How the World Is Fighting Social Isolation

Loneliness/social isolation isn’t just a transient emotion or situation, it’s turned into a global crisis with serious public health consequences. In 2023, then–US Surgeon General Vivek Murthy, MD, sounded the alarm, declaring loneliness an epidemic and citing seminal research equating its harmful effects to smoking 15 cigarettes a day.

The numbers tell a stark story: Recent research has linked chronic loneliness to depression, dementia, and even early death. In 2024, the US Centers for Disease Control and Prevention reported that one in three US adults feel lonely, while a Meta-Gallup survey spanning 140 countries found that more than a billion people experience significant social isolation.

As digital connections replace in-person interactions and traditional community structures erode, the question looms: How did we get here, and what are the United States and other countries doing to reconnect a disconnected world? 

While the root causes of loneliness remain a topic of debate, there is global consensus on the urgency to act. Around the world, governments are taking the issue seriously — each adopting distinct strategies shaped by their cultural, social, and political landscapes.

In 2023, the US Surgeon General’s Advisory introduced a six-part framework to address loneliness. Sweden is fostering connection through shared-housing initiatives, while Norway is combatting senior isolation with community clubs. Meanwhile, the United Kingdom has taken a bold step by appointing a Minister for Loneliness to lead a coordinated national response.

“There are certainly a lot of data that support a change in the degree of socialization that takes place, not just in adults but also adolescents in our society. Today, people have fewer friends and less time for interacting and are less likely to engage in activities that bring them into contact with other people,” Paul Appelbaum, MD, practicing psychiatrist and professor of psychiatry at Columbia University, New York, told Medscape Medical News.

Ellen E. Lee, MD, associate professor and chief of geriatric psychiatry at the University of California, San Diego, agrees that social networks are shrinking and that a growing number of individuals are reporting feelings of loneliness.

“What I’m seeing is that with people who are really lonely and socially isolated, there’s a cycle or a spiral. You may feel lonely and withdraw from social interactions, which makes it worse, and you feel even more lonely. And then if you become sensitive to social rejection, you’re less likely to venture out and find more social relationships,” Lee told Medscape Medical News.

All Ages Affected

Loneliness and social isolation are related but distinct experiences. Loneliness is the subjective feeling of being alone, whereas social isolation refers to an objective lack of relationships or social connections with family, friends, or community.

“Loneliness is just one form of lacking connection,” Julianne Holt-Lunstad, PhD, lead scientific editor of the US Advisory Report and professor of psychology and neuroscience at Brigham Young University, Provo, Utah, told Medscape Medical News.

A recent JAMA study showed that among US adults aged 50-80 years, 34% reported a lack of companionship in 2018 — a figure that rose to 41% in 2020, then fluctuated: 37% (2021), 42% (2022), 37% (2023), and 33% (2024). Social isolation followed a similar pattern, increasing from 27% in 2018 to 56% in 2020, then declining to 46% (2021), 44% (2022), 34% (2023), and 29% (2024).

“While the pandemic disrupted social connections, rates of loneliness and isolation were substantial both before and after the early pandemic. High rates of loneliness and social isolation occurred in several sociodemographic groups, especially those with self-reported fair or poor physical or mental health,” the investigators noted.

The Meta-Gallup global poll showed a significant proportion of respondents across all age groups reported feeling fairly or very lonely: 25% of those aged 15-18 years, 27% of those aged 19-29 years, 25% of those aged 30-44 years, 22% of those aged 45-64 years, and 17% of adults aged ≥ 65 years.

In addition to research highlighting elevated levels of loneliness and isolation among college-age students, Appelbaum pointed to another concern — increasing rates of loneliness among adolescents.

He noted that teens are now spending time that was once used for in-person interactions or group activities online, often through social media or gaming. Still, he emphasized that unhealthy levels of social isolation can affect individuals of nearly any age group.

Appelbaum noted that loneliness is common among retired older adults who’ve lost the workplace as a key source of social interaction, often leading to isolation, depression, and unhappiness.

A Threat to Brain and Body 

As reported by Medscape Medical News, a substantial body of research shows that loneliness and social isolation pose serious risks to both brain and body health. They have been linked to increased risks for dementia, cardiovascular disease, depression, stroke, and type 2 diabetes.

In addition a 2023 review and meta-analysis that analyzed 90 cohort studies, showed that both loneliness and social isolation were significantly associated with all-cause and cancer mortality. Social isolation was also specifically linked to higher cardiovascular disease mortality.

Loneliness and social isolation are also associated with brain changes. A 2019 study showed that individuals with higher loneliness scores had smaller gray matter volume in the left amygdala/anterior hippocampus, the left posterior parahippocampus, and the left cerebellum. These regions, the researchers noted, are central to cognitive processing and emotional regulation.

In addition to the amygdala and hippocampus, a 2021 systematic review showed that the brain regions most commonly associated with loneliness and social isolation included the prefrontal cortex, insula, posterior superior temporal lobe, and ventral striatum. Lee, the corresponding author of the review, which included data across all age groups and from seven countries, noted that the most critical factor may be the brain’s circuitry.

“But we don’t have a good handle on that yet. Neurology-based loneliness research is still in its infancy in terms of getting good imaging strategies and understanding which areas of the brain communicate with others to make this happen,” she said.

Still, she noted that the prefrontal cortex plays a key role in planning and executive function, effectively “triaging” many of these processes, while the amygdala is central to emotion regulation. However, she emphasized that it’s likely not one region alone, but rather how these brain areas work together that matters.

She also pointed out that the relationship between loneliness and brain structure may be a “chicken or egg” situation — it’s unclear whether loneliness leads to changes in the brain or if preexisting brain differences make loneliness more persistent.

How Did We Get Here?

While the pandemic contributed to a global rise in loneliness and social isolation, other key drivers include urban sprawl, increased reliance on technology and social media, and a decline in community engagement.

“I don’t think you can blame it all on COVID, although that probably played a contributing role,” Appelbaum said. He pointed to the rise in remote work and the shift to virtual participation in events like religious services, which often lack in-person interaction. However, he noted that a decline in face-to-face activities — such as volunteering — were already evident before the pandemic.

He noted that a broad social shift was already underway, one that was intensified by the rise of social media technology and further exacerbated by the pandemic.

Lee pointed to a steady decline over the past decade in the size of individuals’ social networks. Contributing factors include higher rates of people remaining unmarried or having fewer children, the loss of spouses with age, and decreased community involvement.

She added that these shrinking social networks are often compounded by isolation and limited access to social support.

A recent study showed that older adults who retired abroad — a growing trend in Europe — were more likely to experience loneliness than those who stayed in their home country, despite being healthier and more affluent. The main contributors were losing contact with family and longtime friends and struggling to form connections in their new communities.

The study’s lead author Esma Betul Savas, MSc, from the Netherlands Interdisciplinary Demographic Institute, noted the importance of social support systems for all ages.

“Older adults may face double jeopardy in retiring to a new country as they are vulnerable to both age-related and migration-related risk factors for loneliness, and loneliness is itself a risk factor for adverse health outcomes,” she said in a release.

Holt-Lunstad agreed, emphasizing that even individuals who prefer solitude may still be at risk. She noted the importance of identifying underlying barriers — such as social anxiety — and finding ways to help people feel more comfortable engaging socially.

Global Solutions

In 2024, the World Health Organization created a Commission on Social Connection and is working on a global agenda “to make the case for action, marshal support to scale up proven solutions, and measure progress.” 

For now, efforts to address loneliness vary widely across countries, with Sweden offering several innovative approaches. One example is the SällBo project— named after the Swedish words for companionship (sällskap) and living (bo) — a housing initiative in Helsingborg, Sweden, that brings together residents of different cultures and generations to foster community through shared activities. In a simpler yet impactful move, the city of Luleå, Sweden, launched a 2023 campaign encouraging residents to greet one another with a friendly “hello” to help reduce social isolation.

In February, Sweden also released its first national strategy to combat loneliness, with three “sub-goals.” These include ensuring social venues are accessible to all, removing barriers to participation, and implementing targeted interventions — such as outreach programs — to help reduce long-term loneliness.

Denmark’s “ABCs of Mental Health“ campaign promotes social integration through activities and states that “A” is for individuals to do something, “B” is to do something with someone, and “C” is to do something meaningful. The campaign is inspired by the “Act-Belong-Commit“ mental health project developed in Western Australia.

Other global initiatives include Norway leveraging community-based clubs to reduce isolation among seniors, India’s intergenerational community projects, and the Netherland’s “chatty registers“ in grocery stores where one check-out line is designated as having a cashier who is happy to have conversations with older customers.

In answer to a 2022 government survey showing that 40% of its citizens over the age of 16 years felt lonely, Japan enacted the Act on Promotion of Policy for Loneliness and Isolation in 2024, and both Japan and the United Kingdom have both appointed “Ministers of Loneliness.”

In addition, the United Kingdom also offers “befriending services,” where a volunteer will make a home visit to an older individual or accompany them to an activity, such as a café or to the theater. 

Social prescribing has also become popular in many countries, including the Netherlands, Singapore, and South Korea. It involves directing patients toward nonclinical community opportunities in order to enhance well-being.

A study published last year in Health Policy compared social prescribing approaches across 12 countries, including the United States, Canada, Australia, and Germany. While the scale and scope of these programs varied widely, and robust evidence on their impact remains limited, the findings suggested potential health benefits and indications of cost-effectiveness.

US Initiatives 

In the United States, the 2023 Surgeon General’s Advisory outlined six pillars for strengthening social connection: Enhancing social infrastructure in local communities, enacting pro-connection policies, engaging the health sector, reforming digital environments, advancing research, and fostering a culture of connection.

“Given the significant health consequences of loneliness and isolation, we must prioritize building social connection in the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders,” the report concluded.

But how much progress has the country made in implementing these recommendations? Not much so far, said Holt-Lunstad. “We still have a long way to go. We have made some headway in terms of a national measurement, but there are several recommendations where we haven’t made any headway.”

One Advisory recommendation calls for national health guidelines on social connection, but Holt-Lunstad noted that no formal steps have been taken. She highlighted a key criticism: The lack of funding or resources for implementation, stressing that real progress requires investment.

She acknowledged some state-level efforts aimed at reforming technology to promote connection and improve safety but said these don’t fully address the root causes.

Holt-Lunstad also served as a subject matter expert in efforts to integrate loneliness and social support into electronic health records — functionality that is now available to clinicians, though not yet widely implemented.

In a study published online in late February, which surveyed 681 healthcare providers, participants ranked social connection as a low priority in relation to mortality and chronic illness. They cited limited resources, inadequate training, and lack of time as key barriers to addressing these issues with patients.

While Lee emphasized the need for broader, more widespread interventions, she noted that numerous studies have explored a wide range of approaches — such as helping individuals strengthen existing relationships, learn to use live video communication tools, or form new connections through shared activities or circumstances.

“The most successful ones we’ve seen are ones that are cognitive-behavioral therapy [CBT] based. CBT is really great at making connections between thoughts, feelings, and behaviors — and to really try and catch those negative social cognitions and reframe them,” she said.

Jury Out on Social Prescribing

What about social prescribing in the United States? While it’s not as widespread as in other countries, momentum appears to be building — at least modestly. For example, in June, the Mass Cultural Council in Boston launched what it called “the nation’s first statewide arts prescription solution,” allowing clinicians to prescribe participation in local arts and cultural activities to support health and reduce social isolation and loneliness.

However, Holt-Lunstad cautioned that research on the effectiveness of social prescribing is still ongoing. While early findings are promising, she noted the evidence remains limited. She also expressed concern that it may become a way for healthcare providers to refer patients elsewhere rather than address social issues within the clinic.

A large meta-analysis coauthored by Holt-Lunstad, showed that integrating psychosocial support into clinical care was linked to a 20% increase in survival probability. She noted that consistently referring patients rather than embedding support within care could be a missed opportunity.

Appelbaum expressed skepticism about the term social prescribing, characterizing it as overly directive and potentially off-putting to US patients. He suggested a gentler approach — framing it as a conversation, encouragement, or a nudge rather than a directive from a clinician.

Rather than a “one-size-fits-all” solution, he recommended offering a range of options — like volunteer work, adult education, sports leagues, or group walks — and encouraging participation as part of treatment.

“Help [patients] recognize that taking care of themselves in this way is likely to be an important part of the answer to the unhappiness or sadness that brought them to the consulting room,” he said.

Ethical Concerns

As for practical approaches, Appelbaum suggested clinicians ask patients about their social interactions over time — comparing past and present experiences.

“Ask: How do you spend your time? In an average week, what other people do you interact with? Although that’s part of the initial workup that’s supposed to be obtained, I’ve read a lot of psychiatric records from other mental health professionals over the years where that piece has been given short shrift,” he said.

Appelbaum emphasized the importance of understanding each patient’s preferred level of social interaction. A decrease in social engagement may be distressing for someone who was once highly social, while others may be comfortable with fewer interactions and even find them overwhelming.

He noted that recommendations should be tailored to the individual’s comfort level and that their preferences should be respected.

When asked about ethical considerations, Appelbaum — who also directs the Center for Law, Ethics, and Psychiatry at Columbia University — highlighted the importance of honoring patient autonomy in addressing loneliness and social isolation.

“People get to run their own lives. Clinicians can certainly suggest changes in a gentle way that address problems, but it needs to be done in a way that respects the agency of the patient. Respect for the individual’s right to choose how to organize their lives is important to maintain,” he said.

Lee agreed, emphasizing that addressing loneliness and isolation requires a tailored, individualized approach.

She noted that loneliness can stem from a wide range of causes and experiences and emphasized the need for more nuanced assessments to identify the most effective, personalized interventions.

Appelbaum and Lee reported no relevant disclosures. Holt-Lunstad reported she has performed paid consulting for the Barnes Family Foundation and Beiersdorf/Nivea Connect.