I'm a doctor now

Social prescriptions are an emerging way to provoke change among planners and engineers.

It took two years and nearly 50 emergency-room visits for Dr. Ardeshir Hashmi to realize he didn’t need to prescribe pills for his 93-year-old patient’s excruciating chest pains. He needed to prescribe ballroom dance.

Years ago someone sent me a story about a doctor prescribing walks to his patients who weren’t happy with their anti-anxiety medications. A few months ago I learned this has a name, and is quite the movement among open-minded health professions.

Social prescribing is a way for healthcare professionals to prescribe non-medical interventions to patients to improve their health and well-being. These interventions can include activities such as exercise classes, art therapy, and community gardening. It starts by recognizing people’s wellness is determined mostly by a range of social, economic, and environmental factors. 

I suppose I define it as anything that the patient and the link worker think will help get them to a better place.

—Dr. Michael Dixon, Chair, College of Medicine and Integrated Health

Social isolation increased nationally from 2003 to 2020, according to the American Time Use Survey. Americans spent an annual daily average of 333 minutes in social isolation by 2020, representing a notable increase from 285 minutes in 2003.

Remember, isolation and loneliness are major public health issues associated with higher risks of premature death. And as you already know, they can be addressed through good urbanism. 

When all our land uses are spread across creation, we have to be deliberate about engaging with others. Let’s face it, social studies keep showing we aren’t good about going out of our way to make healthy life choices. But there’s a huge opportunity for infrastructure experts who realize it’s possible to design spontaneous interactions into the built environment. Even in a single-family neighborhood, local zoning could be reformed to allow retail within walking distance. (Or a thousand other examples you could come up with.)

We’re still in the early days of this movement.

So far, social prescribing is supported by a patchwork quilt of studies, each making a point about a singular aspect of social prescribing, but none able to speak on its value as a whole. —TIME, June 15, 2022

This stuff is harder to measure than tracking changes following pill consumption. Harder, but not impossible. It takes an open mind, willing to connect the dots.

There are some studies that show the benefits of volunteering, and they give you very concrete directions: two hours a week is enough. That’s something measurable, in the same way that I give doses and frequencies for medications.

—Dr. Carla Perissinotto, geriatrician-scientist at University of California, San Francisco

Transportation engineers and city planners can design public spaces that encourage social interaction, including connections between spaces that feel inviting to walk or ride a bike. But it’s going to be hard to break down those silos institutionally because planners and engineers are so accustomed to staying within their standard areas of work. “Feeling good about life” isn’t usually on the radar of infrastructure experts. 

Both the American Planning Association and Institute of Transportation Engineers have formal programs about the links between health and infrastructure. Arguably, they’ve had little effect, but they exist. It’s at least a starting point for you to demonstrate ideas like social prescribing can be incorporated into infrastructure planning and design. Status quo professional organizations are saying the right things. Let’s help them follow through. 

I bought a lab coat as an “I’m not really joking” prop for events where I speak about the links between health and infrastructure. It’s a reminder that anytime my work improves the built environment, I’m basically a doctor, handing out social prescriptions left and right.

(They’re cheap on Amazon if you’re interested.)