Loneliness & the Future of Public Health | EPAM Continuum

Feelings of dissatisfaction regarding our current family, social, and community lives is feeding the global loneliness epidemic. As we try to learn new ways to connect and fulfill these parts of our lives despite our physical distance, a larger conversation is building about how to address the systemic issues that often underpin issues of public health.

It’s ironic that the coronavirus pandemic, a global challenge that requires both cooperative action and physical isolation to be effectively met, came during one of the loneliest points in human history.⁵⁰ Often credited as a product of aging populations in developed countries, increasing technology use, and greater affluence (which can erode the interdependencies–such as the need for shared housing, childcare, or social support–that keep communities together), the problem has been on the radars of governments and healthcare providers for years.

It’s ironic that the coronavirus pandemic, a global challenge that requires both cooperative action and physical isolation to be effectively met, came during one of the loneliest points in human history.⁵¹ Often credited as a product of aging populations in developed countries, increasing technology use, and greater affluence (which can erode the interdependencies–such as the need for shared housing, childcare, or social support–that keep communities together), the problem has been on the radars of governments and healthcare providers for years.

Former US surgeon-general Vivek Murthy declared loneliness an epidemic in 2017, and the UK appointed its Minister of Loneliness the following year. It seems almost a part of cultural identity in Japan (and is a perpetual cultural fascination to outsiders): They have distinct terms for the modern phenomena of social reclusiveness (hikikomori ⁵¹), dying alone (kodokushi ⁵²), and doing things by yourself (ohitorisama ⁵³). The Japanese-pioneered practice of renting friends or family members ⁵⁴ has spread to elsewhere in Asia ⁵⁵ as well as the west.⁵⁶

Loneliness has been getting all this attention not strictly as a mental health issue, but because of the serious physical health effects that studies have associated with it, like how it’s equivalent to smoking 15 cigarettes a day, or it makes you 64% more likely to develop dementia, or even 45% more likely to die.⁵⁷ Because loneliness is now recognized as an important social determinant of health, businesses across healthcare and life sciences have been paying extra attention to how the problem has developed this year and what can be learned to support solutions.

During the pandemic, seniors have been especially vulnerable; already lonelier than average, they are also on the wrong side of the digital divide. It’s not easy for the elderly to adopt digital coping mechanisms like moving a book club to Zoom or visiting a friend’s island in Animal Crossing. Nursing homes and assisted living facilities that curtailed outside visits and internal group activities without keeping residents connected and occupied in other ways saw drastic increases in depression, suicidal ideation, and suicide attempts.⁵⁸

And it’s not just seniors who are at high-risk for loneliness this year. People with chronic illness or who are otherwise immunocompromised are also trapped inside wherever community spread remains uncontrolled. Gen Z (teens and people in their early 20s), notoriously lonely to begin with, is facing remote schooling and diminishing opportunities, like internships, that are the traditional entry points for young people to begin building social ties and participating in society.

The good news is that loneliness and being alone, the way we are during social distancing, aren’t the same. The study that correlated loneliness to dementia didn’t find the same link to social isolation (living alone, having limited social support).⁵⁹ It’s not being alone, it’s how you feel about it that makes the difference: The Pew Research Center has linked feelings of loneliness to a dissatisfaction with one’s family, social, or community life.⁶⁰ This finicky distinction could explain why researchers didn’t see an enormous spike in loneliness after the pandemic hit the US in March.

As it turns out, during the strictest parts of pandemic lockdown, loneliness plateaued.⁶¹ New forms of digital connection took off, FOMO decreased for everyone, and communities came together in solidarity around a shared struggle. Mutual aid groups formed to support people who needed help buying or affording groceries,⁶² volunteers organized to reach out to seniors,⁶³ and normally busy people got to know their neighbors.⁶⁴

We were physically distanced but socially as connected as we’d ever been; alone but not lonely. But as time wore on, and the fun of Zoom parties wore off, that optimistic attitude has faltered. The pandemic has piled on other mental health burdens, undermining our ability to reach out and support each other. Burnout is an impending crisis for healthcare workers, working parents, teachers, and professors, among others who’ve seen workloads double or triple during the pandemic. Financial stress, political conflict, and the uncertainty of lives put on indefinite hold are contributing to anxiety and depression around the world. These stressors will be what isolates us next year more than any stay-at-home order.

As a solution to the public health issue of loneliness, the spontaneous outpouring of social feeling we saw last spring is hard to formally replicate. Repeating the successes of that moment starts with helping people access the digital tools that made it possible–as tired as we are of teleconferencing, where would we be without it?–and continues with building and strengthening the opportunities for and expressions of community that made it effective–mutual support, outreach, and caring.

Loneliness is a classic social determinant of health–a medical issue with social, cultural, and political causes. This is the case for many public health issues, which can rest on food safety regulations as easily as on a vaccine. Both public health and social determinants of health are ways of understanding health problems through a systems-eye view, as much or more the products of interdependent collective behaviors and choices as individual ones. If a pandemic can’t show us the value of that perspective, nothing will.

Loneliness is a classic social determinant of health–a medical issue with social, cultural, and political causes.

An Ecosystem Approach to Aging in Place

Gar Rohatgi
Director, Innovation Consulting & Vertical Lead, Life Sciences
Boston, MA, USA

Loneliness, or feeling a lack of companionship, was already an epidemic among Americans 65 and older before the coronavirus pandemic,⁶⁵ and it’s no secret that 2020 has accelerated the go-to-market plans of businesses in a position to support independent living and aging gracefully in place. By 2030, baby boomers–one in every five people–will be over 65,⁶⁶ and there will only be four potential family caregivers for every person older than 80, down from about six today.⁶⁷ There’s an abundance of interest in how digital technologies can help coordinate care and address loneliness for older people living independently: To successfully meet this need, solution providers must plan go-to-market strategies that recognize that one size won’t fit all.

Discrete technologies that offer to quench loneliness by matching people with caregivers via immense databases, mimicking human interactions with AI and robotics, or monitoring with sensors and triage apps and dashboards, are likely to fall short, ultimately, of needs and expectations. Instead, ecosystem solutions with diverse offerings for seniors will support meaningful experiences, behaviors, and relationships–the stuff that leads to long term feelings of companionship.

An ecosystem player will elevate simple matchmaking to a true supply chain of care by integrating professional and informal family caregivers, remote and local resources, and transactional and long-term relationships. In a forthcoming Resonance Test conversation with Sachin Jain, CEO of SCAN Health Plan, we learned that SCAN’s supply chain of care was effective during the peak of COVID in part because they employ a number of senior citizen members to “make regular phone calls to fellow members to let them know what’s going on in the community, to encourage them to take advantage of the wide array of benefits we offer our SCAN Health members,” said Jain. “We ultimately had people who were able to reach out to folks at a time when no one else was reaching out to them to make sure they were ok.”

Ecosystem providers will also have the ability to utilize AI and robotics, not as an end unto themselves, but as a bridge for nudging people toward real human connections or as a sounding board to help recognize and activate better relationship behaviors. Telepresence robots like AVA, emotionally aware technologies like Affectiva, ML applications like Replika (as Regine Jones discusses in the following perspective), and immersive shared VR experiences like Fortnite concerts are the kinds of experiences that will meld to give people many more ways to develop and supplement connectedness in relationships with real people, in the moment.

Finally, rather than entering seniors’ lives abruptly as monitoring technologies foisted upon them by their anxious children, ecosystem brands will take the opportunity to build brand trust and loyalty during their independent years. A gradual transition to supportive services will assist the aging in maintaining their connections, privacy, and autonomy, even as caregivers are on-boarded to help. EPAM Continuum envisions one such scenario through a hypothetical automotive brand experience in our Silverkey project, as Dustin Boutet explains in this episode of The Resonance Test, but one can imagine similar strategies for the home through home security or cable companies that combine in-person setup and services with monitoring technologies.

The multifaceted needs of independent living and aging in place present a great opportunity for solution providers to impact elder loneliness in an effective way. Those that weave resources, real relationships, and the gradual introduction of in-home technologies into an ecosystem of care will deliver results that not only go beyond band-aid level but also meet the widest range of situational needs for a diverse patient population.

Why Technology is Needed in the Fight Against Loneliness

Regine Jones
Senior Manager, Life Sciences Consulting
Newtown, PA, USA

Healthcare companies are acutely aware of the costs associated with the effects that chronic loneliness can have on an individual’s health. For example, there are 3.5 million breast cancer survivors in the US: Research shows that if they lack strong social support ties in the years following treatment, the results could be fatal. For those lonelier patients, approximately 40% (1.5 million) will have their cancer return and about 60% (2.1 million) will die from it.⁶⁸ Breast cancer patients incur per patient healthcare costs of approximately $120,000.⁶⁹ Heart disease, another condition associated with loneliness, has a $190 billion annual cost impact in the US.⁷⁰

From a life sciences perspective, products we develop and eventually distribute to patients must demonstrate positive health outcomes (related to efficacy). However, if we do not include solutions that combat loneliness as part of our patient programs, we run the risk of undermining the efficacy of our products that treat conditions caused by, exacerbated by, or recurring because of loneliness (i.e. diabetes, hypertension, depression, breast cancer etc.).

According to several articles from Business Insider this year, nearly one-fifth of US healthcare leaders plan to address social isolation and are increasingly looking to startups and technology companies to help―with good reason.⁷⁰

A recent Kaspersky study revealed that among those who have felt less lonely during the pandemic, 60% credited tech such as video calls, messaging, and voice-enabled assistants like Alexa as the reasons why. They expect to see consumers increasingly leverage tech to combat loneliness amid the pandemic and beyond.⁷¹

This is evidenced by the example of “Replika: My AI Friend.” Nearly half a million people downloaded this chatbot-enabled app during the height of COVID-19–the largest monthly gain in the parent company’s three-year history. For people feeling the effects of social isolation, Replika provided the opportunity to converse freely, with a digital interlocutor, via text message.

Loneliness is a complex and subjective health crisis that will require a multifaceted and holistic approach to solve. Given the diversity of the populations most affected (such as Generation Z, the elderly, low income, and men), the solutions required and made available must be equally diverse. Since loneliness cannot be treated with pharmacological intervention, technology solutions must be part of the treatment equation.

Regine and her team recently won a Human Centric Innovation Award for their concept app combating loneliness in breast cancer survivors of all genders. For a more detailed view into several ways technology is being successfully leveraged to combat loneliness, read the article Regine co-authored with colleague Broderick Jones:Becoming Less Lonesome: How Tech Can Attack the Scourge of Loneliness.”



79% of Generation Z was lonely in 2019. 70% of people are feeling lonelier this year due to the pandemic.

Source: TIME Magazine survey

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Key Takeaways


50NPRLoneliness Hasn't Increased Despite Pandemic, Research Finds. What Helped?07.15.2020Source
51BBCThe plight of Japan's modern hermits01.29.2019Source
52The Washington PostSo many Japanese people die alone, there's a whole industry devoted to cleaning up after them.01.24.2018Source
53BBCThe rise of Japan's 'super solo' culture01.13.2020Source
54The New YorkerJapan's Rent-a-Family Industry04.30.2018Source
55NPRNeed Fake Friends For Your Wedding? In S. Korea, You Can Hire Them08.15.2015Source
56VoxI paid $47 an hour for someone to be my friend07.01.2019Source
57UCSF ResearchLoneliness Linked to Serious Health Problems and Death Among Elderly06.18.2012Source
58New York Times OpinionFor Older People, Despair, as Well as Covid-19, Is Costing Lives06.30.2020Source
59Holwerda, T. J., Deeg, D. J. H., Beekman, A. T. F., van Tilburg, T. G., Stek, M. L., Jonker, C., & Schoevers, R. A. (2014); Journal of Neurology, Neurosurgery and Psychiatry, 85(2), 135-142Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL)09.01.2014Source
60Pew ResearchAmericans unhappy with family, social or financial life are more likely to say they feel lonely12.03.2018Source
61NPRLoneliness Hasn't Increased Despite Pandemic, Research Finds. What Helped?07.15.2020Source
62VoxHow to help people during the pandemic, one Google spreadsheet at a time04.16.2020Source
63New York TimesOlder Adults Remain Isolated Despite Reopening. These Programs Help.06.08.2020Source
64WKRG NewsAlabamians get to know their neighbors during coronavirus pandemic05.27.2020Source
65Hwang, T. J., Rabheru, K., Peisah, C., Reichman, W., & Ikeda, M.; International psychogeriatrics, 1–4. Advance online publication.Loneliness and social isolation during the COVID-19 pandemic. 01.31.2020Source
66West View Nursing and Rehabilitation CenterBy 2030, U.S Demographic Milestone Begins To Lower Caregiver Ratio04.20.2018Source
67AARP Public Policy InstituteThe Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers08.29.2013Source
68HealthDay NewsLoneliness May Sabotage Breast Cancer Survival12.12.2016Source
69AARP Public Policy InstituteSpecialty Drugs in Breast Cancer: Health Care Utilization and Costs in the First Year after Diagnosis03.15.2019Source
70Business InsiderHow increased social distancing for the coronavirus could spur a loneliness epidemic03.16.2020Source
71MobiHealthNewsNew study highlights technology’s role in easing Britain’s systemic loneliness problem06.10.2020Source