Note: Transcripts may contain errors. If you wish to re-use all, or part of, a transcript, please contact CBC for permission. Please check the corresponding audio before quoting in print. Copyright © CBC 2023

The Dose Transcript for February 1, 2023

Host: Dr. Brian Goldman

STORIES FROM THIS EPISODE

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. It's been said that Canada and other developed nations are in the grip of an epidemic of loneliness. Experts have said that social isolation is as hazardous to your health as smoking half a pack of cigarets a day. The good news is that things like volunteering to help others and even chatting with someone you don't know can be good for your health. So this week we're asking how can socializing benefit my health? Hi, Kate. Welcome to The Dose.

KATE MULLIGAN: Hi, Brian. Thanks for having me.

BRIAN GOLDMAN: So when you need a pick me up, what's your go to social activity?

KATE MULLIGAN: I have two and they're kind of related. I love being outside in nature and going for a walk. And I also really love just being outside in front of my house. If I get out there in front the front yard with my kids. We're like a magnet for neighborhood activity, and then we get to be around other people and have fun and get physical activity and fresh air and sunshine.

BRIAN GOLDMAN: Well, that sounds neat. You know, often my go to is is going for a run, which is a solitary pursuit. But I have to say that, you know, I'm almost never disappointed when I just have a spontaneous conversation with somebody on the street.

KATE MULLIGAN: Yeah. I mean, it's really it's important to be able to have those conversations with those what we call weak ties, people that you just kind of know in your neighborhood. Maybe the dog walker who goes by regularly or the bus driver that you see that helps us get so outside of our usual everyday bubbles. And that's really good for building social connectedness as individuals, but also as a collective, as a community.

BRIAN GOLDMAN: Can't wait to hear more about this, Kate. So before we begin, though, can you give us a Hi, my name is tell us what you do and where you do it. Just ad lib.

KATE MULLIGAN: Hi I'm Kate Mulligan. I am the senior director for the Canadian Institute for Social Prescribing and an assistant professor in public health at the University of Toronto.

BRIAN GOLDMAN: Okay, here we go. As you've already mentioned in your own introduction, we're hearing more and more about something called social prescriptions. So what are those?

KATE MULLIGAN: Social prescriptions are a way to use your health care visits to reconnect you with non-clinical supports for your health. Things like making social connections, spending time in nature, engaging with arts and culture, or even more material. Things like getting support with housing or income or food.

BRIAN GOLDMAN: And is it meant to be written as a prescription?

KATE MULLIGAN: It can be. It can be something that's very formal in which your doctor or other health care provider writes down a prescription and gives it to you and provides the supports that you need to actually follow through and the people resources to help you do that. Or it can be something much more informal. You could self-refer to an organization or an informal activity that you think is going to be helpful for your overall health and well-being. So there's a range of levels of support depending on what you need and what's available in your community.

BRIAN GOLDMAN: So why are we hearing more about the importance of socializing these days?

KATE MULLIGAN: Well, the research really shows that we know more now about the fact that social connection and a sense of, well, belonging are important determinants of health. And one reason that we know about this now is that we've all experienced this now. We've experienced it for ourselves when we lived through the public health protections during those initial phases of the COVID 19 crisis. So it's easier to explain now to people that social connection and belonging and mattering in your community is important for our health and well-being. It's just an easier sell now than it was even just a few years ago, before the pandemic, when people knew that social determinants of health mattered, but they didn't really realize how important social connectedness was as a social determinant of our health, just as important as things like housing or income or food.

BRIAN GOLDMAN: So before we drill down a little deeper, there's loneliness and there's social isolation. What's the difference between the two?

KATE MULLIGAN: Yeah, they are different. So social isolation is the sort of objective fact of not being around very many other people. And for some of us, we're okay with that. We have different degrees of introversion and extroversion. Whether or not we're energized by being around other people and even opportunities to be around other people. So, you know, that's okay. Loneliness, though, is that subjective experience of not enjoying being socially isolated, wanting to be around other people, or feeling that your experience is prioritized in the world that you live in, So feeling that you're not personally marginalized or part of a group that's been marginalized. So, for example, people living with disabilities who continue to be vulnerable to respiratory viruses if they don't feel prioritized as we open up the world to more in-person activities, if we don't continue some of the supports that made it easier for them to participate before they're going to feel more objectively isolated but also more subjectively lonely, not being able to connect as much as they did before, as much as they want and need. So that's those are the distinctions.

BRIAN GOLDMAN: And you've already raised an important point. There are. Disadvantaged members of society who are more likely to to experience social isolation. Can you? You've mentioned people who have disabilities. Are there others?

KATE MULLIGAN: Yes. I mean, it tends to be people who might be might have mobility challenges or be homebound. So you could be an older adult, for example, or a person living with the disability. But you might also belong to a group that is structurally excluded or marginalized. So, for example, if you're a new immigrant or you're a member of the LGBTQ to plus communities, you might not have as many connections in the immediate geographic community that you find yourself in. You might have to take extra steps to find those connections, and you might also face discrimination. So all of those factors compound and contribute to social isolation and loneliness, and that's likewise true for black communities, for example, and other people who are facing, you know, just don't see themselves represented and prioritized in our broader culture. There's that sort of existential component of of loneliness and dislocation that can result.

BRIAN GOLDMAN: So let's start unpacking some of the research. What does it show us, for instance, about the mental health benefits of socializing or trying a new activity, for instance?

KATE MULLIGAN: Well, we know more about the risks than the benefits in some ways. But so, for example, we know that loneliness is associated with higher rates of depression, anxiety and even suicide. Happily, though, the research about the interventions and the benefits shows that even with one or two good connections in our lives, one or two people we can talk to and connect with, we can thrive and flourish even even in the face of health and social challenges. So even if we're facing marginalization or even if we're dealing with a serious chronic health condition or acute health condition, those one or two connections can help us continue to be healthy in the face of significant change. And I think one of the other things I'd like to say is that when we do something like social prescribing, it helps us to address some of the root causes of our mental ill health. So it asks why we are feeling lonely or isolated and helps gives us resources to address some of the causes by building our self determination, our ability to control more of the conditions for our health and well-being. And that's the act of putting us into the driver's seat, can really help our mental health and well-being.

BRIAN GOLDMAN: Can you give me a for instance?

KATE MULLIGAN: We often use a theory called self-determination theory, which says that when we can make decisions for ourselves, for example, working together with our clinician or what we might call a link worker, a person who has time to sit down with us and really talk about not just what's the matter with us, but what matters to us when we can collaborate on that together, on something that matters, we feel better, we can make our own decisions and we're reminded of our own capacity. And so that other component of self-determination is competence. We start remembering that we're alright. I can do this. I'm capable, right? And it could be a very small step. The first time attending a gardening group, for example. And then one of the most important things that it can give us is a sense of beneficence or our ability to give back to other people. And that's where we see really big improvements in self-reported health and well-being. So when you go from thinking of yourself as someone with an illness or something wrong with you to, hey, I've got something to offer in my community, you really see a benefit. So if you volunteer or maybe through social prescribing, you've been connected with another person who has the same health condition that you have. So those are some of the things we can do to take more ownership over our own health. And that's really good for our mental well-being.

BRIAN GOLDMAN: You know, when when most of us think about socializing, we think about socializing with friends, people we already know. What about socializing with a stranger?

KATE MULLIGAN: It's good for us to, again, having just one or two connections, even what we might call weak ties. The people in your lives who you kind of know, those can help us thrive under challenging circumstances and stay resilient when things are tough, both as individuals and as communities.

BRIAN GOLDMAN: We talked about mental health. How does socialization benefit physical health?

KATE MULLIGAN: Well, just as isolation has mental health risks, it also has physical health risks. So you mentioned off the top that the risks are potentially on par with smoking half a pack of cigarets a day. It increases a risk of premature death from all causes. It increases risk of heart disease and stroke. And there's even a 50% increased risk of dementia when we are socially isolated and lonely. So these are really significant risks that we want to counter and we can counter them in direct ways. For example, we can get people more physically active. We can promote that time in nature and in culture. We can reconnect them with culturally appropriate and anti-oppressive activities. We can get people volunteering and giving back. Those are all things we can do to reduce those isolation risks, get people out around other people and feeling connected to their communities again. And that's really good for our physical health.

BRIAN GOLDMAN: So I know you haven't been talking about the benefits in the same way that you've been talking about the risks that we do know more about the risks, but what evidence is there in the research as it as it is right now, that social connections will help alleviate the risk of dementia or stroke or heart disease?

KATE MULLIGAN: Yeah. So I think most of the research is more about the risk because social prescribing is new. But there are some good studies and clinical trials underway now. And what are the best indicators that we have right now is around self-reported health and wellbeing. Because it's so new, we haven't had time to see some of those longer term and objective outcomes. But the research is underway. In the project that I was involved with, with community health centers all across the province of Ontario. We saw a 49% decrease in self-reported loneliness by participants. So that's where they're saying this is working, this is getting me connected. And then we expect to see some of those other knock on effects on physical and mental health over the longer term.

BRIAN GOLDMAN: Can you tell me a little bit more about how social prescribing is currently working in Canada? Who's doing it? What's the system? How does it work?

KATE MULLIGAN: So we don't have a system yet for social prescribing. And so that's what we're working on through the Canadian Institute for Social Prescribing is really trying to scale up and spread and share good practices from across the country. So right now there are motivated and interested people, health care providers and social services providers and community members who are making it happen where they live. So you don't need to go to a doctor to do this, but that is typically where we're seeing most of the social prescribing happening right now in primary care or in hospital, the home transitions. And we want to grow that to lots of different kinds of settings and lots of different spaces in places across the country.

BRIAN GOLDMAN: What are some of the indications that someone we know may need a social prescription?

KATE MULLIGAN: Well, most of us probably could benefit from social prescriptions because we know that upwards of 50% of our health is determined by non-clinical factors, you know, outside the health care system, outside of our genetics and so on. So that's many of us. So, you know, if there's something that that you need a boost to get going with, you can ask for help, right? Sometimes we know what the healthy thing is or a nonclinical intervention would be that would that would help. But it's really hard to take those first steps. So social prescribing can help give us the support we need to get going with things and to keep it up. If you are a health care provider and you're looking for signs that someone might need a social prescription, it could be that they're coming in with specific mental or physical health challenges that, you know, social activities can really help with. So again, if they're experiencing diabetes, for example, maybe a referral around food, physical activity, being around other people is something that can complement the clinical care that they're receiving. Or maybe it's just that it's something that that you as a clinician can't address given the time and scope that you have. But it's something that's keeping you up at night, something that worries you about the person's context. Like we don't want to just patch somebody up and send them back into conditions that make their health worse. We want to help with those conditions. And so those are some of the things that give an indication that that maybe social prescription can help.

BRIAN GOLDMAN: On the dose, we like to give people tips that they can walk away with. So you've already said that most of us can benefit. How can someone know where and how to begin?

KATE MULLIGAN: So if you think it's something you can do on your own and you don't need as much clinical support with volunteering is a really great start and it doesn't have to be formal other it can be. It can be just helping your neighbor, right? Like shoveling somebody's sidewalk on a snowy day, giving a friendly call to someone, checking in on a friend. All of that helping helps you get a sense of that self determination, which is one of the building blocks toward, you know, having more control of your life and feeling healthier and more well and more connected to the community. You can also have a look at what's available in the community. You can go online or to a community center, check around at your workplace or your school to see what's happening out there where people are doing activities that are of interest to me that I think I might like. And if you do need more support and like I said, most of us probably do. Ask your health care provider because even if they don't currently offer something that they call social prescribing, they probably do have experience referring people to community and social services. And the more they hear about it, the more they will recognize the demand. And if we build that demand across Canada, then the services will follow. And finally, I'll just say you can go to our website at SocialPrescribing.ca to learn more about what's happening. We have a map that shows different social prescribing initiatives across the country, and you can get a sense of what people are doing and it's always growing. And so if you're doing social prescribing, you can add your work to the map too.

BRIAN GOLDMAN: I imagine that it's easier for people who are gregarious. What about those who are introverted? A little bit on the shy side.

KATE MULLIGAN: Yeah. So we talked about how social isolation and loneliness are different, right? So it's okay to be happy with your connections. That's part of the range of normal human experience. So social prescribing, again, it's about taking more ownership over your own health and well-being. So maybe you want to focus more on your autonomy to make decisions in your competence, and you're giving back over that relatedness component, at least to start. Right. So tap into your power to make choices about what works for you. That's really at the core of social prescribing. So it doesn't have to be in a large group to be beneficial to your health and wellbeing. It can be on your own connected to something that's meaningful to you, or it can be with one or two people with whom you have meaningful connections. So getting someone to help you take the first step is really important. And I'll give you one example that I really like. It's from the UK in a group called All Together Better. They put up a sign in a primary care doctor's office that said, Will you help us feed the birds? And people could take home a bird feeder and contribute to their community by feeding the birds. And every week they would receive a visit from somebody who was there to fill the bird feeder. And that was also an opportunity for a social call, a way to check in on the well-being of the person. But instead of feeling like a recipient of a health or social service, the person feels like someone who is helping and volunteering in the community and has a connection. If we can make that cognitive shift away from, you know, what's the matter to what matters or what's wrong with us, to what's strong with us, we are really making a shift in what we think health care and health relationships are all about. So you can be an introvert feeding the birds and still be involved in social prescribing and still get some of the benefits.

BRIAN GOLDMAN: What about someone who is wanting to do something positive in this direction, not for themselves so much, but on behalf of a family member who might be isolated, might have mobility issues, might be elderly, might have cognitive issues.

KATE MULLIGAN: Yeah, I mean, I think some of those same things apply. And, you know, Brian, every time I talk about social prescribing, I get those calls. How do I get this for my neighbor? How do I get this for my parent? How do I get this for the people I see in my community? So again, I think the right way to go is to ask some of the social services and health care providers in your life and in your family members life. Certainly, caregivers are a big part of the work we do at the Canadian Institute for Social Prescribing, and we want to support the well-being of caregivers, too. So you might need a social prescription if you're facing the stresses and strains of being a caregiver. But building demand, asking our providers for help with that helps to show that we want this service and that we think a health system can be more than sick care. It can be about our broader well-being. So I think, you know, one really easy way to start, especially for isolated or older people, is the Friendly Calls program of the Canadian Red Cross. This is a successful program that's been implemented in several provinces and is now a pan-Canadian program where you can get a friendly call from a volunteer on a weekly basis, and that person can make that initial social connection with you and then help you build further connections that can help and support your needs as a caregiver or the needs of your the person that you're caring for. So I think that's a really good starting point. If you're not sure where else to turn.

BRIAN GOLDMAN: And what do you do if that person you're trying to help is either reluctant or hostile to the idea of making connections with others are being helped to make connections with others?

KATE MULLIGAN: Yeah. We can't force people to engage in activities that aren't meaningful to them, right? Putting them in the driver's seat is a really important part of social prescribing. So I think what to do then is to continue the conversations with their broader health care team, to continue offering ideas and showing some of the stories or evidence about the health benefits for people who are connected. And then maybe just starting small right again, starting out with a small action or small activity, a single phone call, a single walk around the block, some of those really, really small actions that help us build toward that sense of our ability to make decisions and be effective in our own care. Sometimes we have to start with those, and people will walk the walk when they're ready and ideally were there when we're there to support them, when they are ready with the services that they need in an informal and human way.

BRIAN GOLDMAN: Well, Kate Mulligan, if you wrote a social prescription for me, I know that I'd take it after after having this conversation with you.

KATE MULLIGAN: That's great. I'm really happy to hear it. I have a sense you probably already know some and just need a little bit of of a boost to get out there and do it.

BRIAN GOLDMAN: Well, I'm thinking also about the beneficent neighbor who shovels everybody's walkway and has this snow blower that he loves to operate to clear the sidewalks on both sides of the street.

KATE MULLIGAN: Yeah, we call that the givers glow. It feels really good to do that for somebody else. So we should all try it today. Some small act of kindness will really help us feel better, too.

BRIAN GOLDMAN: Well, Kate Mulligan, that's a great way to end our conversation. Thank you so much for speaking with me.

KATE MULLIGAN: Thanks, Brian.

BRIAN GOLDMAN: Kate Mulligan is senior director of the Canadian Institute for Social Prescribing and assistant professor at the Dalla Lana School of Public Health at the University of Toronto. Here's your dose of smart advice. Loneliness is the unpleasant feeling of being alone. Social isolation is an objective lack of social connections. Research has shown that social isolation significantly increases the risk of premature death from all causes. It's a risk factor that may rival smoking, obesity and physical inactivity. A lack of social connections is associated with an increased risk of heart disease and stroke. It has also been linked to higher rates of dementia, anxiety, depression and thoughts of self-harm. There's evidence that many adults age 50 and older are socially isolated. Or lonely in ways that may be hazardous to their health. Loneliness and social isolation are especially prevalent among seniors, immigrants, LGBTQ minorities and people who are economically disadvantaged. Social prescribing means connecting people to activities, groups and support that improve health and well-being. Your health care provider or a link worker can do the prescribing. A link worker is a non-health care professional with training in how to change behavior. Usually they have more extensive knowledge than your doctor of local community resources. Examples of social prescribing might include art and dance classes, support of peer networks, cooking classes, caregiver supports, volunteer activities, gardening, communal dining programs and support groups for people who are grieving. Studies are underway, but right now it has yet to be proven that social prescribing improves physical health. However, we do know that people who participate in socially prescribed activities enjoyed nearly a 50% decrease in self-reported loneliness. And it's not just good for people who become less lonely. Don't forget the givers glow. There's evidence that stepping up to shovel a neighbor's walkway also benefits the shoveling. If you have topics you'd like discussed or questions answered, our email address is the dose at CBC Dossier. You can find the dose wherever you get your podcasts. If you like this episode, please rate us five stars so more people can find us. This edition of the Dose was produced by Stephanie Du Bois. Our senior producer is Colleen Ross. The dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

Back To Top »

Provide Transcript Feedback

CBC would like to acknowledge the support of the Broadcasting Accessibility Fund.

How can socializing benefit my health? - Transcript

More Stories Like This