Social isolation is a social determinant of mental health

We don’t hear much about the tobacco industry these days. We take this victory as a fact of history and treat cigarettes as a nearly ancient artifact. Through decades of public and private fights, billions of dollars and the attention and passion of a nation, the victory against the tobacco industry was not certain and remains imperfect.

These and other public health victories share several key characteristics. Tobacco. HIV/AIDS. CFCs (ozone depletion). The ADA. (Limited) environmental protection. Vaccinations. They require sometimes billions of dollars. They are treated as a fact of nature once they are won, as social values catch up with progress. They are seen as impossibilities when they are being fought. Advocates are up against misinformation, straw men, fears of paternalism, corporate armies, and self-interested politicians. They require far too much suffering and damage before people care enough to fight, and far too much fight to achieve these imperfect victories. They are the little against the big for the greater good. Yet they are often fragile victories.

Big tobacco is often held up as an example of public health victory against a cultural norm and industry-backed product. A battle similar yet different in many ways from the fight against the oil industry around climate change and fossil fuels. We have so much to learn from these fights.

And we learn from failed or problematic public health efforts to target complex challenges like childhood obesity based in misguided strategies that further shame and victim blaming.

There are many more public health threats we co-exist with while thinking ourselves advanced. CAFOs and industrial animal production, environmental injustice, misinformation, deeply regressive housing policy, and discrimination. Of course all the “isms” and climate catastrophe.

Added to this mix is the ongoing epidemic of loneliness, social isolation, and alienation.

Another, arguably equally difficult public health challenge, yet it is against no industry or pathogen. It is a health risk equal or greater to smoking but we continue to treat as an afterthought or at best an individual problem. We must not fall into the trap of seeing loneliness as if it is an individual problem that individual people cause themselves or are responsible for, or that can be fixed with individual approaches like therapy alone (funding and improving mental health services can be important components, however, for reducing the burden of loneliness).

There are ways each of us can work to address this epidemic for ourselves and our networks and communities. However, if we consider the ways in which many people responded to COVID, the overall populace is ill prepared to address this epidemic.

We cannot rely on our re-emerging public health system (which we owe in large part to the Biden administration) to reduce loneliness for us because it is limited in scope and capacity, relies on formal services over informal networks, and we cannot count on public funding to remain available when we face a political threat seeking to undermine our very basic institutions.

Yet, at the same time, we need a multi pronged effort with significant public and private funding. We know that loneliness is bad for us and we treat it as if it is each of our individual responsibility. It cannot be solely our individual responsibility to fix something that is clearly socially determined.

This article will focus on actionable ways in which our government and public health and social service sector can target this epidemic to reduce social isolation, loneliness and alienation. These require comprehensive, sustainable, non paternalistic, and multifaceted approaches.

There’s so much we can learn from people who have been fighting this battle for decades and even centuries, disabled people, and people who are disabled by society, psychiatric survivors, people with lived experience of mental illness, madness, and neurodivergence.

So what can we do about the loneliness epidemic when we have no industry to fight, no court cases to win, no lawyers to do this for us, and we have no large nonprofits who are leading this effort.

We know that we can develop ways to reduce loneliness if we can understand the root causes of loneliness. We have a public health sector that is well positioned to address this epidemic. And we have public health approaches which we know are successful or hold promise for decreasing loneliness and increasing social connection.

The following are examples of strategies for a national response to combating the loneliness epidemic. It is not a full plan, but rather some ideas to generate forward motion.

1. Invest in frontline public health workforces — community health workers (including peers) and social workers. We must invest in these workforces, specifically around reducing loneliness and building social support. We have the lowest paid public health workers and the lowest paid social service workers who interact for the longest periods of time with individuals who are struggling. They are trusted. They are the least paid, they are the most likely to be marginalized themselves. Their services are not covered often. They are primed to be a key intervention to address the loneliness epidemic. We do not need more research to prove how bad loneliness is for health. We know this. We do not need new expensive equipment.
2. Public health campaigns and health education to teach the importance of of supporting one another, listening to each other, and ways to improve civic and community engagement, because most of us never learned this sufficiently. Most of us did not have social emotional education in school. Children are just starting to learn this and they are going to be decades ahead of the rest of us. We need empowering education that does not blame the victim.
3. Invest in robust mental health services without forcing services on people. We can ensure that those services are safe and helpful and not harmful because we know from decades, if not centuries of survivors of mental health industry, of social service industry that these services can be more harmful than helpful. We must continue to listen to survivors and consumers, people with lived experience, to make transformative change and not incremental reform. This means broad based efforts to involve survivors and people with lived experience in creating solutions because we know that the people closest to the problems are closest to the solutions period. We do not need more decades of research to prove the problem.
4. We must simultaneously strengthen approaches to fighting structural violence and inequity occurring on local, state and national levels. We need to support people to meet their basic needs and remove structural and political barriers to equity that disadvantage ordinary people, so that people have capacity to build community to to engage civically, to improve the health of our entire society. When people are struggling to survive, they cannot engage civically. Along these lines, we must support immigrants with a legal pipeline to contribute to our communities. Immigrants can strengthen our communities if given the chance to survive here.
5. We must fund a robust nonprofit advocacy effort to advance these and other priorities. We need the organizational equivalents of the Truth Initiative for loneliness and social isolation.

We do not have to rely solely on our government and we cannot rely only on our government. At the same time, the public health system must treat this like the epidemic it is.