Loneliness kills: A new public health crisis (and what we can do about it)

A little-discussed condition raises the risk of premature death by up to 50 percent—making it a health hazard at least as significant as smoking and alcohol and more so than obesity. Yet many medical professionals haven’t heard about it, and the public remains largely in the dark.

We’re talking about social isolation, a national public health crisis.

{mosads}Characterized by a tiny support network and minimal interpersonal contact, it’s a circumstance often associated with older adults experiencing progressive loss. Children move away, a spouse dies, and physical deterioration makes it harder to engage in social activities. Seniors in rural areas are particularly susceptible. Geographic isolation and lack of public transportation combine to keep them alone.

Lack of human contact has serious physiological consequences. Studies show that without human contact our risk of functional decline increases as does our risk of mobility loss. Our risk of clinical dementia increases by 64 percent. These health problems further isolate those suffering from social isolation, threatening a vicious cycle of physical, emotional, and psychological decline.

Although much of the social isolation research has centered on older people, there is reason for broader concern. Even younger generations– who are hyperconnected thanks to social media and technology – report alarming rates of loneliness and social isolation.

How can we curb this trans-generational erosion of happiness and human potential? What are the medical interventions and policy changes for which we should advocate? To help answer these questions, we recently convened a roundtable at the Bipartisan Policy Center in Washington, DC, bringing together some of the nation’s top experts from health, aging, technology, academia, and the private sector to envision a path forward on social isolation.

Our roundtable participants identified four action areas to reverse social isolation:

1. Elevate the Issue of Social Isolation and Loneliness to the National Level. There was broad agreement that a coordinated national campaign is needed to raise public awareness about the prevalence and health impacts of social isolation. Beyond reaching the general public, this campaign should raise awareness within the public health community, and educate and connect seniors experiencing isolation with community resources.  This type of national effort could potentially be spearheaded by a high-ranking federal government official; other countries have taken this approach, with the U.K., for example, appointing a Minister For Loneliness. 

2. Build on Existing Resources and Infrastructure, including the Social and Community-based Service Programs. Systematically identifying how we can better support access to and scale existing services for aging and rural Americans is critical, including leveraging value-based care transformation and repurposing local infrastructure including health departments, senior and community centers, and other local resources. Programs like Meals on Wheels can identify isolated seniors and, with more local cooperation and coordination, connect them with resources to reduce loneliness. Other touch points like faith-based groups, law enforcement and delivery systems like postal service and delivery businesses can also help. Moreover, with 10,000 seniors aging into Medicare every day, we should prioritize expanding coverage for wellness programs like SilverSneakers, which keeps seniors active and creates opportunities for social connections through group exercise.

3. Address Social Isolation through Public Policy Improvements. The upcoming Healthy People 2030 report, led by the U.S. Department of Health and Human Services, should explicitly acknowledge reducing social isolation and loneliness as a national objective for improving the health of Americans.  We should also continue to place a priority on policies that accelerate delivery of affordable broadband to more remote geographies. High-tech solutions, such as telehealth, videoconferencing, and online support groups, are showing promise as a way for older Americans in rural areas to stay connected. Furthermore, federal innovation funding should be considered for research into scalable models to reach our most isolated and lonely.    

4. Reform Health Care Delivery and Payment Systems. Strengthening rural healthcare infrastructure and financing will be central to addressing social isolation among rural Americans. Global hospital budgeting should be explored as an avenue to reorganize care delivery and invest in non-clinical services that address social determinants of health and promote social connectivity. As Medicare Advantage experiences increased flexibility with supplemental benefits, plans should consider benefits that address social isolation and simultaneously reduce health costs. Developing a reliable tool to screen seniors for social isolation would also be an asset, and the Welcome to Medicare and annual Medicare exams could provide an opportunity for screening.  Finally, it is worth examining whether there are appropriate opportunities to address social isolation in a Medicaid wavier or CMMI innovation models.

While there are a number of steps we would like to see taken to tackle this under-recognized public health crisis (which are further outlined here in our roundtable white paper), there is some good news.  Initiatives to address social isolation and loneliness are cropping up from coast to coast. CareMore, a California-based health plan, offers a togetherness program for those identified as lonely, and they’re redesigning clinics to serve as social centers. In Maine, where 58 percent of older adults live in rural areas, Access Health combines medical care with social support, such as assistance with household chores.

Many policy experts are looking toward intergenerational efforts. Older adults boast a wealth of experience and insight but may need transportation or mobility assistance. Younger people often move far from their hometowns and yearn for a feeling of belonging and the support of an older adult. Children can contribute energy and imagination to local support networks, which could start to look a lot like communities of yore reworked for a new era. Integration is ultimately where we’re headed. Combining the knowledge and resources of all stakeholders, from the healthcare industry to educational institutions to government agencies, we maximize our “collaborative IQ.”

As more people become aware of the problem of social isolation—and maybe identify it in themselves—our movement will gain momentum. Together we can weave a stronger social fabric from today’s disparate pieces and ensure a more connected and healthier tomorrow.

Bill Frist, M.D., is a nationally recognized heart and lung transplant surgeon, former U.S. Senate majority leader, and founder and chairman of community impact organization NashvilleHealth. Find him on Twitter as @bfrist. Donato Tramuto is CEO of Tivity Health, which provides SilverSneakers — the nation’s largest community fitness program for older adults — and is founder of the Tramuto Foundation and Health eVillages. You can follow him on Twitter @donatotramuto.