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Heart disease is the number one cause of death for women in the United States. Most of us are familiar with the general advice: exercise more, eat better, stop smoking, manage stress. But even with the best intentions, these instructions can seem abstract, especially if you live in a neighborhood where there’s no safe place to walk, you can’t afford fresh groceries, or you don’t speak to another person for days. What if your healthcare provider could connect you with a community choir, give you a voucher to the farmers market, or ask you to sign up for a guided walk through your local park and call it medicine?
That’s the idea behind social prescribing.
What is social prescribing?
Social prescribing is a referral system that connects people with non-medical, community-based resources and activities to address the underlying conditions that shape their health. Think of it as a bridge between your doctor’s office and the rest of life.
Julia Hotz, journalist and author of The Connection Cure, the first book on social prescribing, has tracked the movement’s spread from the UK to more than 32 countries. “Social prescribing gets its name from the way it aims to address the social determinants of health,” she explained. “This means that people without access to green spaces, people without access to healthy food and people without access to strong social supports would experience further health inequalities.”
Hotz identifies five pillars of social order: movement, nature, art, service and social connection. It is not a substitute for medication or surgery. But it is a powerful complement to both, a way to treat the whole person, not just the diagnosis.
The hidden heart risks in your social life
When most people think about the risk of heart disease, they think about cholesterol, blood pressure and smoking. But decades of research point to something deeper: Your social world shapes your cardiovascular health in ways that may surprise you.
People with poor social health had a 30% higher risk of developing coronary heart disease and stroke, according to a systematic review of 23 studies. Adults who rarely or never received social support were almost twice as likely to accumulate three or more cardiovascular risk factors – including high blood pressure, high cholesterol and diabetes – compared to adults with high levels of support. And loneliness takes its own toll: A 2025 study found that people with chronic loneliness had a 56% higher risk of stroke, even after accounting for depression and social isolation.
Read: How to Socialize When You’re Lonely >>
The biology behind it is straightforward. Stress, loneliness and depression each increase cortisol and inflammatory markers, raise blood pressure and disrupt sleep – all recognized risk factors for heart disease. For this reason, although social prescribing emerged as a response to mental health crises, it is also increasingly recognized as a cardiovascular intervention. In fact, a 2025 study published in Frontiers in Public Health specifically examined societal prescriptions for heart health and found strong associations between prescriptions that include contact with nature, physical activity, and healthy living initiatives and improved cardiovascular outcomes.
“It’s true that social prescribing has a track record of treating stress, loneliness, anxiety and depression, but it can also promote heart health through exercise or nature activities, which are known to reduce stress on the cardiovascular system,” Hotz said.
As a prime example, Hotz cites “Walk with a Doc,” which was started by a cardiologist in Columbus, Ohio, and now operates more than 500 chapters worldwide. “I have spoken to many people who have directly improved their cardiovascular health through these walks,” she said.
The power of the recipe
Why do patients need a prescription for something they can do themselves? Experts point to the “authority effect” of a formal regulation. When a healthcare provider says a social activity is part of your care plan — and not just a nice idea — patients take it more seriously and follow through.
“If your doctor says this is an important part of your health and wellness journey, you’re more likely to do it,” said Adrienne Hundley, director of community strategy at SocialRx, a nonprofit that connects patients with arts, culture and community-based experiences.
A prescription can also reduce the financial burden of participating in community activities by tying them to formal treatment plans so that they can be covered by health insurance, which may work with organizations like SocialRx. Additionally, the Medicaid and Medicare Advantage programs are increasingly addressing social determinants of health through wellness initiatives that include social prescription coverage. Beyond insurers, funding can also come from hospital health equity programs, public health grants, or community nonprofits.
SocialRx covers member participation costs, offers programs in Spanish and other languages, and often includes transportation assistance. Care navigators handle logistics and act as accountability partners, checking in after each experience and helping patients stay on track. All of this helps to remove barriers that may prevent patients from engaging independently.
SocialRx’s model includes 12 monthly doses of community experience over a year. Hundley tells the story of an elderly woman who was nearly housebound for over six months. Her care navigator connected her with a community choir. She went there once, came back and by the third month she was filling in as a piano accompanist. She ended up being the assistant choir director at the senior center several times a week. “I found my people, I found my community and I found a new life,” she told the team. Such a transformation can have strong physiological effects.
According to SocialRx, nearly four in five of its members with positive indicators of mental health problems – anxiety, depression or loneliness – show improvement after the last dose, as measured by the World Health Organization’s Five Well-Being Index. Given the links between these diseases and cardiovascular risk, these numbers could also have implications for heart health.
Social requirements require a personalized approach
Social regulations can look completely different from person to person, and that’s exactly the point. Hotz describes one of the most surprising examples she came across while researching her book: a dementia care farm. “It kind of flipped the script and allowed people with dementia to take over the care,” she said. “Many of them found that being on the farm helped them feel healthy – they felt that working on the farm didn’t remind them of their dementia.”
Hundley has also experienced unexpected changes through SocialRx, which intentionally takes a broad view of what counts as healing. “People love getting their hands on something,” she said, describing a range of offerings ranging from handmade ceramics to expressive journaling to architectural tours that help patients understand the history of their own communities. In San Diego, children get to know a local circus school. In Boston, participants design and model their own fashion creations using reused materials.
What unites all of this is the underlying premise: that a recipe tailored to what really interests and concerns a person is more likely to last and more likely to heal.
A change in the way we think about health
Hundley sees the current moment as analogous to a cultural shift that has already occurred through movement. “We often compare it to how 50 years ago people didn’t see their physical activity as such an important part of health and well-being. But today it seems silly not to think about it. Hopefully in 10 to 15 years it would be absurd not to think about how our social health also impacts our well-being.”
For the millions of women struggling with or trying to prevent heart disease, this change is worth paying attention to now. It turns out that a healthier heart may need more than one pill. Sometimes you need a choir.
This educational resource was created with support from Merck.
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