Coming Together to Address Loneliness and Isolation

Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion. 

People need people. We connect with one another as family and friends, through the communities within which we live, in our workplaces, across support networks that stretch beyond our geographic location, and in many other ways that — whether we intend them to or not — help fulfill our fundamental human need to socialize and interact. These connections can be mundane, simple experiences of everyday life (like a few polite words at the checkout counter). Or they can be more planned, grand, and meaningful such as a wedding celebration with loved ones. Regardless of their nature, all these encounters, big and small, add up and reflect an individual’s level of connection with the world — a vital ingredient in developing and maintaining overall health and well-being. This connection is a social imperative that we, both individually and as communities, have come to overlook far too often.

In a 2023 advisory titled Our Epidemic of Loneliness and Isolation 2023: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community, the Surgeon General makes the case that better social connection — “a continuum of the size and diversity of one’s social network and roles, the functions these relationships serve, and their positive or negative qualities” — is integral to the human condition and to our ability to improve and maintain health. In fact, the Surgeon General theorizes that, “Social connection is a fundamental human need, as essential to survival as food, water, and shelter.”

That’s not hyperbole. We are figuratively and literally dying for human connection. The Surgeon General’s report, using a related example, indicates that a lack of social connection can increase the risk for premature death as much as smoking up to 15 cigarettes a day. Loneliness — “a subjective distressing experience that results from perceived isolation or inadequate meaningful connections” — and social isolation — “objectively having few social relationships, social roles, group memberships, and infrequent social interaction” — increase the risk for premature death by 26 and 29 percent, respectively. Poor or insufficient social connection is associated with a 29 percent increase in risk of heart disease and a 32 percent increased risk of stroke. Researchers have also observed that a lack of social connection results in an increased risk for anxiety, depression, and dementia. More recent studies have even found that such a lack contributes to an increase in susceptibility to viruses and respiratory illness.

The COVID-19 pandemic offered a stark reminder of just how strongly the desire to connect with others is to our lives. Social distancing to slow the spread of the novel SARS-CoV-2 virus, critical as it was, brought with it a deprivation of human interaction — but also inspired numerous, creative ways to “stay in touch.” We congregated on rapidly developing video platforms to chat, share meals, and enjoy holidays. We coordinated to see each other on balconies and stoops in the evenings, just to chat with one another from across the street or alleyway. Maybe you recall a story about someone who lived alone initially, testing and isolating, before taking on a roommate to avoid that solitary experience during the prolonged lockdown phase of the epidemic. One of my fondest, most poignant memories of the pandemic was when our neighbors rallied, widely spread apart, across our back lawn with balloons and banners to celebrate my daughter’s 18th birthday. While these adaptations in how we interacted gave many hope and comfort, for some the loss of regular human contact was unbearable, leading them to simply ignore the risk of being exposed to the virus and resume the interactions that they so desperately craved. Regrettably — but also understandably in a way — people fell ill and often succumbed to COVID-19, as their urgency to be with loved ones and to experience basic human connection, could not be denied.

The data tell a similar story. A 2022 report found that only 39 percent of adults in the United States said that they felt very connected to others. One report cited by the Surgeon General found that approximately half of U.S. adults recounted experiencing loneliness, with some of the highest rates among young adults. However, “less than 20 percent of individuals who often or always feel lonely or isolated recognize it as a major problem,” despite the risks for premature death such loneliness brings about.

Our office and its federal partners are actively working to address social connectedness and track progress. So integral is the notion of human connection that it occupies a key role in the People & Places Thriving: Federal Plan for Long-Term Resilience (PPT) initiative, grounded in the Vital Conditions for Health and Well-Being framework. PPT lays out an approach for federal agencies to collectively strengthen the vital conditions necessary to ensure individual and community well-being, resilience, and thriving. Central to this framework of 7 vital conditions is the essential element of Belonging and Civic Muscle — the critical condition through which individuals and communities are empowered and can subsequently improve upon the other 6 vital conditions. This is based in the fundamental principle that “healthy, fulfilling relationships and strong social supports provide a foundation for individuals and families to thrive.” Such relationships build “social ties, trust, and cooperation” in communities and bring people together. In other words, we must intentionally fulfill the need to connect in order to thrive.

Along with the PPT initiative, Healthy People 2030 — the nation’s decennial roadmap for health and well-being — tracks how and how often we connect with one another. Healthy People 2030 includes several national objectives directly related to social connection: 

• Increase the proportion of adolescents who have an adult they can talk to about serious problems — AH‑03: Adolescents who have an adult to confide in are less likely to take part in risky behaviors.
• Increase the proportion of children and adolescents who communicate positively with their parents — EMC‑01: This type of communication is key to healthy relationships, and it can protect children from health risks and help them do better in school.
• Increase the proportion of adults who talk to friends or family about their health — HC/HIT‑04: Research shows that when people don’t have social support, they’re at increased risk for physical and mental health problems.
• Increase the proportion of the voting-age citizens who vote — SDOH‑07: Voting can help people develop a sense of purpose, feel connected to their community, and take part in decision-making that affects their health and well-being.

Other objectives in Healthy People 2030, such as Reduce bullying of lesbian, gay, or bisexual high school students — LGBT‑05 and Reduce bullying of transgender students — LGBT‑D01, seek to examine how such negative social determinants perpetuate inequities in social isolation for groups like LGBTQIA+ individuals, certain ethnic and racial groups, rural residents, victims of domestic violence, and others who experience discrimination or marginalization.

Overall well-being — OHM‑01 examines individual views on overall life satisfaction that can help researchers and policymakers understand how people broadly view their own lives. This information can inform strategies focused on the health, well-being, and resilience of communities across the United States — including approaches to alleviating the negative effects of social isolation and loneliness. Currently, the National Center for Health Statistics (NCHS) is collecting data related to loneliness and social isolation through its 2024 National Health Interview Survey, expanding the data set, and shedding additional light on the issues.

The Surgeon General’s 2023 advisory establishes a comprehensive approach to advancing social connection, and I encourage you to read and take its recommendations to heart. In our daily lives, we all should, at a minimum, show sincere interest in those with whom we interact. Regularly reaching out to those we serve, those we know, and especially those we love and care for will restore and strengthen the bonds we share. Why not also volunteer where and when we can? 

We all must recognize loneliness and social isolation for the health risks they are and take steps to prevent them. Start by being kind to yourself, give yourself the grace of companionship, and don’t hesitate to seek help from a professional when you feel lonely or isolated. Know you’re truly never alone. 

Yours in health,
Paul 

Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion

In Officio Salutis