Behavioral Health
Article

Social isolation: A quiet social determinant of health

February 3, 2020
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How many friends do you have? When was the last time you called a family member to chat? Would you feel comfortable asking your neighbor to borrow a cup of sugar? Did you leave your house today? This week? This month?

The answers to these questions could have a larger impact on your health than you might imagine.

 Knowing if someone is socially isolated requires asking questions about inter-personal relationships and exploring the social interactions a person has over a given period of time

In December of last year, I attended a day-long conference organized by the Health Policy Institute of Ohio (HPIO) on social isolation across a life. One theme that ran throughout the many presentations was the long-term impact of social isolation on an individual’s health. While I often see older adults as the population most associated with social isolation, no age group is immune to becoming socially isolated and experiencing negative health impacts as a result. I came away from the conference with a new understanding of social isolation as an often-overlooked social determinant of health.  

In 2005 the World Health Organization (WHO) developed the Commission on Social Determinants of Health and delivered a report on social determinants in 2008. While the concept of social conditions impacting health has a rich history, the WHO report prompted a reinvigoration of the focus on how the conditions in which people are born, grow, work, live and age impact the health of the individual person and the health of the population. Government agencies, health systems, educational institutions and health advocates, among others, adopted the WHO social-determinants model and began using the language to discuss health and health outcomes.

 The World Health Organization report prompted a reinvigoration of the focus on how the conditions in which people are born, grow, work, live and age impact the health of the individual person and the health of the population.

Many health-focused organizations have adapted and expanded the WHO model over the past 12 years, and while there is variation, all seem to include the concept of social and community context. In expanded models you might find sub-topics of stress, discrimination, social integration, support systems and community engagement. It is this section of the model that social isolation fits as a contributing factor to the health of the individual.  

Findings from a study conducted by the AARP Public Policy Institute and Stanford University suggest socially isolated Medicare patients are sicker when they enter a hospital and have more difficulty successfully transitioning out of the hospital than their socially connected peers. But it’s not just older adults who feel the negative health impacts of social isolation. Evidence from studies that use animals suggests socially-isolated adolescents follow different developmental paths than their non-isolated peers, which impacts both physiological and cognitive functioning throughout life.

 It’s not just older adults who feel the negative health impacts of social isolation.

Researchers on social isolation have made comparisons between social isolation and the trajectory of concern about obesity on health outcomes. Thirty years ago, health researchers identified a change in behavior trends and predicted the rise in obesity and associated poor health outcomes that we are all very familiar with today. Current social isolation research has identified societal change in social behaviors that have negative health impacts, at this point however, unlike obesity, the general public and health professionals are not very familiar with social isolation.  

Perhaps because it is less tangible, less obvious and harder to measure if an individual is socially isolated than if they do not have a place to live, food to eat or the ability to obtain health insurance, screening for social isolation does not always identify those who are socially isolated. Social determinant of health screening tools do exist and are increasingly adopted by health professionals. Since these tools are designed to cover many social determinants and be administered in a relatively short period of time, they are often unable to distinguish between social isolation and loneliness. For example, one such screening poses the question “how often do you feel lonely or isolated form those around you?” An important question, but not one that will result in knowing if the individual is socially isolated, lonely or both. While they are often related, social isolation and loneliness can also exist totally separately from each other and have different solutions. It is quite possible to be very socially isolated and not have feelings of loneliness. Without deeper questioning, it would be difficult to recommend the appropriate intervention to fully address social needs to prevent or correct social isolation.

 While they are often related, social isolation and loneliness can also exist totally separately from each other and have different solutions.

Knowing if someone is socially isolated requires asking questions about inter-personal relationships and exploring the social interactions a person has over a given period of time. In my personal experience, my health care providers have never asked how many friends I have, how often I talk with my family, if I know my neighbors or how may times in the past week I left my home. During my children’s well visits with the pediatrician, we talk about growth charts, physical activities, favorite foods, sleep habits and the onset of puberty but I cannot recall a single question about any of my three children’s interpersonal relationships. I imagine at first these types of questions would seem quite intrusive and out of place to a patient visiting a medical professional for a routine check-up. However, if they become part of standard practice, they would become more familiar and comfortable to those asking and answering the questions.

 At all points in life, social connections provide a protective factor to negative health outcomes

At all points in life, social connections provide a protective factor to negative health outcomes. Concern about health outcomes, however, should not rest solely on health care providers. Just as public health campaigns and media attention raised awareness about obesity, similar strategies can be employed to broaden the general public’s understanding on the importance of initiating and maintaining connection to others. Within society, there are many opportunities to be attuned to social connection or lack thereof for ourselves, family members, friends, coworkers, clients and neighbors. Pay attention to those connections as it is becoming clear that they are just as important for health as quitting smoking, losing weight or taking high blood pressure medication.

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