Loneliness is the stuff of winter. As the last abandoned Christmas trees are tipped into dustcarts, dark mornings and the bleak midwinter lie ahead of us. Pubs are empty, days are short and the TV looks inviting. Being social may seem like the last thing you need right now. But you’d be wrong.
In the year since my last blog on the topic, loneliness has risen up the public health agenda. For a range of reasons from the purely fiscal to the deeply spiritual, tackling the health effects of loneliness is now concentrating the collective minds of charities, government agencies and social enterprises across the country. The latest challenge laid out by Age UK and others is that “noone should have noone”.
But beyond the campaign slogans, loneliness is a tough one to plan for. A person may suffer acute loneliness at the end of a relationship or when their child leaves home, and a lack of social contact may magnify their pain and impede their resilience to get through that period. A doctor may not see this person until their loneliness presents a tangible symptom, so it is friends and community that bridge the gap between wellness and the waiting room.
Community matters, but it is also those close relationships with friends and family that form a protective ring of social support and render real health benefits.
Intimacy matters: research from the Dietrich College of Humanities and Social Sciences analysed hugging to see if it lowered susceptibility to infection associated with stress and the findings were compelling:
“The results showed that perceived social support reduced the risk of infection associated with experiencing conflicts. Hugs were responsible for one-third of the protective effect of social support. Among infected participants, greater perceived social support and more frequent hugs both resulted in less severe illness symptoms whether or not they experienced conflicts…Either way, those who receive more hugs are somewhat more protected from infection.”
So there is evidence that social support counts, but solutions to loneliness are still hazy. Loneliness is an affliction of the heart, but not one that can be contained in the language of cardiology. You can’t be diagnosed as lonely and given a statin to lower your chances of further developing the disease. And this is the very core of the modern health professional’s problem — how do I work with nebulous concepts that have unclear causality of morbidity and no pills to prescribe? Can I prescribe hugs?
The health system is rooted in the binary terminology of the hard and soft, and diagnostics rely on “hard” data. We can count the number of heart attacks in any given year (more than 30% of all deaths every year are attributed to Cardiovascular diseases), but broken hearts don’t stack up in quite the same way. Loneliness might contribute to the journey to cardiovascular disease — but how do we know?
A growing problem as our population ages
The hard data is that of isolation. Studies into how to improve overall health and wellbeing suggests that reducing social isolation is a key factor. While loneliness and solitude are distinctly different — one can be perfectly happy living alone — statistics show that it is the elderly who live alone more than any other demographic group and this is often through circumstance rather than by design.
According to Age UK, 1.2 million older people are chronically lonely and it may be no coincidence that 51% of all people over 75 live alone and almost 5 million older people say that the television is their main form of company. These are sad tales, but when used coldly against the the brutalist talk of “bed blocking” (how unwelcoming can language get?), the loneliness of the older person becomes a pressing concern worthy of public debate.
Many older people lack social support while at the same time living with a growing number of long term conditions — type 2 diabetes, hypertension, heart disease and so on— so it is the health professional who may be their primary social contact. As one GP in Exeter said as part of our “Health as a Social Movement” research:
“ It’s a rotating door — they just come back again. Patients need people not pills…I estimate that 40- 55% of patients I see every week could be better supported by someone else .”
So how do we shift to a more social model of health?
The RSA’s ‘Connected Communities’ research was able to demonstrate (in a small cohort) that building local networks of social support and strengthening and connecting communities, led to a wellbeing dividend from social connectedness that had the potential to mitigate against mental and physical ill health in the longer term.
The work we are doing with NHS England on understanding how social movements may shift the way we view and act on health as a society is showing that when we are active as citizens and work with the health services, social models of health can combat loneliness, isolation and anxiety.
Social movements, collaboration and keying in to our civic duty
From Harlow to Harlem, there are many inspiring examples of ways to think more holistically about health.
City Health Works, based in Harlem, New York sends health coaches hired from the neighbourhoods they serve into the homes of patients with multiple chronic conditions with the aim of building relationships and helping patients navigate the complexities of the healthcare and social services systems.
In the UK, Altogether Better, is a collaborative initiative that aims to bring citizens and services together to create new models of ‘collaborative practice’ supporting people to adapt and cope with long term conditions and mitigate against loneliness. The group designed a Community Health Champion model that encourages individuals to use their life experience and position in society and their family to influence their friends, families and work colleagues to lead healthier lives.
Building on the success of this model, Altogether Better has devised a collaborative method of working with GP surgeries that connects the community back in to the practice via “Practice Champions” who use their passion and understanding of the local community to enrich decision making in GP practices through the development of a greater understanding of local need.
This humanising of the health system provides a counter narrative to the prevailing media noise around A&E admissions and bed blocking and reminds us that our health is not separate from our social lives, but they are interconnected and our human connections are vital. As RSA Social Brain researcher Nathalie Spencer recently mused on connecting with others: “Socialising is not trivial. A lack of meaningful connections…affects our immune systems, and is a risk factor for heart attacks and death.” She advocated ways to connect with others to improve wellbeing, “we should both deepen existing relationships with friends and family (strong-ties) and broaden social connections with our community and others (weak ties), as each type of bond provides benefits.”
Alyson McGregor of Altogether Better put it beautifully at a recent RSA event “if we want to see transformational change — we must change from the inside out”. Start with our own lives, our friends and families and build out to communities and the health service.
So, as a pub landlady in my spare time (don’t ask!), and a firm supporter of cups of tea, I urge you, even if the footpaths are icy and the days are dark. Get out and see that friend, phone your grandmother, hug your neighbour, or volunteer to contact the elderly on a Sunday afternoon. Health is a social movement. Be part of it.
Find out more about Health as a Social Movement
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Anthony Painter argues that the state expansionists will win over small statists as healthcare expenditure is destined to increase. But their victory may be a Pyrrhic one unless the growth can be limited so better support can also be given to housing, economic security, education and lifelong learning.