Navigating the 'public health epidemic' of loneliness in primary care

Stephanie Tierney is a Researcher in Evidence Synthesis at the Centre for Evidence Based Medicine, University of Oxford, and is part of the SPCR Evidence Synthesis Working Group.

As a child of the 80s, I still recall Margaret Thatcher’s proclamation that “there’s no such thing as society…people must look after themselves first.”

Fast forward 30 years, and social isolation and loneliness have become a major problem in the UK. Coincidence? Possibly. But the consequences of this problem are increasingly being recognised and felt. For example, there is growing evidence to suggest that social isolation and loneliness are associated with negative health outcomes, including higher rates of depression, dementia, obesity, heart disease and death.

The Royal College of General Practitioners (RCGP) have described loneliness as “a public health epidemic”. This feels somewhat ironic in an era when we have more opportunities to connect with people, from a variety of backgrounds and across global locations, through social media. Yet as humans, as social beings, is contact via a keyboard fulfilling enough to address our need for affiliation and belonging? In some cases, finding an online community that one can share with and be part of may be sustaining. However, recent figures from the Office for National Statistics show that 1 in 20 adults in the UK feels lonely ‘always’ or ‘often’.

Given the burden on patients and health and social services, initiatives to tackle this problem are being prioritised. One such initiative is social prescribing, which involves linking patients to local activities, organisations and groups that can offer practical, social or emotional support; it enables people to socialise with those in their community. In the longer term, social prescribing aspires to prevent or manage ill health and to reduce demands on services (e.g. GP appointments). 

At a recent international conference on this topic, following a talk by Dr William Bird, there was much enthusiasm for the promise of social prescribing to combat ‘chronic inflammation’ by reducing loneliness, reconnecting people to their environment, and encouraging them to feel autonomous with a purpose in life. Physical markers of stress were proposed as a means to measure the effectiveness of social prescribing. Other potential benefits were also raised such as happiness, sleep, social functioning and stamina. Yet as Liz Bickerdike and colleagues noted in a systematic review on the topic, we still have much to learn about the mechanisms associated with social prescribing and what works for whom and why.

This is an area that myself and colleagues from the University of Oxford and University College London are exploring in an NIHR SPCR funded realist review. Our review focuses on the role of care navigators, regarded as a key element of social prescribing. These individuals aim to identify non-medical needs of patients, and then support and signpost them to available services, including those within community or voluntary sectors.

We have created an initial programme theory to conceptualise the mechanisms through which care navigators may operate. However, our preliminary work suggests diversity and inconsistency in how this role is currently organised and implemented. A lot remains to be learnt about how the work of these key players within social prescribing can be optimised in the NHS. We look forward to bringing clarity to this conundrum through executing the review.

Stephanie Tierney is a Researcher in Evidence Synthesis at the Centre for Evidence Based Medicine, University of Oxford, and is part of the SPCR Evidence Synthesis Working Group.

Disclaimer: The views expressed in this commentary are those of the author and not necessarily those of the host institution or the NIHR.