Moving from Awareness to Solutions
Innovative Solutions for Addressing Loneliness Throughout Our Communities
Loneliness has never been more on our radar. Coverage of loneliness and its attendant health hazards has appeared in most major publications around the world, sharply increasing awareness of this public health issue. Take as an example a headline in Britain’s The Economist that declared loneliness “a serious public-health problem. The lonely are not just sadder; they are unhealthier and die younger. What can be done?”
What can be done? That question generated candid responses during the Third Annual UnLonely Symposium, which focused on the theme of “Moving from Awareness to Solutions.” Sponsored by The UnLonely Project, a signature initiative of the Foundation for Art & Healing, the half-day event held on May 29, 2019, featured expert panel discussions on programmatic approaches to loneliness and social isolation.
“We have the data on how loneliness won’t just make you miserable, but can kill you, and is the equivalent of smoking 15 cigarettes a day,” said Dr. Jeremy Nobel, a faculty member of the Center for Primary Care at Harvard Medical School and founder of the UnLonely Project, which sponsored the conference in response to growing public health concerns over social isolation and loneliness.
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“Now is the time to move from awareness to action,” added Dr. Nobel. “But what does that really mean?”
To address that issue, the conference was structured into three panels. The first showcased emerging solutions that address the issue of loneliness in various settings, such as the workplace, among older adults, and on college campuses. The second panel probed how successful initiatives can be scaled up so that all potential beneficiaries have access to such programs. The final set of experts discussed the key requirements necessary to ensure these approaches are sustainable and have a lasting impact. The 2019 symposium, as in prior years, was targeted to an audience of professionals from diverse backgrounds that include social work, employee benefits, college health, media, and nonprofit groups. It was a community united by a commitment to tackling loneliness and social isolation.
Examples of successful programs
The first panel provided insight into the surprising heterogeneity of lonely populations. Some are elderly, like those served by the nonprofit group DOROT. Some are young, like the students served by New York University’s Student Health Center. The Administration for Children’s Services is a New York City agency with a staff of 7,000, most of them caregivers scattered among 25 work locations and in the field, “going through a lot of stress,” said panelist Consolata Mogeni, program coordinator for the WorkWell NYC Health and Wellness initiative. “Most are lonely, but that has not been addressed in wellness programs.”
Solutions were tailored to each population. “Loneliness still feels like a taboo word. We found a lot of success using student-friendly language and approaches,” said Jenny Mahlum, assistant director of health promotion and communications for NYU’s Student Health Center.
Panelists agreed that the success of loneliness programs is driven by how they are framed, and the specific choice of language.
“If we called this a loneliness program no one would show up,” acknowledged the Administration for Children’s Services’ Mogeni. “So we called the program a Creative Circle.” With a focus on creativity and the arts, the eight-week program designed by the Foundation for Art & Healing, and “created a support group without them even knowing it,” said Mogeni.
The stigma against loneliness also drove program design and language at NYU, Princeton, and DOROT. NYU chose to use positive language, with such phrases as “connection” and “joy.” NYU has an event where students can doodle on an enormous sheet of scrolled paper. “They start talking to each other and connecting over the art,” said NYU’s Mahlum.
At Princeton, groups of students in Sheila Pontis’ creativity and innovative design class approached other students in relaxed conversation. “That way the person can open up. The students tried to increase the number of encounters, and to physically be with someone face to face,” said Pontis.
Dr. Nobel noted the importance of showcasing various successful methods “so that other organizations can design their own solutions.” A key challenge for program designers, he said, was getting lonely people to engage in a topic that makes them feel uncomfortable.
“This actually is a huge problem,” said Mark Meridy, DOROT’s executive director, who shared a clever approach taken by his nonprofit. Many elderly people won’t admit they are lonely, and so they refuse services. DOROT instead asks them if they would be willing to volunteer to work with high school and college students who have community service requirements. These elderly, isolated New Yorkers go from being needy to being needed. “They volunteer, and are empowered,” said Meridy.
The second panel addressed options for scaling up programs to combat social isolation and loneliness. AARP Foundation and Dow Jones are among the large organizations that demand scalable approaches that are appropriate for thousands of people. Dow Jones addresses loneliness and isolation as part of its overall diversity and inclusion initiatives for employees around the world.
“If you can’t scale this out globally, then people don’t feel included. It’s really hard, but you need a systematic approach,” said Smita Pillai, chief diversity and inclusion officer for Dow Jones. She said that to scale programs, executive leaders need to stand up and talk about their own experiences. The use of newsletters also helps keep initiatives topical, Pillai added.
The AARP Foundation assesses potential programs for scalability. “What are the things that need to be in place for this to work, and that can scale? What are the off-the-shelf solutions?” asked Marc McDonald, the foundation’s vice president for grants and external initiatives.
One method for scaling is the use of partnerships. Dow Jones will partner with nonprofit groups that help it meet diversity goals. For example, a partnership with Easter Seals helped Dow Jones hire more people with disabilities. AARP Foundation uses partnerships to reach specific populations, and to use the partners’ connections “to have an impact and get the trust of the people we are trying to serve,” said McDonald. AARP Foundation has partnered on programs with The UnLonely Project, for example.
Technology is essential to successful scaling. “Everything we do is about scale,” said panelist Tomer Ben-Kiki, co-founder and chief executive of Happify, a company that creates technology tools built around consumer engagement to reduce symptoms of stress, anxiety, and depression. Some four million people have signed up for the product. “Technology has been under a lot of heat recently, but we are on the verge of a new chapter in tech,” added Ben-Kiki. “We are getting closer to humanizing what you find useful in technology.”
“Technology is absolutely necessary to scale,” agreed Dow Jones’ Pillai. “But the human connection is often lost when we scale with technology.” The company relies on technology, the communications channel Slack, for people with disabilities to chat. But it also “encourages a human connection,” she added.
Just as technology can connect people, creative expression through the arts can help people deal with negative feelings, including loneliness. The arts can provide scalable platforms for promoting dialogue around difficult topics that relate to loneliness, including gender definition and identity, noted panelist Alex Stark, an advisor to the Disability and Resource Center at the School of the Art Institute of Chicago, citing his own work as an artist and art curator.
Implementing successful programs to combat loneliness requires a strong commitment from corporations, insurers, and other stakeholders. Dr. Nobel explained that many companies are addressing loneliness “not just because it’s good for business, but because it’s essential for growth in a diversified world.”
But corporations are only willing to invest in such programs if they are sustainable. And so the UnLonely Symposium’s third panel explored the conditions and market forces that can influence or derail loneliness and social isolation initiatives.
Dr. Nobel asked the panel to identify opportunities to address loneliness in a sustainable way. The answer was common sense: Interventions must align with a company’s mission.
“Initiatives that improve health and social connections go together,” said panelist Dr. Doug Nemecek, Cigna’s chief medical officer for behavioral health. “As we start to align these things, it keeps the message alive. It is sustainable because it is aligned with our total care perspective.”
Cigna began focusing on loneliness about 18 months ago after national data identified it as an issue on the scale of smoking or obesity. A sustainable loneliness initiative was possible, said Dr. Nemecek, because Cigna’s senior leadership team “saw the statistics and connection to overall well-being and made sure we had the necessary resources.”
That corporate commitment is key to sustainability, said panelist Dr. Andy Crighton, chief medical officer at Prudential Financial. “You must make it a business imperative. At Prudential, we define health broadly — spiritual, physical, mental, and financial wellbeing. There’s a lot of social interaction in a workplace, and it has to be within the culture and the work environment.”
Two of the physicians on the panel stressed that as a culture, we tend to overly “medicalize” problems. Loneliness can’t be medicalized. It requires a financial investment in care management teams, for example, who can perform an assessment for loneliness or social isolation as the root cause of medical conditions. Dr. Niyum Gandhi, executive vice president and chief population health officer at the Mount Sinai Health System, shared an anecdote about a patient who showed up in the emergency department three or four times a year. After care management team intervention and the addition of a home health aide, the patient has not been hospitalized since.
“You can’t calculate ROI and the number of ER visits as with a disease management program. We actually don’t think of loneliness and social isolation in the same way,” said Dr. Gandhi. “It’s how you infuse that into the culture of what we can do on a daily basis.” For sustainability, he added, organizations need a “broader cultural change” that recognizes the power of community and peer support.
Panelists pointed out that companies can solidify the sustainability of loneliness programs by weaving them into existing frameworks. Many employers already have in place affinity groups, charity work opportunities, or even summer softball teams. Such programs give employees a chance to engage and make connections.
Awareness about loneliness is more prevalent in part because of increased media coverage of the issue. Everyday Health ran an article in 2015 about loneliness as a chronic condition, for example, and later surveyed 3,000 American women about loneliness, with startling results. Asked whether they would rather prefer to breast cancer or be lonely, one-third of women chose cancer, said panelist Elizabeth DeVita-Raeburn, a senior editor at Everyday Health.
As the Third Annual UnLonely Symposium drew to a close, Dr. Nobel invited the audience to be engaged in driving the social narrative for making connections and keeping a dialogue going. The UnLonely Project continues to play a key supportive role.
“It’s our honor and privilege to create these connections,” said Dr. Nobel.