The importance of social isolation and loneliness to health and well-being are well-known, but they gained more attention in 2020 due to the COVID-19 pandemic. Despite their widespread use, these terms are often misunderstood or conflated. Social isolation is an objective measure of social connections or lack thereof, while loneliness is the subjective feeling of being alone that can occur even when someone has others around them.
The health consequences of social isolation and loneliness, including increased morbidity and mortality, are increasingly recognized among physicians, policy leaders, community organizers and the public. Despite the growing public health need to address social isolation and loneliness, the best next steps to tackle this challenge remain unclear. In particular, how might we coordinate efforts across sectors to ensure all interested parties have a seat at the table?
‘We’ve been dealing with this [social isolation and loneliness] for as long as I’ve done this work.’
Social prescribing is gaining increasing attention as a strategy for clinicians and healthcare systems to address loneliness and isolation. Social prescribing involves intervening on social determinants of health by making recommendations and referrals specifically to address that social need. Often that includes addressing health conditions that present barriers to a social need, suggesting social programs, or brainstorming potential social outlets. Social prescribing is not limited to physicians or social workers and can be undertaken by anyone on the individual’s care team. This fits with an overall movement toward interdisciplinary collaboration, including prescribing clinicians, nurses, social workers, community health workers, community organization leaders, and other professionals to work collaboratively to find the best possible interventions for an individual.
Our ongoing goal has been to operationalize the concept of social prescribing in the U.S. healthcare system and promote cross-sector collaboration between health systems, policymakers, community-based organizations, and the public. Each of these parties hold different concerns and goals for how social prescribing can work in our health systems and communities. Our team interviewed members of these groups to understand different perspectives on the problem of social isolation and loneliness and how they might approach social prescribing.
Who Was Interviewed?
As part of a larger study looking at pandemic adaptations to peer programs, we collected 19 interviews from professionals across different health sectors, including 2 researchers or content experts, 6 leaders from community-based organizations in California, 5 direct-service clinicians, and 6 government or policy leaders.
What We Found:
- All groups interviewed described social isolation and loneliness as important and long-standing public health concerns.
“In a variety of ways, we’re hearing more about the importance of addressing loneliness and isolation, whether it’s the surgeon general or other people that publish about this, and identifying it sort of as its own issue … We’ve been dealing with this for as long as I’ve done this work.” (Geriatrics and Palliative Care Physician)
- Clinicians had concerns about whether health systems have the necessary infrastructure to address social isolation and loneliness. In particular, they raised concerns over clinician burnout and the limited infrastructure in health systems to address the greater workload in finding and referring to social programs. Potential solutions included increasing knowledge of local social programs through resource guides and collaboration through interdisciplinary teams.
“Social isolation and loneliness are incredibly important to me. They are not the focus of my work right now. Although I completely understand their interrelationship, especially [in] geriatric[s], but [for] anybody’s health. It’s not something that we have built into our electronic health record, and it hasn’t been identified as a priority for our health system. We don’t have any grant funding or sort of champions in that space … . But I have to be honest. It’s not a priority for my health system right now, and it’s not within my bandwidth to sort of carry alone.” (Family Medicine Physician and Geriatrician)
- Community organizations described the need to tailor social prescribing to the unique needs of each of their target populations, particularly those that are more at-risk for social isolation and loneliness (i.e., LGBTQ+ people, older adults, those with substance use disorders, those with mental health illnesses, people with disabilities, people who don’t speak English), including wide availability of a variety of programs.
“If you think about an older person coming here with no language … the center becomes a social hub for those folks, too, and a support network for them to be able to speak their language, practice holidays together and customs … . These centers really do become sort of a safe place for people to be and to support each other. I think that's super important and it doesn't get recognized or acknowledged or valued as much as it should be.”(Community Organization Leader)
- Policy leaders described a need for sustainable, long-term programming and funding, and mentioned the logistics of adhering to funding requirements as a major barrier.
“But a huge challenge we have is we’ll get a pile of money, and [be told] please do this in the next year. As part of the county, we don’t have a way to hire more people, but we also need to do a competitive procurement. And so that normally takes a year, but you only have a year to spend the money. We have that kind of issue all the time. We need a year to ramp up. And then you’d like the program to last longer than a year.” (Government and Policy Leader)
- Lastly, all parties reflected that funding was a barrier, as well as the generalized stigma around social isolation and loneliness, which makes assessment and intervention challenging when an individual is unwilling to accept any intervention or referral.
“I think the topic of social isolation and loneliness is not an easy one to broach with the population, like the API [Asian Pacific Islander] population. Because there’s a sense ‘That is something bad,’ and people don’t like that. People don’t like to associate themselves with things that are not good, first of all. It’s a little bit of a challenging thing.” (Community Organization Leader)
‘All parties reflected that funding was a barrier, as well as the generalized stigma around social isolation and loneliness.’
What’s Next?
Experts in the field of social isolation and loneliness assert that there is a critical need for intervening and are largely supportive of social prescribing. Each described unique barriers, such as burn-out, limited resources, stigma surrounding loneliness, and lack of consensus on which measurement tools to use and how to refer to programs, which hinder social prescribing from moving forward.
With these barriers in mind, we suggest the following next steps:
- Standardize assessment tools for loneliness and social isolation across sectors based on guidance from the 2020 report from the National Academy of Sciences, Engineering, and Medicine and the 2023 Surgeon General Report to avoid “reinventing the wheel.”
- Create evidence-based and consensus-guided frameworks for social prescribing that can be adapted to different settings (clinics, community organizations, social work, etc.).
- Recognize that addressing isolation and loneliness, whether through social prescribing or other avenues, must be cross-disciplinary.
Encouragingly, there is robust national conversation and activity around making these three steps a reality. As part of this effort, our team is working locally, regionally and nationally on these initiatives to advance the knowledge base and tools related to social prescribing. We hope the above steps allow for an initial approach to integrating social prescribing into care plans and provide an avenue for professionals to foster open conversations and reduce stigma surrounding social isolation and loneliness.
Katrina Hough is clinical research coordinator, Medicine, at UCSF School of Medicine in San Francisco. Ashwin Kotwal, MD, is an assistant professor of Medicine in the Division of Geriatrics at UCSF School of Medicine and co-leads its Social Connections and Aging lab. Nandini Singh, MPH, is coalition director of the Northern California Coalition for Social Connection at UCSF.
Photo credit: Shutterstock/VTT Studios
