Freakonomics Radio - 407. Is There Really a “Loneliness Epidemic”?

Episode Date: February 27, 2020

That’s what some health officials are saying, but the data aren’t so clear. We look into what’s known (and not known) about the prevalence and effects of loneliness — including the possible upsides.

So, Eric, when you read an article that says, you know, more than half of all Americans say they regularly experience X emotion or only 12 percent of Americans feel such and such. What is that experience like for you as a sociologist? Right. So about half the time I think, wow, that's pretty interesting. And about half the time I'm pulling out my hair thinking, no, don't say that. Eric Kleinenberg is a professor of sociology at New York University. Unfortunately, what I find is that journalistic reporting will use survey data when it's useful for the story, and they kind of don't care that much about whether the data underlying it is reliable. And what's wrong with survey data? A lot of survey data is based on a sample that's

not really worth generalizing from. A lot of surveys ask questions that will work for a particular time and place, but might not work very well after that, which means you can get a snapshot of a moment in time, but not really a dynamic portrait of something over time. Would you like an example of how survey data gets used in the media? Okay, here's an example. A top doctor calls it a national health crisis, not obesity or heart disease.

A condition that is so common, you actually may not think of it as a mental health problem. Loneliness. That's right. Loneliness. People who struggle with loneliness end up living shorter lives. And they also are at increased risk for heart disease, depression, dementia, anxiety, and a host of other conditions. And that is the top doctor who rang the alarm on what he calls the loneliness

epidemic. My name is Vivek Murthy, and I was trained as an internal medicine physician. I recently served as Surgeon General of the United States. Murthy is the author of a forthcoming book about loneliness. It's called Together. Well, if you had told me several years ago that I would be talking about and thinking about loneliness, I would have said you were probably wrong. When he was Surgeon General, Murti met with many people suffering from chronic illness and addiction. But I found that behind many of those stories were stories of a deeper emotional pain, and that pain was often manifest as loneliness.

And I realized that there's something very important happening here, which is that people all across the world are experiencing a sense of disconnection from the people in their community, from the more abstract society that they're supposedly part of. I became curious about why that was, about what its consequences were for their health. These consequences are said to be dire, perhaps best evidenced by one jarring statistic that made its way through the media. Loneliness.

It turns out it is a strong predictor of early death, maybe as much as alcoholism and smoking 15 cigarettes. 15 cigarettes. 15 cigarettes a day. Today on Freakonomics Radio, how real is the loneliness epidemic and is it really that risky? Are there any upsides to loneliness and are there any solutions to it? That's coming up right after this. From Stitcher and Dubner Productions, this is Freakonomics Radio, the podcast that explores the hidden side of everything.

Here's your host, Stephen Dubner. Tracy Crouch is a member of Parliament in the UK. I've been an MP since 2010. And also... I was formerly the world's first loneliness minister. Why did the UK feel compelled to have a loneliness minister? Loneliness shows no prejudice. It doesn't matter who you are, how successful you are, how rich you are, where you live in the country, whether you work, whether you don't work. The simple truth is loneliness can hit at any given time.

And why should loneliness be the government's concern? Because it's actually something that can have an enormous public health consequence. I think we are in loneliness where we were with mental health a decade ago. People didn't talk about poor mental health, whereas now we are removing the stigma around mental health, and that means that we can tackle some of the issues relating to mental health. And that was very much the same with loneliness. It's about removing the stigma of being lonely and thinking, well, how can we ensure that people stay connected to society? The very idea of a loneliness minister struck some people as comical.

This is so British. The American comic Stephen Colbert, for instance. They've identified the most ineffable human problem and come up with the most cold bureaucratic solution. But Tracy Crouch didn't mind. I actually thought that it was a really good opportunity to get the message out there that we in the United Kingdom recognize that the issue of loneliness is something that is serious. And that was recognized, actually, by the number of countries who got in touch with us to come and talk about how they, too, could tackle loneliness.

And that included, by the way, the former chief medical officer from the United States. That former chief medical officer being Vivek Murthy. That's right. Yes. Murthy had found compelling the argument that loneliness was increasing and that loneliness can be damaging, even physiologically damaging. The mechanisms for how it works and for how it impacts our lives, I think, are still in the very early stages of being understood. And so we have a lot of data that shows strong associations between loneliness and health outcomes, including shortened lifespans and conditions like heart disease. What we have far less of are the kind of studies that, beyond the shadow of a doubt, prove causation. But when stories about loneliness hit the media, that doubt tends to

be glossed over. Consider the much-reported story equating loneliness and smoking. Researchers say suffering through it can be as lethal as smoking 15 cigarettes a day. That statistic is often cited, so let me give you a little background of where that came from. That is Julianne Holt-Lunstad. And I am a professor of psychology and neuroscience at Brigham Young University. Holt-Lunstad was the lead author of a 2010 paper where that 15 cigarettes a day comparison came from. She and her co-authors did what's called a meta-analysis, rolling up nearly 150 earlier studies that covered more than 300,000 research subjects.

And so this meta-analysis really wanted to look at the overall effect of being socially connected or lacking social connections on overall risk for premature mortality. Some measures of social connection are objective. Marital status, for instance, or network size, or whether you live alone. And others are more subjective, like feelings of loneliness. Yeah, so it's good to define loneliness up front because I think it's used very loosely and can often be used interchangeably with social isolation and other related terms. So how does her field define loneliness? Loneliness has been defined as that subjective discrepancy between our actual level of social connection and our desired level of connection. Okay, that's a pretty concrete definition and maybe not what you or I might typically consider loneliness. Let's hear it again.

That subjective discrepancy between our actual level of social connection and our desired level of connection. With that definition, you can see why loneliness may have spiked lately. With the rise of social media, it's easier than ever to see other people doing things that you'd like to be doing, being with people you'd like to be with. But it's also important to know the difference between loneliness and social isolation. And so someone could be objectively isolated and feel lonely, but it's also possible that you could be objectively isolated and not feel lonely. So you may take pleasure in that solitude. And conversely, someone may have many people around them and yet still feel profoundly lonely. Okay. So loneliness and social isolation are not the same thing. And in their meta-analysis, Lundstad and her colleagues looked at whether there was a relationship between

mortality and social connections generally, including loneliness, social isolation, marital status, etc. In other words, how important is social connection to how long you live? The participants in the rolled-up studies were on the older side, average age nearly 64, and they were followed for an average of seven and a half years. So what did Lundstad find? What we found was that those who were more socially connected across these various indicators had a 50% increased odds of survival. And the researchers controlled for sociodemographic differences, as well as a person's initial health status and cause of death. So what that means is that these studies followed

people over time, and they were 50% more likely to be alive at the follow-up than those who lacked social connections or had insufficient social connections. Okay, so that looks to be strong evidence that longevity is at least strongly correlated with social relationships. But you could imagine that the causal relationship isn't so airtight. It could be, for instance, that people with fewer social connections may have other issues, personality or behavioral issues or whatever, that make it harder to maintain social connections may have other issues, personality or behavioral issues or whatever, that make it harder to maintain social connections. And my concern was that by simply just stating the 50% increased odds of survival,

that the general public and to some extent even perhaps the medical community may not necessarily know what to make of that or how to contextualize that. In other words, Holt-Lunstad didn't want to contribute to sensationalized reporting. We are constantly bombarded with the latest health findings, and it's hard to know what to take seriously and what not to take seriously. But she also didn't want her research finding to get lost. So she and her colleagues tried to draw specific numerical parallels between the risk of low social connectivity and more common physiological risks, things like alcohol consumption, obesity, air pollution.

And smoking. Judging by the media's response to the 15 cigarettes a day comparison, the message got through. But the nuance was lost. Oftentimes people will say that loneliness has a greater risk than smoking up to 15 cigarettes per day. And of course, loneliness was one of the indicators, but it wasn't the only indicator. Remember, the researchers looked at a whole basket of social connections, all of which, by the way, can be measured more tangibly than loneliness.

But in the media reports, it was loneliness that stood out. Now, this doesn't necessarily mean that loneliness doesn't create health risks. So how can you tell? Let's start by asking a different question. Where does loneliness come from? So the late John Cassioppo argued that loneliness is a biological drive. Cassioppo was one of the founders of a field called social neuroscience. Much like hunger and thirst are biological drives, so hunger motivates us to seek out food, thirst, you know, to seek out water, that loneliness is a biological drive that motivates us to seek out others. And being around others, Cassiopo argued, was a key to survival. So we gain added resources by being around others. There's protection from predators. There's protection from the elements.

On the flip side then, when we're alone, we have to be more vigilant. And so throughout human history, being around others has in essence been a form of protection and more effective use of effort. So when we are alone, what's happening to us? So this activates regions of the brain that in turn signal our physiology to adapt to these situations to handle whatever situation we're in. Loneliness is our body's cue that we need to get out in the world and participate in social life. That, again, is the NYU sociologist Eric Kleinemberg. So if you experience some loneliness in your life,

that's not necessarily a bad thing. That can be restorative. And it's not something we necessarily want to eliminate because loneliness is what motivates us to reconnect socially. The problem becomes when it becomes chronic. Loneliness places us in a threat state. And that, again, is former Surgeon General Vivek Murthy. And whenever you're in a state of threat,

you are concerned about self-preservation. Murthy believes this is how chronic loneliness can lead to bad health outcomes. The psychological stress of being in an elevated threat state can lead to biological responses like higher blood pressure and inflammation. You might also become hypervigilant about potential dangers like the proverbial man-eating lion lurking in the tall grass of our ancestors' savannah.

And that's good because I want to err on the side of thinking it's a real threat because my survival may depend on it. But in the modern-day world, if you are in an elevated threat state for a prolonged period of time, not only is it exhausting, but that focus on yourself and that greater suspicion, if you will, of people and events around you can actually be a turnoff to other people. It was Morty who, as far as we can tell, first called loneliness an epidemic back in 2017, which would seem to imply that the threat is not only large, but growing quickly. We don't exactly know how quickly loneliness is growing, but what

we do know is that multiple studies have shown that loneliness is incredibly common. So for example, if you look at a study that was published by The Economist a couple of years ago, they would peg the percentage of adults in the United States who are struggling with loneliness as above 20%. The UK is in a similar range, between 20% to 25%. The number of people struggling with loneliness in the United States is in fact greater than the number of adults who have diabetes. It's greater than the number of people who smoke. For this reason, I think it's worth investing more in understanding in greater depth

the consequences of loneliness, who's at greatest risk of loneliness, and most importantly, what we can do to address it. Coming up after the break, yes, let's look into what can be done to address loneliness, but let's also try to figure out if loneliness is really as common as we think. You're listening to Freakonomics Radio. I'm Stephen Dubner. We'll be right back.

Eric Kleinenberg, the NYU sociologist, has come to hold a fairly nuanced and somewhat contrarian view on loneliness. But he didn't start out that way. The story begins in 1995 in Chicago after a terrible heat wave. 739 people died. Kleinenberg was just starting graduate school at Berkeley, but Chicago was his hometown. It is my city. I cared about it. And Chicago, you know, prides itself as being the city of neighborhoods, a city of tight social connections.

And this was such a big puzzle to me. You know, why did so many people in a booming American metropolis in the 1990s die of this heat wave? After his first semester in Berkeley, he went back home. I started digging around, and I looked at all the data and there was this puzzle that the epidemiologist picked up, which is that they had models that would predict how many people would die given certain climate conditions. And the deaths in the heat wave were far higher. The weather didn't explain it. The physiology of people in the city didn't explain it. So I came up with this idea of doing what I called a social autopsy, right? I was going to open up kind of the skin of the city, just like a

doctor doing an autopsy opens up the skin of a body and try to diagnose the organs that broke down. And the first thing I learned is that people died alone in the heat wave because so many people were living alone. That basic fact, he said, was something that people weren't really talking about. The sad thing about a heat death is it's so easily preventable if you're with someone else That basic fact, he said, was something that people weren't really talking about. The sad thing about a heat death is it's so easily preventable if you're with someone else who recognizes it. One of the most, maybe the most important risk factor for dying in the heat wave was living alone. He ultimately wrote a book about the tragedy called Heat Wave. And this theme of people living alone and dying alone was one of many themes in the book. But Kleinenberg knew he had stumbled onto an even bigger idea, and he planned

a new research project. And it was my conviction that what the Heat Wave had uncovered for me is this incredible spike in loneliness, isolation, disconnection. What I thought I was going to discover in this new project was an America that had become so individualistic, so atomized, so disconnected by, you know, the 20th century marketplace, the decline of public institutions that... And even though you haven't used words to say it, the tone of your voice implies that that's a purely negative outcome. The end of everything. I mean, you think it's bad out there, but I was going to show you just how bad it was. We have destroyed social ties. I was down, man. I thought things were falling

apart. And there is a tradition, by the way, in kind of American intellectual life that sees decline, right? That sees, you know, we're bowling alone. It's the fall of public man, you know, the lonely crowd. I do think that the heat wave allowed me to see something that really had not gotten sufficient attention, which is the fact that we have embarked on one of the most significant social changes in the history of our species.

You know, the rise of the one-person household. What I learned in Chicago, which the demographers in my field of our species. You know, the rise of the one-person household. What I learned in Chicago, which the demographers in my field had not really called attention to, which, you know, cultural historians had not paid attention to, but which is an incredible fact about the world, is that for the entire history of our species,

we have lived in groups out of necessity. You know, we needed to protect each other. We needed to get food for each other. We needed to divide labor. And this amazing thing starts to happen in the early 20th century and to really take off in the 1950s, which is that for the first time

in the history of our species, people start to settle down on their own and to live alone for long periods of time. And now we've gotten to the point where in the most kind of affluent societies on earth, there are enormous numbers of people living alone. This makes it sound as if living alone is in some cases a luxury,

or at least a choice, a preference. According to 2018 estimates from the U.S. Census Bureau, 28% of all U.S. households are single households. And that compares to just 9% in 1950. By the way, this could help explain why real estate is so expensive in so many cities. Even if the population isn't growing, there's demand for more units. In Manhattan, 44% of households are single households. This trend is also strong in places like Denmark, Sweden, and Norway.

So I'm not Pollyannish about this. I mean, I really think this is potentially a very big social problem. But if you look at the big picture here, there is something far more interesting at work. What's interesting, Kleinenberg says, is that the choice to live alone does not necessarily create loneliness. Because one of the surprising things I discovered is that there are more people who are living alone than ever before, but actually people who live alone are surprisingly social. They're more likely than people who are married to socialize with their friends, with their neighbors. They are more likely to participate in all kinds

of shared social activities, you know, going to the gym, going to concerts, going to libraries, cafes, things like this. Even Vivek Murthy cautions against equating aloneness with loneliness. I don't think it's as simple as that. I think just because you live alone does not mean that you're consigned to a life of loneliness. just because you live alone does not mean that you're consigned to a life of loneliness. Just because you live alone doesn't mean that you're somehow living an inferior life. People live alone for many different reasons, and a lot of times because they choose to live alone. But I do think, like with all decisions we make in our life, that there are upsides and downsides. And here's the other thing.

Eric Kleinenberg is also convinced that living with someone does not necessarily insulate you from loneliness. I've interviewed many people who had lived with a romantic partner and were now living alone. And they said to me, one after the next, as lonely as I sometimes feel when I'm on my own, There's nothing lonelier than living with the wrong person. There's no feeling more lonely than having a domestic partner with whom one was once intimate, with whom once had a feeling of trust and connection, and coming home and feeling disconnected from that person. So Kleinenberg wrote another book, this one called Going Solo, The Extraordinary Rise and Surprising Appeal of Living Alone. This led him to ask an important and obvious question. How does our current level of loneliness compare to levels of loneliness at other historical moments?

His answer? This is an area where there's all variety of data, all kinds of surveys of different quality. And if you just read journalism, you would have no idea. His favorite example is a commonly cited statistic from the GSS, or General Social Survey, which has been administered by the National Opinion Research Center since 1972. It's a high-quality survey. It's done repeatedly. And there's a famous problem of one year in the GSS where the measure of social isolation went awry. To measure social isolation, the GSS asks people if they have close friends or confidants with whom they can discuss topics of great personal importance.

The reason for this specific but somewhat odd question is that social relationships can be really hard to pin down in a survey, but having no confidant is a pretty specific marker. For some reason, and there's a lot of debate about this, in the 2004 General Social Survey, people reported a much higher incidence of having no confidant. For decades, only about one in 10 people said they had no confidant. In 2004, about one in four respondents said that. And how big a deal is this finding if you happen to be a sociologist? This is a

blockbuster finding in sociology. I mean, if you think about big changes in American social life, like if you go to the demography meetings and someone finds like a 3% shift in fertility, we're high-fiving each other in the hallways, you know, someone's ordered a keg to the hotel room. It wasn't just this shocking finding about no confidants that got a lot of attention. It was the explanation published in an academic paper on the GSS survey for why this was the case. So what's the big thing that happens in our cultural and social life between 1985 and 2004? Internet. The internet, exactly. So how amazing is this story now? The thing that's going to make us better connected than ever before,

the thing that's going to create meaningful social relationships for us, turns out to make us more alone than we've ever been. My favorite thing about the internet is that it is the single best thing to blame anything on. That's right. And it's such a big part of the story of why we're all talking about isolation and loneliness these days. But it turned out there was an issue with this amazing new finding. Well, we're now pretty sure that there's a problem with the data. It was an anomalous result.

Some of the GSS survey data had been miscoded. Many answers that went into the no confidant column should have actually gone into the decline to answer column. So what did the no confidant finding look like on subsequent GSS surveys? We haven't found it on subsequent general social surveys. But what's the truth then? What's the empirical truth about how much, quote, lonelier we are today? So the sad thing is, I don't think we know.

I think it's a mystery. So before I came to the studio today, I wanted to check into, you know, what's the latest? Has there been some survey that's come out recently that I don't know about? Maybe the research is getting better. So I found a study that got a lot of news attention in December of 2018, and it reported that Americans are more than twice as lonely

as we used to be. This study was done by researchers at the University of California, San Diego School of Medicine. And in the first few lines of the article, we read that estimates of America's level of loneliness today vary from 17 to 57% of the population. And one of the big problems we have in the loneliness debate is that our measures of loneliness have varied dramatically over time. When people ask whether there is this epidemic of loneliness... That, again, is the Brigham Young psychologist Julianne Holt-Lunstad. It's a tough question because it's not entirely clear whether this is something that we're finally just recognizing or whether it's something that

is increasing. And part of that problem is because loneliness has not been systematically measured in the population. And various surveys may use different kinds of methodology. So just to give an example, just in 2018, there was the Cigna survey, the BBC survey, and the Kaiser survey that all had different prevalence rates of loneliness in the U.S. And we have worried about loneliness since the rise of industrial society. Since we started moving away from the village and we agglomerated into towns where we didn't know as many of our neighbors, we worried about loneliness. We worried about the loneliness of farmers. We worried about the loneliness of apartment dwellers, of people driving in cars, of people who went to movies, of people who got the telephone instead of going into social life. And so that is by no means to say that loneliness is not a social problem or that we shouldn't worry about people who get isolated. But if you think that's the only part of the story, you're missing something.

I think it's safe to say we have been missing something, especially if we get most of our loneliness news from breathless TV reports and bombastic headlines. But still, even if loneliness isn't growing, as some people suspect it is, even if loneliness is not as damaging as some people believe it is, the fact remains that loneliness, while it may be a useful biological signal, loneliness can also be hurtful. Unwanted social isolation cannot be a good thing. So, let's hear about some solutions. Anyone have any good ideas? Number one, it turns out, is that service, serving other people, is a powerful backdoor, if you will, out of loneliness. That's the former Surgeon General Vivek Murthy. And one of the things that's powerful about

service is that it shifts the focus away from you and on to other people, and it also reaffirms for you that you have value to give and to share with the world. Tracy Crouch, the UK's former loneliness minister, wants to see an increase in what's called social prescribing. So what we found is that one in five doctor's appointments are solely to do with loneliness rather than other medical conditions. So we started using social prescribing in the UK for a whole variety of things, for example, with obesity. So rather than just prescribing people pills that would hopefully suppress appetite, we'd actually get them to do walking clubs or, you know,

light sporting activities. And so now we've rolled out social prescribing. We have link workers in our doctor surgeries that can have a whole list of organizations locally that people can get involved with to effectively try and make sure that they remain connected in society. As for Eric Kleinenberg, he thinks the best loneliness solutions have to do with how communities are conceived and organized. He wants to see better social infrastructure, as he calls it. The gathering places that are public and accessible, you know, like libraries and parks and playgrounds, public transit systems that work well.

This is the idea Kleinenberg plays with in his latest book called Palaces for the People. But also the real investment in public housing and subsidized housing and in shared housing units. There are programs that do kind of like co-op housing for older people. Like one place I went in Stockholm, it's a place called Fadknapen, which definitely is not how it's actually pronounced, but that's how I say it. And on the first floor, there's this big open kitchen and dining room area and if you live in the building, you commit that three nights a month you will contribute to the cooking and cleaning for the collective and every morning everyone in the building can sign in to dinner that night.

You never have to be there, but you always have the option to have a shared meal. I think what this conversation should be opening our eyes to is the sense that there are actually all variety of ways to organize a society. There are all kinds of ways for us to settle, for us to invest in public goods, for us to share or be private. And we are locked into a very narrow band of choices right now. Coming up next time on Freakonomics Radio. Why are so many millennials gravitating towards socialism over capitalism? I say Scandinavia.

You say Venezuela. It's become a political buzzword. But what does socialism actually mean? I personally would not use the word socialist. I find the word socialism in the U.S. context kind of odd, almost anachronistic. Chell, how is it to live in a socialist society?

You don't think about it like that? What we talk about when we talk about socialism, that's next time on Freakonomics Radio. Freakonomics Radio is produced by Stitcher and Dubner Productions. This episode was produced by Daphne Chen. Our staff also includes Allison Craiglow, Greg Rippin, Zach Lipinski, Matt Hickey, Harry Huggins, and Corinne Wallace. We had help this week from James Foster. Our intern is Isabel O'Brien.

Our theme song is Mr. Fortune by the Hitchhikers. All the other music was composed by Luis Guerra. You can get Freakonomics Radio on any podcast app. If you want the entire back catalog, use the Stitcher app or go to Freakonomics.com. We can also be found on Twitter, Facebook, and LinkedIn, or via email at radio at Freakonomics.com. Freakonomics Radio also plays on many NPR stations. So if you live in America, check your local listings. We can also be found on the NPR One app. If you like what we do, please tell your friends. If you don't, tell your enemies. Talk to you later.