Social Isolation and Loneliness: Are We Asking the Right Questions?
We often think that people who have few social connections are lonely. On the other hand, we tend to believe that people who have many friends or belong to communities are less likely to feel lonely.
However, this is not always true.
Some people live alone, have few social connections, and still feel happy and comfortable with their lives. Others have many friends, spend time with family, and actively use social media, but still feel lonely.
Being socially connected does not always mean feeling less lonely.
Social isolation and loneliness are different concepts. Social isolation refers to having few social relationships or interactions. Loneliness is a subjective feeling that occurs when our social relationships do not meet our needs or expectations. Although they are related, they are not the same (National Academies, 2020).
Both social isolation and loneliness are important public health concerns. Previous research has shown that each is associated with an increased risk of mortality (Holt-Lunstad et al., 2015).
Today, we have many ways to connect with others, especially through social media. We can communicate with people almost anywhere and at any time. However, having more connections does not necessarily mean having meaningful relationships. One study found that greater social media use was associated with higher perceived social isolation among young adults, although this does not prove that social media causes isolation (Primack et al., 2017).
This makes me think about how we approach loneliness in public health.
Is Reducing Social Isolation Enough?
In recent years, social prescribing has received increasing attention. It connects people with community activities and non-medical resources, such as art, music, volunteering, and social groups.
I believe social prescribing has great potential. Social isolation is an important public health issue, and opportunities for social participation can support people's health and well-being.
However, I also think we need to be careful.
If we focus only on reducing social isolation, we may assume that increasing social connections will automatically reduce loneliness.
But this may not always be the case.
For some people, joining a community or meeting new people may help them feel less lonely. For others, social activities may not be helpful, or may even become a source of stress.
We may also overlook people who appear socially active but feel lonely inside.
Research on social prescribing has reported some promising results, but the evidence is still limited. A systematic review found that the effects of social prescribing link-worker interventions on health outcomes remain uncertain (Kiely et al., 2022).
We should not assume that reducing social isolation means that we have solved loneliness.
When we consider social prescribing, I think it is important to understand not only how many social connections people have, but also how they actually feel about their relationships and daily lives.
Do they feel lonely?
Do they feel comfortable being alone?
Do they feel accepted by others?
These questions may be just as important as measuring social isolation.
What Can I Do?
As a physician, public health researcher, and artist, I am interested in exploring different ways to approach loneliness.
I am particularly interested in the role of art and cultural experiences.
Art can bring people together, but I do not think this is its only value.
Listening to music, looking at a painting, spending time in nature, or creating something may help people find meaning in their lives, even when they are alone.
A WHO report reviewed a large body of research and suggested that arts engagement can play an important role in health and well-being (Fancourt & Finn, 2019).
Of course, this does not mean that art can solve loneliness for everyone. We still need more research to understand when and for whom cultural experiences may be helpful.
However, I believe that social prescribing should not be limited to increasing social interactions. It could also help people find meaningful experiences that fit their individual needs and preferences.
Through my research and artistic practice, I would like to explore these possibilities.
I am also interested in a simple but important idea: helping people feel that they are accepted as they are.
Not everyone needs a large social network. Not everyone enjoys group activities. And being alone does not necessarily mean being unhappy.
I do not think the goal should be to make everyone more socially connected.
Instead, I would like to think about how we can support people who experience loneliness, while also respecting those who prefer to spend time alone.
I do not have clear answers yet. This is something I hope to explore through my research, clinical work, and art projects.
Perhaps we should not focus only on how to connect people with others.
We should also think about how people can feel that their lives have meaning and value, even when they are alone.
References
National Academies of Sciences, Engineering, and Medicine. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. National Academies Press. https://doi.org/10.17226/25663
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352
Primack, B. A., et al. (2017). Social media use and perceived social isolation among young adults in the U.S. American Journal of Preventive Medicine, 53(1), 1–8. https://doi.org/10.1016/j.amepre.2017.01.010
Kiely, B., et al. (2022). Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: A systematic review. BMJ Open, 12, e062951. https://doi.org/10.1136/bmjopen-2022-062951
Fancourt, D., & Finn, S. (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. WHO Regional Office for Europe. https://www.ncbi.nlm.nih.gov/books/NBK553773/