Evohealth / I’m not ok. Is social prescribing the answer?

I’m not ok. Is social prescribing the answer?

Sep 17, 2023

Today we are encouraged to ask R U OK? A day to connect with someone who may be struggling with life, to listen and encourage action.

Humans are a social species. We value connection. In the widely popular book Sapiens, Yuval Noah Harari notes that “Evolution favoured those forming strong social ties.”[1] In fact, it is these social ties that have allowed humans to dominate the globe.

But what happens when we are no longer connected, or our social ties disintegrate?

Indicators of social connectedness include social capital, social support, social isolation and loneliness.[2] Loneliness alone is associated with increased mortality and morbidity.[3] One meta-analysis estimates that individuals who are lonely carry a 26% greater risk of an earlier death compared with those that feel more socially connected. This is in addition to increased levels of chronic disease, hospitalisation and utilisation of the healthcare system.

Loneliness is a societal issue, and not for the individual to solve. Surprisingly, the ‘social’ in the widely accepted social determinants of health, as one of the non-medical factors that influence health outcomes, is not prioritised.[2] Other areas such as economic stability, housing, education and our built environment get greater attention with policymakers.

Where social connection is still valued, we can see extraordinary health benefits to the population, in particular the elderly. In his two decades studying the lives of health ageing societies around the world, Dan Buettner has discovered that social connection is a vital component across ‘blue zones’. One such zone and a place of intense research for Buettner has been Okinawa, Japan. In this tropical island there is a tradition of Moai. These are social support groups, usually five or six people, “…a cultural tradition for built-in companionship.”[4] Originally, these groups were formed in childhood and provided financial support. Today they can meet several times a week ‘for a common purpose’ which can include singing, dancing, chat and social connection. It is no surprise then that Okinawa has the highest number of living centenarians in the world. Bringing this learning to a busy, modern world though is not without its challenges.

The United Kingdom is leading the way with a social prescribing framework for connecting patients with services that support the ‘social’ in social determinants of health. Focusing on a personalised approach with “…practical, social and emotional needs that affect their health and wellbeing.”[5] NHS England is working toward embedding social prescribing across primary and community care, including social prescribing link workers in their Primary Care Networks.

As we hurtle forward toward a more digital world, days such as today remind us that some solutions to improving health outcomes sit well outside those that we have become familiar. That while, digital health can provide numerous benefits to delivering healthcare, we are inherently social beings in need of connection with each other to best support our health. Managing this in a structured way for our most vulnerable, through social prescribing, could very well be a cost-effective answer to much of the health burden that too many of us face.

[1] Harari, Y. Sapiens: A brief history of humankind. London. 2011

[2] Holt-Lunstad. Social connection as a public health issue: The evidence and a systematic framework for prioritising the “social’ in social determinants of health. Annual Review of Public Health. Vol. 43:193-213. April 2022. https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-052020-110732

[3] Hawkley.L. Loneliness and Health. Nature Reviews Disease Primers. 8. Article number 22. 2022. https://www.nature.com/articles/s41572-022-00355-9

[4] Blue Zones. Moai – this tradition is shy Okinawan people live longer, better. https://www.bluezones.com/2018/08/moai-this-tradition-is-why-okinawan-people-live-longer-better/. Accessed 14 September 2023.

[5] NHS England. Social prescribing. https://www.england.nhs.uk/personalisedcare/social-prescribing/. Accessed 14 September 2023.

Renae Beardmore

Managing Director, Evohealth

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