(Illustration by the Robert Wood Johnson Foundation)
Current global estimates suggest that 1 in 4 older adults experience social isolation, and 5 to 15 percent of adolescents experience loneliness. Weak social connections cause a higher risk of early death; these are also linked to anxiety, depression, suicide, dementia, and the increased risk of cardiovascular disease and stroke. Weak social connections represent an equivalent health risk to smoking and obesity.
While many consider this rise in loneliness to be largely a social problem, communities around the world are applying innovative public health approaches to connecting people not only to each other but to health professionals and systems that can provide much-needed support.
Here are several tenets of public health and how they are playing out addressing social isolation and loneliness across the globe.
Go to Places Where People Are Most At-Risk
If you were fighting an epidemic, which some consider social isolation to be, you would likely start by going to the source and from there find places with high rates of spread.
In the United Kingdom, the leading older people’s charity Age UK, working with the Office of National Statistics, developed heat maps to show where loneliness was most prevalent. The group analyzed local socio-economic data to detect factors like self-reported poor health, living alone, housing security, and mobility difficulties, which put people at increased risk of loneliness.
Heat maps and other data sets have helped local agencies target services to reach people at risk of loneliness and other challenges. For example, in South-East England a local Fire and Rescue Service used data analyses to guide home visits to vulnerable residents and put those people in touch with practical help, from financial assistance to installing smoke alarms. This approach was then refined to assess how lonely a person is and connect them with the appropriate mental health specialists.
But there’s no substitute for being in the community, listening, learning, and acting. Zimbabwe’s Friendship Bench program, now adapted in eight countries from Malawi to Canada, offers a gateway to mental health support for people experiencing isolation. Trained community health workers are accessible on benches in local clinics and communities, and they support people who turn up with up to four sessions of psycho-social counseling. A 2015 Randomized Controlled Trial showed that participants reported increased quality of life in 60 percent of cases and reduced suicidal ideation in 80 percent of cases.
Help Health Care Professionals Diagnose Loneliness
Diagnosis is the first step to treatment. So, we must train and support health-care professionals, even unlikely ones, to spot and support people at risk of loneliness and social isolation. Health workers are trained to explore the question, “What’s the matter with you?” They also need to ask, “What matters to you?” and find support for nonmedical challenges. This means addressing relationship issues, loneliness and isolation, or financial stress.
One example is pharmacists, who are usually well-connected and respected in their communities. They can recognize patients may be at risk of social isolation, yet their role is often limited to filling a patient’s medical prescription. Pharmacist and health-care professional Jenny Kirschner is developing a global network of pharmacists, Pharmacy Addressing Loneliness and Social Isolation (PALS), to raise awareness and train local pharmacists to recognize signs of loneliness in patients.
Proactive (and pro-social) pharmacists can create what Jenny describes as “emotionally safe environments that promote connectedness.” She is preparing a road map of awareness and education for the sector. For example, in Brisbane, the intern manager of the Pharmacy Guild of Australia attached friendly handwritten notes to prescriptions delivered to isolated people during the Covid pandemic. In another initiative, a pharmacy manager asked local primary schools to find pen pals for older people (with letters delivered via the pharmacy). One patient responded to the letters: “Just the best thing that’s happened to me all year. You have no idea how isolated I have felt.”
Prescribe Connection
There is no pill a pharmacist or doctor can prescribe to treat social isolation. But an emerging “social prescribing” movement is helping health-care professionals tackle loneliness. Practiced in 24 countries, social prescribing supports individuals first encountered in a health-care setting—typically a general practitioner’s (GP) or primary care physician’s practice—with access to nonmedical help through a person-centered conversation with a “link worker.”
England’s National Academy for Social Prescribing (NASP) estimates that one-fifth of GP appointment time is spent on nonmedical problems. Through social prescribing, those patients are diverted toward community opportunities that enhance their well-being. These range from arts, cultural and heritage activities, financial guidance, physical activity, and nature experiences, each of which fosters social connections.
NASP has published 13 evidence publications that suggest that social prescribing can have a positive economic impact. In their paper “Building the Economic Case for Social Prescribing,” social prescribing schemes in England were shown to deliver between £2.14 and £8.56 for every £1 invested. One medical practice achieved a 21 percent drop in health-care costs. Social prescribing can reduce pressure on the UK’s National Health Service (NHS), including reduced GP appointments, hospital admissions, and emergency visits for people referred to social prescribing.
The NHS has funded the recruitment of over 1,600 full-time social prescribing link workers, with the requirement that by the end of 2023, every primary care network will have a link worker available to meet local needs. In some areas, this cadre of paid link workers is augmented by a bigger army of community volunteers, who with training can signpost people they meet to available activities, and who guide people appearing to have more serious challenges towards the professional link workers.
The International Evidence Collaborative supported by the NASP has concluded that social prescribing, in countries as diverse as Iran, India, and the Netherlands can have a positive impact on a wide range of outcomes including reduced loneliness, improved mental health and social connections, and heightened well-being.
Invest in Prevention and Public Health Campaigns
Social isolation among certain groups, most notably the elderly, people with health problems, or people with disabilities is well documented. But social isolation is an issue that can impact anyone and there is a need to both create awareness and offer preventative solutions.
For example, during the Covid pandemic younger people reported significantly higher levels of social isolation and loneliness; we don’t know yet whether these levels were transitory or not. But we must confront the fact that loneliness in youth is widespread and damaging. Listening to young people talk about their experience of loneliness is a vital step. For example, in Japan, Ibasho Chat is a free, anonymous 24/7 text-based internet helpline for young people looking for connection and support. In the United Kingdom, the Lonely not Alone campaign, led by the Co-op Foundation, systematically recruited, listened to, and publicized the voices of younger people talking about their loneliness. And Loneliness Awareness Week 2023 in Australia generated calls to action for more research, normalizing discussion about the issue, empowering communities to address weak social connections, and establishing a peak body, a national leadership organization to spearhead change.
More broadly, Canada’s GenWell Weekends, funded by private donors and corporate sponsors, aim to encourage social connections in a celebratory and preventative way. Canadians sign up to a weekend and choose an activity, from apple picking to sporting events. These catalytic occasions at points in the year when there is a greater risk of loneliness give Canadians “the excuse, reminder or permission” to connect with others. The ensuing Canadian Talk to a Stranger Week led by the GenWell Project draws on compelling evidence being that reaching out helps us to feel better and more motivated.
Public health campaigns like Loneliness Awareness Weeks in different countries, the Great Get-Together, and the Big Lunch in England are boosters for social connection, but they are not sufficient. The effort needs sustaining. For example, Australia moved from an annual call to action, Neighbour Day to Neighbours Every Day, encouraging the one-off impulse to become how we live every day.
Create Safe Spaces for Connecting
Some groups may need a more controlled and safer space to connect.
For example, men are often more likely to find social contact and sustenance via activity and completing tasks. It is a credible generalization that men’s lifelong role in paid work, traditionally and previously imagined as “the breadwinner,” gives them less exposure to the socialization and social skills implicit in traditional women’s roles like bearing and nurturing children and caring for relatives. Professor and author Barry Golding has said, “Men don’t talk face to face, but they will talk shoulder to shoulder.”
As men arrive in retirement, they have underdeveloped social networks and skills and struggle to find replacement activities for paid work.
The Men’s Sheds movement is a strong, well-established response to those shortfalls and to the risk of loneliness, and provides physical and mental health support. Starting in Australia in the 1990s, Men’s Sheds have grown to an estimated 3,000 groups across 12 countries. Men gather in a community-based place, such as a community center, and enjoy company, develop manual and creative skills through do-it-yourself jobs, and work on strengthening and maintaining well-being.
Make It a Priority for Government
Each of these interventions clearly helps combat social isolation. But they can’t operate in a void. Like any significant public health issue, the role the government plays in coordinating efforts, marshaling resources, and addressing underlying issues is essential.
On the broadest level, national government income policies on taxation or benefits can influence how much someone can take part in activities such as traveling to see friends or family or enjoying leisure pursuits. Transportation connects people with friends, family, passions, and pastimes. Decent housing and accessible public spaces help people feel they belong to, take part in, and enjoy their environments.
Some governments understand the interconnected aspect of this public health issue. For example, in 2018 the Westminster government in the United Kingdom introduced A Connected Society strategy underpinned by 60 action points across departments covering many areas of participation in society. It targets the reduction of stigma and shame which many people feel talking about loneliness, strengthening of the evidence base and driving action across society. There is evidence in the United Kingdom of change, in terms of more funding for loneliness programs, policies in local and national government, heightened media alertness, and public concern. Impacts include a ramping-up of local initiatives, increased media coverage of the issue, charitable funders providing support, and the proliferation of local community projects.
New initiatives elsewhere have made progress. Japan passed important legislation this year: an Act to Promote Measures Against Loneliness and Isolation. The Danish government has introduced a loneliness strategy, underpinned by a plan setting out 75 cross-governmental actions. In the United States, the US Surgeon General Dr. Vivek Murthy launched an advisory calling Americans’ attention to the epidemic of loneliness and isolation and setting out detailed guidance for addressing these issues across public life. And the World Health Organisation (WHO) is launching a three-year Commission on Social Connection to foster the accumulation of evidence that will inform causes and treatments, strengthen advocacy, and encourage effective practice.
The Global Initiative on Loneliness and Connection (GILC) which I lead expresses this shared endeavour: creating an active network of nonprofit agencies leading change in their respective countries and societies. GILC is about sharing and learning, as platforms for advocacy and action, to enable many more people to lead more connected lives. By crossing borders, pushing boundaries, and adopting important lessons, we can empower many countries and leaders who are at different stages along the journey.
In Summary
I am hopeful that increasingly governments, societies, and local communities will see the demonstrable value of initiatives such as these, and that they will invest in them to achieve greater scale and national impact. As its name implies, social isolation, at its core, is a social issue. But at the same time, its effects on health and the opportunity to apply public health approaches to this global concern is a call to action. And we’re seeing results and successes around the world. Yes, we must make sure we are connected to one another, but connecting this issue to our health might be the most important connection we make.
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Read more stories by Paul Cann.