Don't drink too much. Quit smoking, Be physically active. Although many people may not follow these rules, they are well aware of how crucial they are to health. But when was the last time your doctor asked how many close friends you have? If you participate in social activities? If you experience periods of loneliness and feelings of isolation?
Although it may not be a routine part of a check-up, the quality of our social connections can have a major impact on our health. People who experience long periods of loneliness have been found to develop serious health problems, including cardiovascular disease, dementia and decreased mobility, at much higher rates than people who don't feel isolated. A major review of research into the effects of social disconnectedness on health, published in the journal PLOS Medicine in 2010, declared loneliness is just as dangerous to health as smoking and takes an even greater toll than obesity or physical inactivity.
There are growing concerns about the effects of loneliness on health as more Canadians live alone, potentially making some vulnerable to social isolation. For the first time, singleton households outnumber those consisting of couples with children, according to census figures released last year. Loneliness is often dismissed as a minor social issue that only affects a segment of the elderly population. But as it turns out, it's a far larger issue.
"I think we've underestimated the importance of the social milieu just as fish underestimate the importance of water," said John Cacioppo, director of the Center for Cognitive and Social Neuroscience at the University of Chicago.
How can a human emotion have such a powerful hold over physical health?
Researchers don't yet have a complete understanding of the relationship, but they say prolonged feelings of loneliness or isolation can cause hormonal, genetic and other changes that may contribute to the risk of developing health problems. Scientists have also discovered that social isolation actually changes the way our brains function. For example, a recent experiment involving Romanian orphans showed that children raised in an institutional environment that was notorious for neglect had significantly less grey and white brain matter and far less electrical signalling than those raised in foster care.
"We're a social species and if you don't have others around you [that] you can trust …your brain effectively knows it's on the social perimeter," said Cacioppo. "All social species, when they're on the perimeter, they're at risk."
Cacioppo, whose groundbreaking research discovered, among other things, that lonely people are more likely to develop vascular resistance, a prime risk factor for high blood pressure, said the health effects are extremely complex and likely developed as an evolutionary response. When we're cut off from social networks, we suffer more frequent sleep disturbances and have higher stress levels as the brain goes into a high alert, protective mode, he says.
Britain is emerging as a leader in addressing social isolation on a population-wide level. Its government announced in November plans to map the incidence of loneliness across the country in order to develop strategies for what Health Minister Jeremy Hunt described as an urgent issue.
Of course, the relationship between loneliness and ill health is more complex than the number of people who sleep under one roof. Being alone doesn't lead to health problems. But when people feel disconnected and cut off from the world, it's a different story. Although living alone may put some individuals at greater risk of experiencing those feelings, research shows that people who live with others can also feel isolated.
"Living alone doesn't mean people are lonely," said Carsten Wrosch, professor in the department of psychology in the Centre for Research in Human Development at Concordia University in Montreal.
A study published last year in the JAMA Internal Medicine journal found people over 60 who felt lonely were more likely to experience functional decline and death than those who weren't, regardless of whether they lived alone.
"Simply solving the issue by placing people living with others is not going to single-handedly remove the adverse health effects," said Emily Bucholz, a Yale University PhD candidate who co-authored a commentary on social isolation and health.
One of the biggest challenges in developing comprehensive strategies that help socially isolated people develop meaningful connections is the fact that few people want to talk about it.
"People would far rather have some awful diagnosis than just admit they were lonely," said Jacqueline Olds, clinical professor of psychiatry at Harvard Medical School who co-authored The Lonely American: Drifting Apart in the Twenty-First Century. "Almost anything would be preferable to saying, 'I'm just as lonely as can be.'"
If governments put a greater focus on the potentially devastating consequences of social isolation, it would be a major step to helping those in need, she said. In the meantime, there are groups working to reach those who would otherwise fall through the cracks.
The Langley Senior Resources Society has established several programs to encourage seniors to create and maintain social networks. Volunteer drivers are on hand to take seniors shopping or to do home visits with those who aren't comfortable venturing out. They also have a "telephone buddy" system that connects trained senior volunteers with socially isolated elderly individuals.
The B.C. centre also recently ran a series of workshops on "Letting Go of Loneliness." The workshops focused on helping elderly individuals accept that while they may never replace the lifelong friends and partners who have died, they can still create new relationships. The response to the programs has been overwhelmingly positive, says Janice McTaggart, director of outreach and volunteer services.
"When you have other things to think about and other things to talk about, you don't dwell on your issues quite as much," she said. "Lots of people that come to the centre here tell us we saved their lives."