The quiet epidemic

There are a lot of epidemics in the headlines and national consciousness — opioids, obesity, gun violence — but one that influences public health crises gets short shrift: loneliness.

It isn’t what you expected, is it?

It is an uncomfortable thing to talk about, and it feels insignificant compared to issues like housing, access to medical care, and food security. It is also an (achingly) private thing, confounding many health practitioners as intractable and outside the scope of their capacity.

But it is a problem — a big problem, and it is impacting our health.

An estimated 40 percent of the US adult population suffer from loneliness, double the number reported in the 1980s. 42.6 million US adults over the age of 45 are believed to suffer from chronic loneliness. To put that in context, it is more than the total population of the state of California, the most populous in the Union.

The impact loneliness has on well-being is well-documented, with researchers identifying loneliness as important an indicator for early death as obesity and smoking. Social isolation (defined as few, consistent social connections and interactions) places individuals at increased risk of heart disease (by 29 percent) and stroke (by 32 percent). Other outcomes include increased inflammation, abdominal obesity in adolescents, depression, and reduced cognitive function in older adults.

It is, in short, difficult to overstate the impact and importance of social interactions and connectivity on health behaviors and outcomes.

Conversations about social isolation and loneliness tend to focus on older populations, as the social networks developed around work (the American social lodestone) disintegrate in retirement. But it is not just older Americans who are at risk. Dr. Holt-Lunstad, a professor at Brigham Young University who studies the impact of social networks on health outcomes, says, “We found stronger risks for those under 65 than for those over 65.”

While the results may show effects of the addition of adolescents in the evaluation, but the change is also due to a “spike” in middle-age. In her analysis of 70 studies, Dr. Holt-Lunstad found isolated middle-aged adults had a higher risk of mortality within the next seven years than their older counterparts.

In North Carolina, the Sudden Project is an inter-disciplinary research program based in the UNC School of Medicine that studies incidence of out-of-hospital sudden, unexpected death among adults aged 18-64 in three North Carolina counties. Dr. Ross Simpson, principal investigator on this study, summarized their findings:

“Our research indicates that sudden, unexpected death is a tragically common occurrence, accounting for over 10 percent of all adult natural deaths. We have identified a number of common risk factors across populations, both rural and urban, but one of the most consistent themes is that of social isolation.”

Social isolation and loneliness are as threatening to health as diabetes and cardiovascular disease. Policymakers, providers, and members of the community should take this epidemic as seriously as other, more visible public health crises.

One example of a way to address is found in the United Kingdom. Earlier this year, Prime Minister Theresa May assigned Sports and Culture Minister Tracey Crouch an additional portfolio on targeting loneliness in what has been branded the “first minister of ‘loneliness.” The government has also committed additional funding to community groups to foster and implement connection networks.

The City of Manchester (the first UK city to become a member of the World Health Organizations network of Age Friendly Cities) leads the nation in developing the infrastructure, including the all-important referral databases and evaluation programs, to address the problem on a systemic basis.

The example Manchester and others present is that this is not an intractable problem. It is also something that cannot be ignored. Long-term care, mental health care, and chronic disease management require community network support and assistance to those who find themselves without adequate networks.

Developing meaningful networks and providing support to isolated individuals may be more challenging than following clinical protocols such as counseling on smoking cessation, monitoring blood pressure, or hemoglobin metrics, but the outcomes could be more significant as well.

Editor’s note: Dr. Ross Simpson is the father of contributor Tina Simpson.