Exploring and better understanding the social determinants of health is becoming the norm in medical education and training. Social isolation and loneliness are important social determinants of physical and mental health, and we as a society need to pay attention and develop ways to reduce their negative effects. There is increasing awareness and understanding of the negative effects of social isolation and loneliness on mental and physical health.
Social isolation can be described as a deficiency in a person's actual social network and relationships (de Jong-Gierveld J et al.2006). Loneliness refers to the negative and unpleasant feeling that arises from the difference between a person's desired social networks and relationships and their actual social networks and relationships (Peplau & Perlman 1982). While social isolation can be measured objectively, loneliness is by definition subjective.
Social isolation and loneliness often occur together, but they can also occur separately. Both are associated with increased morbidity and mortality in all age groups and lead to poorer mental, cardiovascular, and neurological health. Perhaps most importantly, both are associated with an almost 30% increase in early mortality (Holt-Lunstad et al. 2015). Frankly, the data tells us one hard fact. Social isolation and loneliness are more harmful than smoking 15 cigarettes a day (Holt-Lunstad et al. 2010).
The U.S. Surgeon General's 2023 Recommendations on the Healing Effects of Social Connections and Communities details the significance of these effects. We are being asked to look at the negative effects of social isolation and loneliness, not just at the individual but also at the community level.
Individuals and communities feel different impacts based on individual, societal, and structural factors. Individual factors include disease status, age, socioeconomic status, disability status, and the presence of other factors that confer vulnerability. Social factors include social infrastructure and community organization, while structural factors include transportation, housing, and health care access and coverage. Although older adults have been shown to have the highest rates of social isolation (Kannan & Veazie 2023), younger adults are more likely to report loneliness, and research shows that the proportion of young adults has increased over the past 40 years. (Buecker et al. 2021). .
The Surgeon General's report provides a six-pronged approach to addressing this public health emergency, in which health care plays a key role. Recommendations include teaching and testing knowledge in medical education about the effects of social isolation and loneliness on health and health outcomes. Develop a health care system that rewards physicians and other health care workers, including reimbursement, for spending quality time with patients and families and providing education about the importance of social connection. Developing and implementing tools that accurately track indicators of social isolation and loneliness will improve our understanding of its magnitude and how best to intervene.
The goal of health care should be health, not simply treating disease conditions. Failure to take into account the wide range of factors that influence an individual's health is one reason why such significant health disparities occur. It takes our collective knowledge, experience and skills to make a difference and achieve the goal of positive and equitable health outcomes.
Dr. Azziza Bankole, DFAPA, is a professor of psychiatry, program director of the geriatric psychiatry fellowship, and chief diversity officer at Virginia Tech Carilion School of Medicine.
