The coronavirus pandemic bullied America into a government-mandated state of isolation. Schools closed, restaurants locked their doors, the stock market went dark, jobs were eliminated, and the Senate passed an unprecedented $2 trillion relief package. With Tiger King memes and Netflix at the ready, introverts across the nation rejoiced as local governments ordered communities to “stay at home” and for people to practice social distancing — a term that became part of our daily vocabulary.
This viral pandemic not only cast a 40,000-megawatt spotlight on how unprepared America was to handle a communicable disease outbreak, but also on another pandemic that has been sweeping across the globe since the 1970's. This pandemic has been associated with the deaths of thousands of people daily and accounts for the majority of our nation’s healthcare expenses.
Those numbers aren’t hyperbole, a work of science fiction, or a witty April Fools’ joke.
It’s the pandemic of loneliness.
Under President Jimmy Carter, a Presidential Commission on Mental Health was established to recommend policies to overcome nationwide deficiencies in the mental health system. In 1978, this resulted in a report of the Task Panel on Mental Health and American Families that expressed a federal need to address an epidemic of loneliness in the United States.
In the 1970s, the prevalence of loneliness in the US was estimated at between 11–17% of the overall population. Around 40% of middle-aged adults in 2010 described themselves as experiencing persistent loneliness. In 2019, nearly 47% said they felt lonely.
Much like a communicable disease pandemic, the downstream effects of loneliness among the populace increases the demand (and therefore the costs) for healthcare services, decreases worker productivity, amplifies the stress of families, and subsequently results in a deleterious impact on our societal, economical, political, and cultural infrastructures.
During the COVID-19 crisis, the Centers for Disease Control (CDC) warned that those with chronic diseases are at a greater risk of infection. The same can be said for regions beyond the United States. Data from Italy revealed that 99% of people who died from the virus had another illness. 75% percent had high blood pressure, 35% were diabetic, and 33% had some form of heart disease.
If Americans weren’t so sick to begin with, the coronavirus likely would not have such a substantial impact on our nation.
Former U.S. Surgeon General, Vivek Murthy recognized the monumental impact of loneliness on our country when he called loneliness “the fastest-growing public health crisis.” As part of the U.S Healthy People initiative, the social determinants of health were heavily emphasized as influencing the development of chronic diseases. However, the focused efforts of the United States to mitigate the overwhelming impact of loneliness to our public health are essentially non-existent.
Despite sounding the alarm over 40 years ago, our nation has failed to even begin slowing the momentum of the underlying problem — loneliness — that has increased substantially in the twenty-first century. Far before the COVID-19 pandemic, our society had become irrationally apathetic about such a cataclysmic problem.
Loneliness Kills, and It Doesn’t Discriminate
“Loneliness is proof that your innate search for connectedness is intact.”
— Wendell Berry
Loneliness has historically been associated with a few select groups of the population, most notably the poor, the uneducated, and those advanced in age. While these populations do seem to be more lonely than others, loneliness is a very diffuse issue.
You don’t have to look far to find a community riddled with loneliness. In fact, there’s research exploring the associations between loneliness and just about every population under the sun: older people, workers, young people, parents, married couples, military veterans, and students. People with chronic conditions most at-risk for loneliness include those with mental illnesses, intellectual and developmental disorders, people with specific vitamin deficiencies, autoimmune disease, metabolic disease, HIV, diabetes, cardiovascular disease, dementia, and cancer.
Many of the chronic diseases and disorders listed above already place ever-growing demand upon the healthcare system. Nearly half of all Americans have a chronic disease such as heart disease, high cholesterol, diabetes, high blood pressure, or cancer. The cost of chronic disease treatments in the United States is estimated to be near $3.7 trillion, accounting for roughly 20% of our gross domestic product. Between 2003 and 2014, the rate of hospitalizations for those with multiple chronic diseases grew from 63.5% to 78.1%. These chronic illnesses cause about 7 out of 10 deaths in America. Ninety-six percent of Medicare dollars are spent on chronic disease management. Chronic diseases also increase the risk of infection.
Perhaps the most surprising takeaway from this is that just like loneliness, virtually all of these diseases are preventable and reversible. If Americans were able to make even the most modest changes to our health behaviors, we could reduce healthcare spending and improve our overall quality of life.
Loneliness and social isolation have the same cardiovascular effects as smoking 15 cigarettes per day, but these factors also increase the risk of “all-cause morbidity,” in other words, dying from any cause. Loneliness increases the risk of developing dementia by 50% and stroke by 32% while increasing the morbidity risk of cancer by 25%.
Our doctors and nurses on the frontlines helping those with medical conditions exacerbated by loneliness, are often lonely themselves. This should come as no surprise considering loneliness results in more visits to the doctor’s office.
This isn’t exclusive to the United States, either. Research on the influence of loneliness on those with chronic diseases has been conducted all over the world, with several studies coming out of Europe (most notably in Switzerland and France), as well as from China, and Nigeria. The United Kingdom has found loneliness to be so concerning that, in 2018, their Prime Minister appointed a Minister for Loneliness to address the 40% of their population who felt impacted by the effects of loneliness.
It’s a plausible reality that loneliness is the most profound pandemic in history.
A Culture of Misplaced Connectedness
“No man is an island, entire of itself.”
— John Donne
The reduced quality of our interpersonal relationships and declining overall state of our health are linked to the dissolution and fragmentation of our societal bonds of community. Indeed, we have been tethered by the downstream effects of such rampant levels of social discord and disintegration.
For instance, among some entrepreneurial sub-cultures, the primary social currency is issued to those who displayed relentless, socially isolated efforts to “grind” and “hustle” in the pursuit of happiness or monetary reward .
Much the same can be said for employers who create a company culture that values production over everything else. As stated previously, loneliness at work results in decreased job performance, perhaps due to many modern jobs’ reliance on tech and sedentary means of completing labor. And while many big employers are waking up to the importance of optimizing the mental health of their workforce, bringing a therapist into the office doesn’t address the root cause of why workers are lonely and struggling in the first place.
Many companies are attempting to incentivize their employees to accept (without complaint) the need to spend more time at work. However, the truth is that a ping-pong table, beer on tap, or casual Fridays are not a cure-all for a toxic culture that has dehumanized its human capital.
Marketing professionals and advertising agencies recognize that human beings yearn for a sense of “fitting in” with others, and prioritize the development of experiences that emphasize “belonging.” As a result, brands that prioritize “belonging” seem to be generating the highest customer loyalty and profits. Yet, this perceived connectedness through product choice and material acquisition is only an illusion.
Tristan Harris, an entrepreneur and ex-Google design ethicist, co-founded the nonprofit Center for Humane Technology. His perspective is that social media gamification, notifications, and likes are actually engineered to ultimately favor the designer and publisher — not the user. In his article, How Technology is Hijacking Your Mind — from a Magician and Google Design Ethicist, Harris advocates that “we need our smartphones, notifications screens and web browsers to be exoskeletons for our minds and interpersonal relationships that put our values, not our impulses, first. People’s time is valuable. And we should protect it with the same rigor as privacy as other digital rights.”
Especially in the twenty-first century, we have become apathetic to the increased social isolation occurring in our society — and have forgotten that this is not our innate nature.
There Is No Pill for Loneliness
“The fundamental cause of trouble is that in the modern world, the stupid are cocksure, while the intelligent are full of doubt.”
— Bertrand Russell
The determinants of nearly all preventable and reversible chronic diseases stem from the biopsychosocial environment. Paradoxically, our allopathic medical establishment prioritizes the biophysical body, while willfully disregarding the irrefutable influence of the interconnected, web-like network of human biology, the psyche, and socialization of each unique individual.
As opposed to placing an emphasis on less-invasive and more economical interventions within this biopsychosocial environment, most proposed treatments for loneliness and chronic disease are fixated on the utilization of medical technology, diagnostic assessments, surgical procedures and an unwavering reliance on pharmaceuticals.
Dr. Stephanie Cacioppo, director of the Brain Dynamics Lab at the University of Chicago Pritzker School of Medicine, is actually trying to develop a hormone-based pharmacological intervention for loneliness. Should she succeed, this treatment has the potential to contribute to increasing nationwide insurance premium costs. This is likely to add to insurers’ cost-burdens, as socially-isolated patients may find themselves dependent on this medication for life.
The idea of this intervention stems directly from our societal fixation on the biological basis of many disorders, thus creating an expectation of a pill for every ailment. We have grown accustomed to being given prescriptions and having easy access to over-the-counter drugs.. We’re no longer concerned with the reasons almost half of all Americans use prescription drugs, it’s accepted as just part of normal life.
It doesn’t have to be the norm to require medication just to get through the day. Nor should hospitals, assisted-living facilities, and nursing homes be filled with people dying far too early from diseases that are both reversible and preventable — many of whom are being treated with interventions that seek to only suppress symptoms and not address the root cause of dysfunction.
We’re not putting out the fire — we’re just blowing away the smoke.
We’re not fixing the leak — we’re just dumping the water back in.
The challenge we face as a society is that even the most powerful arsenal of biological interventions cannot resolve such widely endorsed and promoted sociocultural dysfunction.
There is a famous Henry Ford quote in which he alludes to people in prior decades thinking they needed faster horses, but it turns out they really needed an entirely new form of transportation. This is also true at present vis-à-vis public health efforts focused on social isolation and loneliness.
We think we need another pharmaceutical breakthrough or Medicare and Medicaid For All, but what we really need is an entirely new system of care that empowers, educates and equips us with a community of support and resources to eradicate disease.
What if our physicians could prescribe interpersonal connection and community instead of an antidepressant?
This is happening in full force at Open Source Wellness (OSW), a “behavioral pharmacy” developed by Dr. Elizabeth Markle and Dr. Ben Emmert-Aronson in California. OSW members have access to a team of psychologists, health coaches, personal trainers, social workers, and therapists who host open group workshops, meetings, coaching and workout sessions for communities and businesses.
If a physician or other healthcare provider has a patient who they feel would benefit from OSW’s services, they can prescribe these social interventions to their patients, just as they would order a diagnostic test or particular medication. Research conducted by OSW on their participants have reported a decrease in hospitalizations, reduced blood pressure, and overall improved mental health. Members of OSW also report eating more fruits and vegetables and engaging in more physical activity after the start of their program.
This innovative practice, termed social prescribing, has actually been shown to instill confidence and connections within communities of patients by building trust and providing them with resources that encourage a greater sense of belonging.
This is Your Call to Action
“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
— Richard Buckminster Fuller
We can’t fix the complex, deeply-rooted, multi-faceted issue of loneliness in isolation — because isolation is exactly the problem. The widely-adopted perspective that interconnected challenges can be addressed in a silo is what has brought us to this very place. Additionally, the hypothesis that the incremental and occasional tinkering of public policy will lead to a macroscopic change in our health and well-being has been proven false time and time again.
Our well-intended efforts to repair our nation to-date have been nullified since we have failed to identify the true cause of loneliness and its downstream effects. Though public policy, law, and industry are critical components of the equation, the way we think, feel and decide about all of those things need to change.
If we have determined that something needs to change, then we must first reexamine the way we make decisions. We must restore the once sacred and esteemed connection between our industry, politics, and societal complexes with our national community.
We need to re-prioritize the health, well-being, and longevity of our national community as being of much greater importance — if not the single most important thing — over all other motivations rooted in a violently virulent strain of capitalism that has infected the brilliant minds of our people. Capitalism is fine, so long as it does not continue to lose its conscience.
The best part about all of this: we do not need to abdicate responsibility to our government, for all of these things to change.
We can voluntarily decide that we will no longer remain victims of this infected system of thinking that is quietly inoculating and numbing our power, ambition, minds, and bodies.
We can empower, educate, and equip ourselves with the infrastructure, support, resources, and tools we need to eradicate this forgotten pandemic of loneliness and its downstream effects — together — without the pre-approval or consent of those we have once delegated this responsibility to.
Align Incentives and Compensation
Our healthcare system, research institutions, government, and third-party insurers must integrate their financial and infrastructural resources to maximize their effectiveness and efficiency, thereby decreasing the economic impact of healthcare delivery. There needs to be increased funding and research into the outcomes of community-based interventions that are primarily focused on addressing the social determinants of health. We can start by leveraging federal incentives within opportunity zones to provide more support for connection and community integration among low-income households, new businesses and environmentally sustainable infrastructures. Additionally, physicians, therapists, social workers, counselors, and even faith-based leaders should have access to government and private funding sources to establish community-based interventions.
Physicians across the U.S. should receive compensation and incentives for providing support and fostering connections within their communities. These connections can happen through shared-group medical visits, hosting workshops, or facilitating an open community question-and-answer forum. Physicians should not be incentivized for seeing a high volume of patients, but should instead be incentivized for keeping them healthy and preventing diseases from occurring in the first place.
Expand Funding and Research Opportunities
The Centers for Disease Control doesn’t have a committee on loneliness.
The World Health Organization (WHO) doesn’t have a community-building budget.
The National Institutes of Health (NIH) doesn’t have a loneliness institute.
The NIH does have institutes for all of the pathology that loneliness has been associated with, such as the National Institute of Mental Health (NIMH), the National Cancer Institute (NCI) or the National Institute on Minority Health and Health Disparities (NIMHHD), but this is an ironically disconnected system attempting to address a public health crisis that can only be resolved by the very act of connection.
What if the federal government established a National Institute for Loneliness and Connection in the same way that the United Kingdom appointed a Minister for Loneliness?
When it comes to the nationwide allotment of healthcare dollars, it turns out that expenditures are severely limited for mental health and chronic disease research. In 2018, the combined salaries of just 62 healthcare CEOs exceeded the entire CDC budget for chronic disease research. This should not be the case in a time when the struggle to combat skyrocketing healthcare costs is causing so much discord and burdening taxpayers.
Encourage Transparency and Activism
We need to encourage everyone to speak out about the various forms of social injustice that lead to loneliness and isolation. We must stop hiding behind false narratives of who we want to be, and start shining light on who we actually are.
We must use our voices if we want to be recognized and understood.
While some may choose to rally with 20 people outside of the country administration office or protest outside of a local city hall, you can also write emails and letters to your local policy-makers, members of your state’s House of Representatives and Senate, as well as other community leaders and influencers. You can also support organizations already advocating for the causes that matter to you by volunteering, donating money, organizing, or participating in their events.
You can share your story. You can open up about your personal struggles with loneliness and social isolation to others, making you a strong beacon of support, and an advocate within your community. Talk about things that matter to you on your social media platforms, and encourage others to share their perspective — even when they differ from yours. Be honest with your family and friends about when things in life aren’t going so great.
It’s not your job to change or convert your social circle to do anything particularly radical. Instead, it should simply be your intent to encourage new thoughts, which ideally lead to new behaviors.
The political establishment surrounding our health is increasingly complex. Billions of dollars are spent each year by big corporations on lobbying to influence policy-makers, as well as to form misleading front groups, associations, and non-profit organizations that are falsely positioned as advocacy groups. The upholding of Citizens United by the Supreme Court in 2010 has left the door open for even more of these predatory and unethical practices.
These practices result in the concealment of important evidence, research, and data that could change perspectives of policy-makers and citizens alike. Unfortunately, there are no powerful lobbyist groups that aim to end loneliness, chronic disease or mental health challenges. Many of the organizations lobbying on behalf of these causes ultimately seek to profit from their proposed policies, clouding the views of our leaders even more.
Clearly, our political establishment no longer has our best interests at heart. Instead, the primary priority is satisfying the capitalist interests of the various industries that rely on our nation’s purchasing activity to stay in business. For this reason, lobbying laws should be overhauled to prevent industry leaders from holding lobbyist or government positions (and vice-versa) permanently. Private corporations who use public resources to conduct research should be mandated to disclose their findings — whatever their outcomes. Furthermore, government and independent agencies that exist for the purpose of our health and well-being should not consider their work proprietary or exclusive, and they should stop creating territorial agendas that are self-serving and counterintuitive to their purpose.
Strengthen Accountability Standards
It should not be acceptable for large segments of our population to be socially isolated for any reason. Even though our nation’s leaders are well aware of this problem, there has yet to be a mass mobilization of resources to address it.
Imagine a relief package offered by congress to commensurate with the incidence, prevalence, and severity of loneliness in the same way one is offered during a communicable disease pandemic. Not only would such a mobilization of resources likely reduce long-term expenses by trillions of dollars, but it would also stimulate an unprecedented collective of innovation and production.
Imagine a daily headline, hourly breaking news segments, a minute-by-minute death and hospitalization counter, a line-up of opinions on whether our leaders are doing enough, and a serious effort by our top media outlets and government agencies to bring awareness to the implications of chronic diseases and loneliness, in the same way all of this is done during a communicable disease pandemic.
Our nation must raise its standards for what is considered not only acceptable uses of our governmental funds, human capital, and resources, but what is considered an acceptable quality-of-life for our people. It’s great to have an increased lifespan, but if the majority of our life is spent being sick, what is the real benefit of living longer?
We need to redefine what “healthcare quality” means in the U.S. While we have created numerous markers denoting the delivery of quality care, these are mostly related to access to specialist physician medical care, reducing preventable re-hospitalizations, and adherence to prescribed medications.
We only need to ask a single question to determine if our our nation is healthy: do you feel happy and well?
If the answer to this question is “no,” then the delivery and the state of our health is not satisfactory — regardless of what the biomarkers, diagnostics or data processed through algorithms and formulas say.
Provide More Engaging and Appropriate Health Education
We all would benefit from a far better understanding of community, loneliness, mental health, and chronic disease. Each of these topics is incredibly complex and draws on fields of study within the biological and sociological sciences, but nonetheless, we must begin to prioritize knowledge in these areas as superior to other less beneficial areas of study that begin as early as kindergarten and last throughout university studies.
We must mandate education that intersects the mind and body, and this education must be provided consistently throughout the years of primary and secondary education. There are no universally adopted and practiced health education standards in American schools that allow for fluidity across various community needs. Additionally, health education is not required to be scientifically accurate. Students and parents alike should receive education on how to foster belonging within their home and encourage their children to do the same among their peers.
Educators should have ample support and freedom to create classroom environments that foster connection and interaction while using evidence-based teaching practices. Further, schools should be seen as sanctuaries that provide open-access groups to all members of the community, including a place for physicians and other healthcare providers to heal others.
Physicians need to learn more about the implications of loneliness outside of its obtuse definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Our medical education system should incorporate more practical education about lifestyle modifications, nutrition interventions, behavioral coaching and behavior change. Pharmaceuticals remain the standard of care for many psychiatric and chronic illnesses. This isn’t because most physicians don’t believe that psychotherapy or other less invasive interventions may be beneficial, but because front-line primary care physicians simply don’t have the knowledge or systemic support to provide or oversee alternative forms of care. Mental health professionals are compensated based on their volume of patients seen, which demotivates and disincentivizes providers from taking on a more proactive role in their patients’ care.
We also need to re-educate ourselves about what is “common” versus “normal” when it comes to feeling isolated and disconnected. Loneliness is not synonymous with depression (though they are related), and it is not an immediate indication that a visit to a psychiatrist is the next best step. Sometimes the most powerful questions can be asked by ourselves as it relates to what is causing us to be lonely in the first place. Rather than finding answers that are external or place us at the mercy of others, we should seek to provide ourselves with answers that position us to be at cause, and powerful enough to mobilize the change we need. We don’t need permission from anyone else to begin healing.
Use Tech and Social Media the Right Way
Technology and social media have made it possible to construct a false narrative that only mimics the qualities of a true community. We can feature a highlight reel of success, meanwhile stewing amidst internal feelings of failure and dejection. Success is often reaffirmed through the issuance of social currency in the form of likes, boosts and follows — while failures are often silenced or scrolled past.
Overcoming loneliness is about re-establishing emotional, spiritual, and social connection — not necessarily decreasing physical proximity. Through modern technology, we can certainly be distant while being united. However, most of us aren’t using modern technology to connect in the right ways. Rather than using social media to truly connect with our network of support, we use it to bolster our reputation and tell a story set in an alternate reality that includes little discussion of what really matters.
Too much technology and social media usage can lead to loneliness — but not if it’s used in the right way. Remember that technology and user interfaces are engineered to provide the most value to its publisher — not the user. For this reason, we should focus on using social media to strengthen existing relationships and foster new, meaningful interpersonal connections. We need to stop hypocritically attempting to censor the free speech and the expression of others while being angered at those who do the same to us. Furthermore, we need to learn how to reprogram our minds and redirect the anxiety associated with being away from our phones into something more productive.
Eat Food Good For Your Brain — Not Just Your Tastebuds
Recent research has shown that our emotions, mood, and cognition are heavily influenced by our diet. We’ve become accustomed to easily accessible, sugary, processed foods that, while providing quick energy, actually results in the later loss of more energy due to the way sugar is metabolized in the body.
There’s an entirely new subfield of psychology, called nutritional psychology, that looks at the way food affects our minds. Many of the processed foods we consume in America adversely affect our brain health. We’re missing out on the vast array of vitamins, minerals, amino acids, and nutrients in colorful fruits and vegetables, nuts, whole grains, and fatty fish that help regulate important biological processes in our gastrointestinal tract and brain. These same nutrients, when incorporated into our diets, can also play a large role in reversing and preventing chronic disease. Dr. Deanna Minich, a clinician, researcher, and educator in the field of clinical nutrition, frequently discusses the importance of eating a diet rich in nutrients from plants, also called phytonutrients, which can be accomplished by choosing a variety of foods across a wide spectrum of colors.
Food access and security is a social determinant of health that is not something most people like to think exists in the U.S as a developed nation. In reality, the lack of access to nutritious food is not exclusive to underdeveloped nations; we have numerous food deserts and a food apartheid right here on American soil. The demographics of those who live in these areas often overlap with the same people at-risk for many chronic diseases, and they are likely to be lonely. Non-profit organizations like Food Tank, America’s think tank for food, work to establish connections, foster awareness and brainstorm solutions to the issues related to food in America.
Improve Access to Care
The health of a nation is only as strong as the health of its people. If it is a basic human right to be happy and well, and our government is responsible for providing for and reinforcing our basic human rights, then it stands to reason that our government should be responsible for providing the infrastructure for doing so. Yet, within our current healthcare establishment, no single party provides the necessary resources for health, nor is it easy to determine who will pay for these resources. In our current healthcare system, each state can make a large proportion of its own laws that affect who can access healthcare.
Improving access to both physical and mental health care must become a top priority. In response to the overwhelming systemic demands of the COVID-19 pandemic, America allowed for the practice of medicine across state lines and relaxed its Health Information Portability and Accountability Act (HIPAA) laws to allow for expanded use of telemedicine. Although HIPAA was enacted to protect patient privacy, there are times that governmental regulations such as HIPAA unnecessarily create barriers to healthcare access.
If we’re aware of the monumental and catastrophic downstream effects of loneliness and chronic disease on our nation, why are we willfully restricting professionals from providing care to those who need it? For this reason, professional practice and telemedicine laws and regulations should be amended to allow for improved access to chronic disease treatment, nutrition counseling, psychotherapy, and health education.
Simply put: Americans need a healthcare system that allows them to access care when they need it, where they need it, and for a price that they need not fear. We must find a way to reduce the need for intermediaries — such as health insurance companies — to make decisions about how much our health is worth to them.
There is a growing number of direct primary care practices in the United States which provide all-inclusive access to most commonly needed primary care services for a single, low monthly fee. Similarly, direct specialist access services, like UBERDOC, allow patients to visit a specialist for one transparent fee. Startups like Talk Space and Ahead allow people to connect with a licensed psychiatrist or therapist online and at a cost that is affordable to many people.
With these simple models of payment, patients simply pay their doctor to take care of them each month. These models of care are not new; they’re just the way it used to be — and should be again. In this case, the innovation is restoring simplicity and balance within a system that used to be just and far less complex.
We Simply Must Act
It’s clear that our foundation for addressing the pandemic of loneliness in the United States is one of sand and not rock. Therefore, we must rebuild our infrastructure so it doesn’t continue to sink.
If we do not act on what we already know, we’re putting out a huge welcome mat and leaving the door wide open to health and societal challenges that are even more devastating than those we’ve faced to date.
It’s time for us to act.
“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”
— Margaret Mead