We know loneliness is a big problem. What we do not know is just how big: Christopher Mikton

Recognising loneliness as a pressing health threat, the World Health Organization (WHO) announced a new Commission on Social Connection in November 2023. The Commission, supported by a Secretariat based at WHO, held its first leadership-level meeting in December 2023.

Down To Earth spoke with Christopher Mikton, Technical Officer at WHO and a part of the Secretariat, to understand what the Commission plans to achieve, the progress made so far, and their efforts to set up a global index that measures loneliness.

Rohini Krishnamurthy (RK): What was the idea behind establishing a Commission on social connection?

 

Christopher Mikton (CM): There are several reasons. One is the emerging evidence. There has been a sharp increase in the scientific data on the link between loneliness and its health impacts on mortality, morbidity, and the like in the last 15 years or so.

Another one is the COVID-19 pandemic. Social distancing measures meant people were at home. This brought home to many people just how important social connections are and how much of an issue loneliness can be for not only older people but for all age groups.

The third reason is the advent of social media. People are worried about the mental health effects of social media: Is social media increasing loneliness, or it is allowing people to connect? There is a whole debate on this.

The fourth reason for WHO is that more and more countries, mainly high-income ones like the United Kingdom and Japan, have started addressing this issue at the national level. Other countries have been developing policies. So, this issue was raising the public health and public policy agenda.

We started taking an interest in loneliness through older people. Three years ago or so, we realised this is an issue in all groups across all countries worldwide. So, we broadened our scope to something that’s much more global and across all age groups.

RK: What are some of the gaps you have identified in the available research on understanding the scale of loneliness across the globe?

CM: When it comes to the scale of the problem, there’s a fair bit of research. We have data from many countries. Recently, there was a survey done by Gallup and Meta that covered 142 countries. There’ve been other multi-country surveys et cetera. We’re trying to put them all together at the moment.

Though we have data, there are gaps. The problem is that different countries do not often use comparable measures. We do not know if we can compare data. One might say the prevalence is 25 per cent and the other might say 10 per cent. So the question is whether the difference is because the measures used are different or was it because the sample was different?

Thus, we need a kind of standardised, valid measure that’s used consistently in many countries so we can start comparing things. And we can see if the different policies and interventions that are being implemented are having an impact in driving things down.

We also don’t have good data on time trends — whether the rates are increasing or decreasing in different countries. So, we need better and more consistent measures that can be applied repeatedly over time to get a better sense of whether this issue is increasing or decreasing. People talk about an increase but there are also indications that it is going down in some countries.

For now, we know loneliness is a big problem. Just how big exactly and the extent to which we can compare it — that’s more problematic at this point.

The other issue is that most studies have been conducted in high-income countries. Most data is available for older people. There are far fewer studies in low- and middle-income countries as well as in youth, especially very young people. We think this is a big impediment to our understanding of the scale of the problem.

RK: The WHO called loneliness a ‘pressing health threat’. What sort of changes do you expect to see in how loneliness is treated?

CM: The idea is to make people, policymakers, healthcare workers, doctors, psychologists, and others aware that loneliness is an issue. It is widespread and has very serious consequences for mortality, physical health, cardiovascular disease, strokes, mental health, suicide, depression, dementia, and the like.

We also want to give stakeholders some sense of what they can do about it and how they can reduce the rates of loneliness.

To do this, we have identified hundreds of studies evaluating several interventions to identify those that work best. Many interventions are psychological interventions like cognitive behavioural therapy. Others are community-level like cooking groups, gardening groups, or physical exercise groups. We have to do this over the next few years with the help of the Commission and also help policymakers prioritise this issue.

Read That lonely feeling

RK: There was a leadership-level meeting in December last year. What was discussed there?

CM: It was the first meeting of the 11 Commissioners, which included ministers from some countries and civil society. They act as the political face of the Commission and will provide a strategic direction to it.

This Commission is made up of the Commissioners, the WHO Secretariat, and a technical advisory group of 20 foremost experts on this topic around the world. We have got people from every region of the world who will advise us.

At the meeting, we tried to agree on a vision for the Commission and identified three aims. The first is to increase the visibility and political priority of this issue. The second is to reposition this issue as a truly global and genuine public health problem, and not just a public health problem that affects high-income countries or old people. It affects all age groups and affects all countries around the world. The third one is to try to identify and accelerate solutions that can be scaled up.

The Commission also agreed on a programme of work for its three-year duration. The first item in this programme of work will be developing a Commission report, which will summarise the evidence and make the case for devoting more attention to loneliness. It will also lay out an agenda for action for the next decade or so.

We have also discussed the possibility of creating some kind of global index on social connection so we can measure it better. We also talked about the kind of advocacy activities the Commission can engage in.

RK: The first Commission report is expected to come out in 2025. What will it cover?

CM: I think it will do three things. One is to summarise what is known. The second is to devote more attention to parts flagged by our summary. Third, it will lay out an agenda of action for countries for the next 10 years. We might have other publications and release the global index to measure loneliness as well.

RK: There have been issues raised that the current loneliness assessment tools cannot be applied across the globe due to differences in language and culture. For example, certain languages do not have a word to describe loneliness. How is WHO planning to address these concerns while developing the global index?

CM: To develop the global index, we will work across different countries and cultures. The idea is to develop a survey of representative samples in as many countries as possible using a cross-culturally valid instrument to get a sense of the rate of loneliness, social isolation, and maybe social connection as well.

WHO is a global organisation and we are going to make a concerted effort to ensure that this global index is cross-culturally valid to make sure that it works in all countries or as many countries.

The global index will draw on existing instruments. We have only just started working on this. It is all exploratory at this point. For the development, and maybe with the implementation of this global index, we may partner with other organisations.

RK: As for interventions, do we know enough about what works?

CM: There has been a real explosion of evidence in the last few years. We are planning to bring it all together and try to derive clear recommendations for what countries should do. Should they be using technological interventions like Artificial Intelligence dolls, cooking classes, cognitive behavioural therapy, or all of them? We need clear recommendations. So that’s one thing we’re going to do.

For now, the most evidence of effectiveness is available for psychological interventions like cognitive behavioural therapy, social skills training, some things like mindfulness-based therapy, and the like.

And there is pretty good evidence that they work. What we’re lacking is two things. One is on evidence of more community- and societal-level interventions. The other is a synthesis of all evidence. The vast majority of these interventions were only implemented these last few years. We need to bring them together, learn lessons from them, and identify what is missing.

RK: Recently, South Korea launched AI dolls to help people with loneliness. How effective are such interventions? Such technologies have also raised concerns over data privacy and security. How can they be addressed?

CM: There has been work on robot pets and using Zoom or other technologies to connect people. There has been a real increase in their use, especially after COVID-19. There’s evidence that some of them work.

When it comes to privacy concerns, these are important issues. But each country has its own legislation and ways of dealing with them. It is not really for us to comment on what every country should do.

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