Some social determinants of health are concrete and physical. A substandard house with mold and pests, for example, will lead to more asthma and respiratory problems. Less walkable areas and access to movement opportunities will increase heart disease. Toxic stress also affects health outcomes. Many things increase toxic stress, including anxiety about being able to pay rent, experiencing racism, and also loneliness.
Loneliness and social isolation have been getting quite a bit of attention over the past couple of years. This is not surprising, given that research has found loneliness can be as bad for you as smoking.
“I am not aware of any other factor — not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery — that has a greater impact on our incidence of illness, and chance of premature death,” says Dr. Dean Ornish, the founder of the Preventive Medicine Research Institute (quoted in Salon).
Loneliness and the Community Development Field
Recognizing loneliness and social isolation as risk factors for poor health raises the stakes on a number of community development challenges and goals. It both strengthens the argument that community development work is a path toward better health, and points toward some parts of that work that should perhaps get more or different attention. Here are some of those ways:
Loneliness being a health risk increases the stakes on fighting involuntary displacement.
When a person is displaced (whether by rising prices or by disinvestment) from a community where they have a strong social network, their risk of loneliness will increase, possibly quite sharply. Moving far from friends, family, congregations, and familiar businesses can be profoundly isolating. (So can having those things close or move away from you.) Psychiatrist (and Shelterforce author) Mindy Fullilove has named the full psychological effect of being displaced, which goes beyond loneliness, “root shock.” Hopefully, increased research on the long-term physical-health effects of loneliness will increase the seriousness with which root shock is taken.
Social isolation being a health risk increases the importance of good third places—and who they are accessible to.
For those without large homes to entertain or the disposable income to spend socializing in restaurants or on golf courses, public spaces where they can socialize are crucial—perhaps not just a matter of quality of life, but of length of life. Community building groups often either manage such spaces or are involved in planning, advocating for, and programming of public third spaces. Making sure they are welcoming and accessible to those who need them most, rather than those who have the most power expressing their wants, is a matter of health equity.
Loneliness being a health risk increases the importance of housing design that facilitates social interaction, as well as social programming.
Sometimes when developing or managing affordable housing it’s hard to find the budget to include a community room, patio, or communal grill. Sometimes the importance of including a functional porch is underestimated. Social programming, alongside services in an operating budget are often considered easy to cut. But when we look at social isolation as a health risk, these line items look less optional.
Loneliness as a health risk increases the importance of figuring out the social interaction aspect of mixed-income communities.
Many researchers are showing that intentionally moving to a neighborhood (or region) with access to a higher level of various opportunities (education, jobs) and more socioeconomic integration is important. On the other hand, it has been shown that cross-group social interaction in mixed-income communities is still often lacking. And sometimes in a mixed-income building, the social expectations of populations who have more socializing options lead to rules and restrictions on the use of community spaces that make them hard to use for spontaneous social interaction and relationship building.
Loneliness being a health risk increases the importance of housing tenure models that value community building.
Community land trusts, co-ops, mutual housing associations, and co-housing all come with various degrees of expectation of there being a community, not just a building. Intergenerational housing and homesharing explicitly promote connections across generations. One could certainly still be isolated in such a development, but organizations that encourage you to serve on boards and committees, participate in welcome cookouts, and see yourself as part of a steward of community-owned land at least provide some avenues to social connection. (Banding together to fight slumlords and eviction can also create some social bonds, though I don’t recommend seeking out slumlords as a route to overcoming loneliness.)
Social isolation being a health risk increases the importance of good transit and overall accessibility.
It can be hard to take advantage of the free concert on the waterfront, volunteer downtown, or regularly visit family and friends when you are reliant on a minimal or commuter-oriented transit system.
Addressing loneliness and social isolation are one more benefit of community organizing and community planning.
One of the fundamental truths about raising resident voices, developing their power, and helping them organize to fight for what they need is that it involves relationship building and it happens in groups. Along with the mental health benefits of regaining some sense of power and agency about your life, participating in community organizing can be a way to develop community itself.
Community development may, in fact, be perfectly situated to address this top health risk. What do you think? How does your organization counteract social isolation?
Miriam, thank you so much for covering this issue. In our current study of healthy public housing redevelopment, mental health, stress, and positive social connections have come up as one of the most important issues. But, there has been surprisingly little research on solutions, especially in recent years. The links you provided will likely be helpful but we just simply need to be devoting more attention in this area.
(I’m hoping to get a chance to talk about this at the Public X Design conference – today is the last day for session proposals if anyone is interested!)
Keep us up to date on what you find! We’ll be running a couple of articles that touch on this in the next few weeks as well.
Miriam, thanks for drawing attention to the impacts of loneliness and social isolation and to the fact that there can be a community development response. In the past six years, I have focused on aging issues from an economic security lens, and many older adults are lonely. They tend to be susceptible to telemarketers and other fraudsters trying to strip them of wealth to the tune of over $36 billion annually according to some sources.
Another challenge is that a number of dwellings that older adults occupy are not safe or healthy. The Center for Disease Control estimates that over 2.8 million older adults annually have a major fall and visit the emergency room.
There are promising approaches including the CAPABLE initiative launched by Sarah Szanton at Johns Hopkins School of Nursing in Baltimore that combines activity of daily living (ADL) plans with safety home modifications designed to enable older adults to Age in Place through a partnership with Civic Works in Baltimore. What they have found out is common sense: older adults who are more active and healthy tend to be more involved. A number of these older adults have become volunteers in their community, some serving on non-profit boards of directors. The evaluation has also shown that there is a lower depression rate among engaged older adults, not surprising.
The CAPABLE initiative and others point to how to reduce loneliness while having older adults become more active in their community. This is a “win-win” and has the potential of being another community development success story.
Just read your article, Miriam, and I’m glad you linked housing/community development with loneliness! I live in Holland and we know many approaches to reduce loneliness, even taskforces…. but I really agree with your conclusions, wrote about that issue in this dutch (translated) article: http://planenaanpak.nl/doc/Loneliness%20is%20not%20an%20affliction.pdf
Thank you for your inspiring links, they confirm my thoughts about the importance to strengthen communities to make a difference for neighbours feeling lonely!