Abstract
“With every true friendship we build more firmly the foundations on which the peace of the whole world rests.”Mahatma Gandhi “If we have no peace, it is because we have forgotten that we belong to each other.”Mother Teresa
The American College of Lifestyle Medicine (ACLM) was one of the first medical organizations to clearly acknowledge that social connections were a key component of overall health and wellbeing. ACLM did this by including positive social connections as one of the six pillars of lifestyle medicine. It was a forward looking position and one of great importance.
A number of recent research trials, publications, and books have underscored how important social connection is for good health. Importantly, this topic formed the centerpiece for a wonderful book published several years ago by the U.S. Surgeon General, Vivek Murthy, entitled “Together: The healing power of human connection in a sometimes lonely world.” 1 If you have not already read this book, I would strongly encourage you to purchase a copy!
I personally first became interested in the power of personal connections to improve health while reading a study published many years ago in California, involving a large group of individuals who had been laid off from work. Interestingly, when these subjects were surveyed, those who had served as volunteers in various organizations after being laid off were much more likely to find another job and also had demonstrable improvements in their health compared to individuals who did not pursue volunteer work. I was fascinated that this study which documented that volunteer work and doing good for others, also yielded benefits for the individuals who volunteered! There is a significant lesson for all of us in this!
My interest in this area was further peaked when I read the seminal book by Dr Robert Putnam, published in 2000, entitled “Bowling Alone: The Collapse and Revival of American Community.” 2 Dr Putnam documents that there has been, over many years, a deterioration in aspects of community in the United States. Even though this book was published almost 25 years ago, the evidence of diminished community was already present. One aspect that was intriguing to me was that in the late 1990s, many investigators thought that the advent of the internet would yield more connections amongst people. Actually, what happened was exactly the opposite. There was a serious decline in interpersonal connections. Dr Putnam documented that there was a 50% decrease in individuals who had at least one friend with whom they could share their deepest secrets. There were lots of connections, but much less sense of true community.
The internet has brought us many wonderful things. However, it can also create hazards. A study published from the University of Pittsburgh several years ago involving 1787 individuals compared individuals who spent two hours or more on the internet on a daily basis those who spent one-half hour or less. Those who spent more than two hours on the internet each day were twice as likely to report feeling lonely as those who spent less time.
Dan Buettner, in his important study and book, “The Blue Zones: 9 Lessons for Living Longer from the People Who've Lived the Longest 2012” 3 clearly demonstrated that countries and areas that are characterized by strong communities exhibit multiple health benefits resulting in significant enhanced longevity of individuals.
All this leads me to back the recent book by U.S. Surgeon General Murthy. Using the prestige of his office, the Surgeon General emphasizes that his mandate is to alert the American public to the emergence of chronic illnesses. As part of this mandate, he developed a significant and research-based book on loneliness and its adverse health consequences.
In his book, Dr Murthy quotes some startling statistics. He observes that loneliness not only crushes the soul, but it is linked to strokes, heart disease, dementia, inflammation, and suicide. Thus, loneliness breaks the heart literally as well as figuratively. Dr Murthy quotes that loneliness “is as deadly as smoking 15 cigarettes a day and more lethal than consuming six alcoholic beverages a day.” Furthermore, as he reports, loneliness is more dangerous to health than obesity. Shockingly, Dr Murthy reports that a majority of Americans now report experiencing loneliness based on a widely used scale that asks questions like whether people lack companionship or feel left out.
Of note, this is not only a problem in the United States, but also around the world. For example, Britain had established a “minister of loneliness” in 2018. Britain has also inaugurated public/private partnerships that collectively join millions of people together in programs like nature walks, song writing workshops, and community liter pick-ups. Other countries are also paying attention. Japan has also appointed a minister of loneliness, while Sweden has a minister of social affairs who has tackled this issue aggressively. There also have been calls in Australia and other countries for such a post.
It is important that we address the issue of loneliness head on. One review of a 148 studies concluded that positive social connections increase the odds of an individual surviving over roughly the next seven years by approximately 50%.
While loneliness was already a significant problem before the COVID-19 pandemic, the social isolation necessary to combat this illness made matters even worse. Dr Murthy quotes a Kaiser Foundation Report in 2018 which found that 22% of adults in the United States reported that they were frequently or almost always lonely or isolated. Another study quoted by Dr Murthy reported that 35% of physicians in the United Kingdom stated that in their clinical practice between 1 in 5 patients every day that they see had a primary complaint of loneliness.
So how do we overcome this problem? Dr Murthy outlines four potential strategies. • • • •
Another very important book was recently published by Drs. Robert Waldinger and Mark Schulz entitled “The Good Life: Lessons from the World’s Longest Scientific Study of Happiness.” 5 is based on a longer than 80-year study of Harvard undergraduate students and individuals who lived in Downtown Boston who had a much lower social status and financial resources. The findings from this study were quite surprising even to the investigators. They found that the single key most important factor for having a meaningful life and good health in both groups was to have meaningful connections to other human beings. This finding may be surprising to some, as it was to the investigators, but it certainly merits considerable thought. I was particularly intrigued by this study since Dr Bob Waldinger was at Harvard Medical School during the same time that I was.
So where do we go from here? ACLM was prescient in listing the power of social connections as one of the key pillars for good health. As I have reviewed articles over the last 15 years at the American Journal of Lifestyle Medicine, I have been struck by how few state of the art reviews or research trials focus on this important pillar. This paucity of articles may be due to how difficult it is to study social connections. Maybe, however, we are simply overlooking a problem that is right in front of our noses! The important message from these recent books and research trials emanates from their shared message of the importance of emphasizing this pillar as equal to all the other lifestyle medicine pillars.
I would like to close this Editorial with several suggestions and a request. First, the suggestions. • •
Finally, a request. As the Editor of AJLM, I welcome more submissions in the area of the power of social connections for good health. This is a very important health issue. In fact, we have used the power of social connections as the theme for this issue of AJLM.
ACLM should be proud to have been one of the first medical organizations to acknowledge the vital health links between social connections and good health. Let’s now take the next step and develop strategies to overcome this problem which we may have overlooked, despite knowing its importance!
James M. Rippe, MD Editor in Chief, AJLM
Professor of Medicine
UMass Chan Medical School, Worcester, MA