Evidence Library
Social prescribing initiatives must reflect a keen understanding of peer-reviewed scientific research; a growing literature finds a robust relationship between social connection and health (both mental and physical), as well as thought-provoking findings on potential applications of specific interventions (art, music, movement, nature, and service) as adjunctive treatments for specific health concerns.
While not a comprehensive list of all studies on social prescribing or its interventions, this library is intended to showcase a representative sample of current, peer-reviewed literature on such interventions. Please check our events calendar and sign up for our newsletter; future webinars will address the body of evidence on each intervention and how those findings can inform delivery of the right intervention to right patients, at the right time.
Jump to: Social connection & loneliness, dance, music, exercise, nature, volunteering and more on the economics of social prescribing
Overview
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Social Connection & Loneliness
Above all, the goal of social prescribing - whether through art, music, movement, nature, or service - is to unite people and their communities. The evidence is very strong that connection has direct implications for physical and mental health alike.
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This article highlights the critical role of social connections in health and longevity, emphasizing that social isolation is a significant risk factor for early mortality. Despite its importance, social factors are often neglected in medical and healthcare settings.
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A comprehensive public health advisory discusses the impact of loneliness and isolation in the U.S., offering recommended actions for different groups and evaluating the strengths and limitations of the available evidence.
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A systematic review and meta-analysis examines the connection between poor social relationships and an increased risk of heart disease and stroke.
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Extensive research shows that strong social relationships and a sense of social connection are linked to a reduced risk of all-cause mortality and various diseases.
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This analysis explores how social support influences stress, presenting evidence for both direct-effect and buffering models.
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The article explores how strong social infrastructure enables communities to better respond to crises.
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Poor social engagement, such as limited social networks and low levels of social support, is linked to a higher risk of dementia, while long-term social engagement offers modest protection.
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Children exposed to adverse psychosocial factors, including socioeconomic disadvantage, maltreatment, or social isolation, are at increased risk for depression, high inflammation, and metabolic disorders in adulthood.
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Functional social support (emotional and practical help) is linked to better adherence in hypertensive patients, whereas structural support (such as the number of social connections) did not show the same association.
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Smaller social networks, particularly those with more family members than friends, are associated with increased risks for both macrovascular and microvascular complications, especially in women.
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Meta-analyses show significant associations between various forms of social support (practical, emotional) and health adherence. Family cohesiveness boosts adherence, while family conflict has a negative impact. This article explores the importance of family dynamics in health outcomes.
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Married individuals, especially those with close marital relationships, have more diverse and richer microbial communities. This is beneficial for health.
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Support from family and friends is associated with lower inflammation, while social strain—such as conflict with loved ones—significantly increases inflammation, with strain showing stronger effects than support in this context.
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Individuals with more types of social ties are less likely to suffer from common colds, experiencing milder symptoms and faster recovery. The diversity of one’s social network correlates with decreased susceptibility to illness.
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Greater social support is linked to better sleep outcomes, suggesting that emotional and practical help from others plays a role in improving sleep quality, regardless of the type of support or underlying health conditions.
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High levels of social capital at the county level are associated with significantly lower drug overdose mortality, with counties having stronger community ties being less likely to experience high or moderate overdose rates.
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Social isolation increases the risk of hospital readmission in patients with heart failure.
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Social integration can have a protective role in immune health; alongside factors like physical activity and adequate sleep, social integration helps reduce the risk of respiratory illness after exposure to viruses.
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Social companionship, work-life balance, and job satisfaction reduce loneliness in the workplace, with lonely workers experiencing higher stress-related absenteeism and turnover intentions compared to their non-lonely peers.
Dance Interventions
A growing body of evidence suggests that not only may certain activities be beneficial for social connection, but they may be valuable inclusions to treatment plans for specific mental and physical illnesses, too. Dance, for example, is demonstrated to produce significant benefit to improving gait and motor control in individuals with Parkinson’s Disease.
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Dance improves gait performance, with post-class improvements observed in both general movement and the Timed Up and Go (TUG) task, suggesting benefits for mobility.
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Therapeutic dance is emerging as a safe and feasible intervention for people with mild to moderate Parkinson’s Disease, showing positive effects on walking, freezing of gait, and quality of life.
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Dance has been shown to improve not only sensorimotor skills but also cognitive and psychological well-being, with evidence supporting its broad impact across validated assessments.
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A qualitative study highlights the benefits of dance and music as cost-effective adjunct treatments for chronic respiratory disease patients, improving health outcomes and patient engagement.
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A review suggests that attending two 1-hour dance classes per week for 10 to 13 weeks can enhance endurance, motor function, and balance, although study quality in the review varied.
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Dance training reduces inflammation in people with Type 2 Diabetes (T2DM) by decreasing neutrophil DNA fragmentation and improving neutrophil clearance.
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Dance programs in women with Type-II Diabetes Mellitus (T2DM) led to significant changes in immune cell profiles, promoting a balance in lymphocyte function and improving immune responses, such as increased IL-10 secretion.
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Dance is shown to offer wide-ranging benefits for children and adolescents with asthma, improving quality of life, balance, exercise tolerance, and social cohesion, with further long-term benefits likely.
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Long-term dance participation is driven by belief in its health benefits, including improved physical fitness, psychological well-being, and reduced healthcare needs.
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Dance Movement Therapy (DMT) has been found to significantly reduce depression scores in adults when combined with traditional treatments, particularly for those under 65, suggesting DMT as an effective adjunct for depression.
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A global study involving older adults shows that dance interventions significantly reduce depressive symptoms compared to control groups, with the largest effects observed in South America and Australia, and higher quality studies showing stronger results.
Music Interventions
Music therapy has long been used in clinical settings, particularly during inpatient hospital stays. If included in social prescribing initiatives, music-as-medicine would become accessible to a larger patient population, including outpatient treatment.
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Music interventions were found to significantly reduce stress, both physiologically and psychologically. Larger effects are seen in heart rate reduction compared to blood pressure or hormone levels.
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NICU infants treated with music therapy showed improved brain function, including faster thalamocortical processing, stronger functional networks, and higher integration in key brain regions.
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Music therapy improves cognitive functions, with active music-making showing greater effects. The therapy was particularly beneficial for enhancing cognitive abilities compared to other control interventions.
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Listening to music enhances memory, attention, and behavioral regulation, with music-based therapies proving effective in treating depression, anxiety, and neurological disorders, including stroke recovery.
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Listening to non-verbal music for 20 minutes daily significantly reduced anxiety and improved vital signs, such as breathing rate, in hospitalized children, showcasing music's therapeutic potential in pediatric care.
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A systematic review demonstrates that music therapy helps reduce chronic pain and depressive symptoms, with patients experiencing greater benefits when they choose their own music.
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Music therapy significantly reduced anxiety in both younger and older age groups, and across developed and developing countries, with positive effects most evident immediately post-intervention, but not at follow-up.
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Music therapy was found to significantly improve motor, speech, and mobility outcomes in stroke patients, supporting its potential to enhance recovery through neuroplasticity.
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Active participation in music therapy, while resource-intensive, has been shown to reduce PTSD symptoms. Even passive listening yielded positive effects, with most studies reporting symptom reduction.
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Similar to active participation, passive music listening also contributed to a decrease in PTSD symptoms. This suggests possible flexibility of music therapy in addressing trauma-related conditions.
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A review highlights music therapy's effectiveness in treating depression when combined with traditional treatments (TAU = treatment as usual), though further research is needed to refine methods and explore long-term outcomes.
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Music therapy significantly reduced pain in palliative care patients more effectively than a talking-only intervention.
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A review of 27 studies on music therapy for Parkinson's Disease shows mostly positive effects on motor symptoms, non-motor symptoms, and quality of life, with few studies showing no benefit.
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Older adults with mild cognitive impairment (MCI) and depression showed significant improvements in cognitive function and depression symptoms after eight weeks of receptive music therapy, compared to those receiving usual care.
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Music therapy led to significant improvements in social reactions among children with autism spectrum disorder (ASD), though it did not significantly affect symptoms, speech, or social behaviors.
Exercise Interventions
Exercise is known to be highly beneficial to health; the following papers provide a sample of the evidence. Inclusion of exercise interventions in social prescribing would facilitate ease of access to exercise programs and provide patients with added assistance in establishing healthy habits.
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A single bout of exercise can improve executive functions, mood, and reduce stress, accompanied by changes in neurochemical levels in the brain.
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Aerobic exercise can reverse age-related hippocampal volume loss, improving spatial memory in older adults. Increased hippocampal volume was linked to higher levels of BDNF, a neurotrophic factor associated with brain health and neurogenesis.
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Exercise therapy can improve diastolic function and promote beneficial heart remodeling in individuals with Type 2 Diabetes (T2DM) and diabetic cardiomyopathy (DCM), primarily by reducing collagen buildup.
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Diet and exercise interventions may lower the risk of gestational diabetes and caesarean section (c-section) compared to standard care, though results were not consistently significant. These findings suggest that lifestyle modifications could be beneficial for reducing certain pregnancy-related complications.
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A 12-week, tailored exercise program significantly increased physical activity levels and helped participants meet activity guidelines compared to a health and wellness group. The exercise group also showed smaller declines in total activity and more consistent engagement in moderate to vigorous exercise.
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Exercise, including endurance and resistance training, effectively reduces fatigue in individuals with COPD, with no clear advantage between continuous vs. interval training or between endurance vs. resistance exercises. Fatigue reduction is often a secondary benefit of exercise interventions.
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Exercise participants showed significant improvements in both fitness and psychological well-being over a 12-week program, with benefits remaining evident at a 1-year follow-up. These findings highlight the long-term positive effects of regular exercise.
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Cannabis use levels were lower during the exercise and follow-up periods compared to the run-in period, suggesting that exercise may help reduce cannabis consumption.
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Individuals engaging in exercise-related activities during treatment achieved longer periods of abstinence from substance use compared to those who did not participate in exercise.
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Exercise during cancer treatment improves fitness, strength, and fatigue, while preoperative exercise in lung cancer patients reduces hospital stay and complications. Neutropenic diets, however, were not found to reduce infection risk during treatment.
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Exercise treatment has been shown to reduce negative symptoms of schizophrenia (such as emotional withdrawal and lack of motivation) though it does not have a significant effect on positive symptoms.
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Regular exercise that meets or exceeds physical activity guidelines reduces the risk of cardiovascular disease (CVD) and mortality.
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Exercise significantly reduces depression scores in participants compared to control treatments.
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Physical exercise can reduce cancer incidence, slow its growth, and improve treatment side effects, making it a valuable part of cancer care. The article also discusses how exercise may enhance immune function and metabolic pathways, aiding personalized treatment plans.
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Different forms of exercise, including aerobic, resistance, and stretching, help reduce pain, depression, and improve quality of life for individuals with fibromyalgia.
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Physical activity and weight management are key to managing knee and hip osteoarthritis (OA). Despite this, many individuals with OA remain insufficiently active or overweight, highlighting the need for better engagement with lifestyle interventions.
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Continued research supports the positive impact of physical activity and exercise interventions on various health outcomes. Regular exercise improves overall quality of life, functional capacity, and mood, benefiting both physical and mental health.
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Exercise, particularly aerobic and resistance training, has been shown to effectively treat depression and anxiety. However, challenges remain, including individual differences in response and the need for sustained physical activity engagement for therapeutic benefit.
Nature Interventions
While time spent in nature for formal therapeutic purpose has not traditionally played a significant role in Western healthcare, growing international movements (including the Japanese movement of ‘shinrin-yoku’, or forest bathing) have inspired recent research on the relationship between time outdoors and wellbeing.
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Nature exposure is linked to improved cognitive function, mental health, physical activity, and sleep. Experimental studies suggest protective effects on mental health, while observational studies show positive associations with physical activity and cardiovascular health, though long-term impacts require further research.
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Participants in therapeutic gardening sessions showed significant improvements in psychological distress and well-being, including reductions in depression, anxiety, and stress. These effects were notably stronger than in the control group.
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Natural environments provide health benefits through both sociobehavioral (e.g., stress reduction, increased physical activity) and regulating services (e.g., heat reduction). These factors contribute to improved mental health and may help reduce cardiovascular disease-related mortality.
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Clinicians are supportive of introducing nature-based interventions (NBIs) in mental health services, citing benefits like improved mood and relaxation. However, barriers such as anxiety, lack of motivation, and accessibility need to be addressed for successful implementation.
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This review explores the various health outcomes associated with nature-based interventions and suggests future study designs to further assess their effectiveness in diverse settings.
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Specific park characteristics may influence physical activity levels and engagement. A multidisciplinary approach is needed to better understand barriers to park use and optimize park design for promoting public health.
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Both Hike Therapy and Surf Therapy resulted in improvements in depression symptoms, though Surf Therapy participants showed greater remission rates from major depressive disorder at follow-up. These therapies may offer alternative treatments for depression in service members.
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A meta-analysis found that nature walks effectively improve mental health, with significant improvements seen across various measures, including anxiety and mood.
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This meta-analysis found that nature walks improve mental health for both within-group interventions and experimental/control studies.
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Forest environments were found to reduce physiological stress markers such as cortisol and blood pressure.
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A brief walk in nature significantly reduced rumination and neural activity associated with self-focused withdrawal, unlike urban walks.
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Green exercise, even in short durations, significantly improved self-esteem and mood, with the presence of water in the environment enhancing these effects. Younger individuals showed the greatest improvements in self-esteem, while those with mental health conditions benefited most from green exercise.
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While nature contact offers numerous health benefits, caution is needed in applying these findings universally, as gaps in knowledge persist, particularly in understanding the full range of effects and underlying mechanisms.
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Regular visits to green spaces were associated with lower rates of depression and high blood pressure, as well as greater social cohesion. A dose-response analysis suggests that even modest exposure to green spaces could substantially reduce these health issues in the population.
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Gardening was found to positively impact a range of health outcomes, including reductions in depression and anxiety, and improvements in life satisfaction and sense of community. Despite some publication bias, gardening's health benefits remain significant across multiple studies.
Volunteering Interventions
While related to the more-established literature on altruism, the study of volunteering for health benefit is relatively novel. Current research seems to indicate the strongest health benefits for older adults, although opportunities for additional research on all age groups abound.
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Volunteering consistently benefits well-being, with the greatest effects seen in those participating in more activities and feeling appreciated for their efforts.
Read more
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Volunteering 200 hours or more annually is linked to a reduced risk of hypertension, increased psychological well-being, and higher physical activity. These benefits were not observed with lower levels of volunteer involvement.
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Volunteering at moderate levels (101–300 hours annually) was associated with fewer depressive symptoms and improved self-rated health, particularly when combined with changes in social network composition.
Read more
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Volunteering among older adults (age 70+) has been shown to slow declines in health and functioning, reduce depression, and improve mortality rates. However, volunteering did not affect the number of chronic health conditions or nursing home residency.
Read more
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Cohort studies indicate that volunteering improves depression, life satisfaction, and well-being, but experimental studies have not consistently confirmed these effects. Volunteers also show a lower risk of mortality, though the impact of volunteering type or intensity remains unclear.
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Volunteering for up to 40 hours a year or with one organization is linked to lower mortality rates, particularly for individuals with limited social interactions or who live alone.
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Volunteering did not reduce depression among younger individuals, but it had a negative effect on depression (it reduced depression) in those over 65. Self-esteem was not found to mediate this relationship in the older age group.
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Frequent volunteering was associated with reduced mortality rates in older adults, with the strongest effects for those who regularly socialized with friends or attended religious services.
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Volunteering is linked to lower baseline depression levels, but it does not predict long-term depression trajectories. For those over 65, volunteering may slow the decline of depression, while it has no effect on younger adults.
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Pain intensity, disability, and depression all showed improvements after training and volunteering.
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Volunteering in returning veterans was associated with significant improvements in health, mental health, and social outcomes, particularly in reducing PTSD and depression symptoms, enhancing self-efficacy, and decreasing social isolation.
The Economics of Social Prescribing
Effective implementation of social prescribing will require a clear economic case for doing so. Social prescribing can include both preventative and curative care; as a result, existing research on the economic impact of preventative healthcare and health promotion, analyses of the cost of disease, and preliminary studies of the economic impact of social prescribing in particular, can help to build that case.
Note: not all of the sources listed below are peer-reviewed articles but include reputable organizations and think tanks.
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This report from the World Health Organization’s European Region outlines estimated costs of poor health and cost savings from health promotion. It can provide a blueprint for similar analyses in the United States. Read more
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This article reached an interesting, nuanced conclusion: objective isolation predicts greater Medicare spending ($1,644) per beneficiary annually, whereas loneliness predicts reduced spending, -$768.
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This analysis found that ‘the indirect costs to employers resulting from employee poor health—lower productivity, higher rates of disability, higher rates of injury, and more workers’ compensation claims— can be two to three times the costs of direct medical expenses. A modest reduction in avoidable risk factors could lead to a gain of more than $1 trillion annually in labor supply and efficiency.’
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This analysis found a mixed picture of impact by intervention; while some interventions were both effective and cost-effective, others were not.
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This article articulates the importance of social connections to positive economic outcomes, including serving as a network for sharing job information.
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The social prescribing intervention generated the largest cost saving for frequent attenders (those regularly visiting the hospital). A five-month intervention generated cost savings of £6113 ($6304) or £78.37 ($80.83) per participant over a five-month intervention.
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The Lancet analyzes research that concludes that expansion of ‘20 existing and proven preventive services to 90% of the population would save an additional US$3-7 billion per year and 2-3 million lives.’
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An analysis describes how ‘a one- standard-deviation rise in the share of households with social ties to East Germany in 1989 is associated with a 4.6 percentage point rise in income per capita over six years’ and posits a causal link between social ties and regional economic development.
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This article synthesizes research that ‘nearly half of all health burden in the USA is attributable to…modifiable risk factors.’ and that more than a quarter of healthcare spending in the US (approximately $730 billion annually) is due to preventable illness.
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A briefing reviews estimates of ROI on social prescribing initiatives, ranging from 0.11 in the first year of operations to 0.43.
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A peer-reviewed article examines the 347 documented outcomes from 87 papers on social prescribing and proposes a framework for conceptualizing those outcomes.
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This briefing includes data on the total cost for direct healthcare for chronic conditions ($1.1 Trillion in 2016 alone) as well as the most expensive conditions in direct healthcare costs (diabetes, Alzheimer’s, osteoarthritis).