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Loneliness Isn't a Public Health Problem
But treating it like one may be the best way to solve it
Loneliness in America is now being treated as a public health crisis.
In 2021, 58% of Americans said they felt lonely, with younger adults twice as likely to feel lonely as seniors. 49% of Americans have fewer than three close friends, 12% have no close friends at all, and 45% say they don’t feel a sense of belonging to any group of people. Compared to two decades ago, Americans spend more time alone and fewer hours with friends and family. In April of this year, Vivek Murthy, America’s Surgeon General, declared the nation to be undergoing a “loneliness epidemic” and said that “rebuilding social connection must be a top public health priority.”
How did we get this lonely? Smartphones and social media played a role of course, with loneliness increasing worldwide around the time they were introduced. Before the internet, factors such as growing individualism, declining marriage rates, shrinking family sizes, increased diversity, enhanced mobility, and improved economic prospects contributed to social fragmentation, which led to loneliness. Covid exacerbated these trends, with people self-isolating, working from home, and socializing less due to lockdowns and safety concerns.
But why has the Surgeon General taken this on as his project? It’s not obvious loneliness is a medical problem as opposed to a social or psychological one. If I was told there was a loneliness crisis and I had to choose one class of experts to deal with it, medical professionals wouldn’t be the first to come to mind. But the claim here is that loneliness doesn’t just feel bad – it’s actually killing us. Murthy writes:
Loneliness is more than just a bad feeling. When people are socially disconnected, their risk of anxiety and depression increases. So does their risk of heart disease (29 percent), dementia (50 percent), and stroke (32 percent). The increased risk of premature death associated with social disconnection is comparable to smoking daily — and may be even greater than the risk associated with obesity.
The studies he cites to support these claims are mostly associational, so we can’t say with certainty that loneliness causes these bad outcomes. But they do show that it’s a major risk factor for all kinds of serious health problems. Here are three:
Holt-Lunstad et al. (2010) analyzed 148 studies (308,849 people) and found that “individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships.” Another meta-analysis of theirs in 2015 found that social isolation, loneliness, and living alone increased likelihood of mortality by 29, 26, and 32% respectively.
Lazzari et al. (2022) reviewed 10 studies (8,239 people) and found that “the risk of developing dementia because of the impact of prolonged loneliness and social isolation is about 49 to 60%… higher than in those who are not lonely and socially isolated.”
Valtorta et al. (2016) looked at 23 studies (181,006 people) and found that “poor social relationships were associated with a 29% increase in risk of incident [coronary heart disease] and a 32% increase in risk of stroke.”
Based on these and other studies showing associations between social disconnection and illness, Murthy has taken to addressing loneliness as a public health problem requiring a public health solution. But this seems to be a misconceptualization of why loneliness is bad to begin with.
Loneliness isn’t bad because it’s associated with physical health issues. It’s bad because it is a terrible experience to go through in and of itself. To be truly lonely is to feel disconnected, isolated, empty, misunderstood, and unnappreciated all at once, all the time. Like loneliness, divorce, sexlessness, and going to jail are all associated with serious health issues and early death, but that’s one of the least worst things about them. Just because a negative experience is a risk factor doesn’t mean we should think of that experience as a public health problem when by standard definitions it would be considered a social or psychological problem.
Indeed, it’s possible to combat loneliness without resorting to medical language. For instance, in the Netherlands the supermarket chain Jumbo made headlines for introducing a “slow checkout lane” for lonely seniors who wanted to have a quick chat with the cashier while purchasing their groceries. In South Korea, the government hands out monthly $500 checks to lonely young people, with the goal of helping them reenter society. In such cases, reducing loneliness is perceived as a justification for action in and of itself, not a means by which disease is averted or lifespans lengthened.
Nevertheless, in a medicalized society such as our own, treating loneliness as a public health problem may be the most realistic way to fight it. Framing loneliness as an epidemic could bring the public to view socializing as something you don’t just do to protect yourself, but do to protect others as well. As we saw during covid, people, corporations, and governments will make tremendous sacrifices to protect those they consider to be vulnerable. Perhaps thinking of loneliness as a disease, for which connection is the cure, could lead to more selfless behavior and investment in anti-loneliness initiatives.
It may also be that there is a significant percentage of the population who A) suffer from loneliness and B) would actually do something about it if a doctor told them to. In the past, religious or community leaders would have been best poised to handle a loneliness crisis by using their social authority to bring people together. But in 2023, doctors and nurses are the most trusted professionals in America, and people might listen if they started telling their patients to join clubs, spend less time online, or prioritize friends and family.
A version of this already exists. Social prescribing, which is popular in the UK and being experimented with in other countries, involves physicians and healthcare workers referring patients to non-clinical services like music classes, gardening, and group walks, on the grounds that social connection will make them healthier. The evidence of it improving health is mixed, but it has been shown to make people feel less lonely. Going forward, doctors are likely to play a greater role in treating their patients’ social problems, and social prescribing provides a template for how it might be done.
Americans may not agree on much religiously, politically, or even scientifically. But they all want to live longer and be healthier. Whether accurate or not, treating loneliness as an epidemic requiring a public health solution may be the most practical way to convince them to start reconnecting with one another.