Dr Jessica Allen from the Institute of Health Equity

Dr Jessica Allen from the Institute of Health Equity writes about the effects that unnecessary loneliness can have on health and how much can easily be done to reduce this.

In 2014 it was reported that more than a million older people in the UK hadn’t spoken to anyone in over a month; that’s about one in ten of the UK’s older people.

In addition, Age UK estimates that around five million older people regard their television or their pet to be their main form of company.

That is shocking, and it’s even more shocking because it is so unnecessary. There is much more that could be done to improve conditions which result in loneliness for all age groups – it’s not difficult and it’s not expensive, it just doesn’t seem to be a priority. In fact, loneliness is driving so much ill-health across all age groups, that the cost of activity to reduce it can easily be offset by reduced health care costs – if cost really has to be a driving motivation in these straightened and narrowly focused times.

The health impacts of loneliness are staggering - older people with weak social ties have a 50% higher risk of mortality than those with strong social ties. Loneliness can be experienced at all ages, of course, and the effects can be just as damaging at all stages of life. Childhood social withdrawal increases the risk of experiencing loneliness and isolation in teenage years – which increases the risk of depression in young adulthood and social isolation in adulthood, which in turn is associated with cardiovascular risk – such as elevated blood pressure during a person's mid-20s.

Loneliness at all ages significantly increases risks of a range of poor mental health outcomes. In fact, so powerful is the health effect of loneliness, that authors of a meta analysis of studies covering 230,000 participants found that the effect of social isolation on survival was comparable to the effect of smoking and greater than the effect of obesity and physical inactivity. Social isolation is clearly a hugely significant, although mostly overlooked, public health and health issue.

Loneliness is experienced differently by different groups of people, but studies have shown clearly where the risks are the highest. Poverty is one of the most significant drivers for social isolation and social isolation is also linked to lower educational attainment, a history of poor quality employment or unemployment, poor quality housing, and low retirement income and pensions. The risks of social isolation and loneliness are not evenly distributed – they are closely associated with other disadvantages and experiences of health damaging environments and socio-economic factors.

The risk factors for social isolation are also related to gender, ethnicity, sexuality and physical appearances – the experiences of which are shaped by social and cultural attitudes. A survey conducted by the Samaritans in 2013 found that one in four contacts were from middle-aged men who wanted to talk about issues related to loneliness and isolation. The report also noted that the men most likely to be affected were predominantly from a disadvantaged background. Experience of unemployment is a particularly powerful driver of loneliness.

Social isolation is, to a large extent, unnecessary and avoidable and there are many interventions which can reduce or even prevent loneliness. Programmes where volunteers befriend people at risk of, or experiencing loneliness, can be particularly effective at all stages of life. Pregnancy is a time when social isolation can increase – especially for young mothers – and this can bring a range of negative mental health impacts for the mothers and their babies. Family action volunteer befrienders visit women offering social, emotional and practical help. An evaluation found very positive outcomes – 88% had reduced anxiety; 59% reduced depression and improvements in mother-baby relationships. Moreover the economic evaluation found benefits outweighing costs.

Many other programmes find similar benefits – Families and Schools Together for instance showed significant improvements in children’s emotional and social behaviours through efforts to improve family and community relationships. Interventions designed to improve community interactions demonstrate similarly positive, cost effective impacts – for example, providing suitable communal areas, play spaces (including for older people), good, safe places to walk and meet and good transport links, can make a significant and sustainable increases in social contacts and reductions in loneliness.

However, most of these interventions are implemented at small scale, providing positive benefits to those who are within the reach of the programme - usually a small number. They are just not implemented at a sufficient scale or with sufficient funding and longevity to really impact the large, and growing number of people who are socially isolated – at all ages.

It’s not so much that we don’t know what to do, it’s more that loneliness and social isolation aren’t political, or societal priorities – they are often seen as personal failings– the result of individual characteristics. All the research shows this is not the case – isolation, loneliness and all the related ill-health and unhappiness is largely driven by social, economic and cultural environments and it is in these arenas that we can act and make real and lasting difference.

Dr Jessica Allen, Institute of Health Equity

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