“Loneliness and isolation represent profound threats to our health and well-being,” states U.S. Surgeon General Vivek H. Murthy, M.D., in a public health advisory.
In the cover letter to an 82-page report titled Our Epidemic of Loneliness and Isolation, released on May 3, Murthy, the nation’s chief public health officer, warns that increasing social isolation is costly to the economy and health of Americans.
Downward Trends
Murthy’s report presents surveys and studies from government agencies and private groups that show a growing trend in social isolation beginning in 2003 that was exacerbated by the COVID-19 pandemic lockdowns and school closures.
Social isolation is measured by the number of social relationships and roles, group memberships, and level of “social interaction” in which a person engages. Loneliness is measured by individuals’ perceptions.
A study published in 2022 referenced in the report found that “only 39% of adults in the U.S. said that they felt very connected to others. …” In addition, “[r]ecent surveys have found that approximately half of U.S. adults report experiencing loneliness, with some of the highest rates among young adults,” states the report.
‘Alone Time’ Growing
Social networks built on participation and strong relationships have declined as social media use soared, according to Murthy’s report.
Americans spend an average six hours a day on social media, and 30 percent of U.S. adults report a “constant” online presence, according to survey data. But their in-person interactions with friends decreased by 20 hours per month, from 2003 to 2020, averaging only 20 minutes a day in 2020. The greatest reduction in personal interactions was among young adults aged 15 to 24 years, whose time spent with friends declined by nearly 70 percent.
Lockdowns and stay-at-home orders during the COVID-19 pandemic accelerated the trend in “declining social participation.” For instance, a historically low 47 percent of Americans reported belonging to a church, synagogue, or mosque in 2020.
Loneliness Costs
Murthy’s report states that the risk of premature death increases by 26 percent for those experiencing loneliness and 29 percent for those defined as socially isolated, the equivalent of smoking up to 15 cigarettes a day.
Indirectly, isolation and social disconnection result in lower academic achievement and decreased work performance, according to the report. “Stress-related absenteeism” in the workforce associated with loneliness costs employers nearly $154 billion annually.
Older Americans increasingly need services to care for them when they become sick or immobile, according to the report. Those are costs potentially averted by people who have family or friends to help care for them, but 29 percent of households consisted of a single adult in 2022.
“Social isolation among older adults alone accounts for an estimated $6.7 billion in excess Medicare spending annually, largely due to increased hospital and nursing facility spending,” states the report.
Pandemic Policies Made It Worse
Public health measures during the COVID-19 pandemic to slow the spread of the disease, such as masks, remote work, and school closures, have made social isolation worse, says Robert Emmons, M.D., a psychiatrist, clinical ethics advocate, and policy advisor to The Heartland Institute, which co-publishes Health Care News.
“The surgeon general’s report identifies an ‘epidemic’ of loneliness, but ‘iatrogenic’ is the word that fits better,” said Emmons. “The advice to improve personal health by increasing social contact is sound and timely, but we can only wish that public health officials had taken a ‘do no harm’ approach during the pandemic,” said Emmons. “Much of the universal risk management policies yielded little in the form of truly preventing serious illness and caused great harm by exacerbating social isolation.”
Medicaid Expansion
The Affordable Care Act’s (ACA) expansion of Medicaid eligibility to able-bodied adults makes it more difficult to deal with the mental health aspects of social isolation, says Liam Siguad, a fellow at the Open Health Project at the Mercatus Center at George Mason University.
“There’s a lot of crossover between this concern of social disconnection and programs like Medicaid,” said Siguad. “Historically, Medicaid has focused on a few key groups of vulnerable Americans, children, the elderly, those with disabilities, pregnant women, … (but the ACA) “threw a wrench in that,” said Siguad. “That led to a massive increase in Medicaid enrollment.”
Access to Mental Health Care
The newly eligible Medicaid populations compete with existing patients for access to mental health professionals, such as psychologists, psychiatrists, and licensed mental health counselors, says Siguard.
“The concern with this huge influx is that the vulnerable already in the program, specifically adolescents with a lot of social isolation, depression symptoms, and social media use, will have a tougher time finding the professional care they need because there are so many more people demanding those services,” said Siguad.
There is evidence that it is more difficult for vulnerable populations of Medicaid patients to access care, says Siguard.
“Preliminary results show there has been this displacement of the traditional medical population most at risk for negative health outcomes, under Medicaid expansion,” said Siguad. “But policymakers simply aren’t predisposed to think of unintended consequences; (these policies) haven’t been scrutinized as they should. More than half the residents in the U.S. live in an area with an active mental health provider shortage. That’s astonishing given the discussion of social isolation and mental health problems.”
Big Band-Aid
Murthy’s report recommends more health care workers, improving infrastructure in the public sector, requiring more transparency from social media companies, and cultivating a “culture of connection.”
A comprehensive approach was tried and failed during the pandemic, says Emmons.
“What lessons have public health officials learned about making their interventions narrower, higher yield, and less harmful?” said Emmons. “No reports yet on that topic.”
Ashley Bateman (bateman.ae@googlemail.com) writes from Virginia.