What should we do to stay healthy and live a long life? I’m sure most of you can list all the ‘dos and don’ts’ just like that: don’t smoke, drink less, exercise regularly, eat healthily and get enough sleep.
But how many of you mentioned the dangers of loneliness?
Loneliness isn’t just a wishy-washy side note that makes people more prone to being depressed. It’s a silent killer that’s claiming the lives of many thousands of Britons every year.
Last week, new figures from the British Heart Foundation showing that premature deaths from heart disease had risen made front-page news.
There was general shock that the number of people in England who died of cardiovascular conditions, such as heart attack and stroke, was the highest annual total since 2008.
Now, clearly, there are a number of factors at play here — experts pointed to waiting lists and the Covid effect. But this trend had started before Covid and, significantly to my mind, it coincides with a rise in people reporting they are lonely (with nearly four million in the UK saying they are chronically lonely).
Loneliness was something that was hardly ever discussed when I was at medical school, but it’s now widely acknowledged we have to tackle it if we’re to improve people’s health.
Cup of cheer: Taking part in a regular coffee morning or other social activities can help to combat feelings of loneliness and keep people healthy, research has found
Modern medicine is geared up to help patients when they become ill — but what we often fail to do is treat the underlying reasons for why patients become ill and ‘fall over’ in the first place. And that’s where loneliness comes in.
I see its effect on a day-to-day basis, in my work in A&E — regularly treating patients who’ve had a stroke or heart attack soon after retirement.
I remember one particular case vividly: a mechanic in his early 60s who hadn’t lived the healthiest of lives — smoking and having a daily fry-up with his colleagues, and without a spouse to keep on at him about his expanding waistline and alcohol intake.
But he was happy — he bantered with his work colleagues and often went out with them in the evenings. However, after he retired, he lost his social connections.
On the face of it, he became healthier: he wasn’t going out in the evenings so his alcohol intake fell, and he had fewer fry-ups.
And without the social pressure of his colleagues smoking, he gave that up, too. But he was lonely — very, very lonely.
One morning, three months after his retirement, he suddenly couldn’t move his right arm and couldn’t get his words out.
He managed to knock on his neighbour’s door, and they called an ambulance.
In A&E, the diagnosis was obvious — he’d had a major stroke.
Despite treatment, he never regained the use of his arm or his speech. He went from being an expert mechanic to a nursing home resident in a year.
The retirement effect was not just a coincidence.
In 2012 a study by public health experts at Harvard Medical School in the U.S., involving more than 5,000 people aged over 50, revealed that being retired was associated with a 40 per cent higher risk of having a stroke or heart attack compared with people who were still working. Was post-work loneliness to blame? There is a lot of good data to show that this is the case.
In a major review, published in the journal Heart in 2016, researchers at York University looked at the data from 23 papers (with more than 35,000 participants). They found that loneliness led to a 29 per cent increase in the risk of a heart attack and a 33 per cent increased risk of a stroke.
More recently a study in Lancet Public Health last year showed that those who were lonely had a 12 per cent higher chance of being admitted to hospital with an infection than those who were not lonely.
Last year the World Health Organisation declared loneliness a pressing global health threat, with the U.S. surgeon general saying that its effects were comparable with smoking 15 cigarettes a day, and greater than either obesity or lack of exercise. And loneliness is spreading, thanks to the lockdowns and a change in social norms created after Covid, with the rise in working from home and binge-watching box sets on days off rather than working in groups and socialising.
The mechanism for how loneliness increases the risk of premature death is incredibly complex but, essentially, it triggers our stress response, leading to increases in blood pressure.
This stress response also affects chemicals in the body, called cytokines, which cause inflammation, a known cause of premature ageing.
In my mind the evidence linking loneliness to poor health is very powerful.
But the evidence we have is from observational studies, where you monitor a factor, such as loneliness, and see the impact further down the line (for example, on death rates).
And others in the medical profession are less convinced by the evidence linking loneliness and illness, with the argument that the correlation could just be a coincidence.
No one to talk to: Loneliness is a silent killer that is responsible for the deaths of many thousands of Britons every year because it can lead to heart disease and strokes
The only way you can actually prove that loneliness causes medical problems is through a type of trial called a randomised controlled study, where one group of patients gets a treatment and another gets a placebo and you see the impact.
It works well when you are testing drugs, for example. However, it’s much more difficult to do this type of trial on something as complex as preventing loneliness.
More importantly, it’s much far harder to fund this type of trial as there’s no profit for drug companies. So the evidence base, in terms of randomised controlled studies, for tackling loneliness is not as strong as it could be.
However, the proof that addressing it has an impact on health is mounting up.
A few weeks ago I met with Jeremy Welch, a GP and senior partner at the Mythe Medical Practice in Tewkesbury, on the edge of the Cotswolds.
He is a passionate believer in the importance of social interactions on people’s health and was especially worried about what was happening to his patients post-lockdowns.
He managed to persuade colleagues to use some of their available ‘medical’ budget in a unique way — by getting all their patients aged over 65 who were lonely to engage in social activities to see if this could improve their health.
He appointed Anne Williams as lead nurse for the health and wellbeing team; they contacted 10,000 patients over 65, getting them to fill in a survey to find out if they were lonely.
Those who said they were (a third of the people surveyed) were invited to join a weekly exercise programme for three months arranged by Anne’s team and all in local community settings. The first six sessions were free — after this, each session cost £3.
In the first year, there were more than 10,000 attendances at these classes, with the key factor being people met for tea and coffee after, and then, those who wanted it, were given information on other social activities available in the area, such as gardening clubs, dance clubs and choirs.
After this intervention, there was a 13.6 per cent reduction in the GP appointments for this group of patients. This compared with an 8.6 per cent rise in GP appointments in similar people in a neighbouring town. It’s too early to see the impact on rates of stroke and heart attack, but I have no doubt it will be positive.
This type of medicine — holistic, and tackling potential problems before they occur — is the key to improving our patients’ outcomes and stopping the NHS imploding from unsustainable demand.
‘It’s just common sense,’ Jeremy told me. ‘Ask any of your grandparents . . . a stitch in time saves nine.’