Social Prescribing and Low-cost Community Health Interventions-A Global View

 

Applying Low-cost Community Health Interventions to Enhance Health in the United States

The United States consists of two Americas, one for the urbanized and another for rural health care and they are vastly different This article explores how the application of low-cost health care interventions in other countries may benefit residents in rural America. Places that lack access to hospitals, clinics, to mental health services, and of course, women’s health centers in other countries have similarities to parts of rural America.  

Leveraging trained volunteers to educate and assist public health initiatives in rural areas is widely practiced in Africa. (He, 2019) There is great variety between services for urban and remote health care. Rural services tend to focus on preventive care, primary health care, and family planning. In the United States, rural health care is less available for family planning, as reproductive health clinics are generally in cities. Some states do not have reproductive health clinics at all, due to the state restrictions on birth control and obstetrics care. It is no longer uncommon in the United States for a woman to travel out of state for an abortion or obstetric care. The chart shows examples of community health resourcing in Africa for remote, rural, and urban environments and all rely on volunteers for community outreach.

Country	Focus	Location
Malawi	Health Surveillance Associates focus on preventive, curative, family planning	Rural/remote
Mozambique	Community Health Volunteers and Community Health Extension Workers focus on prevention, family planning	Rural/nonremote
Kenya	Community Health Volunteers and Community Health Extension Workers focus on prevention	Urban

 

Measures of Quality

Capturing quality measures in terms of outcomes and potential health metrics is uneven for community health centers, because there is so much variety. Of the entities reviewed for this article, all used the Plan-Do-Act-Cycle for implementation of health interventions.

Findings

1.       Community and preventive health interventions are often not funded or underfunded because they don’t provide immediate quantifiable benefits, like number of hospitalization discharges, clinic visits, etc.

2.       Legal and regulatory barriers to reverse engineer the health system and develop low-cost high-value health improvements. Thoughtful legal and regulatory changes should include review of health interventions that have yielded high value at a low public cost from nations outside the USA. The health care regulatory climate in the US feeds a siloed system of invested profit centers, which lack systemic coordination and are often at odds in targeted health goals. (Rowthorn V & 28314501., 2016)

Social Prescribing-Nonclinical services to improve health and well-being.

In April 2024, a paper was published in Science Direct, showing the comparative results of twelve high-income countries, including the United States, which reviewed the impact of non-clinical community health referrals and interventions to determine impact on health and well-being. (Giada Scarpetti, 2024)

Methods of social prescribing include a community navigator, a concept which was widely deployed for the Affordable Care Act enrollments in the U.S. Referrals for housing, health care enrollment, and nutritional guides are examples of social determinants of health. There are other community activities which are low or no-cost which also improve quality of life, including; community gardens, access to green space through parks and wildlands, targeted support like twelve-step programs, access to public libraries, listening to music, and engaging in creative activities, like learning to play a musical instrument.

Current evidence is weak to show the effectiveness of community programs in health improvement for people with multiple comorbidities and social deprivation. (Giada Scarpetti, 2024) In other words, if you have substantial health problems, community programs are a band aid on a suppurating wound. However, as an outreach tool to promote health and channel individuals into optimal patient-centered care community navigators can be effective. In the United States, these programs are funded through grants and demonstration projects. In Europe, the national health programs may provide funding for navigators and other community programs which are linked to positive health outcomes. The goal for community health outreach is to reach more people in dispersed communities earlier in the health paradigm for prevention and resourcing. Communities that have different social determinants for health, such as diet, location, education, and even religion have been shown to exhibit different approaches to health management, diagnosis, and intervention. For example, the secular community may be uncomfortable with church involvement in health promotion, but for people who are members of spiritual groups, this may be the first point of intervention for health awareness regarding mental and behavioral health.

In the United States, the primary organization promoting social prescribing is Social Prescribing USA. It has sponsored a national conference and the second one is set for October 2026. It has a 50-state initiative partnering with Kaiser Health on social prescribing. The link shows the program map for social prescribing projects across the USA. https://www.socialprescribingusa.com/program-map

Community-based nontraditional health interventions in the United States

Project Connection out of West Valley City, Utah, connects people with mental health concerns to supportive community resources to foster well-being. https://www.projectconnection.co/

Project Enhance in Seattle, Washington has two prongs for seniors, one for fall reduction and one for enhancing wellness. It does provide evidence-based analysis of the coaching process, which is rare for community-based efforts. https://projectenhance.org/

 Open Source Wellness out of Oakland, California promotes 8 to 16 weeks of coaching for wellness behaviors through community health centers. It coined the term experiential medicine and is focused on behavioral health to motivate change. One of its’ outreach efforts is partnering through YMCA’s. (Open Source Wellness, 2026)

Baylor University is partnering with Blue Cross Blue Shield to assess the impacts of community art programs on health & wellness.

Arts on Prescription, in Winston-Salem, North Carolina has an arts outreach program with recommendations from geriatricians for seniors through arts and movement. Wake-Forest University is leading a study on movement therapy as a method to promote neuro cognitive health. https://improvment.wfu.edu/ https://improvment.wfu.edu/research/active-studies/

Social RX in Atlanta, Georgia works with community-based organizations to provide mental and social well being for people who may have barriers to traditional care. The goal of the organization is to combat loneliness for protective and therapeutic health benefits. Social RX has partnered with arts organizations in ten states and is working on reaching fifty states. https://www.socialrx.com/about

Capturing the Results of Well Being Efforts

The University of Florida Center for Arts in Medicine is conducting epidemiological research on the impact of the arts on health and well-being. It has amassed hundreds of studies on the epidemiologic impact of art on well-being measures, such as anxiety reduction, pain abatement, and reduction in fatigue. The challenge in gaining widespread support for community organizations linked to health is the research, especially where controls and randomization have been used, is the failure to show a reduction in anxiety meaningfully impacts health metrics, such as hypertension, compared to traditional prescription intervention. Their site lists a randomized control study of 112 patients in the United Kingdom, which tested reductions in anxiety from listening to music with or without video, and were not found to be statistically significant for patients who were undergoing treatment for cancer or orthopedics. (Eckhouse, et al., 2014) However, a randomized controlled trial from the University of Minnesota School of Music, published in 2018, showed a statistically significant impact from the use of music in pain abatement for adult oncology patients in a blood and bone marrow unit. (Reimnitz, 2020)

The scientific proof that social engineering through informal community organizations positively impacts health outcomes is thin, but there have been multiple randomized controlled trials (RCTs) that show a statistically significant (measurable) impact from the art intervention. It is important to note, this does not mean the result would be considered significant in the real-world clinical application for participants. Scientifically measurable does not mean relevant to daily practice applications for the individual or the clinician.

Summary

We have learned that volunteers are essential to support community health efforts, especially in rural areas and training for a more intensive outreach could have a long-term impact payoff for a modest investment. Additionally, there is evidence to suggest that art, especially with music, has significant benefits for health and well-being, which means we should be investing more in these programs and studying the scientific impact on the mind and body. Of course, this is counter to the Trump Administration’s approach of taking a wrecking ball to the National Health Institute, the National Endowment for the Arts, universities, and any organization practicing scientific research. All to support tax breaks for billionaires and a war in the middle east. Ironically, as the tax credits for basic health care for the working-class are expiring, Americans must provide free health care for life for Trump and Melania. As an homage to Mrs. Trump’s jacket scrawled with “I really don’t care do you?” Yes mam, I really do care that tens of millions of Americans are losing their health care, and another million have lost their jobs.”

And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when agreeing to medical procedures, so specify that for which you consent and decline. Having a POLST (Physician Orders for Life Sustaining Treatment) agreement on file with your primary care provider is also a good idea. https://polst.org/for-patients/

This column has been in continuous publication since 2007 and no remuneration is received for the opinions of healthcare analyst and journalist, Roberta E. Winter.

References

Eckhouse, D. R., Hurd, M., Cotter-Schaufele, S., Sulo, S., Sokolowski, M., & Barbour, L. (2014). A Randomized Controlled Trial to Determine the Effects of Music and Relaxation Interventions on Perceived Anxiety in Hospitalized Patients Receiving Orthopaedic or Cancer Treatment. 33(6):p 342-351(November/December 2014.). doi:10.1097/NOR.0000000000000098

Giada Scarpetti, H. S. (2024, April). A comparison of social prescribing approaches across twelve high-income countries. Health Policy, Volume 142,(104992). doi:doi.org/10.1016/j.healthpol.2024.104992

He, ". a.-t.-c.-i. (2019, August 16). Costs of Integrating Close to Community Programs in Five Low-income Countries. British Medical Journal Global Health, 2019: 4(4 (4) e001390), 5507. Retrieved April 15, 2026, from https://go.gale.com/ps/i.do?id=GALE%7CA596166683&v=2.1&it=r&sid=summon&u=wash_main&p=GIC&aty=ip#:~:text=Costs%20of%20integrating%20quality%20improvement%20into%20close%2Dto%2Dcommunity%20health%20programmes%20in%20five%20low%2Dincome%20and%20middle%2Dinco

Reimnitz, L. &. (2020, December 2). A randomized pilot study of music therapy in the form of patient-preferred live music on fatigue, energy and pain in hospitalized adult oncology patients on a blood and marrow transplant unit. Arts & Health, 154-168. doi:10.1080/17533015.2018.1534251

Rowthorn V, P. A.-D., & 28314501., 8.-1. d. (2016, Nov-Dec). Legal and Regulatory Barriers to Reverse Innovation. Ann Glob Health, 2016 Nov-Dec; 28314501, 991-1000. doi:https://doi.org/10.1016/j.aogh.2016.10.013

 

 

 

 

Trump Guts Healthcare on Global Scale

The Trump Administration while busy guilding everything in sight with gold and expanding the White House ballroom, has still managed to cause a massive curtailment in public health resources. Here is the list of his administration’s actions in order of priority, which are most deleterious to global health.   

Cutting billions in grants for medical research causing public universities and research groups to layoff thousands of scientists. These cuts include 16 billion in economic losses and 60,000 in jobs. Some of the research programs have been in existence for fifteen years and the lead investigators will take their programs to other countries to continue their work. France, Switzerland, and Canada are all global research centers. It is estimated the loss of these experts, value of medical technology and treatments generated by medical research will cause a permanent four percent reduction in GDP for the United States.

      Stopping the funding of USAID destined for disease prevention and treatment in the developing world, and demonically highlighted by the Trump Administration’s order to burn 9.7 million dollars of birth control products in Belgium, on August 7, 2025. This despite a U.S. based nonprofit’s offer to distribute the IUDs. hormonal implants, and birth control pills for free within the United States. Apparently, people in the Trump Administration are still confused on basic birth control, as none of these products were abortifants, the reason cited for their destruction. And where were these often life saving devices destined, to Africa, where lack of basic maternal health is rife and loss of life for mother and child is common. Albeit, thanks to the originalist conclusions of the U.S. Supreme Court, maternal deaths are on the rise here too. A further curtailment of Medicaid funding will only worsen the access for prenatal and postnatal care. Many maternal deaths occur after discharge from a hospital, where follow-up care is limited. When a tree falls in the forest and no one hears it, does it make a sound?

          Removal of clinical and scientific experts on the Food and Drug Agency (FDA) review board for approval of medical interventions, including drugs, which will result in more specious, extremely expensive, and dangerous treatments offered without due diligence in the United States. In June, HHS Secretary Kennedy fired all seventeen experts on the review board for vaccines, which were replaced by eight persons, including vaccine skeptics. (Mandavilli, 2025) This action undermines the credibility of the FDA for drug and treatment standards, which has been considered the gold standard globally.

      Direct cuts to public health programs including vaccine development, disease surveillance, and access to care will result in the closure of many clinics and hospitals in rural areas. The Trump Administration’s One Big Beautiful Bill Act (BBBA) disqualifies legal immigrants from Medicaid benefits eligibility and makes draconian cuts to Medicaid which will eviscerate coverage for 16 million people. (Mia Ives-Rublee, 2025) The crowning achievement of permanent tax breaks for the rich and claw-backs for the poor cuts Medicaid by a trillion dollars and only offers rural hospitals fifty billion in subsidies, which are not guaranteed and are subject to new constraints. Further the rural hospital subsidies are only budgeted for five years. Any state that reimburses more than the miserly Medicaid cap determined at the federal level will face funding cuts, further limiting resources and access to care. This is just another way for the Republicans to kill the Medicaid Expansion under the Patient Protection and Affordable Care Act, which has been adopted by 41 of the states. (Kaiser Family Foundation.org, 2025) It appears healthcare has been brought to its knees by nine predominately southern outlier states.

Republicans who voted for the bill essentially are ripping off their own people. It is estimated that 700 hospitals, about a third of all rural facilities will close. Here is a statewide list of rural hospitals that have the most at risk because of the shortsightedness of the Trump Administration Medicaid cuts. (Data is current as of July 2025)

 In this analysis, several states had no hospitals at risk of closure because of the BBBA.

 (Center for Healthcare Quality and Payment Reform, 2025)

Stopping the approval and funding of the highly effective Rna vaccines, which were developed quickly and saved thousands of lives during the Covid Pandemic, which was of course, preceded by appointing the anti-vaxer, with no medical background, Robert Kennedy, Jr. as Secretary of Health & Human Services. (Manadivilli, 2025)

          Further restrictions on access to birth control, reproductive rights, and maternal and child health, with a patchwork of state laws since the Trump appointed-Catholic dominated-Originalistic-Supreme Court overturned Roe-v-Wade in 2022. Women forced to fly outside their state of domicile to obtain urgent medical care during pregnancy complications, even those which are life threatening. Doctors are refusing to provide care for fear of losing their medical license in Idaho, Texas, and other states.

      Eviscerating healthcare savings to taxpayers if the healthcare entity donated to the Trump Campaign; case in point, overriding the Centers for Medicare and Medicaid decision not to reimburse for some of the outrageously costly and no more effective skin coverings for diabetic wound care. Because some of these products come under the biologic rulings, they are considered a new treatment and are more-or-less allowed to charge whatever they want, because the Medicare rules stipulate reimbursement at 6% of whatever the medical device company charges. Diabetic foot ulcers represent 16% of the total Medicare population, but the cost just for the skin coverings is over 10 billion annually for taxpayers. (Pinder, 2025) The Medicaid payment system does need reform, but allowing lobbyists in the medical supply sector to decide that outcome is not in the best interest of the nation. Other countries assess both the efficacy and the price of a medical treatment, weighed against what is currently available, for potentially less money before approval of a treatment device or drug. The U.S. government and the workers who contribute payroll taxes to pay for Medicare and Medicaid programs are not obligated to provide profitability for medical device, pharmaceutical, or medical supply companies. If the United States wants to reduce the cost of Medicare, it must adopt the evidence-based-practice recommendations for the most clinically and financially practical applications. Everyone does not drive a Rolls Royce or a Rivian and the government should not be expected to supply medical devices or applications that are unaffordable. Having a market rate reimbursement system saps resources from other primary health care needs, and for treatments which already have adequate substitutes.

 This article was written by independent journalist, Roberta Winter who received no compensation and is not intended to provide medical advice. Except, when agreeing to medical treatments of an inpatient variety, do stipulate that for which you consent and which you decline. If you do not have a medical directive or a POLST, get one. And this is the healthpolicymaven signing off.

References

Center for Healthcare Quality and Payment Reform. (2025). Rural Hospitals At Risk of Closure. Center for Healthcare Quality and Payment Reform. Center for Healthcare Quality and Payment Reform.org. Retrieved August 7, 2025, from ruralhospitals.chqpr.org

Kaiser Family Foundation.org. (2025, May). https://www.kff.org/statedata/collection/measures-to-identify-states-at-greater-risk-if-federal-medicaid-spending-is-reduced/. Retrieved August 7, 2025, from https://www.kff.org/affordable-care-act/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&selectedDistributions=status-of-medicaid-expansion-decision&sortModel=%7B%22colId%22:%22Location%22,%22sort%

Manadivilli, A. (2025, August 7). On Vaccines, Kennedy Has Broken Sharply With the Mainstream. The New York Times. Retrieved August 7, 2025, from On Vaccines, Kennedy Has Broken Sharply With the Mainstream

Mandavilli, A. (2025, June 24). Vaccine Panel Gutted By Kennedy-Loses Member Ahead of First Meeting. The New York Times. Retrieved August 7, 2025, from https://www.nytimes.com/2025/06/24/us/politics/rfk-jr-cdc-vaccine-panel.html

Mia Ives-Rublee, K. M. (2025, July 3). The Truth About the One Big Beautiful Bill Act’s Cuts to Medicaid and Medicare. Progress.org. Retrieved August 7, 2025, from https://www.americanprogress.org/article/the-truth-about-the-one-big-beautiful-bill-acts-cuts-to-medicaid-and-medicare/#:~:text=The%20bill%20will%20put%20rural%20hospitals%20at%20risk&text=Rural%20hospitals%20have%20some%20of,risk%20when%20rural%20hospita

Pinder, J. (2025, July 21). https://clearhealthcosts.com/blog/2025/07/in-turnaround-administration-proposes-limits-on-skin-substitute-industry/. Clear Cut Costs. Retrieved August 7, 2025, from https://clearhealthcosts.com/blog/2025/07/in-turnaround-administration-proposes-limits-on-skin-substitute-industry/

 

Reducing Environmental Harm From Rechargeable Batteries

 Consumers lack good access to data on the chemical components of rechargeable batteries and the environmental and personal health consequences. The world is migrating away from the internal combustion engine and a huge movement for electrification of vehicles is underway, as a direct response to global warming. It is still more environmentally friendly to ride a regular bike than one with a motor. If someone is riding an ebike instead of walking or using public transit, is that an environmental improvement? The electrification movement is hailed as an environmental coupe, which is true in the reduction of global warming gases and air pollution, but not for all environmental factors. This article digs into the toxic aspects of materials used in electrification of vehicles, bikes, and smart phones.

 Toxic components of Rechargeable Batteries

Rechargeable batteries don’t last forever and disposal of them is not universally secure. The process of creating the batteries that power Priuses, Teslas, ebikes, laptops, and smart phones creates toxic waste. Not all batteries are toxic, but lithium-ion ones are. Toxic chemicals produced include; lithium compounds, nickel compounds, arsenic compounds, and dimethoxyethane. Lithium batteries are not hazardous until they are charged and then they become toxic, which is why there are restrictions on the transportation of lithium-ion batteries. A “dry battery” means a non-lithium carbon electrode battery and is not considered hazardous. (Laura J. Vimmerstedt, 1995) Most smart phones use the lithium-ion battery because it holds a charge the longest, given the increased demands of the data required for these handheld devices. Older models, in particular, the Nokia, used Nickel -Cadmium or Nickel-Metal-Hydride and are not hazardous.

 The tech industry isn’t exactly clean, Silicon Valley has been a superfund site since 1989 from forty years of contamination of the ground water supply by tech manufacturers. Santa Clara County has twenty-three active superfund sites. Trichloroethylene used to clean semi-conductors has been found to increase miscarriage, and create endocrine disruption. (EPA, n.d.)And though the sites are being monitored and cleaned up here, there are myriad locations throughout the U.S. and the world that aren’t.

 Cobalt Mining

Cobalt is a precious metal found in most rechargeable batteries used in devices that need a long-lasting charge. Prevalent use of child labor, lack of any environmental safeguards, and literal enslavement of workers through indentured contracts are all occurring in the Democratic Republic of the Congo (DRC). The DRC, formerly known as Zaire which produces the vast majority of cobalt for the developed world. Siddharth Kara exposes the depravity in his latest, Cobalt Red-How the Blood of the Congo Powers Our Lives. (Kara, 2023) Over multiple trips to mining regions of this mineral rich land he was eye witness to unbelievable cruelty and apathy towards human suffering. It seems no matter what the agreements are with purchasers (Tesla, Apple), there are always end runs around compliance. Even if the no-child labor rules are enforced, the reason these children are forced to work at the age of ten or twelve is to provide food for their families, for often they may be the next provider after a parent is maimed or killed when a tunnel wall collapses.

 Remedies for this horror:

1. Workers need to be paid a living wage, not two dollars a day and a dollar for children. The Global Living Wage Coalition indicates a living wage is nine dollars in the DRC. Absolutely no one should be working for free or forced into labor.

2. Public schools should be free for children, because many of these families are unable to afford the six dollars monthly tuition, thrusting their children into the work place. 

3. Safety standards should be adhered to and any abrogation of them subject to heavy fines, deportation and imprisonment of contractors whom do not comply. 

4. Inspections by an independent third-party entity, similar to the global nuclear inspections would help with the clean up of this industry. There are enough profits in this industry to improve this assualt on humanity.

 Sources of Cobalt Outside of Africa

Given the fact 60% of the world’s Cobalt supply is in the Congo and controlled by the Chinese, the rest of the world is racing to shore up supply lines and develop alternatives. Russia and Australia are the next largest producers. Canada, the Philippines, and Cuba all produce a similar amount. The United States has a single cobalt mine in Idaho, which opened in October of 2022 and will contribute 10% of the global supply. The entire mine is underground and high tech. However, since the volume generated by this mine will initially be so small the processing of the cobalt ore will take place off shore in Sao Paulo, Brazil. This company is owned by Australian mining corporation, Jervois Global. (Kirk Seigler, 2022) Though the US has cobalt minerals in several locations, only the Idaho mine is active. (Burger, 2018)

 Cobalt-free Batteries

Researchers at the University of California Irvine in cooperation with four national labs have found a way to make a rechargeable cobalt-free lithium-ion battery. Huolin Xin and his colleagues were able to show that with an amalgamation of other metals, including titanium, magnesium, and manganese the battery could withstand high temperatures from repeated charges and remain stable. This research was funded by the US government, Department of Energy Efficiency and Renewable Energy. (Bell, 2022) Transitioning away from dependence on cobalt to power devices is smart. Creating a cleaner battery from manufacturing to distribution is smartest.

 The next time you hear an ebook reader tell someone who is reading a hardcover or paperback book that they are more environmentally friendly because they didn’t kill a tree (which are farmed and are a renewable resource), remember how many children die for the minerals in those devices. And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when you agree to inpatient medical procedures. Do stipulate that for which you agree and decline.

 Healthpolicymaven is a trademark which has been in continuous use since 2007. Roberta Winter is the author of  a guidebook to the healthcare system, Unraveling US Healthcare-A Personal Guide, published by Roman & Littlefield in 2013. This column provides no healthcare advice and opinions here are her own.

 References

Bell, B. (2022, September 21). Cobalt-free Cathode Could Lead to Safer, Longer-lasting Batteries for Electric Vehicles. (B. N. Laboratory, Ed.) Brookhaven National Laboratory.gov. Retrieved March 27, 2023

Burger, M. S. (2018). Cobalt Deposits in the United States: US Geological Survey Data Release. doi:doi.org/10.5066/P9V74HIU

EPA. (n.d.). Superfund Sites in Reuse in California. Retrieved March 23, 2023, from United States Environmental Protection Agency: https://www.epa.gov/superfund-redevelopment/superfund-sites-reuse-california

Kara, S. (2023). Cobalt Red-How The Blood of The Congo Powers Our Lives. In S. Kara, Cobalt Red-How The Blood of The Congo Powers Our Lives. St. Martin's Press. Retrieved March 28, 2023, from https://www.amazon.com/Cobalt-Red-Blood-Congo-Powers-ebook/dp/B09Y462D6Z

Kirk Seigler, E. W. (2022, October 8). In Idaho, America's first, and only, cobalt mine in decades is opening. (NPR.org, Ed.) NPR.org. Retrieved March 27, 2023, from https://www.npr.org/2022/10/08/1127310649/in-idaho-americas-first-and-only-cobalt-mine-in-decades-is-opening#:~:text=%22Idaho's%20is%20the%20only%20cobalt,important%20asset%20for%20the%20country.%22

Laura J. Vimmerstedt, S. R. (1995, September). Current Status of Environmental, Health, and Safety of Lithium Ion Electric Vehicle Batteries. Golden, CO: US Department of Energy. Retrieved March 27, 2023, from chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://afdc.energy.gov/files/pdfs/