Despite being the most technologically connected society in history, we are the loneliest, writes Jenny Kirschner
I have always noticed the unspoken pain of loneliness in my patients. Maybe this is because I am an empathetic person, or maybe it is because connection is a human biological need.
Despite being the most technologically connected society in history, we are the loneliest. Loneliness is not a new experience, but it is a signature concern of the COVID-19 pandemic which has helped shine a spotlight on the topic.
Community pharmacists who are inherently caring and empathetic by nature could play an integral role towards reducing loneliness by educating patients and promoting connectedness.
Loneliness is an aversive and subjective feeling of social isolation that arises when an individual perceives that the quality or quantity of social relationships is less than what they desire. If a person feels lonely, then they are lonely.
Loneliness is not equivalent to social isolation, an objective measure of the number of friends, family, or other social connections that an individual has and the frequency of contact with these social connections.
Based on 2018 and 2019 data, it is estimated that one in four Australians aged between 12 and 89 experience problematic levels of loneliness, with an estimated five million Australians experiencing problematic levels of loneliness at any one time.
Since the onset of the pandemic, one in two Australians reported feeling lonelier.
There is a perception that loneliness is only a concern for the elderly, but age does not appear to be a demographic that drives loneliness.
As loneliness is stigmatised, people feel uncomfortable talking about their feelings. What this means is that there are countless Australians living with persistent loneliness who do not access help.
Among others, Dr Michelle Lim, Scientific Chair of Ending Loneliness Together, Senior Lecturer Swinburne University of Technology, predicts loneliness to be the next public health epidemic of the 21st century.
Medicare costs in the USA (2017) arising from loneliness and social isolation estimated at US$6.7 billion annually (similar cost estimates are currently lacking in Australia).
Science teaches us that loneliness is much more than an uncomfortable emotion. Professor John Cacioppo, former director of University of Chicago Centre for Cognitive and Social Neuroscience, studied loneliness for 21 years and talked about loneliness as biological warning machinery.
Just like hunger is an unpleasant situation that motivates someone to seek out food and thirst motives someone to seek out water, he described loneliness as a pain that alerts us to take care of our social body which one needs to survive and prosper.
And much like hunger or thirst, loneliness, if left unresolved, can have serious health consequences.
When I first experienced loneliness I wanted to understand what was going on, so I went looking.
Research shows that loneliness is as lethal as smoking 15 cigarettes per day, making it even more dangerous than obesity.
Other effects on health include: a 29% increase in the incidence of coronary heart disease, a 32% increase in the risk of stroke, poorer cardiovascular health indicators such as elevated blood pressure, elevated cholesterol and predicts future poorer mental health severity including depression. 
Loneliness has also been shown to put people at greater risk of cognitive decline and dementia.
As pharmacists we spend time talking to patients about quitting smoking and weight management to reduce their risk of chronic diseases, and yet we do not talk to them about loneliness. I believe it is our professional responsibility to expand our own health literacy in the science of loneliness.
Loneliness is complex and there is no one size fits all approach to resolve it. Countries are responding with various approaches.
For example, London was the first country to appoint a Loneliness Minister (2018) and Japan recently (2021) echoed this action. There is also a growing movement of social prescribing. The concept has gained traction in the NHS organisations of the United Kingdom as well as in Ireland and the Netherlands.
Social prescribing is when health professionals refer patients to services available in the community in order to improve their health and wellbeing.
In essence, the health professional is ‘prescribing’ a social activity (a holistic, non-medical service) that is personalised to a patient’s interests, rather than prescribing a medicine. Examples include anything from gardening to physical activity and volunteering.
I believe that community pharmacy can be an integral part of the solution toward reducing loneliness. We need to increase awareness by improving pharmacist knowledge and their understanding of loneliness, helping to reduce the stigma and creating emotionally safe pharmacies.
We often talk about a whole person and holistic approach to health. To embody this we need to ensure that we value both the medical care and social care of our patients.
As one of the most highly accessible health professionals, pharmacists should consider local community asset mapping—documenting a community’s existing resources and local social activities. This way, we can informally ‘prescribe’ local activities to our patients promoting connectedness.
Social prescribing can be easily incorporated into a pharmacist’s everyday counselling, checking in on the social health of our patients too.
Now, beyond seeing the loneliness of my patients, I have learnt that educating them and facilitating their connections to other people and social activities is a health imperative. We should all strive to be a pharmacist who prioritises not only the physical needs of our patients but equally their social needs, assisting with social connections as part of the loneliness solution.
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