From Social Isolation to Connection: A Prescription for Health and Wellness

Abstract

Social isolation and loneliness are a public health crisis—nearly half of U.S. adults report feeling lonely, yet most don’t recognize it as a serious issue—impacting people across communities and generations. The impact on physical and mental health is overwhelming. This paper is a glimpse into this problem, and provides an overview of how to approach conversations as a health care professional, highlighting the role of a pharmacist. This expanded role also aligns with lifestyle medicine principles, where the focus shifts from disease treatment to wellness promotion. In this framework, pharmacists act as health coaches, community educators, and system-level innovators.

“Social prescribing is a holistic approach to healthcare that encompasses connecting people to community activities, groups, and services.”

Introduction

Social isolation and loneliness are a public health crisis—nearly half of U.S. adults report feeling lonely, yet most don’t recognize it as a serious issue—impacting people across communities and generations. The impact on physical and mental health is overwhelming. Table 1 defines the various words related to social connection and isolation. This paper is a glimpse into this problem, and provides an overview of how to approach conversations as a health care professional, highlighting the role of a pharmacist.

Table 1.

Definitions of Selected Terms Related to Social Health. ¹

Belonging	Basic human need—feeling of deep connection to others, places, and experiences
Loneliness	Subjective feeling due to perceived isolation or lack of meaningful connections; a discrepancy between preferred and actual experiences
Social connection	Relationships and interactions a person has with others—components include structure, function, and quality
Social infrastructure	Programs and physical elements of a community that support social connection
Social isolation	Limited number of social relationships, group affiliations, and rare social interactions
Solitude	State of being alone, by choice, where one does not feel lonely

Evidence of the Impact of Social Connection on Health

Social isolation and loneliness are a growing public health issue, with nearly half of U.S. adults reporting loneliness, affecting health as much as smoking, diabetes, and obesity. Despite its prevalence, less than 20% of those affected with loneliness or social isolation see it as a major problem. This is impacting younger and older populations. Lack of social connection significantly harms health, increasing the risk of premature death by up to 29% and heightening risks for heart disease, stroke, anxiety, depression, and dementia. Social isolation makes people more susceptible to illness. It has major economic costs, including a $6.7 billion in Medicare spending and workplace absenteeism resulting in $154 billion. Loneliness affects individuals’ health, academic performance, and productivity, while also impacting community well-being and resilience. ¹

Challenges in the Age of Technology

Technology can be a double edge sword for social connection. On one hand, there can be increased accessibility to social networks, reduced barriers to communication, and educational or social engagement. It allows people to connect with others that may not live geographically close, and connect with groups that are more difficult to find in person. On the other hand, sometimes these interactions can be superficial, may make people feel more disconnected or lonely, and the access or knowing how to use technology may be limited. One study evaluating young adults and social media use, it was found that people with higher social media use seem to feel more socially isolated than those with lower social media use; however, reasons were not elucidated. ²

As people age, their social networks shrink, and older adults are more prone to loneliness and isolation. In one study that evaluated mobile technology for adaptive aging, information and communication technologies (ICTs) offer potential to enhance social connections, but their effectiveness varies based on factors like access, education, and social resources. Research on ICT use in older populations is limited, with disparities across demographics and mixed results on benefits. While technology may provide one way to address the increase social isolation as people age, future studies need to focus on expanding access, understanding the role in aging, and exploring low-cost solutions for improving social connectivity. ³

In general, across generations, technology is incorporated to help with social isolation and connection, however, it may also be harmful. It should be leveraged as one tool in the toolbox with consideration to its challenges.

Social Prescribing

Social prescribing is a holistic approach to healthcare that encompasses connecting people to community activities, groups, and services. The World Health Organization (WHO) in the Western Pacific recognizes social prescribing as being a vital tool to achieve health and non-health service integration and has created a course on this topic.^4,5

This is a key practice adopted in several countries, but it is not yet widely implemented in the United States. In England, there is a social prescribing link worker that provides individualized support to people in creating personalized care and support plans as well as providing support to organizations in the community to be sustainable and accessible. Another example is in Canada, where health equity is a cornerstone of effective social prescribing to ensure barriers are removed for people to be access programs and experiences. ⁶ In the US, some organizations are practicing social prescribing or researching its implementation; many individual healthcare providers are also incorporating it into their practices.

Studies in pharmacists have been done in countries where social prescribing is prevalent. One study explores social prescribing competence among Norwegian community pharmacists and students, revealing limited knowledge but strong enthusiasm for development. The findings highlight the need for education and further research to enhance social prescribing knowledge and engagement in primary healthcare. ⁷ Another study explores stakeholder perspectives on involving community pharmacists in social prescribing pathways for mild to moderate depression and anxiety. The findings include the potential of the pharmacist being an accessible and able to provide non-pharmacological alternatives to antidepressants. This paper also emphasizes the need for proper training, funding, and support to integrate pharmacists effectively into primary care services. ⁸ A meta-analysis that included 6 studies explored the involvement of community pharmacy in social prescribing, highlighting its role in non-clinical interventions, referrals, and service delivery, particularly for people with higher medical needs. While the evidence is limited, the findings suggest potential benefits for patients and showed the need for further research. ⁹

Scales to Assess Loneliness

There are several different scales that are utilized to assess social isolation and loneliness. Some scales are utilized more in research, while others may be conducive to use in clinical practice. Differences among scales include: length (number of questions), language (positive or negative wording), initial development purpose (research or service use), and whether they directly ask about loneliness or approach it indirectly. Each scale has its strengths and limitations based on these factors. Examples of scales utilized include: Revised UCLA Loneliness Scale (16 items), Three Item UCLA Loneliness Scale (3 items), Berkman-Syme Social Network Index, Steptoe Social Isolation Index, Duke Social Support Scale, Lubben Social Network Scale, de Jong Gierveld Loneliness Scale, Cornwell Perceived Isolation Scale, and Campaign to End Loneliness (3 item). While it may not be possible to use these scales in every patient encounter, finding familiarity with these assessment tools, findings way to bring it to practice, can assist with evaluating loneliness and recommending interventions.^10,11

6 Key Approaches to Promote Social Connection: The Role of the Pharmacist

• (1) Pharmacists are trusted by the community and have personal connections with their patients. Tap into that connection to further personalize interactions—be aware of nonverbal cues, verbal things patients share, and ask questions directly.

• (2) Assess social isolation and social connection: Having a tool like the UCLA Loneliness Scale offers an objective way, depending on your practice site. Otherwise, similar questions can be asked, both directly and indirectly.

• (3) Education: Prefacing why these questions are being asked and why recommendations are being given is important. People don’t always recognize the role social connection plays in their health and wellness—so explaining the “why” matters.

• (4) Resources: Learn about resources in your community. Ask yourself: Are there social workers or other healthcare providers patients could be referred to? What community centers—senior centers, libraries, etc.—are available? Often, these places can further assess and connect people to groups and activities.

• (5) Recommendations: As with any health behavior change, ensure changes are attainable. Identifying one or two ways to incorporate social connections is key. It may start with attending one community center program this week or calling one friend. For those just beginning, using the SMART approach—Specific, Measurable, Achievable, Relevant, Time-bound—can boost self-efficacy. Additionally, 2) consider the “FITT” prescription—Frequency, Intensity, Time, and Type—of social connection, analogous to physical activity prescriptions.

• (6) Reflect inward: This isn’t just about patients—healthcare professionals, and people in general, may experience social isolation or loneliness. It’s easy to get caught up in daily life and forget this pillar. Finding ways to incorporate social wellness in your own life is essential.

Conclusion

Social health cannot be ignored and as it is not an obvious pillar that is often discussed, bringing awareness is vital. Pharmacists play an important role in helping themselves and patients understand this pillar, evaluate loneliness and social connection, access community resources that support their health. In addition to managing medications, they ensure that prescriptions do not interfere with participation in activities that promote well-being, such as social groups or physical exercise. As trusted healthcare providers, pharmacists often have these personal relationships with their patients. With this insight, they are able to have conversations about the connection between social health and overall well-being. Pharmacists can then provide recommendations and referrals to appropriate resources, such as support networks, social activities, or wellness programs, helping patients make the link between social connection and improved health outcomes. This expanded role also aligns with lifestyle medicine principles, where the focus shifts from disease treatment to wellness promotion. In this framework, pharmacists act as health coaches, community educators, and system-level innovators.