Monthly Archives for May 2023

Warning: Being lonely and isolated is hazardous to your health

Published in RINewsToday on May 8, 2023

Last Sunday, just days before releasing an advisory or “public statement” raising the alarm about the devastating impact of loneliness and isolation in the United States, U.S. Surgeon General Vivek Murthy published an essay in the New York Times announcing its planned release. In his essay he also talking about his own personal struggles with loneliness and called for enhancing social connections to be made a “top public health priority”. 

One day before the release of Murthy’s new advisory on May 2nd, White House Press Secretary Karine Jean-Pierre said Murthy’s new advisory is a component of the Biden administration’s bigger efforts to address the nation’s mental health.  The releasing of this advisory was well-planned, being issued in May, designated as Mental Health Awareness Month in the US.

Sounding the alarm

The 81-page advisory report titled “Our Epidemic of Loneliness and Isolation,” finds that even before the COVID-19 pandemic, about half of U.S. adults reported experiencing measurable levels of loneliness.

While the advisory is “not an extensive review of the literature” the information was culled from electronic searches of research articles published in English and resources suggested by “subject experts,” with priority given to meta-analyses and systemic literature reviews.

As the nation’s chief advocate for public health, Murthy is using his office as a bully pulpit to issue an advisory calling for the nation’s immediate awareness and attention to the widespread epidemic of loneliness and isolation. He also provides a roadmap as to how it might be swiftly addressed.

According to the advisory, even before the onset of the COVID-19 pandemic, approximately half of U.S. adults reported experiencing measurable levels of loneliness. Disconnection fundamentally affects our mental, physical, and societal health. Loneliness and isolation increase the risk for individuals to develop mental health challenges in their lives, and lacking connection can increase the risk for premature death to levels comparable to smoking up to 15 cigarettes daily.

The advisory noted that the physical health consequences of poor or insufficient connection include a 29% increased risk of heart disease, a 32% increased risk of stroke, and a 50% increased risk of developing dementia for older adults. Additionally, lacking social connection increases risk of premature death by more than 60%.

While there are no new promises of federal dollars for tackling this societal problem, the Surgeon General’s advisory is tended to raise awareness and lays out a framework for a National Strategy to Advance Social Connection, which has never been implemented before in the United States. The advisory also provides suggestions about how specific groups – including governments, providers, researchers, health organizations, schools, high-tech companies, media, parents and caregivers, community-based and philanthropy organizations, workplaces and individuals – can take to increase connection in their lives, communities, and across the country and improve their health.

“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,” said Murthy, in a statement announcing the release of this advisory. “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.,” he said.

Brigham Young University Professor of Psychology and Neuroscience, Julianne Holt-Lunstad agrees with the Surgeon General’s assessment of the national importance of recognizing that loneliness and isolation can be hazardous to your health and to society’s wellbeing. “The advisory shows that too many Americans lack social connection in one or more ways and the evidence of the severe consequences have been growing for decades. While the pandemic helped raise awareness, since this was problem well before the pandemic, getting back to normal is not enough,” she says. 

“This advisory helps bring greater awareness to this important public health issue, and sets forth a framework for a national strategy –with detailed recommendations for various stakeholders—to begin to take action.  The personal and societal costs of inaction are far too high,” says Holt-Lunstad.

Along with affecting a person’s physical health, loneliness and isolation can contribute substantially to mental health challenges, too, says the advisory.  In adults, the risk of developing depression among people who report feeling lonely often is more than double that of people who rarely or never feel lonely.

Meanwhile, loneliness and social isolation in childhood increase the risk of depression and anxiety both immediately and well into the future. And with more than one in five adults and more than one in three young adults living with a mental illness in the U.S., addressing loneliness and isolation is crucial to fully addressing America’s mental health crisis, says the advisory. 

The advisory notes that while the epidemic of loneliness and isolation is widespread and has profound consequences for our individual and collective health and well-being of the nation, there is a simple way to attack this societal problem: social connection.

Social connection is beneficial for individual health and also improves the resilience of the nation’s communities. Evidence shows that increased connection can help reduce the risk of serious health conditions such as heart disease, stroke, dementia, and depression. Communities where residents are more connected with one another fare better on several measures of population health, community safety, community resilience when natural disasters strike, prosperity, and civic engagement.

Six pillars to advance social connection

This Surgeon General’s Advisory lays out a broad framework for the United States to establish a National Strategy to Advance Social Connection based on six pillars.

Pillar one calls for strengthening social infrastructure (parks, libraries, and playground) and the programs and policies in place.

The second pillar urges government at all levels to create “Pro-Connection” public policies like accessible public transportation or paid family leave to foster more connections in the family and community.  

Because loneliness and isolation are risk factors for patients with heart conditions, dementia and depression, the third pillar calls for utilizing heath care providers to assess and identify patients for risk of loneliness and intervene.

Pillar four calls for critically evaluating our relationship with technology to ensure that how we interact digitally with others doesn’t reduce meaning and healing personal connections with others.

More research is needed to study the impact of loneliness and isolation, beyond the evidence outlined in the advisory.  Pillar five calls for the deepening of our knowledge to understand the causes and consequences of social disconnection, populations at risk, and effectiveness of efforts to boost connections.

Finally, pillar six notes the importance of cultivating a culture of connection to influence the relationships of people we have in our daily lives. 

This week in an RINewsToday article on combined loneliness – and grief – Dr. Mari Nardolillo Dias noted the compounding risk for individuals. Dias says, “Grief and loneliness are common, albeit toxic, bedfellows,” and she suggests building in small activities to look forward to which she says gives us “hope” for the future. (https://rinewstoday.com/griefspeak-choose-hope-mari-nardolillo-dias/)

Social engagement can help maintain good brain health 

For years, researchers involved in the publishing of 13 Global Council on Brain Health (GCBH) reports on various brain health topics including the impact of social isolation and loneliness. “We’re thrilled that the Surgeon General is focusing new attention and energy on this critical topic,” says  Sarah Lenz Lock, senior vice president of policy and brain health at AARP, also serving as GCBH’s executive director.

Both the GCBH reports and the Surgeon General’s advisory talk about the importance of social connections to health, says Lock. “The GCBH focused on how critical social engagement was to maintaining good brain health as you aged beginning in 2016, while the Surgeon General report in 2023 talked about all ages and health conditions, and followed the extreme social isolation brought about the pandemic that occurred afterwards,” she notes.  

According to Lock, the pandemic was a forced natural experiment that demonstrated the harm of loneliness and isolation which is what we had being saying long before.  But now we can see it in even more stark terms [after the pandemic],” she adds.

Lock sees the Surgeon General’s efforts to create a National Strategy to Advance Social Connections to be an extremely important initiative. “People of all ages need to take steps to stay connected with others for their health and mental well-being.  It’s not just a “nice to have’ this kind of project, it’s a critical need to have for the health and well-being of our nation,” she says. 

While there is no federal funding allocated to fund implementation of the advisory’s recommendations, a divided Congress might just be able to come together to address the personal and societal problems caused by loneliness and isolation. “This is an issue that affects both parties and we hope that it is viewed as a bi-partisan issue. Further, the healing power of social connection goes beyond individual health. The more communities, society, and leaders, can feel connected the more we can trust and rely upon one another and tackle many of the issues that we face as a nation,” adds Holt-Lunstad.

During this session of Congress, the Surgeon General’s advisory should be put placed on its policy agenda to hammer out new laws to enhance the nation’s social connections.  In concluding the advisory’s letter from the Surgeon General, Murthy warns:  “If we fail to do so, we will pay an ever-increasing price in the form of our individual and collective well-being. And we will continue to splinter and divide until we can no longer stand as a community or country.”

For a copy of the Surgeon General’s advisory, go to: https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf

GCBH has published 13 reports on various brain health topics. All of them can be found here: https://www.aarp.org/health/brain-health/global-council-on-brain-health/resource-library/. 

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Tips on Connecting with Others

Below are recommendations to optimize and promote social engagement from the GCBH report. The recommendations are ordered so that the first ones might be appropriate for people who have very few social connections. This is followed by suggestions for those who are relatively socially active. The final recommendations are for those people who are already socially active. The GCBH also recommends that these people consider increasing the diversity or variety of their engagement. It is recommended that people should generally maintain a variety of the suggested types of engagements.

To promote meaningful social engagement:

1. Focus on the relationships or social activities you enjoy the most.

2. If you have no one around who can help you engage socially, turn to professionals who can assist. a. Examples: telephone hotlines, drop-in centers, a chat with a local religious leader, etc.

3. If you feel lonely, you can try to change this by making a new connection or by seeking different opportunities to engage with others.

4. If there are barriers to interacting with people (e.g., difficulty getting around, unsafe neighborhood), see if you can identify someone you could ask for help, and let someone assist you in making connections.

5. Try to keep a circle of friends, family or neighbors with whom you can exchange ideas, thoughts, concerns and practical matters, and who can also help or encourage you. It does not need to be a large group of people as long as those in it are important to you and you are important to them. Try to have at least one trustworthy and reliable confidante to communicate with routinely (e.g., weekly), someone you feel you can trust, and you can count on.

6. If you are married, this can benefit your cognitive health, but you should consider fostering other important relationships. Individuals who have never married or are divorced or widowed often have many other connections that provide support.

7. Try to speak every now and then (e.g., monthly) with relatives, friends and/or neighbors; communicate in person, or by phone, email or other means.

8. Help others, whether informally or through organizations or volunteer opportunities. For example, visit a lonely neighbor or friend, shop for/with them, or try cooking together.

9. Maintain social connections with people of different ages, including younger people. Keep in touch with grandchildren or volunteer to help people at a local school or community center. Think about the skills you have and that you use routinely that might be valuable to pass on to others. Offer to help teach a younger person skills you may already have, such as cooking, organizing an event, assembling furniture, saving for the future, investing in the stock market, etc.

10. Add a new relationship or social activity you didn’t try before. Place yourself in everyday contexts where you can meet and interact with others (e.g., stores or parks).

11. Be active and challenge yourself to try out organized clubs, courses, interest groups, political organizations, religious gatherings, or cooking classes.

12. If you are already socially active, diversify your activities. Consider joining or starting a group that doesn’t exist in your community and is centered around a common interest (e.g., a workout group).

Practical tips for those who have trouble engaging socially:

1. People can take small steps to connect with others. Share a smile a day with someone, show interest in someone by asking how they are, hold a door for someone, and practice a random act of kindness.

2. Reach out to neighbors or acquaintances whom you may not have spoken to in a long time: for example, call, send a card, email, or check social media.

3. Look at the list of additional resources that we provide in Appendix 1 and consider using them.

Source:  AARP

Ratcheting up SSA’s customer service will take more funding 

Published in RINewsToday on May 1, 2023

Over two months ago, as required by law, Kilolo Kijakazi, Acting Commissioner of Social Security Administration (SSA) released the fiscal year 2023 operating plan to Sen. Patty Murray (D-Wash.), chair of the Senate Appropriations Committee. The report, released on Feb. 10, 2023, details how SSA plans to use its $14.1 billion budget allocation for the year. 

Kijakazi wrote in the report’s transmittal letter: “In FY 2023, we will build the foundation for improved services by rebuilding our workforce after ending FY 2022 at our lowest staffing level in over 25 years.”

According to Kijakazi, at the end of Dec. 2022 the initial SSA claims-pending level soared to almost 975,000 cases.  This was more than 380,000 cases higher than at the end of FY 2019. “The average initial claims wait time through Dec. 2022 was 206 days compared to 120 days in FY 2019.  It will take a multi-year effort and sustained funding to restore our average initial disability claims wait times to pre-pandemic levels,” she says.

While Kijakazi anticipates processing 129,000 or 7% more initial disability claims in FY 2022 (52 weeks), she expects wait times for a disability decision at the initial and appeal levels to increase for a period of time because backlogs will continue to grow while the agency hires and trains new staff. 

Although the FY 2022 outlay represents $785 million of the agency’s budget of $13.34 billion, it was less than the $14.8 billion President Joe Biden requested for administration funding. In February 10th correspondence to the House and Senate Appropriation Committees, Kijakazi stated that while budget increases will cover fixed costs and support staffing in the upcoming fiscal year, “some performance will show improvement in FY 2023, while others will show temporary degradation.” 

Conversations regarding SSA’s customer service challenges

In February 28th correspondence to SSA’s Kijakazi, AARP’s Nancy LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer, recognized increased funding was necessary for SSA to address its customer service problems. AARP recognizes that federal funding has not kept pace with increases in operational cost and demands, but the agency “needs to do more to constrain operating costs and increase productivity,” Kijakazi says.

LeaMond called the “expected decline in service troubling, given multiple assurances from SSA that the funding level received would be sufficient to at least maintain the modest customer service improvements made last year.”

“Your operating plan asserts that the already unacceptable average of call wait time of 33 minutes will be longer this year, increasing to 35 minutes, and people trying to call the agency will get a busy signal 15 percent of the time, more than double the rate last year.  This is an unacceptable step backward,” wrote LeaMond.

LeaMond says that SSA’s operating plan doesn’t address several customer service areas, especially the challenges of beefing up staff to improve in-person services and reducing wait times and busy rates that the public should expect when calling their local office.  She called for more details and when beneficiaries can expect improvements to online services.

“Even more concerning is the fact that the operating plans note that disability-related service improvements are not expected to occur before 2024 fiscal year,” adds Leamond. While the plan provides details about disability claims, and appeal workloads, as well as prioritization of claimants who have been waiting the longest, she calls on SSA to “act more quickly to improve the disability process.”

“The Social Security Administration (“SSA”) has large fixed costs, such as rent on its network of 1200 field offices, and those fixed costs increase every year. SSA’s funding does not come from the general government budget, but rather from Social Security’s accumulated reserve of $2.8 trillion. Yet for over a decade, Congress has restricted SSA from spending the funds necessary for adequate service,” says Nancy Altman, President of Social Security Works (SSW).

Adds Altman, “While Congress this year allowed SSA to spend more, the additional dollars did not even cover all the fixed costs. They certainly did not correct the many years of underfunding. Service will not significantly improve unless Congress allows SSA to spend more of  Social Security’s accumulated reserve  — at the bare minimum,  the $15.5 billion that President Biden has requested — but ideally significantly more.”

Biden budget seeks to fix SSA’s customer service issues

In a blog article penned on March 30, 2023, Kathleen Romig, Director of Social Security and Disability Policy at the Washington, DC-based Center for Budget and Policy Priorities, says that SSA has an opportunity to ratchet up its consumer service impacted by decades of restricted funds by receiving increased funding. “With additional funding in for the coming year, the agency could invest in the staff and technology it needs to better serve the public,” she says.

“Since 2010, SSA’s customer service budget has fallen by 17 percent after inflation, with its staffing falling a commensurate 16 percent – marking the lowest level in 25 years. These cuts happened even as the number of Social Security beneficiaries grew by 12 million, or 22 percent. Being forced to serve millions more people with fewer staff and resources has caused tremendous strain at SSA, and beneficiaries are suffering the consequences,” says Romig.

On March 9th, Biden released a FY 2024 budget calling for increased appropriations to SSA. According to the Office of Management and Budget (OMB), the president’s budget provides an increase of $1.4 billion (a 10% increase) over the FY 2023 budget to cover salaries, benefits and rent increases. It would also improve customer service at field offices, state disability determination services, and teleservice centers.   

Each year, SSA processes more than 6 million retirement, survivors, and Medicare claims, and more than 2 million disability and SSI claims, says OMB, charged with producing the president’s budget. Biden’s budget increase boosts staffing levels from FY 2023, allowing the agency to process about a half a million more disability cases in FY 2024 that were completed in FY 2022, significantly reducing wait times for those decisions.

GOP debt limit bill drastically cuts SSA’s operating budget

Just last week, by a razor thin margin, House Speaker Kevin McCarthy (R-CA)’s Limit, Save, Grow Act of 2023 (H.R. 2811) passed by a partisan vote of 217-215. Four Republicans voted “no”. While this legislation to lift the nation’s debt limit allows the U.S. Treasury to pay the nation’s bills, it has no chance for passage in the Democratic-controlled Senate. However, it will force the president’s team to the negotiation table with Republican House and Senate leadership, hoping it will push compromise on future spending limits.

Failure to increase the debt limit would have catastrophic consequences for the U.S. and global economies, as well as for all Americans, who rely on the federal budget to provide public services. (from Social Security and Medicare to food safety inspection, air traffic control, school nutrition, and environmental. 

After the House vote, Alex Lawson, SSW’s Executive Director of Social Security, charged that 217 House Republicans just voted to cut Social Security. “Nearly every Republican in the U.S. House just voted to slash the already inadequate funding of the Social Security Administration (SSA). If this bill becomes law, it will force SSA to close field offices, reduce hours, and lay off thousands of workers. This will make it far harder for Americans to claim the benefits they’ve earned,” warned Lawson. “Cuts to SSA are cuts to Social Security, and we will hold every single one of these members accountable,” he says.

Max Richtman, President and CEO of the Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM) agrees with SSW’s assessment. One day before the vote, he wrote House members to urge them to pass “clean’ debt limit legislation.

“If the spending cuts and other [GOP] legislative changes that are incorporated in this legislation were ever to become law, the negative impact would be felt by virtually every American family in every Congressional District in the country,” wrote Richtman.

According to Richtman, the GOP’s proposed debt limit legislation includes among its provisions a roll-back of ALL discretionary federal spending to Fiscal Year 2022 levels in FY 2024, with growth limited to one prevent annually for the next decade. “This is not a minor trimming of spending that has been portrayed by some, but a dramatic slashing that will have devastating impacts on the Americans who rely on the affected programs for their health and well-being,” says the nationally recognized Social Security advocate. 

Reluctance to cut Defense and Veteran Health funding would have at least a 23 percent reduction to all other programs for FY 2024, charges Richtman, this resulting in funding cuts to SSA’s customer service budget.

“Cutting funding by six percent would significantly affect SSA’s ability to serve the public and undermine the Agency’s core-mission – producing longer wait times for benefits and to reach SSA representatives, as well as reduced access to in-person programs, noted Richtman, stressing that face-to-face access with SSA’s employees is critical to those who are elderly and disabled.

SSA calculates that for every $100 million in additional funding cut the federal agency would be forced to lay off an additional 1,000 employees, this equivalent to closing 40 field offices, says Richtman.

Since 1960, Congress has acted 78 separate times to permanently raise, temporarily extend, or revise the definition of the debt limit – 49 times under Republican presidents and 29 times under Democratic presidents, says the U.S. Treasury.  Like in the past, this Congress must follow to raise the nation’s debt limit, and is expected to do so.

Ultimately, it is crucial for Biden and McCarthy’s negotiations to hammer out a “clean” debt limits bill that will not cut SSA’s operational funding further which could send the agency’s customer service efforts into a tailspin. It is time for Congress to fix SSA’s operational funding issues once and for all to improve customer service provided to 65 million beneficiaries. 

For a copy of SSA’s 2023 Operating Plan go to https://www.ssa.gov/budget/assets/materials/2023/2023OP.pdf.

For a summary of H.R. 2811, Limit, Save, Grow Act of 2023, go to 

https://www.govtrack.us/congress/bills/118/hr2811/summary

For a copy of President Biden’s FY 2024 Budget, go to:  https://www.whitehouse.gov/omb/briefing-room/2023/03/09/fact-sheet-the-presidents-budget-for-fiscal-year-2024.