AT A COLLOQUIUM last month at the Harvard T.H. Chan School of Public Health, Nobel Prize-winning economist Angus Deaton spoke of a global rise in preventable deaths by suicide, alcoholism-related liver disease, and addiction, calling them "deaths of despair." From the perspectives of public health and medicine, we recognize the outsized role that loneliness and social isolation play in those deaths of despair.
This is not an American public health issue alone. Globally, the World Health Organization now lists social support networks as one of the factors that determine health, while the United Kingdom recently created a minister of health to address loneliness as a public health priority.
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Researchers define social isolation as something with objective, quantifiable markers such as living alone, having few social network ties, or a dearth of social contacts. Loneliness is more subjective. It is something we perceive; we feel the absence of the social connections we desire. It's lack of companionship, or lack of intimacy with others.
Social connections have a profound influence on risk for mortality and are associated with a 30 percent increased risk of early death. In fact, loneliness can have long-term effects on health and is as lethal as smoking 15 cigarettes a day. But health, and certainly happiness, are more than the absence of illness. Loneliness saps vitality, impairs productivity, and diminishes enjoyment of life.
Loneliness affects more than one-third of American adults, especially people facing such challenges as the loss of a loved one, major illness, the return from military service, or marginalization because of minority or immigrant status. People suffering from chronic or major illness can be lonely and isolated as these disorders progress, a burden often shared by their caregivers. External factors also are to blame. Research indicates that Internet and social media engagement exacerbates feelings of loneliness, depression, and anxiety.
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As a society, we thrive when we are connected. Strong social bonds play a causal role in long-term health and well-being. Social connections, in a very real way, are keys to happiness and health.
If there is any doubt that people crave knowledge about the secrets to happiness and health, consider this: An academic's 2015 YouTube video on the lessons learned from a Harvard research study has been viewed nearly 21 million times.
"The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health. Taking care of your body is important but tending to your relationships is a form of self-care too," said Dr. Robert Waldinger, a professor of psychiatry at Harvard Medical School and director of the Harvard Study of Adult Development, an ongoing research project since 1938.
If our Holy Grail is happiness and health, how do we combat loneliness and isolation?
First, the media's coverage of the topic is welcome. As global awareness rises, the stigma of feeling lonely and isolated is drastically reduced. We in public health must be especially sensitive to how loneliness affects specific at-risk populations, including the sick, older adults, college students, veterans, and the marginalized.
Second, solutions founded on evidence-based programming must acknowledge loneliness and isolation as public health issues. Public health professionals need to make connected communities achievable. That means empowering workplaces, schools, community centers, places of worship, and even the local coffee shop with programs and tools that bring people together in meaningful ways. And primary care providers need to consider loneliness to be a modifiable risk factor for ill health.
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And let's not overlook innovative approaches. This month, for example, the UnLonely Film Festival and Conference in New York will showcase successful programs that are chipping away at social isolation. Such initiatives aren't complex or expensive. Former surgeon general Dr. Vivek Murthy introduced a five-minute exercise during staff meetings called "Inside Scoop," which allowed staffers to share photos highlighting meaningful personal stories. He noted how this personal sharing reduced stress and increased both connections to others and to the group's mission.
Finally, the critical nature of social relationships should be included in national public health priorities, taking its place with obesity, substance abuse, and physical inactivity. Public health researchers and practitioners must continue to study and promote effective responses to loneliness and isolation — in particular, how to roll back those heartbreaking, preventable deaths of despair.
Michelle Williams is dean of the Harvard T.H. Chan School of Public Health. Dr. Jeremy Nobel is a faculty member of the Center for Primary Care at Harvard Medical School and founder of the UnLonely Project.