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Speaker 2: Oh hey, it's the guy at the falafel truck who
Speaker 2: gives you extra hummus Ali ward. So if you come
Speaker 2: to Ologies for the toads, but you stay for this
Speaker 2: science based self help advice, this one delivers with info
Speaker 2: on how to lift your blues with some suggestions that
Speaker 2: make us healthier and calmer, less anxious, and more present.
Speaker 2: This episode may alter the course of your life. So
Speaker 2: this guest is an award winning author and a journalist
Speaker 2: who has written for Time, Wired, Scientific American, the New
Speaker 2: York Times, and she spent several years interviewing doctors and
Speaker 2: patients and digging into published research for a book that
Speaker 2: has been praised by Harvard University as the best public
Speaker 2: health book of the year, and it's backed by a
Speaker 2: bunch of doctors who are like, yes, this, And when
Speaker 2: I got a heads up on her book, The Connection
Speaker 2: Cure the Prescriptive Power of Movement, Nature, Art, Service and Belonging,
Speaker 2: I was like, is this bullshit? And then I looked
Speaker 2: into the bibliography and I wanted to chat with her
Speaker 2: for selfish reasons because it ripped. I was like, this
Speaker 2: is great, so I figured you might want to hear
Speaker 2: it too, and hence an episode was very much in order.
Speaker 2: Actually two episodes, so part one and two. Because this
Speaker 2: interview itself is almost two hours long. It's worth two installments,
Speaker 2: trust me. So social prescribing it has its own ology,
Speaker 2: and sure I've found it used only one time in
Speaker 2: this scientific literature, but the field is well established. But
Speaker 2: we're going to discuss the etymology in a it. But first,
Speaker 2: thank you to patrons for supporting the show for as
Speaker 2: little as one dollar a month and been in your questions.
Speaker 2: Thanks to everyone walking around in Ologies merch we have
Speaker 2: summer stuff like hats and even bathing suits to wear
Speaker 2: on your rear end. We also have Smologies episodes for free.
Speaker 2: They're in their own feed wherever you get podcasts. If
Speaker 2: you're looking for shorter filth free episodes suitable for classrooms,
Speaker 2: and she rated those are linked to the shotouts also
Speaker 2: for free. Thank you for supporting the show just by
Speaker 2: leaving reviews. I read them all. I pick one to
Speaker 2: spotlight as proof. And this week it's from listener and
Speaker 2: reviewer Mandy Cpa, who wrote that I have quoted the
Speaker 2: show so often that my family cheered when I opened
Speaker 2: a sweatshirt at Christmas. And I'm assuming it was an
Speaker 2: Ology sweatshirt, but if it wasn't, that's fine too. Also
Speaker 2: bonus shout out to a reviewer as FETVJ who left
Speaker 2: a really nice review years ago saying that Ologies has
Speaker 2: gotten them and countless others to get that dream drive
Speaker 2: going and get their next degree in ecology after they
Speaker 2: thought they had lost it forever. And they updated their
Speaker 2: review last week to add I have since achieved my
Speaker 2: dream of being a park ranger, and that they use
Speaker 2: factoids from Ologies in their educational programs. So keep it
Speaker 2: the good work. I'm rooting for you. The world needs
Speaker 2: you more than ever. Okay, So Saya Geneology, let's get
Speaker 2: into it. It is most commonly known as social prescribing,
Speaker 2: and it centers on a shift from like what's the
Speaker 2: matter with you? To what matters to you in treating
Speaker 2: and preventing illnesses? And I ask this guest an absolute
Speaker 2: fire hose of not smart questions about why five main
Speaker 2: factors improve our quality of life and longevity? Why do
Speaker 2: we need to go outside more? How to figure out
Speaker 2: what lights you up? How to schedule time for hobbies
Speaker 2: if you have no time for hobbies, free stuff you
Speaker 2: can get to make you happier. How has quarantine and
Speaker 2: a pandemic affected how we interact? What if social interaction
Speaker 2: gives you the willies? What if depression keeps you from
Speaker 2: doing things that lift depression? How do you hang out
Speaker 2: with people without being drunk? Is there any data to
Speaker 2: support chilling out? The scientific deal with cold plunging? If
Speaker 2: your health insurance covers having fun? How capitalism can literally
Speaker 2: kill us? Where to volunteer to check off a lot
Speaker 2: of life improving boxes. How much money you can save
Speaker 2: if you join a knitting circle or a fishing club.
Speaker 2: If protesting is a good hobby, if you build it,
Speaker 2: will they come? And why she hates the title of
Speaker 2: her own book with author journalist Deep Diver and absolutely
Speaker 2: lovely and altruistic person and salu genologist Julia Jules has.
Speaker 3: My name's Julia Hatts, and my pronouns are she here.
Speaker 2: I have known of your book for a while and
Speaker 2: when I first got it, I was like, whoa, this
Speaker 2: is a thing.
Speaker 3: It's a thing.
Speaker 2: I was trying to describe it to patrons so they
Speaker 2: could submit their questions, and social prescribing was sort of
Speaker 2: the closest thing that we could like nail it down to.
Speaker 2: But what do you call this science?
Speaker 3: Yeah, great questions. I mean the study of health. But
Speaker 3: the word that people actually use is something called saluto genesis.
Speaker 3: And this is the study of health. Like if you're
Speaker 3: ever in Italy and they say salut, or Spain or
Speaker 3: in France they say something that actually comes from this
Speaker 3: Greek word, you know, salude, which refers to health. And
Speaker 3: so every time you know you're clinking the wineglass, they're saying,
Speaker 3: to our health, to our health, to our health. And
Speaker 3: it's used in contrast to this thing called pathogenesis, right,
Speaker 3: the study of disease, which science has done such a
Speaker 3: great job at. I mean the fact that you know,
Speaker 3: I could go to a doctor, they could swap my throat,
Speaker 3: they could be like, yep, you have a strep throat pathogen.
Speaker 3: I'm gonna treat you with antibi boom. That's amazing, But
Speaker 3: there's been far less attention to the opposite, to the
Speaker 3: study of what makes us healthy.
Speaker 1: Oh oh shit.
Speaker 3: Yeah. It's actually as kind of a cool origin story.
Speaker 3: It was this doctor who, after the Holocaust, had been through,
Speaker 3: you know, a concentration camp and was really curious about
Speaker 3: why is it that some people live healthier lives, how
Speaker 3: is it that some people go on to be healthy
Speaker 3: after this horrific experience, And so he was the one
Speaker 3: doctor anton Antonovsky who coined this idea, we should study
Speaker 3: the factors that make us healthy. Health is not just
Speaker 3: the absence of disease. It's the process through which individuals
Speaker 3: understand that their life is comprehensible, manageable, and meaningful and
Speaker 3: can function even in the face of these extreme environmental changes.
Speaker 2: So it's like that not just surviving but thriving kind
Speaker 2: of study.
Speaker 3: It's not just surviving but thriving exactly. And it totally
Speaker 3: makes sense that we don't think about health this way.
Speaker 3: Like from our earliest ages, we were going to the
Speaker 3: doctor strep throat ear infection boom, we got the medicine.
Speaker 2: But an infection or breaking your arm trying to do
Speaker 2: a backflip on your aunt's trampline are pretty clear cut
Speaker 2: in terms of diagnosis and treatment, but not so much
Speaker 2: chronic pain, lingering, illness, and mental health just waking up
Speaker 2: feeling like trash, going to bed feeling like trash, and
Speaker 2: then filling the waking hours with breaking horrific news like
Speaker 2: what could go wrong here?
Speaker 3: For a long time, our healthcare systems haven't really been
Speaker 3: set up to ask this question. But now, based on
Speaker 3: the fact that people are getting sicker and sicker. You know,
Speaker 3: modern medicine, therapy, it has its place, it's done wonders
Speaker 3: for us, but clearly there is something about our environment
Speaker 3: that's making us sick. So what of hell health care
Speaker 3: actually got involved in helping us feel better, in prescribing
Speaker 3: us resources and activities that help us feel healthy. And
Speaker 3: this is where the practice of social prescribing comes in.
Speaker 2: And does it help mental health? Does it help physical health?
Speaker 2: Or is it kind of like when your mental health
Speaker 2: is better, your physical health is better, and vice versa.
Speaker 2: When it comes to tackling this, where does this tend
Speaker 2: to concentrate? What does it affect?
Speaker 3: A great question? And shout out to your great Dolerology
Speaker 3: episode with doctor Rachel Softness, who talks about the way
Speaker 3: that all of our pain is interconnected, so all of
Speaker 3: our health is too, and we kind of like know
Speaker 3: this intuitively. For example, today it's like a beautiful spring
Speaker 3: day in New York. I was so excited about this interview,
Speaker 3: so I went for a little run before it. I
Speaker 3: got my heart rate up, I got those endorphins going.
Speaker 3: We know that movement is associated with the release of
Speaker 3: endorphins and serotonin, but also that exposure to sunlight is
Speaker 3: going to calm down. So that's the beautiful thing about
Speaker 3: social prescriptions. They've been used to treat to help treat
Speaker 3: everything from anxiety and depression, things you know associated with
Speaker 3: a deficit and serotonin, as well as chronic pain, type
Speaker 3: two diabetes, even dementia in some cases. And I want
Speaker 3: to be really clear and say this is not not
Speaker 3: not a replacement for other kinds of medicine. This is
Speaker 3: just about putting another option on the menu.
Speaker 2: So an illness or depression isn't in your head, but
Speaker 2: social prescribing or behavior modifications can help, sort of like therapy.
Speaker 3: Can, absolutely absolutely and you know it comes down to
Speaker 3: this really fundamental statistic that eighty percent of our health
Speaker 3: outcomes as a population are driven by differences in our environment.
Speaker 2: Oh it's nuts.
Speaker 3: Yeah, if you're working, you know, three jobs, if you
Speaker 3: have to drive an hour to work, if you don't
Speaker 3: live in a community with green space, if you're struggling
Speaker 3: to you know, keep ends meet, if you're the sole caretaker,
Speaker 3: all these environmental factors are going to impact your health.
Speaker 3: Only twenty percent of our health differences come down to
Speaker 3: what happens in clinical care.
Speaker 2: Twenty percent is clinical, eighty percent environmental. Oof y'all.
Speaker 3: So you would think then that eighty percent of our
Speaker 3: health care would be about treating us through those environments.
Speaker 3: It would be about finding sources of childcare, it would
Speaker 3: be about getting transportation to take us to green spaces.
Speaker 3: So that's kind of like the practical, but philosophically what
Speaker 3: social prescribing is. It comes down to shifting the question
Speaker 3: that doctors often ask, you know, what's the matter with you?
Speaker 3: Tell me about your symptoms to what matters to you?
Speaker 3: Tell me about what brings you a unique sense of
Speaker 3: joy and purpose, and then let me, as your doctor,
Speaker 3: work with my team to actually prescribe you something that
Speaker 3: help helps you get closer to what matters to you.
Speaker 3: So for you, Ali, Ward, I have made you.
Speaker 2: Julia held up a little medicine bottle like a tiny
Speaker 2: capped diorama. That's amazing. This is that you're showing me
Speaker 2: right now, an amber prescription bottle, white cap as you see,
Speaker 2: and there are objects in it, and I want to
Speaker 2: know one of those objects.
Speaker 3: Yeah, well, let me caveat this by saying, you know these.
Speaker 3: This is a limited social prescription bottle for you, Ali.
Speaker 3: You have so many things in listening to your show
Speaker 3: learning about you that matter to you. But here a
Speaker 3: couple I've picked out. So number one, of course, we
Speaker 3: have a doggie, your beautiful doggie right.
Speaker 2: Yes, gmy gremlin, who was dozing next to me and
Speaker 2: whose collar you might hear jangling, but also was in
Speaker 2: miniature in this little bottle.
Speaker 3: Gommy, I know your dog matters to you so much. We,
Speaker 3: of course, of course, have a little bug. It's actually
Speaker 3: a little snail. They didn't have too much in the
Speaker 3: bug collection. Over here, we have your partner. We have
Speaker 3: a ukulele. Yes, it's all underneath a tree.
Speaker 2: Oh my god, I'm ana cry. Oh my god, that's amazing.
Speaker 2: How did you remember that I played ukulelely?
Speaker 3: Oh girl, I've been listening to you a long time.
Speaker 2: Oh my god, I haven't played in years either.
Speaker 3: That is just it. That's exactly what you said right there.
Speaker 3: That is what social prescribing aims to do. It aims
Speaker 3: to help us tap into, like what are the things
Speaker 3: we love to do when we were younger? What are
Speaker 3: the things if we had two more hours in the week,
Speaker 3: what would we spend it doing. We think of those
Speaker 3: things as like nice to have one day if I
Speaker 3: have time. Healthcare is saying no, this matters to you.
Speaker 3: This should be part of your health care plan because
Speaker 3: guess what if I prescribe you a spot in a
Speaker 3: ukulele class that meets every Tuesdays at six o'clock with
Speaker 3: nine other people, You're gonna make the time for it.
Speaker 3: And I guarantee you and I have lots of stories
Speaker 3: around this as proof and end scientific studies is proof
Speaker 3: that your health will improve.
Speaker 2: Shit, now I got to join a ukulele group. That
Speaker 2: would be so cool. You know what. My sister works
Speaker 2: with dementia patients and they have a ukulele group that
Speaker 2: comes in place for them like once a month, and
Speaker 2: like the days when the ukulele people come and play,
Speaker 2: and now, fuck, I'm gonna have to do that.
Speaker 3: I love it. It's a sign, it's a sign.
Speaker 2: It's so cool. So for me, those are things that
Speaker 2: I love. I love looking at bugs. I love running
Speaker 2: around with Gammi Egg a gremlin. I was just running
Speaker 2: around with her in the yard and it was so
Speaker 2: cute and fun. I love hanging out with Jarrett all
Speaker 2: those things, love trees. What are other things that people
Speaker 2: might prescribe? Are there any doctors write that down on
Speaker 2: a pad so that you take it seriously, because it's
Speaker 2: so easy to be like, oh, sounds pretty nice, wish
Speaker 2: a hoteme or whatever, even though we spend so many
Speaker 2: hours scrolling non sense egg exactly.
Speaker 3: So it's a big yes to that question. First, let
Speaker 3: me talk about the different kinds of social prescriptions that
Speaker 3: there are and why they are what they are. So
Speaker 3: I've written this book, The Connection Cure, which is all
Speaker 3: about how doctors in thirty countries around the world, including
Speaker 3: the US more on that are actually prescribing this. So
Speaker 3: it's not just doctors, it's therapists, it's nursers, it's community
Speaker 3: health workers. It's social workers. And we can also talk
Speaker 3: about why, like why now are they doing this? But
Speaker 3: you'd asked about like the kinds of prescriptions, and from
Speaker 3: my research, it pretty much comes down to five core ingredients.
Speaker 3: Let's say it comes down to movement, nature, art service,
Speaker 3: and belonging.
Speaker 2: Oh wow, I got it, thanks once again, movement, nature,
Speaker 2: art service, and belonging. By the end of the episode,
Speaker 2: you're going to be applying for a personalized license plate
Speaker 2: that reads mnasb for And.
Speaker 3: So there's a couple of reasons for that. And the
Speaker 3: first one is like, in these thirty countries, you know,
Speaker 3: these were the types of social prescriptions that people kind
Speaker 3: of kept organically independently landing on. And we know this
Speaker 3: from the data that part of this has to do
Speaker 3: with the way we as humans are wired to be
Speaker 3: in these kinds of environments, right, Like, think about us
Speaker 3: tens of thousands of years ago. We were out there
Speaker 3: trying to survive on the big bad Way. We had
Speaker 3: to move our bodies, and so it was adaptive for
Speaker 3: us to be able to move our bodies well. And
Speaker 3: our bodies respond to that kind of movement, right, we
Speaker 3: increase our levels of serotonin, we increase our endorphins. Right,
Speaker 3: it's not just you know Ellwood's.
Speaker 2: Uh, endorphins make you happy. Happy people just don't shoot
Speaker 2: their husbands.
Speaker 3: They just don't. Endorphins make you happy. Happy people don't
Speaker 3: shoot their husbands. That whole line. Like, that's true, So
Speaker 3: right movement, and that's not that controversial.
Speaker 2: Right.
Speaker 3: Doctors have been saying for fifty years, exercise more, exercise
Speaker 3: more nature. Same is true there. I mean, there's some
Speaker 3: really fascinating research from the nineteen eighties showing that nature
Speaker 3: has these unique powers of restoring our attention. It's really
Speaker 3: interesting the eighties too. I know you're an eighties baby,
Speaker 3: like yep, kind of like the prime decade of you know,
Speaker 3: everything's distracting, video games, commercials, beyond this and that. Well,
Speaker 3: what these researchers found is that because of the way
Speaker 3: that we evolve to be in nature, we evolved be
Speaker 3: able to say, hey, you know, there's a bird up
Speaker 3: there that looks like a tasty dinner. There's a fish.
Speaker 3: There's something about the way we respond to it that
Speaker 3: doesn't suck up our attention. It actually restores our attention
Speaker 3: such that when we leave a natural setting, we feel
Speaker 3: more calm, we feel more restored, we feel like we're
Speaker 3: actually better at focusing.
Speaker 2: That's so funny because I love running and walking, and
Speaker 2: if I do it on a treadmill inside of a gym,
Speaker 2: it feels really different than me going to the local
Speaker 2: lake and seeing people and seeing dogs, and I always
Speaker 2: see that guy running at the same time, and there's
Speaker 2: spiders in the trees. And I never put a lot
Speaker 2: of weight into that. I just think it's a preference,
Speaker 2: but it's actually probably chemically like helping my brain.
Speaker 3: So much so, I'll tell you two really interesting studies
Speaker 3: that show, yes, it's not just you, this is pretty universal.
Speaker 3: So these researchers at Stanford University put students into conditions.
Speaker 3: They had them walk for ninety minutes. And in one condition,
Speaker 3: the walkers were, you know, just walking along like the
Speaker 3: busy street next to a highway, not a lot of green,
Speaker 3: not a lot of nature, not a lot of room
Speaker 3: for the imagination. In the other condition, those students walked
Speaker 3: in a park setting, you know, with all these lush
Speaker 3: trees and animals. Just ninety minutes. Well, what did they
Speaker 3: find at the end of these ninety minutes When they
Speaker 3: compared these two groups. You know, not only did the
Speaker 3: students in the nature group self report feeling more calm,
Speaker 3: more relaxed, you know, better at focusing, but they also
Speaker 3: did fMRIs and they found that students who walked in
Speaker 3: the nature group had less activity in their subgenual prefrontal cortex,
Speaker 3: which is associated with rumination, which is associated with anxiety
Speaker 3: and depression. So, oh my god, you put that all together, yeah,
Speaker 3: and you find that, Wow, it's not just in our heads, Like,
Speaker 3: there's some serious antidepressant, anxiety relieving effects of being in nature.
Speaker 3: And I think it comes down to the way we
Speaker 3: evolve to love and pay attention to nature.
Speaker 2: So this was a twenty fifteen study titled Nature Experience
Speaker 2: Reduces Rumination and subgenual Prefrontal Cortex Activation in the Journal
Speaker 2: of the Proceedings of the National Academy of Sciences of
Speaker 2: the United States of America, and it notes that more
Speaker 2: than half of the world's population live in urban settings,
Speaker 2: and while urbanization has many benefits, it's also associated with
Speaker 2: increased levels of mental illness, including depression, and in fact,
Speaker 2: it says city dwellers have a twenty percent higher risk
Speaker 2: of anxiety disorders and a forty percent higher risk of
Speaker 2: mood disorders as compared to people in rural areas. And
Speaker 2: I thought maybe that was all just having cheaper rent.
Speaker 2: But the paper details that those ninety minute walks and
Speaker 2: the effects on rumination centers of the brain, and it
Speaker 2: concludes that nature experience may improve mental well being and
Speaker 2: accessible natural areas within cities may be a critical resource
Speaker 2: for mental health in our rapidly urbanizing world. So city
Speaker 2: dwellers give us parks or give us death, like for real,
Speaker 2: But what else do all human animals need for enrichment?
Speaker 2: So there's movement, there's nature, there's belonging, there's art.
Speaker 3: There's belonging. There's art. Art's another one. I love. People think,
Speaker 3: oh art, you know, that's nice, but like, really, doctors
Speaker 3: are going to prescribe that. Researchers from Drexley University looked
Speaker 3: at what happened after just forty five minutes of engaging
Speaker 3: subjects in an artistic activity and found that they had
Speaker 3: significantly reduced their levels of cortisol of stress.
Speaker 2: No way, so I perused this twenty sixteen study Reduction
Speaker 2: of Cortisol levels and participants responses following art making in
Speaker 2: the Journal of the American Art Therapy Association, and I
Speaker 2: found delightfully that scientists did spit tests for cortisol levels
Speaker 2: on thirty nine volunteers between the ages of eighteen to
Speaker 2: fifty nine before and after a crafting session, and then
Speaker 2: they asked them to describe their experience, and the researchers
Speaker 2: gave them collage materials, modeling clay, and markers and just
Speaker 2: told them scientifically, go to town, do whatever you want. And
Speaker 2: the data show that making art stuff resulted in lower
Speaker 2: cortisol levels, and the participants said it was relaxing, enjoyable,
Speaker 2: helpful for learning about new aspects of self, freeing from constraints,
Speaker 2: and that the process of initial struggle to later resolution
Speaker 2: and losing themselves in that flow was all pretty nice
Speaker 2: and chill. And no, to be an artist you do
Speaker 2: not need teen angst or decades of experience, or even
Speaker 2: a septum piercing as there were no significant differences in
Speaker 2: outcomes based on prior experience or art supplied choice, or gender.
Speaker 3: And this is not that novel. I mean, art therapy
Speaker 3: has been around as a discipline. There's something about the
Speaker 3: way engaging with art sort of helps us shift our
Speaker 3: perspective and realize like, hey, we're not alone. But yeah,
Speaker 3: that also comes down to the way I think we
Speaker 3: as humans trying to make it in the big bad wild.
Speaker 3: We told stories with each other, we painted on caves,
Speaker 3: we made jewelry, We tried to seek out and talk
Speaker 3: about the beauty of the world. So there's something very
Speaker 3: primal about that too.
Speaker 2: Well, let's get depressed. How are we living that is
Speaker 2: not hitting these bases? Because I don't know a lot
Speaker 2: of people who are like thriving at the moment tbh,
Speaker 2: Like I know people who are succeeding, But on a
Speaker 2: day to day how is your mental health doing? Is
Speaker 2: a struggle?
Speaker 1: All right?
Speaker 2: And you know we live in the United States, which
Speaker 2: is like going through some stuff, But like, how is
Speaker 2: twenty twenty five living maybe not engineered to hit these bases?
Speaker 3: Absolutely well, you're asking the great question because that's exactly
Speaker 3: how I felt when I wrote this book, sort of
Speaker 3: in the throes of the pandemic, especially, And I think
Speaker 3: it was no coincidence that rates of stress, rates of loneliness,
Speaker 3: rates of anxiety, depression, all these things going up, up, up,
Speaker 3: up up up.
Speaker 2: Could see the recent long COVID episode too.
Speaker 3: And you know, there has to be a reason for that,
Speaker 3: and what is that reason? And I think a lot
Speaker 3: of it comes down to the way our environment is
Speaker 3: making us sick. Now we go back to like our
Speaker 3: evolutionary needs for survival, movement, nature, art, service, and belonging.
Speaker 3: They weren't just a nice to have if I have time.
Speaker 3: You needed to do this to survive, and importantly, you
Speaker 3: couldn't do it alone. Like, yeah, you try to survive
Speaker 3: out there in the big bad wild on your own.
Speaker 3: Good luck. But now, of course, as I talk to
Speaker 3: you from my Brooklyn apartment, I can have all of
Speaker 3: my basic needs met without leaving. I need food, I
Speaker 3: can order it. I want entertainment, I can stream it.
Speaker 3: I want to feel a sense of belonging. Maybe I'll
Speaker 3: turn on a TV show where you know, I'm feeling
Speaker 3: a connection to the characters. So I think it's become
Speaker 3: easier and easier for us to choose an environment that
Speaker 3: disconnects us from these things. And yet when I just
Speaker 3: replay back twenty minutes ago when I showed you this
Speaker 3: and I saw the way that your face lit up,
Speaker 3: when you've remembered how much you love ukulele, or when
Speaker 3: you described to me the difference between running outside and
Speaker 3: running you know, on a treadmill. Intuitively, you know that
Speaker 3: these things are good for us. And it's not just intuitive, right,
Speaker 3: there's a ton a ton a ton of data showing
Speaker 3: that these five things in particular have profound effects for
Speaker 3: our mood, our energy, our attention levels, our longevity. But
Speaker 3: the question is okay, great, so now what I mean
Speaker 3: what do we do about it? And for a while, right,
Speaker 3: it was sort of this thing of the doctor with
Speaker 3: the wagging finger saying, Ali, you should relax, you should
Speaker 3: take some time for yourself, you should go outside more,
Speaker 3: you shouldn't blah blah blah whatever it is.
Speaker 2: Yeah, I heard that. It would infuriate me, like literally
Speaker 2: had doctors. I was going through a very unfailure, had
Speaker 2: doctors telling me, can you just like quit your job?
Speaker 2: And I was like, who are you going to pay
Speaker 2: my rent? Like what are you taught? No? And you know,
Speaker 2: my friends being like, you need to relax, you need
Speaker 2: to take time off. And it's really hard when you're
Speaker 2: like if I take time off or whatever, what if
Speaker 2: I drop the ball on all my stuff?
Speaker 1: Right?
Speaker 2: The anxiety of losing the momentum you have with work
Speaker 2: or whatever, it keeps you from relaxing, Right, how do
Speaker 2: people accept that as a prescription?
Speaker 3: Right, we're all on this treadmill. I totally get it.
Speaker 3: So let me tell you. Let me tell you a
Speaker 3: story that shows, you know, what we kind of expect
Speaker 3: to happen in healthcare and what it could become and
Speaker 3: what is starting to happen. So one of the first
Speaker 3: stories in the book is about this guy named Frank.
Speaker 3: And you know, Frank is this lovely older man. He
Speaker 3: was a truck driver. And you can imagine the life
Speaker 3: of a truck driver. You know, you're sitting in your car,
Speaker 3: so you're sitting most of the day. You're probably not
Speaker 3: pulling over the side of the road and picking fresh
Speaker 3: tomatoes like, you're probably eating fast food and you're alone. Right.
Speaker 3: So Frank was in this profession, and you know, he
Speaker 3: would go to the doctor and he would have a
Speaker 3: terrible time there because what did the doctors do. They
Speaker 3: would always focus on what was the matter with him.
Speaker 3: They would sort of shame him and say, you know, Frank,
Speaker 3: you're overweight, you have type two diabetes. I'm going to
Speaker 3: prescribe you insulin. You're going to be on this insulin
Speaker 3: for the rest of your life. And so because of
Speaker 3: that negative experience, because going to the doctor, Frank really
Speaker 3: felt terrible about himself and felt exactly how you feel, like, Okay, yeah,
Speaker 3: well I know that my job is the problem, but yeah,
Speaker 3: I'm not going to like go to an Equinox class
Speaker 3: after my long day of truck driving. What can you
Speaker 3: do for me? They didn't have a lot of answers
Speaker 3: until he met somebody who adopts social prescribing and practices
Speaker 3: health a little bit differently and really is big into saludogenesis, right,
Speaker 3: the study of health, and that doctor, doctor Ali Hart, said,
Speaker 3: you know, Frank, tell me about something you loved to
Speaker 3: do when you were a kid. And it just so
Speaker 3: happened that Frank had moved to this new community, he
Speaker 3: didn't really know anybody, he didn't really know how to
Speaker 3: get involved, and so Frank starts to talking and eventually
Speaker 3: they both realized that they both love right their bike.
Speaker 2: Oh that's so cute.
Speaker 3: Right, And it wasn't this conversation of Frank, you need
Speaker 3: to exercise more, tell me what you love to do
Speaker 3: to exercise. It was all about what do you love
Speaker 3: to do as when you were a kid, and Frank
Speaker 3: could have said art. Frank could have said anything, but
Speaker 3: he said riding his bike. So then the doctor didn't
Speaker 3: say okay, great, good luck, go ride your bike. He said,
Speaker 3: here's what I'm going to do. I'm going to prescribe
Speaker 3: you a bike, and I'm going to prescribe you a
Speaker 3: spot in this cycling course that meets Tuesday evenings after
Speaker 3: your shift, and if you don't want to go alone,
Speaker 3: I'll go with you.
Speaker 2: Wow, dude, that's a good doctor.
Speaker 3: That is a good doctor. And let me tell you
Speaker 3: what happens to Frank. So he's prescribed a spot in
Speaker 3: this course, and he's nervous. He doesn't know anybody. He's
Speaker 3: an older adult, he hasn't been bike riding in years.
Speaker 3: That's who the course is designed for. Eventually he starts going.
Speaker 3: It becomes a weekly routine. He starts befriending the fellow cyclist.
Speaker 3: They have their little you know, WhatsApp group on the side.
Speaker 3: They call themselves the Chain Gang. Eventually, even after this
Speaker 3: Tuesday course ended, the ten of them said, well, we
Speaker 3: really love doing this, let's keep meeting. Even outside of
Speaker 3: this prescription. Frank eventually loses forty pounds. He's able to
Speaker 3: come off his insulin, which is what doctors originally told
Speaker 3: him was impossible. And more importantly, he doesn't see himself
Speaker 3: as this sick person who hates doctors. He sees himself
Speaker 3: as this healthy person who's able to create his own health.
Speaker 3: And sure the social prescription helped him get there, but
Speaker 3: ultimately these are all things that now that the bridge
Speaker 3: has been made, he can do on his ol because
Speaker 3: you really have to experience the health benefits first to
Speaker 3: be able to say, Okay, this is worth my time.
Speaker 3: This is an investment in my time. When I go
Speaker 3: for that two hour bike ride, I'm going to come
Speaker 3: back feeling more energized. I feel like I'm saving time
Speaker 3: down the line. So that is one example of what
Speaker 3: this could look like.
Speaker 2: And if you're like I wish I knew the name
Speaker 2: of that free program that gives bikes to older adults
Speaker 2: and provides a six week course to intro them into
Speaker 2: biking and road safety, it's called pedal ready in the UK.
Speaker 2: Now in the US you can check with local YMCA programs.
Speaker 2: You can find resources through AARP or there's something called
Speaker 2: silver sneakers which can be covered by Medicare Part B
Speaker 2: and some supplemental health plans, and Silver Sneakers has a
Speaker 2: bunch of different fitness programs, from pickleball to water workouts,
Speaker 2: and their site says that from national gyms to local
Speaker 2: community centers, there are more participating fitness locations available in
Speaker 2: the US to Silver Sneakers members than there are Starbucks,
Speaker 2: which is frankly dizzying and very encouraging, but what if
Speaker 2: just getting there is brutal. You can also look to
Speaker 2: the National Aging and Disability Transportation Center to help out
Speaker 2: older adults, people disabilities, and caregivers. And I also just
Speaker 2: found out that in forty one countries there's a p
Speaker 2: pro called Cycling Without Age, where volunteers on a bike
Speaker 2: can pick up older adults and give them rides in
Speaker 2: a try shaw, which is like a petticab for those
Speaker 2: who need a ride and some nature and fresh air
Speaker 2: and some good convo. And the passengers also seem to
Speaker 2: get that. And you can start a Cycling Without Age
Speaker 2: chapter in your area, or you can hit the site
Speaker 2: that will link on our website to see if there's
Speaker 2: a chapter nearby. I looked just out of curiosity. I
Speaker 2: live in LA and there's one in Hollywood via the
Speaker 2: La Bicycle Coalition, and after a quick break, we're going
Speaker 2: to address whether you're the one having a ride or
Speaker 2: giving it, what if mobility is an issue. We'll also
Speaker 2: chat about how to pick a hobby, how the epidemic
Speaker 2: of loneliness affects emergency medicine, whether cold plunges are bullshit,
Speaker 2: and more. Right after a quick hello from sponsors who
Speaker 2: make it possible to donate to a cause of theologists
Speaker 2: choosing this week, Julia pointed us toward grow NYC, and
Speaker 2: she's going to tell us more about them later in
Speaker 2: the show, So thank you sponsors.
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Speaker 2: Okay, where were we Yes, whether you're the one having
Speaker 2: a ride or you're given one. What if mobility is
Speaker 2: an issue? Let's say that you have a disability where
Speaker 2: you can't hop on a bike. Do those types of
Speaker 2: like art combined with a club where you're going to
Speaker 2: see people and do the art, or you're doing something
Speaker 2: where it's art and its service. Does it typically help
Speaker 2: if it's more than one thing, more than one of
Speaker 2: those five things at once, totally.
Speaker 3: And I mean even with the biking, it was you know,
Speaker 3: movement was nature and it was belonging right. And it's
Speaker 3: also service because now Frank goes and he talks to
Speaker 3: people about his experience, he helps other people in issues.
Speaker 3: I think more often than not it's some combination of it,
Speaker 3: and I think more important than the activity itself is
Speaker 3: about it mattering to the person. Oh, you know, like
Speaker 3: of course, physical movement is really good for things like
Speaker 3: you know, being overweight, type two diabetes, that sort of thing. Art,
Speaker 3: the study show is really good for stress and anxiety.
Speaker 3: Service is really good for people older in their life.
Speaker 3: It's also good for people with chronic pain. But you know,
Speaker 3: at the end of the day, it's gonna be about
Speaker 3: what matters to the person and also what's available in
Speaker 3: the community. And to your point, if somebody can't physically
Speaker 3: leave their house, I talk about a couple of examples
Speaker 3: where there are virtual social prescriptions available as well.
Speaker 2: And those also are helpful despite the fact that you're
Speaker 2: on a screen, like if you have limited options.
Speaker 3: Absolutely, yeah. I mean one story is about this ninety
Speaker 3: two year old named Glenn, who I mean, he's ninety two,
Speaker 3: so he literally had no social connections left. I mean,
Speaker 3: I can't even imagine the experience of being that age
Speaker 3: and having nobody to talk to, not leaving your house
Speaker 3: in years because you can't drive anymore. Well, he gets
Speaker 3: prescribed a volunteer phone call buddy, And this volunteer phone
Speaker 3: call buddy is not just instructed to, you know, say hey,
Speaker 3: how are you Glenn, but is instructed really in the
Speaker 3: mechanics of belonging, of really making Glenn feel known, which
Speaker 3: evolution tells us that part of the reason why we
Speaker 3: seek belonging and seek close relationships is because of the
Speaker 3: way that we want to be seen and known, and
Speaker 3: this helps us with our evolutionary advantages, that sort of thing.
Speaker 3: So that's what Glenn is prescribed, and sure enough, after
Speaker 3: these phone calls they develop a genuine friendship. Ryan helps
Speaker 3: the you know, his phone call buddy helps Glenn go
Speaker 3: to the doctor's office he grocery shops for him. He's
Speaker 3: able to help him get a handle on his other
Speaker 3: health issues that he really didn't have the motivation to
Speaker 3: do before. So that's just one example of what this
Speaker 3: could look like. But I absolutely think, yeah, it doesn't
Speaker 3: make sense to prescribe somebody a cycling class who has
Speaker 3: their mobility compromised or doesn't have green space near them.
Speaker 3: It needs to be really about meeting people where they're at.
Speaker 2: I think that's the other thing about feeling known is
Speaker 2: you can't feel truly known if you can't be authentic
Speaker 2: and connecting the things that you actually love brings out
Speaker 2: an authenticity that you can't really suppress. Like for me,
Speaker 2: I might not have this authenticity if I were to
Speaker 2: go volunteer doing something that I hated doing, or if
Speaker 2: I did a hobby that I wasn't interested in. I
Speaker 2: don't think that my authentic self would show up, and
Speaker 2: so that being known as who I am wouldn't arise.
Speaker 2: But for me, you know, I definitely have battled anxiety
Speaker 2: and depression. For you, when you were motivated to write
Speaker 2: this book, especially in the throes of quarantine and things
Speaker 2: like that, did you find yourself coming from a place
Speaker 2: of wanting to help others or wanting to help yourself,
Speaker 2: or what personally drove you down this road.
Speaker 3: Yeah, I mean, and first of all, you know, it's
Speaker 3: incredible that you could share that and you can be
Speaker 3: the person that you are. I think our culture has,
Speaker 3: you know, such a negative and limited depiction of what
Speaker 3: that is. And that's kind of why I wrote this book,
Speaker 3: because it's like all of us, by virtue of living
Speaker 3: in this world, we were really not designed to thrive in.
Speaker 3: You may struggle with some of those symptoms at time
Speaker 3: to time, and it's not a fault of the person.
Speaker 3: It's a fault of a world that doesn't set us
Speaker 3: up for what we need. So you know, for me,
Speaker 3: I yes, I really identified with that, and I think
Speaker 3: it's one of those things where I didn't really realize
Speaker 3: why I was writing the book until i'd written it.
Speaker 3: It was kind of like, this is interesting. I know
Speaker 3: a lot of people who really aren't thriving right now,
Speaker 3: but certainly not me. Until you know, I, oh my gosh,
Speaker 3: I'd been so blind to all of the ways I
Speaker 3: was dealing with anxiety, depression, attention issues. I had, like
Speaker 3: these chronic migraines, that I like swore something was wrong
Speaker 3: with me. I clearly had a tumor, you know, and
Speaker 3: was getting trying to get all these answers until I
Speaker 3: really got inspiration from the characters I reported on and thought, no, actually,
Speaker 3: it's funny how my migraines tend to be worse when
Speaker 3: I have no sleep and I have no control over
Speaker 3: my time or my inbox and all the things that
Speaker 3: you know lots of people on your pod have shared before.
Speaker 2: So remember Julia is a professional journalist, and it's prone
Speaker 2: to falling down research holes for stories. So digging into
Speaker 2: the research it's not something new to her. And after
Speaker 2: compiling all these interviews with patients and doctors and looking
Speaker 2: at data, she decided to structure the book that she
Speaker 2: wrote in three parts. They're social Prescribing for better health,
Speaker 2: social prescribing for better health care, and social prescribing for
Speaker 2: you and me, because journalists heal thyself.
Speaker 3: I think it was a combo of that, and that's
Speaker 3: what encouraged me to really write this part three where
Speaker 3: I got real deep, like, hey, I'm not doing well
Speaker 3: in all these ways, and based on the science, and
Speaker 3: based on what matters to me, and based on what's
Speaker 3: available in my New York community. I'm going to prescribe
Speaker 3: myself these things when I'm feeling this way, and I'm
Speaker 3: going to report back. And even though the book is
Speaker 3: called The Connection Cure, I hate that title. I really
Speaker 3: you hate the title?
Speaker 2: Did you title it?
Speaker 3: Nope? Between you and me and all your listeners?
Speaker 2: Really no, But I get it.
Speaker 3: It's catchy. They both start with see. But you know,
Speaker 3: I think I opposed to it because it sort of
Speaker 3: reinforces this idea that we can be cured, or that
Speaker 3: we are sick as individuals, when really it's our environment
Speaker 3: that's sick.
Speaker 2: Right.
Speaker 3: Like the analogy I use is like, think about you
Speaker 3: have a lot of science see listeners. So here's a
Speaker 3: little thought experiment. We have ten people in a room
Speaker 3: and seven of them are sweating, uh huh. In our
Speaker 3: current healthcare system or healthcare as it had been, we
Speaker 3: would take those seven people. We would diagnose like, okay,
Speaker 3: precisely when does the sweating start? And you know, can
Speaker 3: I prescribe you something that blocks the sweat? Blah blah
Speaker 3: blah blah. We'd go through sort of the clinical work
Speaker 3: up before asking if most people are sweating, maybe the
Speaker 3: room is too.
Speaker 2: Can we put the air conditioning on the fact that
Speaker 2: I didn't see that coming?
Speaker 3: Is like, but we all don't. We all don't because
Speaker 3: we're so steeped into this sort of culture that starts
Speaker 3: more and very young. When we don't feel well, we
Speaker 3: assume that something is wrong in our bodies and that
Speaker 3: there is something there to treat that wrong, specific thing
Speaker 3: in your body. This goes back to what doctor's Off
Speaker 3: said and that there is truth to that.
Speaker 2: So doctor Rachel's often side note or doctors Off was
Speaker 2: our guest on the Dolerology episode about pain and it's
Speaker 2: biopsychosocial origins and the behavioral therapies based in scientific research
Speaker 2: on chronic pain. And we'll link that one in the
Speaker 2: show notes. So it's not a pain to find. But yeah,
Speaker 2: the world is a little fucky and so are our bodies.
Speaker 3: You know, it's not made up, it's not fake. These
Speaker 3: afflictions are very real. But by continuing to just treat
Speaker 3: things in a biomedical way and not treating with the
Speaker 3: environment as well, you know, we're really missing out.
Speaker 2: Well, what happens if you're so deep in the shit
Speaker 2: that you can't make yourself do this? Like that's one
Speaker 2: thing with depression is depression is like why brush your teeth?
Speaker 2: So then it's hard to just be like I'm going
Speaker 2: to join a knitting circle. What are the like steps
Speaker 2: out of the swamp?
Speaker 3: Absolutely and that's you're absolutely right. There's something called the
Speaker 3: depression catch twenty two really really frustrating that. You know,
Speaker 3: the symptoms of depression are fatigue, low energy, low mood.
Speaker 3: You know, you want to isolate and lay in bed
Speaker 3: all day, when the thing that is best for treating
Speaker 3: those symptoms is getting outside, moving, socializing. But of course
Speaker 3: somebody who's in the thick of it, that's going to
Speaker 3: sound like the worst thing possible. And this was true
Speaker 3: for somebody I report on in the book. Her name's Amanda.
Speaker 3: So this happened during quarantine. And during quarantine, you know,
Speaker 3: this was in itself a very socially disconnecting time. Now
Speaker 3: you can imagine how somebody who during quarantine, they're already
Speaker 3: very socially connected, what would their bodies do if during
Speaker 3: that time this was true for Amanda, she finds out
Speaker 3: her husband is having an affair, her mom passes away,
Speaker 3: she loses her job, and then because of all this
Speaker 3: she has to move to a place where she knows nobody.
Speaker 3: And this is during quarantine itself, so God super super disconnected,
Speaker 3: no wonder that Amanda is severely severely depressed. So she
Speaker 3: gets to prescribes an SSRI and it really really helps her.
Speaker 3: It really really helps her with those extreme, deep dark thoughts.
Speaker 3: And it was true that after Amanda began her antidepressant,
Speaker 3: she said, this is great. I'm better than I was,
Speaker 3: but I'm still not thriving. What can I do to thrive?
Speaker 3: But it came again with this catch twenty two thing
Speaker 3: of she didn't really want to leave her house. She
Speaker 3: didn't know anybody, so where would she begin? That step?
Speaker 3: Felt really really hard.
Speaker 2: Yeah.
Speaker 3: So fortunately the place where Amanda moved was a place
Speaker 3: that had just adopted social prescribing.
Speaker 2: Whoa where was this?
Speaker 3: So this this beautiful seaside community in England, and she
Speaker 3: ultimately starts to get a little bit curious, what would
Speaker 3: it be like if I went swimming? And again the
Speaker 3: thought of her taking herself out there to practice swimming
Speaker 3: felt really really hard. But she happened to have this
Speaker 3: mental health in her who said there are sea swimming
Speaker 3: lessons available on prescription. And it's actually because of all
Speaker 3: this data showing that cold water exposure, swimming, moving your body,
Speaker 3: belonging is really really good for certain symptoms of depression.
Speaker 3: It's going to be covered for you. Can I prescribe
Speaker 3: you a spot nice again, kind of like with Frank
Speaker 3: with the cycling. It makes it so much easier when
Speaker 3: a it's something you're already a little bit interested in,
Speaker 3: when you have all the logistics covered, when you know
Speaker 3: that there are other people in your boat that are
Speaker 3: going to be there, and when there is a specific
Speaker 3: time and place to do it. So Amanda gets prescribed
Speaker 3: this sea swimming lesson which I go in the water
Speaker 3: with her when I go out to meet her. And
Speaker 3: let me tell you, it is free zing. I was
Speaker 3: there in September. These women do this three hundred and
Speaker 3: sixty five days a year cold open see no wetsuit
Speaker 3: total ballers.
Speaker 2: Oh god.
Speaker 3: And you know, like some of this is true on
Speaker 3: a level of physiologically, we know for the same reason
Speaker 3: we love to cold showers, there's something about that that
Speaker 3: makes us feel really awake and alert and energized and
Speaker 3: all of these wonderful sort of antidepressant effects. But also,
Speaker 3: of course there's the fact that Amanda is trying a
Speaker 3: new skill, she's moving her body, she's doing it with
Speaker 3: her fellow swimmers. She's exposed to this beautiful seaside environment
Speaker 3: she's never been before. And then kind of like Frank,
Speaker 3: of course, they form a little texting group. They decide
Speaker 3: we want to you know, actually be friends. Let's have
Speaker 3: tea on the weekend, let's make jam together, like do
Speaker 3: all this English shit.
Speaker 2: And.
Speaker 3: You know, come to not only make sea swimming a
Speaker 3: part of like their friendship routine, but also all these
Speaker 3: other things as well. So I know that it's going
Speaker 3: to look different for everybody. I'm not saying that the
Speaker 3: solution is sea swimming, but maybe for some people at
Speaker 3: some point there's that thing that they're a little bit
Speaker 3: curious about, and there's a healthcare provider who can help
Speaker 3: bring you closer to that thing.
Speaker 2: Listen, I know what you're thinking, because I'm thinking it too.
Speaker 2: So I looked into cold plunges, partly just to be petty,
Speaker 2: and I did find a twenty twenty two paper titled
Speaker 2: health effects a voluntary exposure to cold water a continuing
Speaker 2: subject of debate, and it was published in the International
Speaker 2: Journal of Circumpolar Health, which noted that while some studies
Speaker 2: have been small, cold water immersion quote seems to reduce
Speaker 2: and or transform body adipose tissue as well as reduce
Speaker 2: insulin resistance and improve insulin sensitivity, which may have a
Speaker 2: protective effect against cardiovascular and metabolic disease and could have
Speaker 2: preventative health effects. However, without further conclusive studies, it says
Speaker 2: the topic will continue to be a subject of debate,
Speaker 2: so a further study twenty twenty three is wildly descriptive
Speaker 2: and very generously hyphenated short term head out whole body
Speaker 2: cold water immersion facilitates positive effect and increases interaction between
Speaker 2: large scale brain networks. In the journal Biology, dunked a
Speaker 2: bunch of people in twenty degree water Americans. That's celsius,
Speaker 2: so it was really sixty eight fahrenheit and the researchers
Speaker 2: measured brain connectivity and self reported emotional states before and
Speaker 2: after this cold water immersion, and their findings showed that
Speaker 2: participants felt more active, alert, attentive, proud, inspired, and less
Speaker 2: distressed and nervous after having a cold water bath, and
Speaker 2: the changes in positive emotions were associated with the coupling
Speaker 2: between brain areas that involved attention control, emotion and self regulation,
Speaker 2: and the study continues that the results indicate that short
Speaker 2: term whole body cold water immersion may have integrative effects
Speaker 2: on brain functioning, leading to that reported improvement and mood.
Speaker 2: But heads up, heads out whole body cold water experimenters.
Speaker 2: In twenty twenty two, the American Heart Association cautioned via
Speaker 2: an incredibly sassy article titled You're not a Polar Bear,
Speaker 2: the plunge into cold water comes with risks that plunging
Speaker 2: the body into cold water can trigger a sudden increase
Speaker 2: in heart rate and blood pressure, known as the cold
Speaker 2: shock response, So some cardiologists caution against it for anyone
Speaker 2: with heart issues, So talk to your doc if that's you,
Speaker 2: and in general, keep your head out of the water
Speaker 2: to avoid gasping from it and then flooding your lungs
Speaker 2: and or acclimate slowly to colder water. But yeah, sixty
Speaker 2: eight degrees is not that bad because, let me tell you,
Speaker 2: it can feel pretty invigorating and the cold plunge is
Speaker 2: pretty quick, just a few minutes. I've been a science
Speaker 2: correspondent for CBS's Innovation Nation for like a decade, and
Speaker 2: we did a segment on this. Okay, so if we're
Speaker 2: going I'm preparing myself mentally and also putting my hair back.
Speaker 2: So does she get herself into these situations for science?
Speaker 1: You got this?
Speaker 2: True?
Speaker 1: That's cool.
Speaker 2: It feels like I have a little butterflies clig everywhere
Speaker 2: inside my bike.
Speaker 3: You look cold, cold, little butterflies.
Speaker 2: And I will say for the rest of the day,
Speaker 2: it feels like you know when you're caught in a
Speaker 2: rainstorm outside and then you go inside and you change
Speaker 2: into dry clothes and you're like, oh, that's like the best.
Speaker 2: It feels like that all day after you do one. Also,
Speaker 2: it did hurt less than wearing high heels at a
Speaker 2: wedding reception. But I also have never done it again,
Speaker 2: So there's that. And when it came to researching the book,
Speaker 2: both personally and like taking a trip out and jumping
Speaker 2: in the ocean hopefully having tea, yeah, lot of tea,
Speaker 2: and like pouring through all this research, how did you
Speaker 2: figure out which research was well vetted? And you can't
Speaker 2: quite do a double blind research on sea swimming versus
Speaker 2: staying inside, So like, how how does the research for
Speaker 2: this go into it? Especially if we're kind of geared
Speaker 2: toward seeing a placebo pill versus an active ingredient, Like,
Speaker 2: how do you research it?
Speaker 3: Yeah, it's a great question, and it's why some of
Speaker 3: this research comes onto very valid criticism sometimes. I think
Speaker 3: the way that I wanted to structure the book is
Speaker 3: sort of in like two levels. So on one level,
Speaker 3: there's all of the science showing that movement is really
Speaker 3: good for us. Nature's really good for us, art is
Speaker 3: really good for us. And in those service belonging, right,
Speaker 3: and in those studies, we have the best kind of
Speaker 3: data we have, you know, longitudinal studies showing that people
Speaker 3: who have close social connections literally live longer than those
Speaker 3: who don't. This is based on eighty years of data.
Speaker 3: Same with people who garden, same with people have a
Speaker 3: strong sense of purpose. Right. We also can you know,
Speaker 3: like we did with the nature walking study, you can
Speaker 3: sort of randomize people, put them into conditions, do all
Speaker 3: these physiological tests that demonstrate Yeah, movement, nature, art, service
Speaker 3: belonging really really good for us and certainly not bad
Speaker 3: for us. Yeah, but you're absolutely right that the social
Speaker 3: prescribing bit it can be tough to measure because it's
Speaker 3: kind of like the problem is the solution people have
Speaker 3: to opt in, and we don't want to. We don't
Speaker 3: want to force a social prescription on somebody who's absolutely
Speaker 3: has zero interest in this. But it is true that
Speaker 3: when we look at the data suggesting that social prescriptions
Speaker 3: do work for things like mild anxiety and depression, they
Speaker 3: do improve people's mood, they do help people feel less
Speaker 3: lonely and manage their stress, and then they reduce pressure
Speaker 3: on healthcare over time. There were some studies in England
Speaker 3: showing that one in five people going to the doctor
Speaker 3: are doing that for social reasons.
Speaker 2: Oh my god, Oh that makes me so sad and
Speaker 2: sick to my stomach.
Speaker 3: Oh my god, so sad. There was even this one
Speaker 3: story I heard about a guy who would check himself
Speaker 3: into the emergency room every Friday night because he was
Speaker 3: so lonely and afraid of being alone on the weekend.
Speaker 2: Oh god, this weekend. I actually had lunch with a
Speaker 2: few friends, and one is an er nurse in California,
Speaker 2: and she says her favorite patients are her regulars, the
Speaker 2: ones who may be older or sometimes unhoused, and they
Speaker 2: need a place to go for a night where people
Speaker 2: will be kind to them and they can get a
Speaker 2: shower or a sandwich or they're just lonely and they
Speaker 2: need company. And she says, many other healthcare professional side
Speaker 2: eye them, but she knows that they're in a type
Speaker 2: of pain too, and it's real and it makes me
Speaker 2: want to cry so hard.
Speaker 3: And so in those sorts of situations, a social prescription
Speaker 3: makes a lot of sense. And what the data, which
Speaker 3: is again imperfect for all the reasons we talked about.
Speaker 3: It's often small scale, there often is no control group,
Speaker 3: no randomization, but it does seem to suggest that, yeah,
Speaker 3: people improve their health and it reduces pressure on health care.
Speaker 2: I'm wondering is this different in different nations? For example,
Speaker 2: if you have nationalized health care, right, they might take
Speaker 2: great less of a burden on the system. If you
Speaker 2: live in a society where health care is for profit.
Speaker 3: Not yeah, not nationalized yet yep, do they want you
Speaker 3: to get better? Is a great question. It's exactly how
Speaker 3: I said up the book, and I think, you know,
Speaker 3: there's two answers to that, Like, on one hand, it's
Speaker 3: true that this is a much easier sell for places
Speaker 3: with nationalized health care. That's actually how this began. So
Speaker 3: this practice began in England in the nineteen eighties, after
Speaker 3: you know, doctors were seeing more and more people coming
Speaker 3: to them because it's free, Like why the hell not. Yeah,
Speaker 3: but those doctors then the problem is they only have
Speaker 3: fifteen minutes to see the patient, and if people are
Speaker 3: coming to them for things that are complicated like depression
Speaker 3: and anxiety and you know, things that are not as
Speaker 3: simple as oh, you have strepped throat, let me prescribe
Speaker 3: you an antibiotic. That's tough, right, because the patients aren't
Speaker 3: getting the care they deserve, and that means the doctor
Speaker 3: has less time for the person with the clinical problem.
Speaker 3: I tell the story about my friend Gaviy in the
Speaker 3: book to show you the state of healthcare in places
Speaker 3: where it's nationalized, in particularly England, Like there's a little
Speaker 3: British component to this. She waited until her tonsils turned
Speaker 3: black before she went to the doctor because she was like, well,
Speaker 3: you know, somebody probably has a worse issue than me.
Speaker 3: Health care is limited, we don't want to use it.
Speaker 3: And that's true, Like it's not just England, a lot
Speaker 3: of places. It's a wonderful thing. I very much support
Speaker 3: universal health care, but when you make it free and universal,
Speaker 3: you have more people coming there. So social prescribing makes
Speaker 3: sense from an investment perspective of saying, Okay, if there
Speaker 3: are people coming to the doctor, the hostel, or even
Speaker 3: the emergency room for non clinical, non medical reasons that
Speaker 3: might better be treated by a prescription for a ukulele
Speaker 3: group or swimming lessons or a bicycle than they would
Speaker 3: with anything a doctor who's clinically trained can prescribe. Let's
Speaker 3: do that, and this will save the taxpayer's money, right,
Speaker 3: you know. But I was like, that's great, but where
Speaker 3: I live in the United States, not only is healthcare
Speaker 3: not nationalized, but it's also freakin huge. There's also all
Speaker 3: these other inequities that you talk about a lot on
Speaker 3: your podcasts with women and people of color. There's already
Speaker 3: so much shit to fix in healthcare. So really, is
Speaker 3: it magical thinking to think that doctors are all of
Speaker 3: a sudden going to start prescribing art classes. And I'll
Speaker 3: say a couple of things, you know. One is that
Speaker 3: do you have or do you know anybody who has
Speaker 3: an insurer who covers their gym classes?
Speaker 2: I don't think so, I mean, and I can't imagine
Speaker 2: would they cover like a fitness or an equinox or
Speaker 2: only a lot you know what I mean, like, what
Speaker 2: even is covered? So I don't know. Yeah, I think
Speaker 2: a lot of people also are just like I don't
Speaker 2: even have health insurance.
Speaker 3: Right, absolutely, And that's true, right, the healthcare in the
Speaker 3: US is so limited, And it's true that for some people,
Speaker 3: particularly older people like my parents, they are actually starting
Speaker 3: to get their you know, very cheap and like not
Speaker 3: fancy gym membership covered. Not because these insurers have wonderfully
Speaker 3: big hearts and want my parents to be more active,
Speaker 3: but because this is seen as a money saving investment
Speaker 3: over time. In other words, if covering a gym membership
Speaker 3: gets my dad, who loves the couch, loves a pine
Speaker 3: of ice cream, is retired, is otherwise not really going
Speaker 3: to be moving his body, and is on for blood
Speaker 3: pressure medications. If a prescription to the gym might help
Speaker 3: him get off one of those medications, might prevent future
Speaker 3: health expenditure down the line, then that's a good investment
Speaker 3: for them.
Speaker 2: Okay, So gym memberships may be covered either fully or
Speaker 2: partly by your health insurance if you have it, so
Speaker 2: ask them. That is a step aerobics in the right direction,
Speaker 2: and healthcare companies who want to pay out less in
Speaker 2: heart surgeries. Know that access to a rowing machine or
Speaker 2: some zumba classes keeps you out of the hospital, and
Speaker 2: it also keeps more money in their bottom line. But
Speaker 2: it saves you money in terms of deductibles and copays
Speaker 2: and lost work, But what about all the other stuff.
Speaker 3: So that is starting to happen in the United States.
Speaker 3: Believe it or not. I'm sure your jaw's about to drop.
Speaker 3: But there are places that are doing the same for
Speaker 3: art classes really for similar reasons. Yes, where I'm from
Speaker 3: in New Jersey, Horizon Blue Cross, Blue Shield right now,
Speaker 3: if you are on one of their plans and you're
Speaker 3: at risk of overspending on your insurance, they will prescribe
Speaker 3: you an art class. What in partnership with you know,
Speaker 3: the different art providers in the newer community. And it's
Speaker 3: not just the prescription, right, it's transportation, it's all the
Speaker 3: work up because you know, they believe that this is
Speaker 3: something that is going to save the money and prevent
Speaker 3: health issues down the line.
Speaker 2: For more, you can feel free to kick back with
Speaker 2: the twenty twenty three Journal of Economy and Society paper
Speaker 2: Social Prescribing and the Search for Value in Healthcare. So
Speaker 2: it gives some quick history. Social prescribing emerged in the
Speaker 2: US in the nineteen sixties when there was rampant malnutrition
Speaker 2: in children, and one physician, Jack Geiger, started prescribing food,
Speaker 2: which was paid for by the local health center's pharmacy budget.
Speaker 2: So instead of treating the effects of malnutrition with medicines
Speaker 2: that cost money, they just prevented it for less money
Speaker 2: with food for the people who didn't have enough food.
Speaker 2: So there's plenty of legitimacy and financial reason behind this,
Speaker 2: especially where equity is considered. And this paper explains that
Speaker 2: the World Health Organization considers social determinants of health to
Speaker 2: be the conditions in which people are born, grow, live, work,
Speaker 2: and age, and it says these circumstances are in turn
Speaker 2: shaped by this wider set of forces, things like economics
Speaker 2: and social policies and yes, politics, things like patients needs
Speaker 2: for housing and food and income benefits and transportation and
Speaker 2: legal support can be less expensive than the effects of them.
Speaker 2: And this is called value based care and it involves
Speaker 2: good economics people. And the paper cites previous research that
Speaker 2: has found that nearly ten percent of Americans can't afford
Speaker 2: health insurance and some have to use government funded free
Speaker 2: or low cost programs, and also as a country, even
Speaker 2: for those who are ensured. The United States spends more
Speaker 2: per capita on healthcare than any other industrialized nation, yet
Speaker 2: it ranks far below its peers in health outcomes and
Speaker 2: has some of the worst health inequalities. Even the US
Speaker 2: Secretary of Health and Human Services during Trump's first term
Speaker 2: was like, Yo, we're saving nearly four k per patient
Speaker 2: if we focus on fixing the cause of some of
Speaker 2: these illnesses, like type two diabetes, because we all know
Speaker 2: insulin is not cheap. We have a diabetology episode that
Speaker 2: goes into it. So conservatism in a capitalist society has
Speaker 2: a real like pull yourself up by your bootstraps, get
Speaker 2: a job vibe, while also scrubbing the word equity from
Speaker 2: the National Institutes of Health archives, but then spending more
Speaker 2: money to fix the problems inherent to inequity. It's a
Speaker 2: real fuck around and find out situation we've got going
Speaker 2: on here, So it doesn't align with money saving. And
Speaker 2: also on the social conservatism and the bent toward religion
Speaker 2: based politics and this newly established White House Faith Office.
Speaker 2: I do want to cite the Bible, which I google
Speaker 2: to find a few passages such as Matthew ten eight.
Speaker 2: Heal the sick, raise the dead, cleanse those who have leprosy,
Speaker 2: drive out demons freely you have received, freely give. Now.
Speaker 2: I'm not a religious person, but perhaps the new Department
Speaker 2: of Government Efficiency can find some good economic strategies in
Speaker 2: those God bless the USA. Trump approved bibles that sell
Speaker 2: to schools for sixty to one hundred dollars, So yeah,
Speaker 2: crack that open and find some good economic policies, because
Speaker 2: a thousand in prevention might be worth a million in cures. Now.
Speaker 2: Health insurance companies also a good strategy, so if it's
Speaker 2: good for their bottom line, then they'll help you out.
Speaker 2: And it's interesting to come at it from a instead
Speaker 2: of everyone telling me I should go and I should volunteer,
Speaker 2: I should join a thing, and I should exercise the
Speaker 2: data DA. It's nice to think of it as like
Speaker 2: sticking it to the man a little bit.
Speaker 1: Yeah.
Speaker 2: Look, it's kind of nice to be like, no, I'm
Speaker 2: gonna do this for me, so you can't keep you
Speaker 2: inside scrolling and buying things to try to feel better, Like,
Speaker 2: fuck you, So I'm going to go for a walk
Speaker 2: in the park instead of engaging in capitalism. To try
Speaker 2: to make me feel better because it doesn't even work.
Speaker 3: Hell yeah, I love a good fuck you walk exactly
Speaker 3: Like It's so true, though, I mean, and that's where
Speaker 3: like these badass doctors are coming into play. I think, frankly,
Speaker 3: between you and me and your listeners, insurance companies are
Speaker 3: probably going to be the last to buy into this.
Speaker 3: There's some, there are some, and I think again, like
Speaker 3: insurance sent to me is bad, bad, bad bad Right
Speaker 3: now in the USA, I'd say some are trying to
Speaker 3: do this and say, look, you know we care. But
Speaker 3: I think it's really going to happen first with doctors
Speaker 3: and therapists. Like my best friend Kate, for whom that's
Speaker 3: exactly true for she was seeing a teenager who kind
Speaker 3: of like Amanda, was put in a really stressful environment
Speaker 3: and was severely depressed and wanted to get this girl therapy,
Speaker 3: but the only therapist that was in her insurance plan
Speaker 3: didn't have availability for six months. So what are you
Speaker 3: going to do tell someone who's severely depressed to wait
Speaker 3: six months? No, you're going to prescribe them an SSR,
Speaker 3: And again, like that can be a great solution for
Speaker 3: a lot of people. I think the problem is that
Speaker 3: it shouldn't be the only solution. We shouldn't be doing
Speaker 3: that because the other options feel too hard or too unavailable.
Speaker 3: We should be really trying to prescribe people what is
Speaker 3: the best thing for them. And so my friend Kate,
Speaker 3: who is a doctor and loves this, says, I would
Speaker 3: love to have prescribed her an art class. She's extremely creative,
Speaker 3: and I think being in an environment that's not her
Speaker 3: current home environment that could surround her with people who
Speaker 3: would inspire her, that would be amazing. But where do
Speaker 3: I begin. That's where the work ahead is. Ah.
Speaker 2: I have questions from listeners. Can I ask? Okay? One million? Okay?
Speaker 2: Also we donate to a charity of your choice. Is
Speaker 2: there any off the top of your head that's related
Speaker 2: or you can think about it too.
Speaker 3: Yes, I have one I love. It's called grow NYC.
Speaker 2: Which is lovely because grow NYC was born in the
Speaker 2: spirit of the first Earth Day, which is appropriate for April.
Speaker 2: And their mission is to empower all New Yorkers with
Speaker 2: equitable acts us to fresh, locally grown food, neighborhood green spaces,
Speaker 2: and care for the environment.
Speaker 3: So you know, we know that nature Art Service movement
Speaker 3: belonging is amazing for us. We also know that those
Speaker 3: opportunities are not as available to some people, so groups
Speaker 3: like Grow NYC work to put on free horticultural education,
Speaker 3: free field trips, investing in green spaces so that more people,
Speaker 3: regardless of your income or where you live, can have
Speaker 3: access to these medicines.
Speaker 2: So cool, We're can it donate in your honor and
Speaker 2: then we'll put a link off so in the show notes.
Speaker 2: I know I've already kept you so long because this
Speaker 2: is the best, but you have time for some listener questions.
Speaker 2: We'll fire up absolutely let's spire away sweet so she's
Speaker 2: down to clown a little longer, and we will return
Speaker 2: next week to answer questions about forest bathing, health insurance,
Speaker 2: social prescribing in different parts of the world, disabilities and
Speaker 2: social prescribing, animal therapy, how to handle the social part
Speaker 2: if you're an introvert or frankly hate socializing, and how
Speaker 2: these strategies are used even in dire medical circumstances. And
Speaker 2: why also writing a pedicab for zero dollars could benefit everyone.
Speaker 2: So we'll be back next week with those So ask
Speaker 2: Salu genealogical people sometimes basic questions and people buck the system,
Speaker 2: do the things your ancestors evolved you to do. Mindless
Speaker 2: scrolling steals your time and life and money, not to
Speaker 2: mention your data. Pharmaceutical companies and insulin makers love it
Speaker 2: when you're sick and sad. And there are people out
Speaker 2: there whose lives will be changed by hanging out and
Speaker 2: crafting or biking or fishing or chatting, including ours. So
Speaker 2: next week we'll be back with more suggestions, research and encouragement,
Speaker 2: because honestly, this two parter it's an actual lifesaver. As
Speaker 2: far as I'm concerned, I think it's one of our
Speaker 2: most important episodes in that realm. So tell everyone you
Speaker 2: know to listen. Things are hard and we need to
Speaker 2: not burn out. We got to survive this. Since this
Speaker 2: interview with Julia, I have started walking around my favorite
Speaker 2: lake four or five times a week. I love it
Speaker 2: so much that I got the shape of the lake
Speaker 2: painted on one fingernail to remind me every day how
Speaker 2: much that simple thing makes me so much happier and
Speaker 2: gives me something to look forward to and makes me
Speaker 2: less pissed and anxious. I'm also getting my work done
Speaker 2: in much less time because I'm not constantly looking for
Speaker 2: something online to raise my spirits, which it never does.
Speaker 2: And since I've been walking more, Jarrett and I have
Speaker 2: been taking Grammy to this nearby park and walking and
Speaker 2: she gets to sniff, pee and terrorize lizards, even though
Speaker 2: she never comes close to catching one. I literally found
Speaker 2: my ukulele and I dusted it off, and my first
Speaker 2: session with this ukulele group is this coming weekend. And
Speaker 2: I wrote and researched this entire episode outside under an
Speaker 2: umbrella in my backyard, smelling trees, hearing hummingbirds orby, and
Speaker 2: letting g Remy hang out, keeping her eyes open for
Speaker 2: lizards w do catch. And I thought that I had
Speaker 2: to earn this, but I don't. This is the stuff
Speaker 2: that makes life easier and makes us stronger to get
Speaker 2: through the hard parts. You don't wait until you earn it.
Speaker 2: You just take a fuck you walk, don't surrender your
Speaker 2: life to corporations, cut banks, text your crush, volunteer somewhere
Speaker 2: you selfishly just love being. You can join a club,
Speaker 2: you can start a club. Thank me later, Thank Julia
Speaker 2: once again. Her book is The Connection Cure, and you
Speaker 2: can find her on Instagram at Hot's Thoughts, which we'll
Speaker 2: link in the show notes. Along with grow n YC.
Speaker 2: We have links to all the research we talked about
Speaker 2: on our website at aliward dot com slash salu genology
Speaker 2: that's linked in the show notes. We are at ologies
Speaker 2: on Instagram a blue sky. I'm Ali Ward with one
Speaker 2: L on both smologies or shorter kid friendly episodes, and
Speaker 2: they're wherever you find podcasts. They're also linked in the
Speaker 2: show notes. You can find merch at ologiesmerch dot com.
Speaker 2: You can tag any photos of you in it ologies
Speaker 2: merch or just tag us and we'll repost you on Mondays.
Speaker 2: Thank you to Aaron Talbert, who admins the Ologies podcast
Speaker 2: Facebook group. Avelene Mallick makes our professional transcripts. Kelly ar
Speaker 2: Dwyer does the website. Noel Dilworth is our lovely scheduling
Speaker 2: producer who also posts your art on Fridays and your
Speaker 2: merch on Mondays. Susan Hale Managing directs the heck out
Speaker 2: of things. Jake Chafy edits beautifully and lead editor who
Speaker 2: connects it all together is Mercedes Maitland of Maitland Audio.
Speaker 2: Nick Thorburn made the theme music and if you stick
Speaker 2: around to the end of the episode I do tell
Speaker 2: you a secret. I already told you a long one,
Speaker 2: but I will end it with as proof of how
Speaker 2: much easier it's been for me to just stay on task.
Speaker 2: I need you to know that. Jarrett sent me a
Speaker 2: link to a video tour of the one hundred and
Speaker 2: twenty acre one hundred year old home that looks like Heaven,
Speaker 2: owned by Walton Goggins, who is sweet Baby Billy on
Speaker 2: the Righteous Gemstones, also Rick from White Lotus, Whoms I Love,
Speaker 2: and I clicked on this video tour of this beautiful
Speaker 2: house and I was like, I'm going to save this
Speaker 2: for later after I finish the show. Who is she?
Speaker 2: She's someone who walks around the lake and takes her
Speaker 2: dog to the park and apparently has increased executive function.
Speaker 2: So thanks Julia. Okay, go gather some friends or strangers,
Speaker 2: make a diorama in an empty pill bottle. Tag me
Speaker 2: in any photos that you make so I can see
Speaker 2: what you love. Okay by by pacodermatology, homeiology, or doo zoology, lithology, technology, meteorology, paratology, apology, seriology, selenology.
Speaker 2: I also play recketball. Do you have any hobbies?
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