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