Shifting the focus from loneliness to social health

It’s been one year since the U.S. surgeon general issued a national warning about an epidemic of loneliness. Other countries recognized the problem earlier: the United Kingdom appointed a minister for loneliness in 2018; Japan did the same in 2021. These initiatives have brought attention to — and spurred action around — an important problem with serious health consequences, which include increased risks of heart disease, dementia, and premature death.

But with Gallup recently reporting that nearly one-quarter of the global population is lonely, there’s no resolution in sight. What is needed to advance the conversation and effect real change?

Having spent more than a decade working in this space, including studying solutions for loneliness at the Harvard T.H. Chan School of Public Health and leading programs around connection as a nonprofit founder and strategic partner to organizations like AARP and the Department of Health and Human Services, I believe it’s time to shift the strategy from reactively responding to loneliness to proactively promoting social health.

What is social health?

By “social health” I do not mean social drivers of health, or the conditions in one’s environment that contribute to well-being. Instead, social health is an essential pillar of health, alongside physical and mental health. Whereas physical health is about the body and mental health is about the mind, social health is about relationships; it is the dimension of an individual’s overall health and well-being that stems from quality human connections.

First defined by Robert D. Russell in 1973 and more recently advanced by other researchers, social health has been overlooked in the health sector and mainstream discourse. Among Wikipedia’s nearly 7 million articles, not one is devoted to social health. Appreciation for this vital part of human health urgently needs to spread to support people who are lonely and also make strides toward better health for all.

Why social health matters

There are three main reasons why reorienting around social health will ignite more impact.

First, loneliness is a sign of poor social health, but it is not the only one that matters. The three-quarters of people worldwide who don’t feel lonely may still benefit from optimizing their social health in other ways. For instance, maybe you feel very connected to family and friends and therefore don’t feel lonely, yet you aren’t close to anyone in your neighborhood (like 46% of Americans) or you don’t feel like you belong at work (like 64% of Americans).

To draw an analogy, just because you exercise often and are not overweight doesn’t mean there aren’t other ways to be more physically healthy, such as getting better quality sleep or eating more nutritious meals. Just because you interact often and don’t feel lonely doesn’t mean there aren’t other ways to be more socially healthy, such as developing deeper friendships or cultivating a sense of community.

Second, the overemphasis on loneliness draws too much attention to the negative. In my work advising organizations in health care and other industries, I often hear program leaders complain that bringing up isolation or loneliness pushes their participants away — and sometimes leaves them feeling worse.

In contrast, framing the conversation around social health is empowering. As researchers have outlined, health can be improved more effectively by building on assets in addition to addressing deficits. This means not only spotlighting loneliness and fixing obstacles to social health, but also amplifying people’s relational strengths and creating opportunities for more meaningful connections. Social health as a goal is inclusive and preventive: Like not waiting for a cancer diagnosis to take care of your physical health or neglecting mental health until you have an anxiety attack, people can benefit from strengthening their social health, whether or not they feel lonely.

Third, the language of social health highlights the health significance. Researchers have found that people significantly underestimate how important relational factors are for longevity. Last year, the World Health Organization launched a Commission on Social Connection, which will help raise awareness and legitimize this topic. But it should take it a step further and formally promote social health. In the same way that the language of mental health has helped people take their emotions more seriously, the language of social health will help people take their relationships more seriously.

Elevating and advancing social health

Targeted efforts that help the subset of people who are truly suffering from chronic loneliness must be complemented with broader initiatives that advance social health for all.

To that end, Spain offers inspiration. While doing research for my forthcoming book, I interviewed Joan R. Riera, who led the loneliness strategy for the city of Barcelona. He told me that he intended it to be the first and last loneliness strategy there, because he recognized that addressing loneliness only gets you so far. In fact, surveys revealed that only 3.5% of Barcelona’s residents reported feeling lonely often, yet 25% of older adults said they lacked companionship and 26.5% of kids wanted more friends. They need a social health strategy more than a loneliness strategy.

In the same vein, the U.K. and Japan should consider whether it is time to pivot away from ministers for loneliness and appoint ministers for social health instead. Other countries that are taking on loneliness may have more impact in the long term with this upstream approach.

People need to be educated that social health is as important as physical and mental health and be given engaging ways to improve their social health, building on initiatives like the U.S. surgeon general’s Connection Challenge. It’s also important to educate health care professionals that relationships help determine their patients’ outcomes and that connection is a form of medicine.

With so much attention on loneliness and the pressing need for more progress, it’s time to appoint the same level of importance to social health that we’ve given to physical and mental health and illuminate the path forward out of the darkness we’ve been stuck in for far too long.

Kasley Killam, MPH, is the founder of Social Health Labs and author of “The Art and Science of Connection: Why Social Health Is the Missing Key to Living Longer, Healthier, and Happier” (Harper Collins, June 2024).