Solutions for loneliness need innovation, vision

Re: “Loneliness a growing public-health concern,” column, Aug. 19.

In 1962, John F. Kennedy said: “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard.”

JFK’s inspirational words resonate today. The hardest challenges are an opportunity to bring out the best in society, a chance for citizens and their government to rise to the occasion, to demonstrate their character and commitment to innovation, a key driver of human progress.

While the president shot for the moon, many of the most difficult challenges are here on Earth — and much more mundane than space travel. Problems such as loneliness.

Loneliness is an emotional pain resulting from a mismatch between the relationships we have and those we desire, in terms of size, but especially quality. Loneliness is a common experience; it can emerge after the death of a loved one or when we move to a new city. In many cases, it’s temporary, and eventually dissipates. But for some people, loneliness becomes chronic and harmful.

As retired professor Trevor Hancock recently wrote in the Times Colonist: “The mental and physical health consequences of loneliness are an emerging publichealth concern.” It impacts our immune system and stress hormones, and is a risk factor for early mortality on par with other established risk factors such as obesity, physical inactivity, and air pollution.

Although anyone can feel lonely, loneliness is of particular concern in later life. As the City of Vancouver Seniors’ Advisory Committee recently explained in a report authored by Eddy Elmer, older adults have a greater number of chronic health conditions and mobility impairments that can make socializing difficult. Its effects can also accumulate over the years, “causing a ‘wear and tear’ on the body that becomes more pronounced over time.”

In recent years, there has been a proliferation of initiatives to alleviate loneliness. Notably, in January 2018, British Prime Minister Theresa May appointed a ministerial lead for loneliness.

But combating loneliness can be very difficult, particularly when it’s entrenched. As Vancouver’s committee observed, chronically lonely people often develop negative perceptions of others, become socially anxious and, paradoxically, push people away and withdraw even further. This creates a self-reinforcing feedback loop.

Thus, in many cases, we cannot reduce loneliness simply by bringing lonely people together. They might resist. It can also make matters worse: Lonely people might reinforce one another’s negative perceptions. And telling people to volunteer is not a panacea. As author Emily White writes in her book Lonely, random socialization of this sort can leave some feeling “doubly alone.”

To address entrenched loneliness, the best available evidence suggests that more targeted, intensive interventions might be required. In a 2011 meta-analysis, researchers found that cognitive-behavioural interventions are most effective. There might also be a place for medication (e.g., to reduce social anxiety).

But Hancock finds such approaches “completely unsatisfactory.” He complains that they are “individualized and very expensive” and that “with such a large-scale problem, we need a population-wide public-health approach.” He appears annoyed that the researchers “largely dismissed such seemingly common-sense approaches as providing social support, encouraging social engagement or teaching social skills.”

Hancock might not like the metaanalysis results, but they are what they are. The more common-sense approaches might work for people whose loneliness is caused primarily by lack of contact and whose social perceptions and behaviours have not become counterproductive, but for many chronically lonely people, we must look beyond superficial interventions and toward meaningful, evidencebased solutions that address the negative feedback loop in which they have become stuck. Otherwise, we risk implementing well-meaning solutions that produce little or no lasting benefit and could carry substantial costs in terms of time and limited resources.

Rather than cower in the face of a challenge, JFK encouraged citizens to conquer it. We aim for the moon “because that challenge is one that we are willing to accept, one we are unwilling to postpone and one which we intend to win,” he said.

To combat loneliness, we must rise to the occasion and confront the hardest cases. That will keep us on the path of an improved way of life. Lonely British Columbians deserve nothing less.