Abstract
Aristotle defined the nature of a human being as a zoon politikon, a social entity based on community and, therefore, forming community. For centuries and well into the 20th century, the clan or its more modern form, the extended family, was the globally unquestioned standard model of the human way of life. With all its advantages and disadvantages, its lack of autonomy, subordination to a larger whole, hierarchies and repression, but also cohesion in times of need and protection of the weaker family members. First industrialization and later globalization broke up these traditional structures and gave the inhabitants of the prosperous industrialized countries a historically unique freedom, an unimagined autonomy and self-determination that was certainly bought with the loss of the safe haven of the extended family.
But has that really changed that much, or has the physical social network not rather just shifted to virtual worlds? Ninety-seven percent of young U.S. Americans use at least one digital social network. Nearly 9 in 10 use them daily, and almost half are online virtually 24/7. 1 You cannot really be alone in today's crowded cosmopolitan cities with their uninterrupted media exposure. And yet more and more people feel lonely. Nearly half of U.S. adults sometimes or always feel lonely, isolated, and complain about a lack of meaningful relationships; one in five people report they rarely or never feel close to others. Contrary to expectation, the older adults report not only the least loneliness but also the best overall health among U.S. adults, while young adults score worst on both dimensions, which suggests that virtual social networks do not replace real ones after all. 2
And loneliness is not just an unpleasant feeling, loneliness makes us sick—mentally and physically. Studies show that loneliness is as big a risk factor for chronic disease and mortality as smoking or obesity. 3 People with stronger social relationships have a 50% increased likelihood of survival than those with weaker relationships. 4 This is because loneliness is pure stress on the body. Being separated from the clan was not only unpleasant but potentially fatal for our ancestors, so loneliness causes the release of stress hormones with all their well-known immunosuppressive long-term effects. 5
Based on these findings, loneliness as a health problem has only recently been brought into the focus of medicine. The United Kingdom has pioneered the development of an approach to the medical consequences of loneliness. And apparently it was sorely needed: an estimated 20% of all patients who see a General Practitioner (GP) in the United Kingdom do so for social reasons, not medical ones. 6 And GPs are neither trained nor have the time to deal effectively with such problems. A solution to help health professionals avoid frustration and chronic work overload seemed appropriately necessary!
One such approach is social prescribing, a model that connects patients in general practice, as well as in other health disciplines, with social sources of support in the community. It thus provides a unique referral option to nonmedical groups and institutions, in addition to physical and psychological care.
The services to which patients are referred are varied and usually involve offers from the voluntary and community sector, which include community activities, physical activity, and support services. Services may or may not aim to address the psychological problems and impaired well-being that are common among patients who seek health care frequently. What they all have in common, as defined by the Social Prescribing Network, is that they are “enabling healthcare professionals to refer patients to a link worker, to co-design a nonclinical social prescription to improve their health and wellbeing.” 7
In the United Kingdom, social prescribing is an important topic, but initiatives and first refinancing approaches are also increasingly emerging in other European countries and the United States. 8
Early studies suggest that social prescribing actually reduces the frequency with which GPs or other health professionals are consulted, so it actually reduces the burden on the health care system. 9 The extent to which the health of patients is actually improved cannot yet be conclusively assessed due to the heterogeneous data situation. 10 Despite this rather preliminary evidence, there is much to suggest that social prescribing is a worthwhile approach. Qualitative studies show, for example, that it strengthens control beliefs, resilience, coping, and self-confidence, and positively influences lifestyle, diet, and exercise behavior. 11
In January 2018, U.K. Prime Minister Theresa May created the post of ministerial lead for loneliness to ensure that tackling loneliness remains a permanent parliamentary priority. A position often erroneously, but quite appropriately, referred to as the Minister for Loneliness. A major step toward comprehensive consideration of the biopsycho
And the field of integrative medicine and health is in particular predestined to embrace and advance social prescribing and the idea of community as a field of health care activity. As Helene Langevin, MD, the director of the NIH National Center for Complementary and Integrative Health, so aptly put it in her pioneering Whole Health commentary in our journal: “Integrative health is not simply putting complementary and conventional medicine together. It is an emergent field of study that aims at transforming health care through a balance of analysis and synthesis, a focus on health, and an understanding of the fundamental interconnectedness of human life with its environment—both the social determinants of health as well as the physical environment.” 12
Integrative health, taken to its fullest, naturally includes consideration of social aspects, and is, therefore, medicine for and by means of community.