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Heart disease is the leading cause of death among women in the United States. Most of us are familiar with the standard recommendations: exercise more, eat better, stop smoking and 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, if you don’t have easy access to fresh produce, or if you don’t speak to another person for days. What if your doctor could refer you to a community choir, give you a voucher to the farmers market, or tell you that you could sign up for a guided walk at your local park as if those options were medications?
This is the idea of social regulations.
What are social regulations?
Social prescribing is a referral system that connects people with non-medical community activities and resources to address situations that impact their health. Think of them as bridges between your doctor’s office and the other aspects of your life.
Julia Hotz, journalist and author of The Connection Cure, the first book ever written about social prescribing, has followed the movement as it spread from the United Kingdom to more than 32 countries. “Social prescribing gets its name from the way it takes into account social factors that impact health,” he explained. “Refers to the fact that people without access to green spaces, healthy food, and important social connections experience greater medical disparities.”
Hotz identifies five pillars of social prescriptions: physical activity, nature, art, service, and social connection. It is not a substitute for medication or surgery. But it is an effective supplement, a method of treating a whole person and not just treating the diagnosis.
The Hidden Heart Risks of 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 life influences your cardiovascular health in surprising ways.
According to a systematic review of 23 studies, people with poor social lives are 30% more likely to develop ischemic heart disease and cardiovascular accidents. Adults who rarely or never received social support were almost twice as likely to develop three or more cardiovascular risk factors, including high blood pressure, high cholesterol and diabetes, compared to people with strong social ties. And loneliness causes significant harm: A 2025 study found that people with chronic loneliness had a 56% increased risk of cardiovascular disease, even after the results were adjusted for depression and social isolation.
Read: How to Build Social Connections When You Feel Lonely >>
The science behind it is simple. Stress, loneliness and depression increase cortisol and inflammatory marker levels, increase blood pressure and disrupt sleep – all known risk factors for heart disease. So while social prescribing began as a response to various 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 identified important links between prescriptions that included contact with nature, physical activity, and healthy living initiatives with improved cardiovascular outcomes.
“It is true that social prescribing has historically addressed issues such as stress, loneliness, anxiety and depression, but it may also be helpful for heart health, as physical activities and contact with nature, which are known to reduce stress on the cardiovascular system, could be prescribed,” Hotz said.
As an example, Hotz cites Walk with a Doc, which was founded by a cardiologist in Columbus, Ohio and now has more than 500 locations around the world. “I have spoken to many people who have directly improved their cardiovascular health through these walks,” he said.
The power of prescription
Why do patients need a prescription for something they can do themselves? Experts emphasize the “official effect” of a formal prescription. When a healthcare provider says a social activity is part of your care plan, not only is it a good idea, but the patient will take it more seriously and follow instructions.
“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 creates connections between patients and arts, culture and community experiences.
Having a prescription could also reduce the financial burden of participating in community activities because they can be incorporated into formal treatment plans so they can receive health insurance through companies that work with organizations like SocialRx. Additionally, Medicaid and Medicare Advantage programs are increasingly addressing social determinants of health through wellness initiatives that include social prescription coverage. In addition to insurers, funding can also come from hospital medical equity programs, public medical grants, or community nonprofits.
SocialRx covers its members’ costs of attendance, offers programs in Spanish and other languages, and often includes transportation assistance. Care coaches handle logistics, provide follow-up care and motivation, talk to patients after each experience, and help patients continue treatment. All of this is useful in removing barriers that could prevent patients from participating in these activities individually.
The SocialRx model includes 12 monthly doses of community experiences over the course of a year. Hundley told the story of an elderly woman who had not left her home in more than six months. His nursing advisor connected him with a community choir. Once upon a time, he returned and in the third month he took part as an accompanying pianist. At the end of the program, she was the assistant choir director at the senior center and attended the choir several times a week. “I found my people, my community and a new joy in life,” he told the team. Such a transformation can have strong psychological effects.
According to SocialRx, almost four out of five of its members with factors related to mental health problems such as anxiety, depression or loneliness show improvements after the last dose, as measured by the World Health Organization’s Well-being Index (five). Given the connection between these factors and cardiovascular risk, these numbers could also have implications for heart health.
Social regulations require a personalized approach
Social regulations can be very different for each person, and that’s exactly the point. Hotz describes one of the most surprising examples he came across while researching his book: a therapeutic farm for people with dementia. “It was a game-changer and allowed people with dementia to take on the role of carer,” he said. “Many of them found staying on the farm to be helpful for their well-being. They felt that when they worked on the farm, no one reminded them of their dementia.”
Hundley has also experienced unexpected changes with the SocialRx program, which intentionally takes a broad view of what counts as healing. “People love to be busy,” he said, describing a wide range of offerings ranging from ceramic making and expressive writing to architectural walking tours that help patients understand the history of their community. In San Diego, children interact with a local circus school; In Boston, participants design and model their fashion creations using recycled materials.
What unifies all of this is the underlying premise: that a prescription that is consistent with what truly cares about and motivates a person is more likely to be fulfilled and cure the patient in the long term.
A change in our view of health
Hundley sees this moment as a cultural shift that has already occurred in sports. “It often seems similar to 50 years ago: people didn’t see their physical activity as such an important part of their health and well-being. But now it seems ridiculous not to think about it. Hopefully in 10 or 15 years it will be absurd not to know that our emotional health influences our overall well-being.”
For millions of women struggling with or trying to prevent heart disease, this change is worth paying attention to now. A healthier heart may require more than one pill. Sometimes it requires a refrain.
This educational resource was created with support from Merck.
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