How “Arts on Prescription” Could Change the Course of Healthcare

In this interview, Dr. Tasha Golden, Director of Research at the IAM Lab, discusses social prescribing, evaluating the nation’s first arts on prescription program “CultureRx”, and sharing what needs to happen for the arts to help us heal – together.

Q: Many people are discussing “social prescribing” or “social prescription” and its growing impact on communities and the healthcare system. What is it exactly, and how does it complement traditional and current healthcare practices – especially in the midst of a health and healthcare crisis?

There’s no one definition of social prescribing, but it’s understood as a process that allows healthcare and social care providers to write prescriptions or referrals to community resources and opportunities that help address what we call social determinants of health. Social determinants are factors like housing, food, employment, safety, education, social supports, opportunities to pursue interests, access to beauty and nature… And these factors can affect our health more than clinical care, more than medicine or genetics, or even our behaviors.

It comes down to our contexts and environments, our ecology of health. Sometimes I have students imagine: What kind of world has to exist for human beings to be able to thrive? Whatever factors you imagine that we can’t just create for ourselves – you can think of those as social determinants of health.

The goal of social prescribing is to bolster health and health equity by helping healthcare providers link people to resources that address these more ecological factors: like housing and food assistance, job skills training, support groups, time in nature, volunteer opportunities, arts and culture experiences, and more. When a provider makes a referral, the services or resources are free.

Social prescribing has been in place for decades in the UK and in other countries, but the term and related practices are pretty new in the States. That said, we do have something similar! In the U.S., when healthcare providers refer people to community resources in order to address social determinants of health, this is often called “community referral” or “nonclinical referral.”

But typical “community referral” practices in the U.S. tend to focus strictly on basic services, whereas social prescribing includes these services as well as many more community resources, like art or music experiences, parks and gardens, volunteering opportunities, etc. The model has recognized from its beginnings that arts, culture, nature, and social connections can all have important health benefits. The reality is that the benefits of these kinds of experiences aren’t equitably available, so connecting people to them via healthcare visits not only bolsters health but also helps open access.

Q: Within social prescribing, we have ‘arts on prescription’ – what is that exactly?

It’s a specific subset of social prescribing. Since typical U.S. referral practices are more limited than social prescription, there are new initiatives that aim to add components that the U.S. is typically “missing,” like arts, culture, and nature. When a program’s specifically focused on enabling referrals to arts, culture, and nature, I’d call that an “arts on prescription” program. This isn’t a technical or formal term, but it helps distinguish these programs from the more encompassing idea of “social prescribing” – which refers to that fuller range of resources that address social determinants of health.

Arts on prescription programs can be important for expanding how we think of health in the US. After all, there’s not a scientific reason for the exclusion of arts, culture, or nature from community health referrals. When there are assets and resources that have been shown to help people heal, reduce symptoms of various conditions, have a better quality of life, connect with their own cultures and their own values, etc, then we have to tap into those assets in order to advance health. Ignoring or excluding them isn’t an evidence-based decision; it’s instead a decision based on norms, tradition, or a lack of knowledge or funding.

Q: Social prescribing has been an integral part of healthcare systems in various countries around the world – particularly in the UK – for decades. How do you see social prescribing and arts on prescription gaining ground in the United States?

First, it’s important to acknowledge that getting and maintaining prescriptions can be a nightmarish process for a lot of people in the U.S. So this word “prescription” will, for some people, seem to indicate that arts and culture are going to become as hard to get as their other prescriptions! So to be clear, that’s definitely not what we’re aiming for. The aim is for healthcare referrals or prescriptions to be an additional access point; not a gatekeeper. And of course, the overarching goal is to improve whole-person health.

When it comes to what’s emerging in the U.S., we’re seeing models like Art Pharmacy that are partnering with insurance companies to provide sustainable funding for arts prescriptions. Other models are working to increase the inclusion of arts, culture, and nature in existing community referral networks, and experimenting with platforms that support this.

We’re also seeing work that goes beyond a healthcare focus. There are arts-on-referral partnerships being created with school systems, social care agencies, justice systems, and a range of community organizations that can refer students, clients, or patients to arts, culture, or nature experiences.

This multisector work helps us consider that fabric of community care. Who and what should be included in networks of care? Who and what have we been missing? What needs to change so that we can better address social determinants of health and improve health equity?

Q: Let’s talk a bit about CultureRx: the first “arts on prescription” model in the United States, launched by Mass Cultural Council. You led the pilot evaluation, and just published the study in Frontiers in Public Health – what surprised you the most about the findings?

“CultureRx” is a Massachusetts (MA) program that brought together 12 cultural organizations with over 20 healthcare providers across the state, and created partnerships that allowed providers to write “prescriptions” for various arts and culture experiences that benefited their patients’ health.

There’s so much I could say about the findings, which were overwhelmingly positive, but when it comes to surprises… The responses from the healthcare providers surprised us. They ranged from pediatricians to general practitioners to mental health providers, and most used the program readily and intuitively. But many also reported that it bolstered their own wellbeing! One physician said it felt like they were “prescribing beauty”, or that they were making people happy, and added that “we don’t do a lot of making people happy in medicine.” Several described how nice it was to see the joy and interest in their patients when they mentioned the opportunity for a free arts or culture experience. This was an important finding at a time when we’ve been seeing unprecedented rates of burnout among healthcare workers.

Q: You were a touring musician for many years. How does being an artist shape your advocacy for social prescribing / arts on prescription?

Ok there are a lot of ways I could answer this, but two things come to mind! First, over years as a touring songwriter, listeners and audience members regularly shared really personal stories with me, that related to my songs: stories about their histories of abuse or depression or other challenges. Many said they’d never told anyone before they told me.

This happened so consistently that I couldn’t help wondering: How and why do stories become speakable through music and the arts? And if there are significant aspects of our lives that we can’t share without the arts, what does this fact mean for our healthcare practices? Our social care systems? For education?

It was clear to me that we’re going to have to (re)integrate these worlds and practices if we’re going to advance health. I became a public health scientist because I needed to research art’s impacts on health, and what this means for our systems and practices.

And second, my lived experience as both an artist and health scientist means it didn’t and wouldn’t occur to me to imagine health and the arts as separate practices or sectors. They’ve always been integrated in me as a person, and so I perceive that integration in the world around me, too.

The lack of integration is the curiosity from my perspective! And these emerging social prescription and arts on prescription programs are addressing that lack and expanding the fabric of community care. They’re grounded in the question, “What do humans need in order to be well, to thrive, to heal, to reduce suffering, to connect with one another, to make meaning?” And, “How do we create an ecology that responds to that?”

Arts, culture, and nature have always been part of that health ecology. We’ve ignored and excluded them to our detriment. We can rectify that mistake.

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This interview was condensed for clarity.

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