Summary of recent publication on social prescribing: Social prescribing in the USA: emerging learning and opportunities
The Lancet recently published an article about emerging lessons learned from social prescribing practice across the US. Social prescribing is defined as a means for trusted individuals in clinical and community settings to identify non-medical, health-related social needs and connect individuals to non-clinical supports and services within the community through a “non-medical prescription” to improve health and well-being and strengthen community connections5. While social prescribing has been more widely adopted in countries with national health services, the USA presents a unique context due to its heterogeneous and largely privatized health system1….
The study investigated 23 examples of arts, culture, and social prescribing programs across 11 states6…. Historically, US social prescribing efforts primarily focused on addressing basic needs like food, housing, transportation, and employment3…. However, these emerging programs show an increasing scope, incorporating varied activities to holistically support health, including nature-based activities and, particularly, arts and cultural activities such as music lessons, museum visits, and workshops, reflecting a growing body of evidence for their health benefits8. While many programs now focus on diverse activities, some still integrate support for basic needs8. Programs leverage existing community assets and often involve discussions with participants about their preferences, allowing for flexibility in response to changing public health needs9. Participants are not restricted to a specific demographic and can be referred from various sources beyond healthcare, such as schools, universities, insurance companies, caseworkers, and neighborhood groups, or even self-referral10. Programs target various health issues, including mental health, social isolation, childhood obesity, and addiction, and can focus on underserved groups or be open access6…. Some initiatives are emerging that involve families11.
The research identified several key barriers and enablers for implementing social prescribing in the USA:
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Barriers include the significant challenge of funding, with programs facing delays, inflexible structures, and difficulty securing long-term agreements, which can force reliance on volunteers and undervalue the work12. Communicating with overloaded healthcare providers can also be challenging13. Furthermore, making programs accessible and engaging to participants faces hurdles like limited awareness, lack of language translation, digital exclusion, and practical issues such as transportation, childcare needs, and associated costs14. High staff turnover is also a major barrier15.
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Enablers involve the crucial role of partnerships across various organizations and sectors, which contribute referrals, delivery support, and strategic links13…. Employing skilled staff (including link workers and activity providers) and investing in their training is essential for building trusting relationships with participants and effective program delivery15…. Programs taking action to address accessibility issues, such as providing travel or food and scheduling activities mindfully, are better positioned for success14. Using technology to streamline processes and match participants to activities, as seen in some innovative programs, can also be an enabler18.
While systematic reviews have noted methodological weaknesses in the broader evidence base, the quality of evidence for social prescribing is increasing, with more randomized controlled trials being published or in progress19. Nearly 350 different outcomes have been explored, encompassing individual health, lifestyle, behaviors, and health system outcomes, including health service use and economic savings19. The US examples specifically highlight the potential of social prescribing to lower the costs of healthcare and provide better support for Americans20. Novel funding models, such as a health insurance company funding a program for members at risk of high spending, demonstrate the potential for cost savings within a privatized system21. Ultimately, the article argues that social prescribing offers potential cost savings and health benefits as a public health tool22.
The findings suggest that social prescribing is already active in the USA, exhibiting varied activities, target populations, and models22. The work highlights that successful implementation is possible even within a largely privatized health-care system4…. To reach its full potential, further action is needed to address the identified barriers, leveraging the existing community assets across arts, culture, nature, and community sectors that are currently disconnected from those who could benefit22.