A Community Connection

The social prescription approach takes healthcare beyond the clinical setting

Dr. Heidi Prather

As roughly 60% of the U.S. adult population struggles with at least one chronic disease, the country’s overall approach to treatment is sick care not healthcare, said Heidi Prather, DO, FAAPMR, Sports Medicine, CAQ, attending physician, Hospital for Special Surgery (HSS), Department of Physiatry, New York; professor of physical medicine and rehabilitation, Weill Cornell Medicine, New York; and medical director, HSS Lifestyle Medicine Program. She also serves as a diplomat to the American College of Lifestyle Medicine, Chesterfield, Mo.¹

In her keynote speech to the members of the ARP at ACR Convergence 2025, Dr. Prather discussed social prescription, an approach to the practice of medicine that expands the focus beyond the medical treatment of disease. With social prescription, a healthcare professional refers a patient to non-medical community programs designed to address various social determinants of health, such as loneliness, social isolation or insecure finances.

“It should be a personalized plan that promotes health, well-being and community connection,” Dr. Prather said. Patient engagement is central to success.

The Research

A U.K. study looked at implementation challenges of 20 link workers and social prescribing experiences of 19 clients. The term link worker covers a wide scope of industries, with people of various types of credentials who could be a health coach, navigator, social worker, nurse, physician or other medical worker. The study’s organizational approach emphasized a client’s personal responsibility for his or her health.²

“That is exactly what needs to happen,” Dr. Prather said. “But we as healthcare providers do a very poor job of enabling people to be a part of their own healthcare solution. That is a part of our system problem; that’s not an us problem.”

Researchers in the U.K. study found that a key benefit of social prescribing was significant help to some people with chronic disease. Challenges included embedding the approach within primary care and voluntary sector systems.

Other research on social prescribing showed that patients were more likely to enroll in the study program if they believed they would benefit from what was prescribed and if they had access to supported transportation to the first visit or activity, said Dr. Prather. Factors that contributed to the patient staying with a program included skilled and knowledgeable activity leaders and if the patient saw a change in symptoms or conditions.³

“There takes quite a bit of time for a symptom change, unless the person involved in the change really immerses himself, and I have data on that. So this expectation that one visit we’re all in doesn’t play out in the world that I’ve been working in,” Dr. Prather said, noting that sustainability is hard.

Even with challenges, social prescribing efforts have a shot at making a difference, said Dr. Prather. Another study showed that despite lack of standardized validation, missing data and other problems, most evaluations for social prescribing actually went toward a positive change.⁴

Impact on Providers

For healthcare providers, beware of burnout among those leading efforts to implement social prescribing. Exhaustion, no energy, mental distance and negative feelings related to your job is something “we all know about,” she said.

Cultivate a support system with colleagues to implement workplace interventions and promote cultural change and workload modification, Dr. Prather advised. Foster social support within small groups of people who you work with both in-person or virtually. She noted that working for change within a large system can be more difficult.

“Connection is really, really important for you as a provider,” she said, adding that sunlight and nature also bring bountiful benefits.

Lifestyle Medicine

Dr. Prather continued her discussion with highlights about programs she helped develop at Washington University School of Medicine, St. Louis, and her current post at the HSS Lifestyle Medicine Program. She began by naming other types of medical practices: integrative, alternative, functional and preventive, and conventional medicine.

“Then there’s lifestyle medicine, which is looking at root cause aligned with behavioral change, and we have very strong evidence that this works,” Dr. Prather said. “So lifestyle medicine focuses on educating and motivating patients around six pillars of health, which is including nutrition as whole food, plant, predominant diet, lifestyle, regular activity, physical activity, restorative sleep, managing stress, social connections, as well as avoidance or minimizing risky substances.

“The big difference in this, it’s all evidence-based and requires the patient to engage,” she said. “I cannot passively ask somebody or force them to sleep better. It doesn’t work. So these six pillars, again, are really important.”

Patients are not ready or likely to engage in their own healthcare if they don’t understand how different aspects of the pillars are related. This lack of understanding can lead to a sort of revolving door, with a patient coming back in the office six months later for the same unresolved issue, noted Dr. Prather. Health literacy is a key element in lifestyle medicine, she said, because better literacy is related to better outcomes.

Dr. Prather tells patients that progress to a healthier diet is just that and does not require overnight change. She reminds providers that you have to meet patients where they are, whether they’re closer to two than five on the interest in participation scale or they bought the shoes but haven’t yet made it out the door to exercise.

Catherine Kolonko is a medical writer based in Oregon.

References

1. Carney TJ, Wiltz JL, Davis K, et al. Advancing chronic disease practice through the CDC Data Modernization Initiative. Prev Chronic Dis. 2023 Nov 30:20:e110.
2. Pollard T, Gibson K, Griffith B, et al. Implementation and impact of a social prescribing intervention: An ethnographic exploration. Br J Gen Pract. 2023 Sep 28;73(735):e789–e797.
3. Husk K, Blockley K, Lovell R, et al. What approaches to social prescribing work, for whom, and in what circumstances? A realist review. Health Soc Care Community. 2020 Mar;8(2):309–324.
4. Bickerdike L, Booth A, Wilson PM, et al. Social prescribing: Less rhetoric and more reality. A systematic review of the evidence. BMJ Open. 2017 Apr 7;7(4):e013384