Bringing Social Health to Healthcare: A Call to Action
Scientifically reviewed by Stephen Braren, Ph.D. & Rose Perry, Ph.D.
Social health—the aspect of overall well-being that stems from our relationships, connections, and community—is an integral component of our everyday lives. Poor social health, such as experiencing social isolation or loneliness, has significant negative impacts on both mental and physical health. Yet, despite its importance, social health is often neglected in traditional healthcare settings due to a lack of social health education, resources, and provider time. Integrating social health screenings and social prescribing into the healthcare system is a critical step toward recognizing and treating social health as an essential pillar of overall health and well-being.
Editor’s Note: This article is the first in a series dedicated to turning research into actionable strategies to integrate social health into systems and practices that improve overall well-being. The articles not only advocate for systems-level transformation to elevate social health, but also equip readers with practical insight into how to make that change happen. In this inaugural piece, we advocate for integrating social health into healthcare practice in the U.S., and provide actionable tools for healthcare providers to begin doing so. Look out for more upcoming articles in this series, and subscribe to The Creature Times below to follow along and delve deeper into the science of social health.
A large body of scientific research shows that social connections have substantial impacts on both physical and mental health conditions, such as heart attack, stroke, depression, anxiety, and even mortality [1]. Based on this research, social health—defined as the “aspect of overall well-being that stems from connection and community”—is a critical dimension of health that should be recognized and treated as a core component of clinical practice. Yet, it remains largely overlooked in healthcare—not because it’s harder to assess or address, but because it’s not yet routinely prioritized like physical or mental health.
Integrating social health into healthcare practice requires two principal steps: social health screening and social prescribing. In this article, we aim to inform healthcare workers (i.e., doctors, nurses, social workers, etc.) of the importance of social health screenings and social prescribing, and advocate for their integration into healthcare systems to provide the whole-person care essential to supporting overall well-being.
Social Health Screening
Social health screenings are tools designed to specifically evaluate the quality and/or quantity of a person’s social connections and relationships. Typically, they include questions about feelings of loneliness and social isolation. For instance, one of the most widely used social health measurement tools, the UCLA Loneliness Scale, includes questions like “How often do you feel that you lack companionship?” [2]. Another commonly used scale is the Berkman–Syme Social Connection Index, which measures social isolation by asking about a person’s marital status, frequency of contact with other people, and participation in group activities [3]. Similarly, the Brief Social Connectedness screener, which contains only three questions, assesses loneliness, social isolation, and emotional social support [4].
These and other validated scales are commonly used in academic research to measure social health outcomes. However, they are not yet widely adopted in healthcare or clinical settings, despite endorsements for use in clinical care from the National Academy of Sciences, Engineering, and Medicine, The Coalition to End Social Isolation and Loneliness, and others [5, 6].
It’s important to note that social health screenings are distinct from traditional Social Determinants of Health screenings, which assess external social and environmental factors such as food insecurity, education access, and transportation availability. In contrast, social health screenings evaluate the quality and quantity of an individual’s social connections and relationships, including loneliness, social isolation, and social support. Recognizing and assessing these relational factors is vital, as they have a profound impact on overall health and are frequently overlooked in standard healthcare evaluations. Table 1 provides examples of how social health screenings can be implemented in clinical settings, depending on staff capacity and available resources.
Table 1. Social Health Screening Methods. Examples of social health screening methods, tailored to different clinical settings and staff roles, demonstrating how screenings can be integrated into healthcare workflows based on available resources. Potential pros and cons for each method are also given. PCP = primary care provider, CHW = community healthcare worker.
Social Prescribing
Once individuals experiencing or at risk of experiencing loneliness and social isolation are identified, medical providers can refer them to social health support services through a process called “social prescribing.” Through this referral-like process (illustrated in Figure 1) healthcare professionals—such as physicians, social workers, or community healthcare workers (CHWs)—connect the patient to community-based programs and resources, to enhance their social health and, consequently, their overall well-being [7].
In creating a social healthcare plan, clinicians should ideally collaborate with patients to create personalized plans that align with their circumstances, interests, and resources—drawing on local community-based programs, initiatives, and volunteer organizations as referral options. Healthcare providers can also look to well-established international social prescription models to inform their patient care. For example, art-based models (e.g., Arts on Prescription) connect patients to group activities such as dance, drama, music, painting, and poetry, to reduce social isolation and foster community engagement [8]. Similarly, exercise-based models (e.g., Exercise Referral/Exercise on Prescription) involve referring individuals to supported group exercise programs (e.g., cycling, dancing, swimming), which promote physical health while creating opportunities for social interaction [9].
Figure 1. Social health screening to social prescribing pathway. In Stage 1, social health screenings are administered in routine medical appointments. In Stage 2, social prescriptions are given by either the physician or other clinic staff (i.e. social workers or CHWs). In Stage 3, follow-up re-screening is performed to evaluate efficacy of prescription and continuation of prescription if necessary. PCP = primary care provider, CHW = community healthcare worker.
Notably, there is a great deal of research documenting the benefits of social prescribing, including strengthening patient well-being, increasing perceived social support, and reducing social exclusion and feelings of loneliness [7, 10]. Furthermore, linking patients to social interventions and groups through social prescribing can also directly impact mental and physical health [11]. For instance, in one interesting study, researchers found that participating in socially-prescribed community programs alleviated mental health issues in chronically ill and lonely patients, reducing their primary healthcare usage [12]. Similarly, another study explored the impact of prescribing a nature-based social program with low-income parents and their children. The results showed that after three months of weekly park visits with other enrolled families, participants’ stress levels, as well as feelings of loneliness, significantly decreased [13].
Despite its documented benefits in other countries (e.g., the U.K.), social prescribing in the U.S. is currently limited, especially at federal and state levels. However, some healthcare providers in the U.S. have started integrating it into their practice. For example, at the Los Angeles VA Hospital, the neurologist Indu Subramanian connects veterans living with Parkinson’s disease through a virtual support program to combat loneliness and social isolation, a leading cause of suicide in this high-risk population. Additionally, on a larger scale, the organization Social Prescribing USA has been actively involved for several years in advocating for the national implementation of social prescribing.
Making Social Healthcare Standard of Care
While integrating social health screenings and social prescribing into standard care in the U.S. requires support from policymakers and payors, healthcare practitioners play a critical role due to their direct interaction with patients. However, while most healthcare providers are aware of the impact that social connections have on a patient’s health, only a small portion have begun to assess this dimension of health in their practice [14].
One of the most reported concerns among healthcare professionals is whether patients will be open about stigmatized issues like loneliness or isolation. However, research indicates that patients view the healthcare setting as a safe space to discuss these issues and believe social health information should be used to improve their care [15].
Another significant barrier is clinician time constraints, exacerbated by the U.S.’s fee-for-service payment model, which prioritizes patient volume over quality of care [16]. While value-based care models, which are focused on quality of care, are gaining traction in the U.S., incorporating social health into this framework is essential to ensure its long-term integration.
A potential solution to time limitations is shifting the responsibility for social health screenings and social prescribing to social workers or community health workers (CHWs). These professionals can conduct screenings, provide referrals, and connect patients with community resources, easing the burden on physicians while increasing screening reach and cost efficiency. For example, primary care clinics employing CHWs screen patients at significantly higher rates (28.8%) compared to those without CHWs (15.3%) [17]. This team-based approach demonstrates promise in creating sustainable, patient-centered models of care.
Clinicians may also hesitate to address social health due to a perceived lack of influence over patients’ social lives or inadequate community-based services to support referrals. While these are valid concerns, social prescribing does not require clinicians to become social health experts. Instead, physicians can contribute to patients’ social health through signposting (e.g., providing program materials), direct referrals, or coordination with social workers and CHWs [18]. These referral pathways streamline the process and help connect patients to existing programs, even in resource-limited settings.
A Call to Action
Social health has too often been overlooked as a vital dimension of health, despite compelling evidence that it is as critical as mental and physical health. By integrating social health screenings and social prescribing into routine care, healthcare systems have the opportunity to address the profound impacts of loneliness and social isolation on health, improving both individual and public health outcomes alike. Achieving this shift requires a collaborative effort. Healthcare providers can take actionable steps by leveraging validated social health screenings and social prescribing pathways, while policymakers and payors must invest in infrastructure, funding, and support needed to make these practices sustainable. Previously successful models, such as the integration of behavioral or mental health into primary care, demonstrate that incorporating new dimensions of health into routine care is both possible and effective [19].
The time to act is now. Recognizing and addressing social health in clinical practice is not just an opportunity to improve care—it is an imperative to create a healthier, more connected society.
Cite this article:
Fiorentino, A., & Cooke, L. (2024, December 15). Bringing Social Health to Healthcare: A Call to Action. The Creature Times, Social Creatures. https://www.thesocialcreatures.org/thecreaturetimes/bringing-social-health-to-healthcare
In-text References
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