PDF Summary:The Connection Cure, by Julia Hotz

Exercise works at least as well as antidepressants to treat depression. Nature exposure rivals Ritalin for ADHD. Art therapy lowers cortisol and reduces PTSD symptoms. These findings are part of the growing evidence behind social prescribing, a health care practice gaining ground worldwide in which doctors write prescriptions for birdwatching groups, community orchestras, and volunteering programs instead of, or alongside, conventional drugs.

In this guide to Julia Hotz’s The Connection Cure, we trace social prescribing from its origins in a run-down East London church to national policy in the UK and pilot programs across the world. We examine the models of health that social prescribing draws on, explore why lifestyle diseases have overwhelmed conventional medicine, and look at the science behind the five activities Hotz says work best as prescriptions: movement, nature, art, service, and belonging. We’ll also add perspectives from medical expert Gabor Maté, evolutionary biologist Daniel Lieberman, and others on what it would take to make us truly well.

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Why have lifestyle diseases become so prevalent? Building on the insight that our health is a function of our environment, Hotz argues that it’s because modern life has disconnected us from our natural sources of well-being. Today, most of us sit far more than we move, often staring at screens indoors, away from nature. We make and consume content instead of creating and appreciating art. We prioritize personal success with little regard for the health of our communities, and we’re more socially isolated than ever. All of this, according to Hotz, is making us sicker and sicker.

(Shortform note: Hotz isn’t the only one to argue that modern life has disconnected us from what makes us human. In The Myth of Normal, physician and philosopher Gabor Maté and his son Daniel Maté argue that what we’ve come to think of as healthy and normal is shaped by our social, economic and cultural systems. They say that society has come to value things like productivity over connection, and that when people don’t or can’t conform to this standard, they experience distress. We then label this nonconformity “abnormal” or wrong and medicalize it—treating it as a problem to be solved with the biomedical approach (pills and such). But the Matés, like Hotz, hold that the social conditions of modern life are the real roots of our ills.)

In the sections below, we’ll explore three reasons our conventional approach to health care fails to address these problems.

Reason 1: The Conventional Approach Can Only Manage, Not Cure

Hotz writes that modern medicine has largely solved the problem of infectious disease outbreaks with vaccines and other drugs (like antibiotics). Because of this success, our health care systems continue to operate in the way that worked for infectious diseases: Diagnose the condition, prescribe a medicine, and repeat if necessary. This is why when you don’t feel well, you go to a doctor, get a diagnosis, and often walk out with a prescription for a pill, an injection, or a medicated cream. Then you do it again the next time you don’t feel well.

But because lifestyle diseases aren’t caused by infections, they don’t respond as well to the “diagnose, prescribe, repeat” model of medicine. There’s no straightforward root cause—no bacteria or virus that you can just kill with a pill. Hotz says that medications for lifestyle diseases can manage symptoms by doing things like blocking pain or inflammation, but they can’t heal the condition itself. Despite this, we continue to treat people as if there’s something wrong with them (like an infection) when in fact, they aren’t well because they’ve been disconnected from natural sources of health.

(Shortform note: While the approach taken to fighting infectious diseases may not work as well for lifestyle diseases—there may or may not be “a pill for every ill”—previous advances in medicine have still left us with numerous benefits. For one, it’s not just vaccines and antibiotics that prevent infectious diseases, but also public health infrastructure, which plays a vital role in detecting and managing outbreaks. Public infrastructure also determines how much access we have to natural sources of health: Residents of some communities, like inner city neighborhoods, have fewer opportunities to get out into nature, and research by traditional medical providers is bolstering support for improving access to parks as a means to address health concerns.)

Reason 2: Medications Have Serious Downsides

Even when medications do help with symptoms, they often come with significant long-term side effects and can create dependency, according to Hotz. Take the newer diabetes and weight-loss drugs like Ozempic—while they may help people lose weight, they’re associated with severe side effects like nausea, vomiting, and even stomach paralysis. Plus, people need to take them indefinitely to maintain the benefits, which creates a revolving door effect: Patients get some symptom relief, but because the underlying environmental and social causes of their ill health aren’t addressed, they keep coming back to the doctor for more.

(Shortform note: The term “side effects” can be misleading; it downplays an inconvenient fact: Side effects are effects. Officially called “off-target effects,” they simply aren’t the effects that the producer was going for. Hotz’s example of Ozempic is vivid—notorious for causing “Ozempic face,” the drug has quite a few side effects. So why do we keep using pills instead of addressing the underlying structural conditions? Some argue that it’s because the pharmaceutical industry works to perpetuate the structural conditions that keep it profitable, such as by colluding with governments to subvert regulatory processes or influencing doctors to sell more pills.)

Reason 3: Health Care Systems Are Breaking Under the Pressure

Further, this revolving door effect is a large part of what’s overwhelming health care systems around the world. Hotz reports that health care systems everywhere are in crisis, writing that in the UK alone, over 7.75 million people are on waiting lists for treatment, while general practitioner (GP) appointments often last less than five minutes. Some patients wait over 12 hours to get from the emergency room to a hospital bed.

Some of this pressure comes from those patients who keep coming back for medicine to manage their lifestyle diseases—studies show that 50% of all GP appointments are for long-term conditions. Another large contributor is what researchers have found are essentially “social” appointments (one in five visits), or trips to the doctor for purely social reasons. According to Hotz, the people who do this are often lonely elders who head to the emergency room on a weekly basis because that’s all the social interaction they can get.

In either case, Hotz says, patients don’t need conventional medicine, but health care workers don’t know what else to offer. So doctors become overwhelmed with patients they can’t effectively treat, which means less time for patients with medical problems they can treat (like colds or the flu).

Comparable Health Care Pressures in the US

Perhaps because social prescribing originated in the UK (more on that later), Hotz takes the UK’s National Health Service (NHS) as a primary example of a health care system buckling under the pressure of lifestyle diseases. Some might argue that this is because the NHS is a free, publicly funded system and is therefore limited in how much access to care it can provide, but it’s worth noting that the US’s fee-based health care system is experiencing similar strain.

The US has no single waitlist for doctors’ visits; a comparable reference point is the average wait time for those visits. As of 2025, the average wait is 23.5 days for a basic physical, up 16% since 2009. Meanwhile, time spent “boarding,” or waiting for a hospital bed in the emergency room, is on the rise, with 5% of patients waiting up to 24 hours, twice as long as the worst waits Hotz reports in the UK.

What about long-term conditions? At 39% of total visits and 52% of visits by those 65 and older, about as many Americans as Brits go to the doctor for help with chronic conditions. Socially isolated elderly Americans are also more likely to visit the emergency room than their more well-connected peers, possibly for social interaction.

One possible conclusion to draw from this data is that it doesn’t matter how the system is funded—it’ll be subject to the same structural conditions that cause lifestyle diseases, and therefore beset by patients who have them. With emergency departments around the world facing overcrowding issues that worsen the health outcomes of everyone in them, even patients that doctors can treat are impacted by others’ lifestyle diseases.

Social Prescribing Can Solve These Problems

Hotz argues that social prescribing can provide genuine solutions to the problems named above. For one thing, social prescriptions can address the root causes of lifestyle diseases in ways that medication alone can’t. For instance, early evidence shows that:

• Exercise prescriptions are at least as effective as antidepressants for treating depression.
• Nature prescriptions work as well as Ritalin for ADHD symptoms.
• Art therapy can reduce PTSD symptoms and lower cortisol levels.

What’s more, social prescriptions are often available at low cost and come with no risk of the serious side effects associated with many medications, like weight gain, heart palpitations, or suicidal thoughts. And when they work, you don’t have to keep going back to the doctor—you just stick with the activities you’ve become involved in.

Does Social Prescribing Really Get to the Root of the Issue?

Hotz hedges throughout the book, maintaining that drugs have a place in medicine and suggesting that social prescribing is complementary to pharmaceutical treatment. But others take a harder line, saying that pharmaceuticals are tools of social control, and that mental health treatment should be limited to people with genuine neurobiological disorders (like cerebral palsy).

What’s the risk of taking prescription drugs? It could be as bad as losing touch with the real world. Psychiatrist Joanna Moncrieff argues that under capitalism, big pharma has successfully promoted a “psychiatric re-shaping of personhood” where distress, depression, and fatigue—natural responses to poverty, discrimination, and insecurity—are treated as medical problems rather than the results of socioeconomic inequities. Under this paradigm, drugs serve to keep quiet and sedate all the people who feel that something is very wrong with the world.

However, social prescribing might face the same pitfall. With his notion of “McMindfulness,” Ronald Purser argues that traditional Buddhist meditation has been warped into a tool for coping with, rather than changing, the structural conditions that cause suffering. Depending on how you approach them, Hotz’s examples of social prescribing might do the same: Exercising, getting out into nature, and engaging in art therapy may help you adjust to, rather than change, the conditions that are causing your ill health to begin with.

All the same, there’s an argument to be made that even when structural change would help, we can only ever do our best under the circumstances as they are, not as we wish they were. In this regard, we might approach social prescribing as a way to resist injustice: If it reduces your dependence on the industry that profits from the very illness it perpetuates, that’s a step in the right direction.

Patient benefits are one thing, but social prescribing’s upsides don’t stop there—it also reduces the pressure on medical services. According to Hotz, early studies in the UK found a 28% reduction in demand for GP services and 24% fewer emergency room visits among people who received social prescriptions. In other words, social prescribing can free up health care workers to focus on treating patients who actually do need conventional medical care.

(Shortform note: These statistics might be influenced by the UK’s universal health care system through the NHS. The NHS committed funding for over 1,000 social prescribing link workers by 2020-2021, making social prescriptions available to all citizens regardless of their ability to pay. But in countries without universal health care, these benefits might be harder to achieve—those who can’t afford medical care in the first place won’t show up in statistics about reduced doctor visits.)

How Social Prescribing Is Changing Health Care Around the World

Now that we’ve described what social prescribing is and why Hotz says it’s needed, let’s look at how it’s actually spreading around the globe—and what that tells us about the future of health care. In this section, we’ll detail its origins in the UK and its spread to the EU, as well as the headway it’s making in Asia, Australia, and the US (its toughest battleground).

Origins in the UK: From Church Practice to National Policy

Social prescribing as we know it today began almost by accident in 1984, when a priest named Andrew Mawson took over a rundown church in Tower Hamlets, a poor neighborhood in London. The church attracted people with all sorts of problems—unemployment, poverty, poor health—and Mawson decided to transform it into a community center in the hope of helping them. Soon after, he got assistance from Sam Everington, a doctor who’d observed that his patients kept coming back with the same problems, but traditional medicine wasn’t helping. Everington made social prescribing’s trademark shift in language—instead of asking “What’s the matter with you?” he started asking “What matters to you?”

Combined with Mawson’s community space, this meaning-focused approach to health led to a different kind of prescription—one for social activities. Through the years, this approach drew more converts and contributors, and in 2019, the UK government committed over £5 million to expand social prescribing across the country through the National Academy for Social Prescribing (NASP).

(Shortform note: This origin story has proven remarkably durable. Sir Sam Everington remains a GP at the Bromley by Bow Centre—now with over 100 projects under its roof—and was recently named Patron of the National Academy for Social Prescribing. Meanwhile, Lord Andrew Mawson (who was elevated to the House of Lords for his work) continues advocating for community-led health care models. The Centre has helped thousands of people and serves as an international model for health care providers from other countries. In addition to continued funding of national-scale social prescribing, different UK agencies also offer grants for organizations looking to expand access to social prescribing services.)

European Expansion: Same Principles, Different Models

Hotz writes that as social prescribing spread across Europe, different countries adapted the approach to fit their health care systems and cultures. In Portugal, Dr. Cristiano Figueiredo found he could implement social prescribing by working with social workers who were already on staff at his clinic. Those social workers started asking deeper questions about what people needed to do to feel fulfilled—and then connecting them to community programs accordingly.

Other European countries have pioneered programs focused on specific kinds of social prescription. For instance, in the Nordic countries, Sweden developed Arts on Prescription programs, and Denmark created Exercise on Prescription. Because funding opportunities are still limited, Hotz says, these programs aim to prove the benefits of social prescribing on a smaller scale and to expand once they’ve been studied and validated.

(Shortform note: European social prescribing has matured considerably since the time of Hotz’s writing. In January 2025, the EU launched SP-EU, a €6.9 million, five-year research project to test social prescribing specifically for vulnerable populations—LGBTIQ+ individuals, refugees, first-generation immigrants, and isolated older adults. The program includes randomized controlled trials across multiple countries, including Portugal and Denmark (but not Sweden), and it’s aiming to build the robust evidence base that earlier pilot programs lacked. Figueiredo isn’t involved, but he continues to champion social prescribing in Portugal.)

Asia and Australia: Focusing on Aging Populations

In Asia, social prescribing has largely emerged as a response to rapidly aging populations, says Hotz. Singapore, facing the challenge that by 2030 one in four residents will be over 65, has developed an “active aging center” model. These centers allow elderly people to live independently while participating in group activities—exercise, communal meals, games, shared shopping trips. The model aims to reduce loneliness among Singapore’s elderly, which was leading to hospital visits that medicine couldn’t really address.

(Shortform note: Singapore’s active aging centers stand in stark contrast to traditional US nursing homes. Singapore now operates 223 centers, with 80% of seniors living near one, and the city’s community hospital system was recently designated by WHO as the world’s first Collaborating Centre for social prescribing. But US nursing homes struggle with endemic loneliness, with one study showing that 61% of US nursing home residents experience moderate loneliness and 35% experience severe loneliness. Singapore’s model keeps elders living independently in their communities with social support built in, while the US model institutionalizes elders in facilities that remove opportunities for social connection.)

Meanwhile, in South Korea, global health expert Eun Woo Nam has created a pilot program in a “Little Library” above a fast-food restaurant, where elderly women participate in intergenerational activities with local children—singing together, making tea from marigold flowers, and giving each other shiatsu massages. Hotz writes that despite this program having limited resources, participants reported reductions in loneliness and depression.

(Shortform note: Nam’s Little Library program exemplifies a broader movement toward intergenerational housing that addresses isolation for both seniors and young people simultaneously. Research shows these arrangements benefit both generations: Young people gain wisdom and perspective while older adults experience decreased depression and increased cognitive stimulation—similar to what Nam discovered in his pilot program.)

The United States: Overcoming Entrenched Practices

According to Hotz, social prescribing faces its biggest challenge in the United States, where pharmaceutical companies are powerful and there’s an entrenched “pill for everything” culture.

Hotz traces the roots of this culture to the mid-20th century, when researchers noted the euphoric effects of a drug intended to treat tuberculosis. Other scientists realized this drug could potentially treat depression, and soon after, pharmaceutical companies started producing mood-altering pills to treat supposed chemical imbalances in the brain. As Hotz points out, though, research doesn’t actually support the idea that conditions like depression are caused by chemical imbalances. Regardless, this theory became popular, and today it’s commonly assumed that medications are an effective fix for mental health conditions.

(Shortform note: Another reason treating illness with pills is such a compelling idea is that our brains evolved to seek efficient solutions. Early humans who could quickly solve threats (such as finding food and avoiding predators) survived better than those who overthought every challenge. This means we instinctively prefer simple, immediate solutions over complex, effortful ones. Pills promise just that—take once daily, and your problem is solved. Wanting to believe in silver bullet solutions might also be why the people who pioneered early pharmaceuticals thought they’d work to begin with.)

Since doctors first began prescribing mood-altering pills, US pharmaceutical companies have grown larger and more powerful. Hotz reports that the US is one of only two countries that allow direct-to-consumer prescription drug advertising, with companies spending $6 billion annually on ads. She argues that these ads condition people to think of taking medications as the norm. Meanwhile, the US’s for-profit health care system incentivizes quick fixes over time-intensive solutions. Overworked doctors, facing patient loads that studies show would require 26.7 hours per day to handle properly, often prescribe drugs because they don’t have time for deeper conversations about what’s really affecting their patients’ health.

(Shortform note: The pharmaceutical industry wields extraordinary power in US politics. According to OpenSecrets, the industry spent nearly $400 million on lobbying in 2024 alone—more than any other sector—and deployed 1,839 lobbyists, 56% of whom are former government employees. This spending buys results: Direct-to-consumer advertising became legal only after intense lobbying. Meanwhile, Big Pharma continues to persuade doctors (who do in fact write more prescriptions when they’re tired) to get in on the profit.)

So why do pills and big pharma prevail in the US? According to Hotz, it’s because Americans are caught in a cycle: Life in the US is stressful, so people become ill. Then, insurance companies categorize them in terms of their symptoms, and pharmaceutical companies create medications to manage those symptoms. Overburdened health care providers prescribe those drugs, but because they don’t really heal the illnesses, the patients have to keep coming back for more.

(Shortform note: Gabor Maté—who argues against the excessive pathologization of normal responses to a broken world—might add that it’s not just life now, but trauma from earlier in life that keeps us ill. In The Myth of Normal, Maté writes that many of us are shaped by emotional wounds we suffer early in life, whether from neglect, abuse, or other adverse experiences. When these traumas go unresolved, they continue to influence how we think, feel, and behave, limiting our potential and disconnecting us from the world. So on top of the stressfulness of modern life, many people are set back to begin with, and it may be difficult to find trauma-informed care.)

Social Prescribing’s Wins in the US

Despite these obstacles, social prescribing is gaining ground in the US, Hotz says. The movement began in the 1960s, when Dr. Jack Geiger created America’s first community health centers. These serve basic needs in struggling communities, doing things like prescribing food to malnourished families. More recently, Professor Barry Zuckerman pioneered medical-legal partnerships, where doctors and lawyers team up to address social determinants like housing code violations that cause asthma. Meanwhile, programs like HealthBegins help identify “upstream” social causes of health problems and prescribe treatments like food and housing assistance.

(Shortform note: Geiger, Zuckerman, and HealthBegins share a common lineage: They all treat health not just as medical, but as a social and political issue. Geiger worked as a medic for civil rights protesters as part of Freedom Summer in 1964. There, he recognized that denying medical care—which Jim Crow did to Black communities—was an act of oppression, whereas providing health services was liberating. Zuckerman extended the spirit of this insight when he realized that landlords would ignore tenants, but not lawyers who knew how to hold them to account. HealthBegins systematized these efforts, helping health care providers to identify “upstream” social causes of ill health and intervene ahead of time.)

Now, Hotz reports, a new generation of health care workers is prescribing movement, nature, art, service, and belonging alongside traditional treatments. Doctors Indu Subramaniam and Ardeshir Hashmi are just two of the many professionals prescribing things like support groups for Parkinson’s patients or ballroom dancing for lonely elders, respectively.

In 2022, these individual efforts were united under Social Prescribing USA, a national organization founded to expand access to social prescribing in the US. That year, Hotz attended the organization’s first event at Harvard, which brought together 40 practitioners from across the country. She reports that the energy in the room was exciting and passionate and predicts a bright future for social prescribing in the US and elsewhere.

(Shortform note: Social Prescribing USA has made substantial progress since Hotz attended their 2022 Harvard gathering, and they’ve set out a roadmap that aims to deliver social prescribing for all Americans by 2035. As of 2025, they were working on pilots in all 50 states and heading toward hosting the first Social Prescribing USA Conference in 2026. Meanwhile, Dr. Subramaniam continues to advocate for a more holistic approach to Parkinson’s, the neurodegenerative disease in which she specializes. Dr. Hashmi sits on the board of Social Prescribing USA and continues to further his work with geriatric patients.)