Last week, the Jo Cox Commission on Loneliness launched its final report, further raising the profile of an issue whose impact on health and wellbeing was for insufficiently recognised for many decades. As government, civil society and businesses seek to grapple with this complex social issue, my hope is that we can look imaginatively at responses; through a dual strategy of supporting those who do become chronically lonely to reconnect with others and fostering a society which helps prevent loneliness in the first place.
My interest in loneliness and social isolation arose by chance about twenty years ago when I was given a book called Heatwave. A relatively obscure PhD thesis looking at a heatwave in Chicago had been written up as a surprising engaging book, mapping out the harmful consequences of sustained hot weather on elderly patients. The first conclusion was that the premature death of scores of older people remained below the national news radar compared to most natural disasters. But an equally important second conclusion was that far fewer members of the relatively well-connected Latino communities died, compared to much more isolated African American and white working class communities. Social connections can make the difference between life and death.
What I didn’t realise at the time was that this impact goes far beyond the importance of neighbourliness and social support in a time of acute need. As a group of campaigners, public health experts, charities and older people themselves have been highlighting for the past few years, loneliness and isolation matters to our health in all sorts of ways. As the Jo Cox Commission notes, loneliness can increase blood pressure and heart disease, depression and cognitive decline. The Commission reinforces the message of the Campaign to End Loneliness and others: that the impact of loneliness on mortality and morbidity is similar to that of smoking, excessive drinking or failing to exercise.
So how should we respond? Whilst this continued focus on loneliness is welcomed, it doesn’t feel as if we have yet formulated a full response as a society. Is the detrimental impact of loneliness just something which should prompt us to take more care of our more family and friends? Is it something where government could or should have a role? The Commission suggests some ideas but also passes that challenge over to others to work through.
It’s a question which I and others at Social Finance have been reflecting on over the last three years as we have worked with partners to establish a new pilot service to seek to help people overcome chronic loneliness — Reconnections. Working with a range of partners, we have been developing an approach in Worcestershire which supports the lonely older people to reengage with others. To provide a single point of referral so that community organisations, social workers, family members can easily link people up with support. To mobilise hundreds of volunteers to work alongside people for six to nine months to help rebuild their confidence and reengage with activities and others. And to seek to establish a culture of mutual support in which those helped go on to help others.
With around 1,000 older people now engaged in Reconnections, we are confident that at the end of support the majority will report being less lonely, and that people are still less lonely after 18 months — although some slip back somewhat. Anecdotally, many people also report getting healthier and using health services less frequently, although we are yet to get the first findings of a full-scale study on people’s use of health services over time.
But the process of establishing such a service has not been easy. Raising awareness among busy GPs or social workers takes time. When they engage with older people, loneliness is often just one of a host of emotional, practical and medical challenges they are facing — more than a volunteer can address on his or her own. Nor is ‘organising’ a response to loneliness across a whole county straightforward. It rests on both a high quality ‘professional’ infrastructure of training volunteers, supervising good practice, capturing and applying learning, whilst also keeping a focus on people’s individual needs and aspirations and being rooted in a culture of gift and mutual support.
Supporting people to overcome chronic loneliness takes some time and resource, and isn’t always successful. Reconnections costs around £750 per person at the moment. This is cheap in medical terms — about half the cost to the NHS of someone having their tonsils removed or a tenth of the cost of a hip replacement — and potentially more valuable to people’s overall health and wellbeing. With further innovation, such as shifting more support and administration online, the cost should fall further. Yet in public health terms it would still be a significant pressure on resources. Further, waiting for people to reach such a chronic condition for it to be noticed is surely not optimal for them or for society as a whole.
We therefore need a dual strategy. We need to keep innovating to find better ways to specifically help people overcome chronic loneliness, refining and developing approaches such as Reconnections. And we need to take a much wider approach to preventing loneliness, by recognising that it is one of the many benefits to arise from investing in our social and community infrastructure and reinforcing the fabric of our society.
That strengthening of our social fabric rests on careful collective weaving. Of laying down the warp of community institutions around which the weft of informal friendships and mutual support can be threaded: local sports clubs; local social groups; schools which involve the whole community; festivity and arts; even community pubs and inclusive social media. In addition to helping prevent loneliness, it would benefit us all. These networks and institutions help young people navigate adolescence, and parents looking after small children. They reinforce a sense of common identity and purpose, and provide opportunities for meaningful political debate.
My hope is that, over 2018, national and local government, civil society and businesses will therefore put renewed effort into this drive to weave a stronger and richer social fabric. This will require new resources, as the Lottery provided new resources in the early 1990s — perhaps a super tax on social media advertising to raise £1 billion per annum, or hypothecated proportion of inheritance tax. It will require better incentives — for example on schools to play a greater role as community hubs. And it will require tens of thousands of individuals to look outwards, to better engage those around us and hopefully have fun in the process — from getting involved in local sports groups to tapping into the experience of our older neighbours and family members.
Jo Cox strikes me as someone who was interested in both supporting the most vulnerable overcome adversity and in helping build a society which avoids such problems in the first instance. Putting both into practice in seeking to tackle loneliness would be a fitting legacy.