Is Loneliness an Undervalued Pathway between Socio-Economic Disadvantage and Health?

Abstract

Loneliness is a growing public health issue. It is more common in disadvantaged groups and has been associated with a range of poor health outcomes. Loneliness may also form an independent pathway between socio-economic disadvantage and poor health. Therefore, the aim of this study was to explore the contribution of loneliness to socio-economic health inequalities. These contributions were studied in a Dutch national sample (n = 445,748 adults (≥19 y.o.)) in Poisson and logistic regression models, controlling for age, gender, marital status, migration background, BMI, alcohol consumption, smoking, and physical activity. Loneliness explained 21% of socioeconomic health inequalities between the lowest and highest socio-economic groups in self-reported chronic disease prevalence, 27% in poorer self-rated health, and 51% in psychological distress. Subgroup analyses revealed that for young adults, loneliness had a larger contribution to socioeconomic gaps in self-rated health (37%) than in 80+-year-olds (16%). Our findings suggest that loneliness may be a social determinant of health, contributing to the socioeconomic health gap independently of well-documented factors such as lifestyles and demographics, in particular for young adults. Public health policies targeting socioeconomic health inequalities could benefit from integrating loneliness into their policies, especially for young adults.

Changing the narrative: Loneliness as a social justice issue

“…In addition, while many authors include only basic needs in this definition, others have argued for the importance of considering multiple aspects of well‐being, including social needs (Faden & Powers, 2008). Consistent with this view, scholars have advocated for individuals to have the right not to be lonely (Lederman, 2023; Meisters, Putrik, et al., 2021) with some defending loneliness as a moral injustice (Brownlee, 2020) and a breach of human rights (Brownlee, 2013). Social justice is not merely a philosophical or theoretical principle operating at a high level.…”

Lost Connections: Why the Growing Crisis of Loneliness Matters for Planetary Health

“…As just one example, food insecurity is associated with significantly higher odds of loneliness in youth [42]. At the same time, loneliness is also a distinct social determinant of health, which suggests that measures addressing loneliness have the potential to reduce socioeconomic health inequalities [43]. For now, evidence-informed interventions aimed at reducing loneliness at larger community scales remain limited [44].…”

Selected Research Issues of Urban Public Health

“…Community characteristics of neighborhoods, their importance for physical and mental health of the inhabitants, and the creation of mixed communities are among the approaches to health-promoting urban development [128][129][130][131]. In neighborhoods with weak social cohesion, high levels of violence, and lack of safety, residents are more likely to experience health risks such as sleep deprivation, depression, lack of physical activity, or use of addictive substances [132][133][134][135][136]. Social cohesion thus represents a relevant attribute for health-promoting neighborhoods [135].…”

“…Social cohesion in neighborhoods is closely linked to the built environment and to issues such as mobility and infrastructure as connecting or dividing elements (e.g., intimidating spaces: poorly planned and abandoned places, underpasses, heavily travelled roads). However, associations between social cohesion, health, and urban environments deserve more interdisciplinary research attention [136].…”