The Health Effects Of Loneliness

Social risks beyond SDoH

In May 2023, the US Surgeon General, Dr. Vivek Murthy, released an advisory, drawing attention to the public health crisis of loneliness, isolation, and lack of connection. Research has shown that feelings of loneliness and isolation are significantly increasing across various age groups of Americans. Social trends with more people living alone and less close relationships align with the increase in feelings of loneliness.

Multiple studies have confirmed the devastating effects of loneliness and isolation, which are correlated risk factors for declines in health status and a host of medical and mental conditions. Lack of social connection can increase the risk of premature death comparable to smoking daily.

Cigna conducted a national survey in 2018, finding that loneliness levels have reached an all-time high, with nearly half of 20,000 US adults reporting they sometimes or always feel alone. Forty percent of survey participants also reported they sometimes or always feel that their relationships are not meaningful and that they feel isolated.

The Surgeon General laid out a framework for a National Strategy to Advance Social Connection, detailing recommendations that individuals, governments, healthcare, and community organizations can take to improve health through better social connections.

Social isolation and loneliness increase the risk of poor health outcomes

Social isolation comes from a lack of social contacts and having a low number of relationships and interactions regularly. Some people who have less social contact experience feelings of loneliness or social isolation.

There are many physical and mental health consequences from insufficient social connection, including increased risk of:

• Heart disease by 29%
• Stroke by 32%
• Dementia in older adults by 50%
• Premature death by more than 60%

Adults who report feeling lonely are at more than twice the risk of developing depression. Additionally, when children experience loneliness and social isolation, their risk of depression and anxiety increases immediately and in the future.

According to the 2020 Consensus Study Report published by the National Academies of Sciences Engineering and Medicine, “Over 4 decades of research has produced robust evidence that lacking social connection— and in particular, scoring high on measures of social isolation—is associated with a significantly increased risk for early death from all causes."

And the impact of isolation is expanding. A 2022 study revealed that only 39% of adults surveyed in the US felt very connected to others. When comparing the prevalence of loneliness, which is reported to affect about 50% of US adults with other health conditions, social isolation is far more widespread than the percentage that smoke (12.5%), experience obesity (41.9%), or live with diabetes (14.7%).

Lack of social connection worsening since the 1950s

While Dr. Murthy's advisory puts the country on notice that loneliness and isolation have become significant public health problems that require immediate awareness and action, social connection has been on the decline since the 1950s.

In 2000, Harvard political researcher Robert Putnam's book “Bowling Alone: The Collapse and Revival of American Community" was published. It spoke to the decrease in civic involvement through membership, volunteering, community committees, and other group activities. By spending less time in community, Putnam pointed to the lack of social interaction and civic discussion critical to thriving civilizations.

Social connection, including its structure, function, and the quality of relationships with others, is a critical and underappreciated factor in individual and population health, as well as community safety, resilience, and prosperity.

Specific populations are at the highest risk for social isolation

The Surgeon General Advisory shared research that indicates certain groups of individuals are at higher risk of isolation and loneliness, including individuals:

• With poor physical or mental health
• Living with disabilities
• Facing financial insecurity
• Living alone
• Who are single parents
• At younger and elderly ages
• From ethnic and racial minority groups
• Who identify as LGBTQ+
• Living in rural communities
• Who are victims of domestic violence
• Experiencing discrimination or marginalization

“Given the significant health consequences of loneliness and isolation, we must prioritize building social connection the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders. Together, we can build a country that's healthier, more resilient, less lonely, and more connected," says Dr. Murthy.

The benefits of improved social connection

Social connection encompasses interactions, relationships, roles, and the depth of experience among individuals, communities, and society. However, social connection is on a continuum, and evidence points to a gradient where low social connection is associated with poorer outcomes, and higher levels lead to better results.

Extensive scientific findings across disciplines like epidemiology, neuroscience, medicine, psychology, and sociology agree that social connection is a significant predictor of longevity and better physical, cognitive, and mental health. The benefits of social connection also extend beyond health-related outcomes, influencing educational accomplishment, workplace satisfaction, economic prosperity, and overall well-being and life fulfillment.

The first step to improving health through social connection

In recent years, dramatic changes due to the COVID-19 pandemic, home isolation, increased social media use, and virtual technologies have accelerated rates of loneliness and the effects of isolation. While technology can facilitate communication and data exchange, it cannot make up for the depth and meaning found in real-life, personal connections.

The US Surgeon General's Advisory on the Healing Effects of Social Connection and Community, titled “Our Epidemic of Loneliness and Isolation," offers 6 pillars to advance social connection as part of a national strategy, including:

• Pillar 1: Strengthen Social Infrastructure in Local Communities
• Pillar 2: Enact Pro-Connection Public Policies
• Pillar 3: Mobilize the Health Sector
• Pillar 4: Reform Digital Environments
• Pillar 5: Deepen Our Knowledge
• Pillar 6: Cultivate a Culture of Connection

The third pillar, mobilizing the health sector, strives to train healthcare providers, assess and support patients, and expand public health surveillance and interventions.

Because social connection is a protective factor for health, and social isolation and loneliness are risk factors for several major health conditions—cardiovascular disease, dementia, depression, and premature mortality from all causes—addressing social connection is an essential aspect of addressing social risk.

Assessing social connection

When assessing or strategizing how to improve social connection, there are 3 vital components to consider, including:

1. Structure - The number and variety of relationships we have with co-workers, friends, family, and neighbors, as well as the frequency of interactions with strangers.
2. Function - The degree to which people support each other and supply for others' needs.
3. Quality - The level of positive, helpful, and satisfying relationships and interactions an individual experiences regularly.

Healthcare providers, health plans, the public health community, and community-based organizations can look for ways to build social connection into their existing programs, team up participants, and add questions regarding social connection to social risk assessments.

Changing decades-long social trajectories takes time and intention

Loneliness and social connection are proven major health risks. This evidence, paired with the current national strategy to raise awareness, creates an immediate opportunity to include social isolation in social determinants of health (SDoH) and social risk programs.

According to the US Surgeon General, “Our epidemic of loneliness and isolation has been an underappreciated public health crisis that has harmed individual and societal health. Our relationships are a source of healing and well-being hiding in plain sight–one that can help us live healthier, more fulfilled, and more productive lives."

RTI designs evidence-based social risk assessments and interventions

RTI supports organizations at the forefront of healthcare. Our team of experts covers the spectrum of issues faced by payers, providers, and vendors today. From health equity, data analytics, and quality improvement to population health and digital health technologies, we can help you achieve care, quality, and cost goals. Contact us.