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Would you expect your doctor to prescribe a swim in the ocean, arts and crafts, or volunteering in a garden? Doctors around the world are now doing just that. They prescribe connection with nature and other people as real treatment for anxiety, chronic pain, depression and more. Health journalist Julia Hot says this isn't just a wellness trend. It's called social prescribing and it's backed by scientific research. Doctors are building it into care plans and tracking its impact with real data. Julia traveled the globe to report on this approach and wrote all about it in her book the Connection Cure. Welcome to Curiosity Weekly, Julia.

Julia Hotz (7:05)

Thank you so much Sam. So great to be here.

Dr. Samantha Amin (7:08)

We are thrilled to chat with you about this. It's something I've been thinking about a lot lately is connection with other people and just getting out into nature more. I live in a city so, so it feels like something I need to like actively do, you know?

Julia Hotz (7:22)

Absolutely. You and me both. I'm also in New York City and you know, I used to think about getting out into nature and you know, going to museums and connecting with other people as maybe a nice to have. Right. But I was so fascinated by all of the scientific research that shows this is actually good for us on a physiological level.

Dr. Samantha Amin (7:43)

Yeah, that's so interesting. So for people who may be new to this concept, how would you define social prescribing and how does it differ from like the typical types of things we think about medically?

Julia Hotz (7:54)

Right. So a social prescription is a healthcare referral for any non medical resource or activity like you teed up in the intro, it can be for an art class, it can be for a bird watching club. And the idea is, you know, most medicine focuses on treating the symptoms of what's the matter with us. And that's really good. We want that, right? We, of course, we should have relief from our pain. But social prescribing flips the script and says we also need to be reconnected to what matters to us. Because health isn't just the absence of disease, it's also the creation of lasting well being. It's not a replacement for pills, it's not a replacement for therapies. It's about another option on the menu. But what's different here is that you're actually being prescribed a specific activity in the community to do that. It's the difference between saying, you know, Sam, you should go, you know, exercise more and saying, sam, I'm going to Prescribe you a 10 week cycling course. And get this, if you don't have a bike, insurance is going to cover that.

Dr. Samantha Amin (8:58)

And giving that prescription, it legitimizes things. And it also, as you mentioned with the insurance, makes it more feasible.

Julia Hotz (9:06)

Listeners might be wondering why would a private insurance company do that? And I think it has to do with increasing data that suggests when people are in, in an environment that de stresses them, that connects them to other people, that has all of these health promoting features, people are less likely to get sick, people are less likely to need medicine and therapies and surgeries. And actually this lowers the cost of care, lowers the rate of hospitalization over time. The idea is, you know, you would work with a trained health professional to really understand what does matter to you, what does motivate you and what's available in your community to help help you do that. You know, time and nature, it shouldn't just be reserved for those who have a car and free time. It should be viewed as essential medicine because it is. And we as healthcare need to lower the barriers to make that possible.

Dr. Samantha Amin (10:02)

What does the scientific evidence say about how effective social prescriptions are for things like depression, anxiety, chronic pain, loneliness, you name it.

Julia Hotz (10:12)

So let's talk about, you know, first of all, social prescriptions. My book structures them around five key pillars. Movement, nature, art, service and belonging. And there's a very robust body of research showing that moving our bodies is really good for us on so many different physiological levels. It increases our serotonin and endorphins. Being engaged with nature and art likewise tends to reduce our cortisol production. It tends to lower all these inflammation markers. And so much compelling longitudinal data finds that when, when we engage with other people in a meaningful way, when we volunteer, when we feel a strong sense of connection to them, this too has all these health promoting effects. It's been associated with greater longevity, lower risk of cognitive decline, cardiovascular risk, dementia. And I think it has to do with the way that actually our bodies evolve to engage with these five things. So when we don't have them, our bodies respond and when we do have them, our bodies respond positively. So that's why there's so much evidence suggesting that nature prescriptions, for example, are really good with disorders involving attention. Art prescriptions have been deemed as really effective for anxiety movement prescriptions for depression. And then when you look at places like the uk, where there's been social prescribing in place for a long time, you see some pretty interesting national health outcomes such as, you know, people improve their mood, lower their loneliness over time and that this translates to real gains in the healthcare system. Less hospitalization, fewer primary care visits, you know, return on investment. Because those people instead, those, for example, lonely older adults, tend to be very, very costly for the healthcare system. If those folks are now getting their connection and de stressing, you know, activities from someplace in the community and they're not coming the hospital, that's a big win for the healthcare system.

Dr. Samantha Amin (12:21)

That makes a lot of sense and also makes it nice that you're getting that more direct guidance on how to go about it. It's not just generic because every person will benefit from a different manifestation of those five, you know, might look a little bit different for everyone.

Julia Hotz (12:35)

Exactly. Yeah. I like thinking about them as, you know, the book is set up so that you're really learning about the science of the five and you're learning case studies of the five, but more often than not they're a combination of all the above. The most important thing is that it's really rooted in what matters to the person. You know, we're not going to be like forcing farm work, somebody who hates that. Right. That's the key.

Dr. Samantha Amin (13:04)

There's some criticism of social prescribing and I love that you engaged with it. Even in the book. Some people say social prescribing's kind of fitting into that paternalistic model of healthcare where the patient is a more passive observer in their care rather than being at the center of their own health. Like, shouldn't they be driving the connections that they want? What's the right balance to strike there with when it's time for a doctor to intervene and you know, kind of guide you towards the friendships and settings you need versus when it should be all up to the person at the.

Julia Hotz (13:36)

End of the day. You know, I think I was one of those critics who said, why do we need social prescribing? Can't we just prescribe ourselves these things? And the thing is, I don't. First of all, opportunities for connection, engagement with nature, engagement with the arts. It is becoming easier and easier to find that, I think, because culturally we're realizing how important it is. And I think more and more, you know, for people who don't know where to begin, social prescribing is popping up as a first step. I think a lot of times also in US Healthcare, we will wait and wait and wait and wait and wait until we have to go to the emergency room. And that's why at the end of the book, you know, after being so inspired by, for example, the woman who receives a sea swimming prescription for her depression, or the man who receives a culture prescription for his anxiety, I really started to see myself in their stories. Not to suggest that, you know, my suffering is equivalent to theirs, but all of us are bound to experience some traces of anxiety, depression, chronic pain at some point in our lifetime. And if we could do social prescribing proactively, if we could say, you know, I am feeling really distracted today, I'm going to prescribe myself nature, because the research suggests that nature helps us restore our attention, I'm going to do that. I think it's preventing and it's building the good habits that could potentially mitigate that buildup. Where you have to end up in the emergency room.

Dr. Samantha Amin (15:11)

Are there other ways that individuals can begin to self prescribe community, movement or art in their own lives, even if they're not able to access a formal program or doctor's order?

Julia Hotz (15:23)

One is just by getting really granular in that what matters to you question. And I like to ask questions like if you had two more hours in your week, what would you spend it doing? What's something that you loved to do as a kid but haven't thought about since? What's an example of an activity that puts you in a state of flow? You could spend seven hours doing it and not think about anything else. When was the last time you experienced awe? You know, full body goosebumps that just the wonder of the world. So really think about your answers to those questions. And then another way you could approach it is by what the science says is the opposite of the symptom. So for example, when I Am feeling really stuck or sad or ruminating, and I just want to, you know, lay in bed and doom. Scroll. The research tells me that as counterintuitive as it is moving my body, as hard as it feels moving my body is going to reduce the activity in my prefrontal cortex, which is associated with rumination. That's what I do when I'm feeling like I have 72 tabs open and can't seem to focus on anything. That's when I know I. I need a dose of nature. Just 20 minutes, the research suggests, is enough to get these physiological benefits. When I am feeling really anxious about something, you know, worried about my older parents, for example. Art can be so good at putting us in a state where we're outside of our heads. We're focused on the beauty of something else. If we're feeling really angry and frustrated and grumpy and sorry for ourselves, service to other people can reverse that. And finally, when we're feeling lonely, which we're all bound to feel, I mean, that's the big conclusion of this book. All of us in this vastly disconnected world are bound to feel lonely. At some points, prescribing ourselves sources of belonging, whether it's through joining a community potluck, whether it's through getting involved in a local cause, whether it's through volunteering at a community garden, this can have the opposite effect and make us feel like we belong.

Dr. Samantha Amin (17:35)

Was there a certain moment during your reporting around the world that just fundamentally changed your understanding of the connection between this more social side and social connections and nature and health?

Julia Hotz (17:48)

It's a great question because, yeah, my path to reporting on this was not direct at all. I actually used to be a researcher in loneliness. You know, what is it? What causes it? What are some solutions to it? And in my mind, I'd had this very sort of stereotypical picture of what loneliness was that tended to happen to older adults, that it tended to happen when you were physically isolated. But it turns out, first of all, loneliness is associated with increased anxiety, depression, stress, even chronic pain because of the way that loneliness acts in our bodies. Loneliness is actually a very adaptive thing. It signals our need to reconnect with other people because evolutionarily, we needed to feel a sense of belonging with people. We needed to cooperate with them in order to survive. And so I became really interested in the way that loneliness is not just this particular thing affecting older adults. It actually impacts so much of our health. And so I was really curious, first of all, and what is the opposite of loneliness? What works to then first tackle loneliness, but then tackle all of these other related ailments. And so that's what got me super turned on to social prescribing. And I think it's always the sign of a good idea when it's not just happening in one place. Social prescribing is now happening in 30 places of all different sizes, all kinds of healthcare systems, and the evidence for it just grows and grows every day.

Dr. Samantha Amin (19:19)

Are there any resources that you'd recommend?

Julia Hotz (19:22)

The book's website socialprescribing co. They've got a ton of research that appears in the book on Again, why are these five things so good for us? As well as a directory of free or donation based activities people can prescribe themselves. And by the way, that directory is crowdsourced. So if you're listening to this and you're thinking, I know of a great program, please reach out and add it to the list. It's growing every day.

Dr. Samantha Amin (19:48)

Julia Hotz is a health focused journalist and author of the Connection Cure. You can find the book and the resources at SocialPrescribing co. Check it out in the show notes. Thank you so much for joining us Julia. That was so fascinating.

Julia Hotz (20:02)

Thank you so much, Sam. It was so great to be here.

Dr. Samantha Amin (20:08)

In any piece of creative work, whether it's books, movies, tv, music, this podcast, even, there's a secret math equation going on behind the scenes. It convinces you to consume the work, it keeps you engaged, and it explains how you feel about it after it's over. I'm talking about familiarity versus novelty. The push and pull between these concepts can dictate how we perceive a piece of art and explain a lot about culture at large. Let's use music as an example. If a song has too much novelty, think of something very avant garde that doesn't follow a traditional structure. It's probably not going to get millions of streams on Spotify. On the other hand, if a song has no sense of surprise or novelty involved, if it's too familiar, it can be totally boring or unoriginal. So recently a research team from Carnegie Mellon and Indiana University Bloomington set out to quantify what the ideal ratio between familiarity and novelty is that makes a piece of art popular. And they did so by using a very unique and fascinating data set. Fanfiction if you don't know what fanfiction is, it's where fans of really anything can write their own stories that reimagine or expand on characters, plots, or settings from their favorite creative works. It's only online and it's wildly popular on certain niche corners of the Internet, and it has a few major differences from other kinds of art that make it fit well with this research. First off, you can't legally sell fanfiction because someone else owns the right to the intellectual property. As a result, fanfiction is free, so the writers aren't making any money off what they're doing. Their payoff is getting read, getting comments, or just the joy they get from writing. There's no traditional advertising or promotion, but the readers can like leave comments, bookmark, and even interact with the authors while they're still writing the story in real time. The sites hosting the fanfiction keep clear and concise metrics so there are fewer variables in collecting the data compared to other art forms. Going back to music, there's a lot of external factors involved that makes it difficult to measure what the researchers were looking for. Things like media coverage or advertising dollars or fame. They influence how you and I hear a song or album. You can imagine how hard it would be to calculate novelty and familiarity when there are so many pieces of social influence at play. So the research team analyzed 671,908 fanfiction stories from 23 different fandoms. Then they used machine learning to measure how familiar each one felt, from the plot to the setting to structure to the characters. And then they compared that to how much readers engaged with it. They hypothesized their findings would align with something called balance theory, which suggests that we like things that have a perfect balance of convention and innovation, familiar and new. But it turned out that the exact opposite was true in fanfiction. When it's familiar, that actually beats novelty, and that contradicted their original hypothesis to an extent. The familiarity attracts the readers, but the more novel, the more likely readers were to express enjoyment. Come for the familiar, stay for the plot twist. By teasing apart these two different forces, it can help explain phenomena beyond fanfiction and show us that human culture works the same way. Most of the time, you're sticking to what you know, to what you're familiar with. But actually, every so often when something brand new bursts onto the scene and shakes us up, it changes our very definitions of what's normal and pushes our culture forward. Before you go, we love hearing from you about what science topics pique your curiosity. Rate and review us on Apple Podcasts or Spotify and let us know what you're into. Or you can me at Science Sam. We may just feature the topic on an upcoming episode for Warner Bros. Discovery Curiosity Weekly is produced by the team at Wheelhouse DNA. The senior producer and editorial correspondent is Teresa Carey. Our producer is Chiara Noni, our audio engineer is Nick Kharismi and head of production for Wheelhouse DNA is Cassie berman. And I'm Dr. Samantha Yuin. Thanks for listening.

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