other places –

to actually prescribe legal aid in response to medical problems. This has been found in places where it's tried to also, lo and behold, reduce hospitalizations, improve health outcomes, the kind of data magic points that are needed for local systems to keep reinvesting in this.

We also have lots of individual passionate doctors prescribing small slices of these five core elements that the book focuses on.

There's a movement that started in 2005 called Walk with a Doc, which is the story of basically this doctor in Ohio, kind of like Ollie and Frank story, who just said, you know, I know what you really need is an opportunity to move and to make it fun. So I'm going to walk with you in the park every Saturday and I'm going to invite my other patients to join.

Started in 2005, this concept has now spread to 500 different chapters around the world. A similar story with Park's prescriptions. Started in California, has now spread all over the country. And what's really exciting is ever since I wrote this book, there's been more and more momentum for arts on prescription prescriptions.

really innovative pilot in New Jersey, in which New Jersey PAC, a local arts provider, has teamed up with an insurer, Horizon Blue Cross Blue Shield, to offer six months of art prescriptions to patients at risk of overspending on their insurance. And

And so you might be thinking, why would an insurance company invest in this? Well, that's exactly it. If we, for the same reason insurance companies are investing in gym memberships,

Arts prescriptions can also have those same preventative health effects. It could be seen as a sound investment for a health insurer, which is why just a couple of weeks ago, Massachusetts announced the first statewide arts prescription program with an insurer. So the momentum is building community by community, state by state. And I think it's also important to acknowledge that

We, you and me, not you and me specifically, but we as consumers, I think also kind of contribute to

this culture of diagnose, treat, repeat, I will say that I myself, you know, I'm a big seeker of quick fixes. Like just before this interview, I had like two iced coffees and, you know, I'm running on super little sleep right now. And I know this isn't good, but I also know this is my culture and it's going to take all of us to acknowledge the importance of these prescriptions in our lives if we really want that systemic change to happen too.

Julia, there are two questions I always finish the podcast with. The first is that the theme of the podcast is curiosity. What are you most curious about today?

What a great question. You know, there's been a lot of talk about youth mental health, and that is something I wish that I had touched on more on in the book. And I am most curious about what is going on in the minds of young people right now. Do they think that we're telling the story on youth mental health accurately? I would love to know how they jive or don't jive with social prescribing. Because I think that, you know, that's another piece of this. Like,

the healthcare system we're building now, it's not just for us, it's for our future. There is so much in your book, and I always feel like I can never get to all of it. In fact, if you saw my list of questions here, there's so many I have to skip just for time constraints. And I just want to ask you, is there one thing that I haven't asked that you'd like to leave us with?

Hmm. That's a great question. And, you know, sure. I'll say if there's one thing that I think that I hope your listeners would take away from this conversation from the book, it's this, you know, social prescribing. Yes. It's a specific practice. It's a specific idea. It's a specific movement.

But it's also a way we can live our lives in the direction of more joy, meaning, and relationships. Ingredients we know we need to thrive. And

I think that this book packages the story of social prescribing in stories about the power of movement and nature and art and service and belonging. But those five things are really just gateway drugs for us to be more present in the world. Something that I think we all need.

deeply, deeply want, whether we identify as someone who is sick and has symptoms or we just occasionally don't feel well. I think it's something that we can all use more of in our lives. And I would hope that people don't think, you know, I'm trying to preach any one account of this. I think the question of answering what matters to you to get there is really important.

Is there any one thing you've changed, anything that's then become different for you as a result of doing this research, talking to these folks, writing this book, anything that you've put into practice for yourself around connection, social connection, social health?

Absolutely. I think all of it, all of them, all the above. I might have mentioned this before we started recording, but I've been researching this for a long time. And for a while I told myself like, okay, I'm doing this because I'm a journalist and this is a cool story. And it seems to me that this is growing all around the world. But as I wrote the book, I

as I listened to the stories of the people who received social prescriptions, I was like, oh my gosh, like this, this is me. I need this. This is why I'm doing this. Like I, even though I haven't thankfully very privileged not to have been, you know, diagnosed with a formal disorder, like I really identify with some of these symptoms sometimes. And I,

Now I use their stories as a guide. Like when I am feeling really stressed and like my to-do list is endless, I will go and take, you know, 10 minutes for myself outside. When I am feeling really sad about something and like I just want to lay in bed all day or

I will think about the people who did the opposite and got out of bed and moved their bodies, something we know is effective for some of the symptoms of depression. I will do that. When I find myself really worried about something, I will try to immerse myself in some piece of art.

So that's a long answer, but I really live by this stuff. And I never imagined myself as being a health author because Lord knows I am not always the healthiest person. But I think that's the beauty of this movement is like you don't have to be. It's really about using science and designing your own sort of medicine based on what matters to you.

Thank you so much, Julia. It has been such a pleasure to speak with you. It's such a great book. I appreciate that you're sharing that it's also worked for you. And it's something that you've almost sounds like you've made a practice in your life. Thank you so much. Thank you so much, Gail. Back at you. I'm such a fan of you and this podcast. It's such an honor.

Curious Minds at Work is made possible through a partnership with the Innovator Circle, an executive coaching firm for innovative leaders. A special thank you to producer and editor Rob Makebelli for leading the amazing behind-the-scenes team that makes it all happen. Each episode, we give a shout-out to something that's feeding our curiosity.

This week it's an exhibit called Subversive, Skilled, Sublime. Fiber art by women featured at Smithsonian's Renwick Gallery in Washington, D.C. Women's work with cloth, thread, and yarn was often dismissed, but artists in this exhibit challenged that thinking with their incredible creations.