When Julianne Holt-Lunstad first began studying how relationships influence our physical health two decades ago, some of her colleagues scoffed at the topic. ”They thought it was fluff,” says Holt-Lunstad, a professor of psychology at Brigham Young University.
The idea doesn’t seem so fluffy now. A decade later, in 2010, Holt-Lunstad published research showing that people who had strong social relationships had a 50% increased likelihood of survival than those with weaker ties. Being disconnected, she showed, posed comparable danger to smoking 15 cigarettes a day, and was more predictive of early death than the effects of air pollution or physical inactivity.
“Humans need others to survive,” Holt-Lunstad said over dinner in London one recent evening. “Regardless of one’s sex, country or culture of origin, or age or economic background, social connection is crucial to human development, health, and survival.”
As we become increasingly aware of the importance of social connections, governments from Australia and Denmark to Japan and the UK are starting to take loneliness a bit more seriously. In January, British lawmakers set up a commission to tackle loneliness after the murder of Jo Cox, a member of parliament who was vocal about the issue. Soon after, British prime minister Theresa May appointed a minister to tackle the issue. Meanwhile in the US, in April 2017, the Senate Committee on Aging held a hearing on the subject at the same time that Mike Lee, a Republican senator from Utah launched the social capital project, a multi-year study of the web of social relationships in our lives, including families, communities, workplaces, and religious congregations. And the World Health Organization now lists “social support networks” as a determinant of health.
Of course, measuring emotions is not like measuring body mass index, or blood sugar levels. It’s complicated—and not everyone thinks loneliness is quite the crisis it’s cracked up to be. At the heart of the current debate is not whether a lack of social connection harms us—it does. The question is how bad loneliness is, and what we can do about it.
What loneliness does to our health
Holt-Lunstad has now conducted two meta-analyses on social connection and early mortality. The first involved 148 studies, representing more 300,000 participants. It found that by the time half of a hypothetical sample of 100 people has died, there will be five more people alive with stronger social relationships than people with weaker social relationships.
The second meta-analysis (pdf) involved 70 studies representing more than 3.4 million individuals primarily from North America, but also from Europe, Asia and Australia. It examined the impact that social isolation, loneliness, or living alone might have on mortality.
Researchers found that all three had a significant and equal effect on the risk of premature death—one that was equal to or exceeded the effect of other well-accepted risk factors such as obesity. Specifically, those classified as lonely had a 26% higher risk of dying, and those living alone a 32% higher chance of dying, after accounting for differences in age and health status.
Researchers who study social connections take care to separate social isolation—not having anyone to talk to—from solitude, which is a matter of choice, and loneliness, which is the perception of social isolation. They examine functional measures of support (how much support you have from others in your life and the perception of how much support you have) as well as structural support, such as marital status, social networks, living alone, and social isolation.
Prior to her research, Holt-Lunstad suspected that functional support probably mattered most for people’s health; that is, whether you were married or had warm bodies in the house with you would be less important than feeling that you had meaningful connections. That hypothesis didn’t bear out.
“Surprisingly, some of these structural measures were just as robust,” she said. There’s no doubt that you can be lonely in a marriage; conversely, you can be incredibly connected and live on your own. But living alone carries a higher risk. “You can live alone and have a wide social network and yet living alone carries just as strong as a prediction of risk for premature mortality as loneliness and social isolation,” she said.
Holt-Lunstad was not the first to connect social isolation to early death. But she synthesized the research to show it had an effect, and has since argued that social connection should be treated like obesity: As a public health issue worthy of research, investment, and prevention. She’s far from alone in her advocacy. Earlier this year, the American Association of Retired Persons (AARP) estimated that social isolation—an extreme form of loneliness—costs Medicare $6.7 billion a year.
Lonelier than ever?
Holt-Lunstad says that loneliness is a widespread problem, citing estimates that 22%-50% of the US population are socially disconnected. And according to the largest-ever study of loneliness done by the BBC (55,000 participants), 33% of respondents reported they “often,” or “very often” feel lonely, with the highest concentration among those aged 16-24 (40%).
But others question the characterization of loneliness as an epidemic of the modern age. Claude Fisher, a sociologist at the University of California, Berkeley, famously challenged the results of a 2004 survey that concluded that social isolation was on the rise. He continues to argue that while the health risks of loneliness are real, there is no loneliness epidemic.
“Either Americans have always been getting lonelier and lonelier or this is a false but irresistible cultural motif,” he writes, noting that there is insufficient evidence showing a steady trend in loneliness over the last several decades.”Like the mistaken belief that Americans are increasingly rootless and mobile, it fits into the widespread cultural frame that modern life is about disintegration and alienation.”
Eric Klinenberg, a professor of sociology at New York University, says that while a culture of individualism and reliance on technology may indeed make people feel lonely, the data doesn’t support the idea that people are lonelier now than they were 50 years ago. “Social disconnection is a serious matter, yet if we whip up a panic over its prevalence and impact, we’re less likely to deal with it properly,” he writes in the New York Times.
The risk of overhyping loneliness as a blanket social problem, he says, is that we’ll wind up failing to target the people who are most in need of help. “In places like the United States and Britain, it’s the poor, unemployed, displaced and migrant populations that stand to suffer most from loneliness and isolation,” Klinenberg explains.
Indeed, there’s a cold irony to the fact that the UK has appointed a loneliness minister while the government’s austerity programs has cut funds to the very institutions that would promote connection: Libraries, care for the elderly, and the program Sure Start, targeted at poor families. As Rebecca Mead writes in the New Yorker:
..[t]o imagine that a problem as damaging and pervasive as social isolation can be remedied with ample good will and sufficient cups of tea, rather than with a renewed commitment to the kind of institutions that the government continues to undermine, is wishful thinking.
Seeking connection
Regardless of whether loneliness is an epidemic, it is clear being socially disconnected is bad for our health. However, the path to addressing the problem is less clear. For one thing, as Holt-Lunstad says, a concerted governmental effort to make people more socially connected would likely sound intrusive to a culture like that of the US, which tends to favor autonomy over the collective. ”We don’t want government interfering in our personal lives,” she said.
Moreover, the evidence to date on programs to connect people is mixed, in part because there is little data collection. Many programs, with the best of intentions, don’t work. It’s a chicken and egg problem: In order to research the best and most effective interventions, governments would need to deem loneliness a public-health issue first.
On an individual level, part of the solution may lie in talking more about loneliness in the first place. John Cacioppo, a psychologist who died in March, told the Atlantic that we don’t talk about feeling lonely because it is stigmatized. We tend to celebrate individual achievement, with success marked by what we do and not how we live, or give to others. That means admitting to loneliness is tantamount to be admitting supreme human failure—the self is not sufficient. “It is the psychological equivalent of being a loser in life, or a weak person,” he said in a Ted talk.
This in turn makes it harder to seek help. For one thing, he is clear that loneliness can be useful, acting as a biological warning signal, like hunger or thirst, to prompt humans to seek the connections they need.He was also frank about how the many misconceptions people have about addressing loneliness, arguing it is not about just being around other people. It’s easy to be in a crowd and be lonely. Nor is the solution about building social skills; many lonely people are perfectly adept in social situations. So what works? He developed an acronym called EASE, as he explained to the Atlantic:
The first E stands for “extend yourself,” but extend yourself safely. Do a little bit at a time.
The A is “have an action plan.” Recognize that it’s hard for you. Most people don’t need to like you, and most people won’t. So deal with that, it’s not a judgment of you, there’s lots of things going on. Ask [other people] about themselves, get them talking about their interests.
The S is “seek collectives.” People like similar others, people who have similar interests, activities, values. That makes it easier to find a synergy.
And finally when you do those things, “Expect” the best. The reason for that is to try to counteract this hyper-vigilance for social threat.
Holt-Lunstad says the key is mobilizing more attention, research, and education to get to better answers about loneliness. To the critics who question what can be done about loneliness, she counters, “We don’t have good solutions for other public health issues, such as obesity or even quitting smoking.” And whether loneliness is growing or simply static, at a moment of peak discord and political animosity, connecting may well be the only way to save us.