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There is said to be a war on obesity, a war on smoking, a war on alcoholism, but where is the war on social isolation, friendlessness and hostile relationships? According to a review of nearly 150 studies of more than 300,000 people, mostly in North America and Western Europe, poor social relationships are as big a contributor to early death (not including suicides) as smoking 15 cigarettes a day or having more than six drinks a day. They are twice as deadly as obesity, says the review by Julianne Holt-Lunstead, a psychologist at Brigham Young University in Provo, Utah.

People do not necessarily die of loneliness, but they are more susceptible to disease, including heart disease, cancer and HIV/AIDS, for reasons that may be in part biological (loneliness weakens immune systems) and in part because they are less likely to take up healthy habits. Good friends act as a buffer against disease.

Decades ago, infants in orphanages died at an alarming rate, no matter what their initial state of health or the quality of medical care they received. "Lack of human contact predicted mortality," Prof. Holt-Lunstead writes. The point seems obvious, at least today, but "the medical profession was stunned to learn that infants would die without social interaction." Practices in custodial care changed, and more babies survived; Prof. Holt-Lunstead wonders what might be done with greater recognition of the importance of social relationships to health.

There is no easy prescription, but in light of the review's findings the public schools deserve support and funding for their efforts to teach conflict resolution, co-operation with others and the ability to work in groups. Volunteer mentorship programs should be encouraged. The findings also suggest that the current obsession with obesity could be counterproductive if, however unintentionally, it shames heavy people and alienates them from others.

Psychiatrist George Vaillant of Harvard University spent decades tracking the lives reflected in the Grant study, which followed a group of seemingly well adjusted "Harvard men" from the early 1940s until today. Ultimately their lives were little different from those of less privileged people. Some became alcoholics. Some suffered from mental illness. Some were happy and fulfilled. "The only thing that really matters in life are your relationships to other people," Dr. Vaillant says.

Feeling cared for and loved is as important to health as exercising, quitting smoking and not drinking to excess. There's a public-health campaign in there somewhere.

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