With the return of the holiday season, I think of my patients who spend this “most wonderful time of the year” alone: the middle-aged woman with hypertension and depression, unable to travel at Christmas to see her daughter in another state; the younger man on the verge of homelessness with lung problems and anxiety.
The contrast between reality and the Norman Rockwell version of the seasonal festivities can be especially stark for those who spend the holidays in solitude. Even after the lights and decorations are returned to boxes in closets and garages, those who are disconnected from others will continue to face poorer health outcomes, both mental and physical, than those with strong relationships.
Loneliness and social isolation are important – and treatable – public health problems that deserve more attention.
In my years as a family physician, some of the most challenging cases I’ve encountered have been patients without a support circle. I recall the middle-aged man trying to get sober after years of heavy drinking, an older man with schizophrenia and heart failure who was estranged from his family, a Spanish-speaking single mom with chronic back pain who cared for a teenage daughter. They all struggled to make meaningful progress, in part because they lacked connections to others.
Loneliness and isolation contribute to higher rates of mental illness and dementia. They increase the risk of heart disease and stroke by an estimated 29 percent and 32 percent, respectively. They may diminish the function of the immune system and increase infections and cancer deaths. Disconnection can raise the risk of dying early as much as daily smoking. From a neuro-imaging standpoint, social exclusion and loss look similar to physical pain.
Rates vary, depending, in part, on how survey questions are asked, but loneliness is common. A survey earlier this year by the University of Michigan showed that 34 percent of adults ages 50 to 80 had felt isolated from others some of the time (29 percent) or often (5 percent) in the past year. A Gallup survey from February indicated that 17 percent of U.S. adults felt lonely “a lot of the day yesterday.” Globally, 24 percent of adults reported feeling “very” or “fairly” lonely in a new Meta-Gallup survey released earlier this fall. Those who are low-income, disabled, or have chronic medical problems are at higher risk of isolation.
In my experience as a doctor, the patients who do well are often the ones with strong family support: the older couple with five adult children living nearby, the elderly woman with COPD who came to every medical visit with an attentive daughter or grandchild.
When I faced my own diagnosis with multiple sclerosis, I relied on friends and family to help with childcare, meal preparation, and, most important, to boost my spirits. With their ongoing support, I am able to lead a normal life 14 years later.
An 80-year cohort study, The Harvard Study of Adult Development, validates my observations. It followed over 700 men – and later their spouses and over 1,300 descendants – throughout their lives. As described in their 2023 bestselling book, The Good Life, authors and study leaders Robert Waldinger and Marc Schulz concluded that having healthy, fulfilling relationships was the single most important predictor of longevity and happiness.
We’ve faced significant setbacks in recent years. The rise of social media – which may sometimes replace meaningful in-person interactions and contribute to feelings of inadequacy and depression – has created new barriers, especially for younger generations. Widespread isolation required during the COVID-19 pandemic, which reduced even brief but beneficial “micro-moments” of connectivity (conversations with a bus driver or store clerk, for example), contributed to increases in feelings of loneliness. We have yet to recover.
Solutions
Sometimes I’ve wanted to play matchmaker for my patients – not to start a romance, but a friendship. It was never possible, given privacy concerns, but I was pained to see many of my patients face profound loneliness. I didn’t think of it as a health concern, but I should have.
Healthcare providers and leaders would do well to take a broader view of health, which we now know is affected by so much more than clinical interventions and medications. We need to encourage patients to prioritize important relationships and support community initiatives – including those in schools, workplaces, and neighborhoods – that provide opportunities for people to make connections.
In May, U.S. Surgeon General Dr. Vivek Murthy issued an advisory on what he called a “public health crisis” of isolation and lack of connection in our country.
“Given the profound consequences of loneliness and isolation, we have an opportunity, and an obligation, to make the same investments in addressing social connection that we have made in addressing tobacco use, obesity, and the addiction crisis,” Murthy wrote.
His Framework for a National Strategy to Advance Social Connection calls for a mobilization of healthcare providers to better assess and support patients as well as an expansion of public health surveillance, research, and increased awareness. In addition, he recommends implementing “pro-connection” public policies and strengthening community infrastructure through investments in local institutions, the built environment, and community programs to bring people together. In late October, he launched a tour of U.S. colleges to encourage students to develop and nurture relationships.
Other nations have something to teach us as well. In a recent piece in the New York Times, Nicholas Kristof discusses strategies used by other countries to reduce loneliness. Great Britain, for example, created a post for a minister of loneliness in 2018, and has invested the equivalent of more than $100 million to increase connections, often at the local level, through low-tech community gatherings and volunteer activities. Other countries, like Japan, are following suit.
The BBC Loneliness Experiment, also launched in 2018, compiled suggestions from 55,000 respondents about how to address loneliness. Some of the ideas included finding distracting activities, joining social organizations, talking with friends and family, and remembering that feelings of loneliness are often temporary.
Perhaps by recognizing and framing loneliness as a health problem, as Dr. Murthy has done, solutions in the U.S. will be more forthcoming.
When I was in medical school in the mid-1990s, my study partner and I would sometimes argue about which disease, from that week’s lessons, was the worst. Among parasitic infections, was it visceral leishmaniasis (spread by sand flies) or Guinea worm disease? One could cause fever, swelling of the liver and spleen, and anemia. And the other could cause painful blisters – with worms. What I’ve since realized as a practicing physician is that the worst disease isn’t based on the diagnosis, but on the conditions surrounding the patient. Those who are alone, fighting an illness without friends or family, suffer the most.
Lisa Doggett, a columnist for Public Health Watch, is a family and lifestyle medicine physician at UT Health Austin’s Multiple Sclerosis and Neuroimmunology Center and senior medical director of Sagility. She is the author of a new memoir, “Up the Down Escalator: Medicine, Motherhood, and Multiple Sclerosis.” The views expressed in her columns do not necessarily reflect the official policies or positions of Public Health Watch, UT Health, or Sagility. Doggett can be reached through her website.