Loneliness, A Health Risk Like No Other

Arguably more than smoking or obesity, one of the greatest threats we face today is loneliness. In 2023, the US Surgeon General made headlines when he warned that loneliness poses health risks as deadly as smoking up to 15 cigarettes daily. In Japan, terms such as "elderly living alone" and "dying alone" are often used by the media, but the latest surveys show that, in fact, young people are more likely to feel lonely than the elderly. The problem transcends generations. In considering health care and wellbeing, we have to confront the public health crisis of loneliness. In this article, I will look at how loneliness can affect our health, and discuss the current state of loneliness in Japan.

Today, many people value having their privacy safeguarded and to live at an healthy distance from others. At the same time, we see people suffering from loneliness akin to being excluded from society.

To begin with, what is "loneliness"? Another word that is very similar is "isolation", but what is the difference?

Loneliness is the negative and subjective emotion of not having the social connections that one desires. Isolation, on the other hand, is an objective state of not being in physical communication with society, including one's family^*1. Many people feel lonely when they are isolated, but there are also people who suffer from loneliness even when they are not socially isolated. Loneliness is a subjective emotion.

Another related concept is "solitude," which refers to being alone of one's own will. It can be a positive emotion, or a state of concentration and facing oneself, making it distinct from loneliness^*1.

Social isolation, which leads to loneliness, has been shown to carry a greater mortality risk than smoking or drinking alcohol, both well-known health risks^*2 (Figure 1). In addition, research shows that feelings of loneliness clearly shorten life expectancy^*3, with indications of links to cardiovascular disease, type 2 diabetes, and other illnesses^*4.

Furthermore, feelings of loneliness can cause physical pain. In an experiment to examine the brain activity of people who were excluded from a game, reactions were registered in the anterior cingulate cortex of the brain. Similar reactions can be observed when physical pain occurs^*5.

While the disease of loneliness cannot be observed under a microscope, it is undoubtedly eating away at our physical health.

Why does just feeling lonely have such a negative impact on our bodies? The reason may lie in the process of human evolution.

Early humans were able to protect themselves from external threats and increase their chances of procreation by building intragroup connections. Challenges that could not be overcome by individuals may have been overcome through innovations arising from group intelligence^*6. The reason that humans seek connections with society may well be because it is a survival strategy.

Through a long evolutionary process, our bodies have come to experience intense stress and heightened alertness when we are isolated from others and feel lonely. This reaction is useful for avoiding danger in the short term. However, the immune system's balance becomes disrupted if this state persists. In fact, we know that protracted feelings of loneliness can cause changes in our white blood cells, weakening the body's resistance to viruses^*7. Furthermore, shallow and intermittent sleep can become a risk factor in various diseases^*8.

In antiquity, people who were isolated from the group would not have been able to survive for very long, so the negative effects of loneliness on the body may not have been a problem. Yet, in the modern world, isolation does not lead to immediate death. While you can survive, if loneliness persists for a long time, you ultimately risk damaging your health.

According to a survey by the Cabinet Office, about 47% of Japanese people responded that they "always" or "sometimes" feel lonely^*9. Elderly people living alone has become a social problem. Of the Japanese people who die alone, approximately 62% of men and 59% of women are aged 60 or older^*10. Going forward, with the aging society progressing, the social isolation of the elderly is likely to grow more serious. Conversely, this research also shows that around 40% of people who die alone are under the age of 60, or still in the prime of their working lives.

Looking at the results of the aforementioned Cabinet Office survey by demographic, we can see that the percentage of people of working age younger than 60 who answered that they "always " or "sometimes " feel lonely is higher than that of people aged 60 and over^*9 (Figure 2). Looking at the results by gender, the percentage of both men and women in their 30s who answered that they feel lonely was the highest*9 (approximately 60% of men in their 30s and approximately 53% of women in their 30s).

Although it is relatively easy to support people who are objectively isolated, there are likely many people of working age who are not objectively isolated but still feel lonely, making it difficult for them to receive support from those around them^*11.

In addition, after "bereavement of family members", "living alone" is the main cause of feelings of loneliness^*9. The latest survey indicates that the number of single-person households will continue to increase, and that by 2050, approximately 44% of all households will be single-person^*12. Loneliness is expected to continue spreading among the Japanese population if we leave things as they are and do nothing to address the problem.

We have already discussed the devastatingly negative impact that loneliness has on people. As I mentioned at the beginning, one of the most frightening aspects of loneliness is that, because it is a subjective emotion, there is no universal cure.

In closing, I will introduce some recent initiatives in Japan to combat loneliness. A Minister in Charge of Loneliness and Isolation was established in 2021. This is the second such position created in the world, after the United Kingdom established a cabinet position specializing in countermeasures against loneliness and isolation^*13. This minister leads meetings of the Council for the Promotion of Measures against Loneliness and Isolation, and based on the recommendations and discussions of the experts present, many measures have been put into practice^*14 (Figure 1).

However, in Japan, in addition to the aging population, there are many factors driving the increase in social isolation, such as the depopulation of rural areas, urban concentration, problems in disaster-stricken areas, bullying, and harassment in the home and workplace. As such, it is difficult to take sweeping measures. Moreover, the lonelier a person feels, the less likely they are to seek support voluntarily^*15, making it difficult for them to receive support from outside.

In response, the Council stated that: "We need more places where people can talk casually. [...] People need to be able to connect naturally, rather than being told to go somewhere because they have a particular issue^*15. The idea of needing places where people can gather has been brought up overseas too, leading to the development of places designed to stregthen the social connections between people in a given area. Examples include designing riverbanks to also serve as parks, or redesigning libraries as places where local community networks can form^*16. Such community connections can have a tremendous impact in overcoming emergency situations like natural disasters^*16,17.

Here are what I believe to be the hints for solving the problem of loneliness, while also pursuing economic benefits through collaboration between the public and private sectors. A previous Cabinet Office survey suggested that while young people tend to feel lonely and many of them have no one to talk to, there are also many people who actively want to help those around them^*18. By creating a framework that allows young people to connect with each other naturally, there is the potential for them to move toward solving problems on their own.

To alleviate the sense of loneliness among Japanese people, whether led by the government or private entities, it is necessary to consider efficient measures within the constraints of limited resources while also ensuring approaches that are in tune with the needs of each community and individual. That is precisely the kind of work that empathetic humans should do and that AI cannot easily imitate.