Kiffer is Assistant Professor in Health Sciences, Simon Fraser University, British Columbia, Canada. He is also affiliated with The Pacific Institute on Pathogens, Pandemics, and Society; The Canadian Alliance for Social Connection and Health; and the GenWell Project.

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Kiffer George Card

<h4>Could public health guidelines help stop loneliness?&nbsp;KIFFER GEORGE CARD shares both research and his perspective on how we can address the pandemic of loneliness. He advocates coming together in a whole-of-society response, which means addressing the very problem he is seeking to solve.&nbsp;</h4>United States Surgeon General Vivek Murthy recently called&nbsp;<a href="https://www.cbsnews.com/news/loneliness-surgeon-general-epidemic-covid/">loneliness an epidemic</a>&nbsp;and issued a&nbsp;<a href="https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf">public health advisory</a>&nbsp;on the healing effects of social connection and community.&nbsp;The report warned of the considerable adverse effects of loneliness and social isolation – comparing it to <a href="https://doi.org/10.2105/ajph.2013.301261">other leading risk factors</a>&nbsp;for premature death such as smoking, obesity, elevated blood pressure, and high cholesterol.<h4>Loneliness and social isolation can be harmful</h4>In my work as a social and behavioral epidemiologist, I have studied how social and community connectedness shapes health outcomes,&nbsp;<a href="https://doi.org/10.1007/s10461-017-1939-7">ranging from HIV</a>&nbsp;to&nbsp;<a href="https://doi.org/10.1080/13691058.2018.1439186">substance use</a>.&nbsp;For example, my colleagues and I have previously shown that social isolation is associated with a&nbsp;<a href="https://doi.org/10.1007/s10461-020-03000-2">48 percent increase</a>&nbsp;in odds for premature death, and that lonely people have&nbsp;<a href="http://dx.doi.org/10.1136/jech-2019-213566">71 percent higher odds</a>&nbsp;of reporting fair or poor health.&nbsp;Other researchers have also documented the havoc that loneliness wreaks on individuals, showing that lonely and isolated people have&nbsp;<a href="https://doi.org/10.1093/abm/kaaa029">poorer immune function</a>, experience&nbsp;<a href="https://doi.org/10.1016/j.bbi.2019.08.189">higher levels of inflammation</a>, and are at greater risk for&nbsp;<a href="https://doi.org/10.1136/heartjnl-2015-308790">heart disease</a>,&nbsp;<a href="https://doi.org/10.1038/ncponc1134">cancer</a>&nbsp;<a href="https://doi.org/10.1186/s12889-017-4948-6">and diabetes</a>.&nbsp;While everybody’s vulnerability to loneliness and social isolation differs, we all need social connection. Perhaps just as importantly,&nbsp;<a href="https://www.health.harvard.edu/blog/the-secret-to-happiness-heres-some-advice-from-the-longest-running-study-on-happiness-2017100512543#:%7E:text=The%20Harvard%20Study%20has%20found%20a%20strong%20association,isolation%20is%20a%20mood%20buster%2C%E2%80%9D%20says%20Dr.%20Waldinger.">Harvard research</a>&nbsp;from the longest-running cohort study ever conducted suggests that warm social relationships are the most important predictor of happiness across the life course.&nbsp;In other words, people who are disconnected lead sicker, sadder, and shorter lives.&nbsp;<h4>Public health guidelines</h4>In response to this epidemic of loneliness, my team at&nbsp;<a href="https://casch.org/guidelines">the Canadian Alliance for Social Connection and Health&nbsp;</a>has&nbsp;<a href="https://www.universityaffairs.ca/news/news-article/university-researchers-are-helping-to-create-a-canadian-guide-for-social-connection/">engaged experts from across Canada</a>&nbsp;and globally to develop the world’s first public health guidelines for social connection.&nbsp;Similar to the&nbsp;<a href="https://food-guide.canada.ca/en/">nutrition</a>,&nbsp;<a href="https://www.participaction.com/">exercise</a>,&nbsp;and&nbsp;<a href="https://ccsa.ca/canadas-guidance-alcohol-and-health">alcohol use</a>&nbsp;guidelines promoted by many national governments, social connection guidelines have the potential to improve our health and happiness by helping us all prioritize social connections in our daily lives.&nbsp;They can also raise awareness among healthcare providers and policymakers to ensure these experts are taking actions consistent with the latest evidence highlighting the importance of social health.<h4>Promising guidelines for better social health</h4>Regardless of levels of introversion or extroversion, insufficient social connection is associated with poorer well-being. While everybody’s vulnerability to loneliness and social isolation differs, we all need social connection. Yet, people generally&nbsp;<a href="https://doi.org/10.1016/j.tics.2022.02.007">underestimate the benefits of connecting</a>&nbsp;with others and overestimate the costs, which include the emotional labor and mental energy needed to manage relationships and your self-presentation.<a href="https://doi.org/10.1027/1614-0001/a000048">Regardless of levels</a>&nbsp;of introversion or extroversion, insufficient social connection is associated with poorer well-being.&nbsp;This is because social connection is a biological imperative. We evolved in&nbsp;<a href="https://theconversation.com/dunbars-number-why-my-theory-that-humans-can-only-maintain-150-friendships-has-withstood-30-years-of-scrutiny-160676">close-knit communities</a>. For ancient humans, social exclusion was a death sentence. Loneliness is our body’s way of&nbsp;<a href="https://doi.org/10.1080/02699931.2013.837379">keeping us connected</a>, but sometimes&nbsp;<a href="https://casch.org/theory">we get trapped</a>&nbsp;by it.&nbsp;Public health guidelines can help raise awareness of the importance of social connection and provide us with a road map for better social health. But what should these guidelines look like?&nbsp;This is exactly what&nbsp;<a href="https://www.newswire.ca/news-releases/from-social-distancing-to-social-connection-the-genwell-project-s-nationwide-survey-reinforces-the-importance-of-human-connection-as-canada-transitions-to-post-pandemic-recovery-822887144.html">my team has set out to understand</a>&nbsp;as part of a multi-phased, mixed-method study funded by and conducted in partnership with the Canadian government.&nbsp;<figure class="image image-style-align-center image_resized" style="width:75%;"><img src="https://cdn-prod-static.heartfulness.org/7tips_social_connection2_68d5da4a3a.jpg"></figure>So far, we have identified a few promising approaches that each of us can act on right now:<ol style="list-style-type:decimal;"><li>Make sure to have&nbsp;<a href="https://static1.squarespace.com/static/60283c2e174c122f8ebe0f39/t/645a88655583045704102e40/1683654757592/CSCG_Evidence+Brief_Number+of+Friends.pdf">three to five close friendships</a>&nbsp;to call on when you’re in need.&nbsp; Research has shown that individuals who have at least three to five close friends experience the lowest levels of loneliness, anxiety, depression, and a range of other adverse health outcomes. Having too many friends can sacrifice quality for quantity. Having too few can leave you alone in a time of need.</li><li>Get&nbsp;<a href="https://static1.squarespace.com/static/60283c2e174c122f8ebe0f39/t/640e0384b9ce9e602bf93c77/1678640005938/CSCG_Evidence+Brief_Social+Time.pdf">one to three hours of social interaction per day</a>.&nbsp; That’s between 7 and 21 hours of social time per week – far more than the average of&nbsp;<a href="https://www.bls.gov/news.release/atus.nr0.htm">34 minutes of socializing most of us get each day</a>. This value aligns with the approximate&nbsp;<a href="https://www.researchgate.net/profile/Robin-Dunbar/publication/235356868_Theory_of_mind_and_the_evolution_of_language/links/53dfc58b0cf2a768e49bddbd/Theory-of-mind-and-the-evolution-of-language.pdf">24 hours per week</a>&nbsp;that tribal and pastoral societies have historically enjoyed. While this may seem like a daunting jump in social hours for some, social interactions can include a wide variety of activities: chit chat with your barista, a phone call to a friend, conversation over dinner.</li><li><a href="https://static1.squarespace.com/static/60283c2e174c122f8ebe0f39/t/640e03a10c9c9c5dbec35801/1678640034544/CSCG_Evidence+Brief_Network+Composition.pdf">Prioritize spending time with those closest to you</a>.&nbsp; We’ve found that individuals need to socialize with both “strong” and “weak” ties, but that the balance of your social energy should be spent on close friends and family with whom you have warm relationships. This is because close relationships fulfil our most important&nbsp;<a href="https://doi.org/10.3389/fpsyg.2020.00901">relational needs</a>: to feel loved, acknowledged and validated. Building these&nbsp;<a href="https://journals.sagepub.com/doi/full/10.1177/0265407518761225">strong ties takes time</a>.</li><li>Diversity in your social network is important too.&nbsp; <a href="https://doi.org/10.1177/0146167214529799">So-called “weak ties” – those you don’t have a close relationship with – also matter</a>. In fact, studies have shown that&nbsp;<a href="https://doi.org/10.1093/geroni/igaa009">talking to neighbors</a>&nbsp;can build a sense of community;&nbsp;<a href="https://doi.org/10.1080/15555240.2018.1436444">making friends at work</a>&nbsp;can reduce job stress; and even&nbsp;<a href="https://doi.org/10.1016/j.jesp.2022.104356">talking to strangers</a> can create a sense of safety and provide a meaningful source of connection. Different relationships provide different types of support.&nbsp;</li><li>Recognize the risks of&nbsp;<a href="https://static1.squarespace.com/static/60283c2e174c122f8ebe0f39/t/63e67385a6ab9322c8125ea6/1676047237951/CSCG_Evidence+Brief_Living+alone.pdf">living alone</a>.&nbsp; People who live alone are at increased risk of loneliness and&nbsp;<a href="https://doi.org/10.1016/j.eclinm.2022.101677">studies have shown</a>&nbsp;that living alone,&nbsp;<a href="https://doi.org/10.1093/nutrit/nuv024">particularly for men</a>, is hazardous to your health. That means that if you live alone, prioritizing social relationships may be especially important to you.&nbsp;</li><li><a href="https://static1.squarespace.com/static/60283c2e174c122f8ebe0f39/t/6410a513a2173037c04a2141/1678812436160/CSCG_Evidence+Brief_Old+Friends.pdf">Reach out to old friends</a>&nbsp;and don’t be afraid to&nbsp;<a href="https://static1.squarespace.com/static/60283c2e174c122f8ebe0f39/t/640e03cb6924ff0526a018e9/1678640075343/CSCG_Evidence+Brief_New+Connections.pdf">make new ones</a>.&nbsp; Keeping and maintaining relationships can be hard – especially in today’s fast-paced world. Renewing old friendships can be an easy way to keep your social calendar full, but keeping a healthy level of engagement with new people will make sure your friendship well doesn’t run dry.</li><li>Don’t forget the importance of solitude.&nbsp; Just as time with others is important, it’s also important to have time alone. It is perfectly good, and even healthy, to spend time alone. We call this “<a href="https://doi.org/10.1002/9781118427378">solitude</a>.” In fact, for some, time with others may even&nbsp;<a href="https://doi.org/10.1007/s10902-023-00661-3">exacerbate feelings of loneliness</a>. Time alone provides an opportunity to restore your social reserves and meet your own personal needs.</li></ol>Following these and other strategies can improve your health and well-being. However, addressing loneliness, like many of the big problems we face today, will require a whole-of-society response. Public health guidelines for social connection can provide the foundation for such an approach.<figure class="image image-style-align-center"><img src="https://cdn-prod-static.heartfulness.org/7tips_social_connection3_6c8c0ad1cd.jpg"></figure>This article is reprinted with permission from the author and The Conversation under Creative Commons license from&nbsp;<a href="https://theconversation.com/could-public-health-guidelines-help-stop-loneliness-7-tips-that-show-how-crucial-social-connection-is-to-well-being-205358">https://theconversation.com/could-public-health-guidelines-help-stop-loneliness-7-tips-that-show-how-crucial-social-connection-is-to-well-being-205358</a>.<hr><h4 style="text-align:center;">Illustrations by ARATI SHEDDE</h4><hr>&nbsp;