Consulting Dr. Hiroshi Murayama from the Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology
Self-quarantine during the COVID-19 disaster brings to the forefront an existing problem in modern society: isolation and loneliness. The elderly who are living alone are especially affected. Being forced to self-quarantine puts serious stress on one's physical and mental wellbeing. It worsens one's anxiety. So how do we frame social isolation and loneliness as health issues? What types of treatment are available to combat these issues? Shut-ins, self-neglect, and social prescription have become keywords while discussing social isolation and loneliness as medical issues. We have interviewed experts who have initiated this conversation. For the first interview, we have Dr. Hiroshi Murayama from the Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology. He is also the author of 『つながりと健康格差』(lit. Relationships and Health Equity) (Poplar New Book, 2018). He explained to us how social isolation and loneliness should be considered as health risks.
Increase in dementia, cardiovascular diseases and cancer deaths
ーー “Is there evidence that proves social isolation and loneliness affect our wellbeing?”
There has been a collection of epidemiological research related to the effects of isolation and loneliness since 1970. Presently, we are still gathering results from the meta-analysis. "Poor social relationships" has been reported to increase the incidence of
cardiovascular diseases. It has increased coronary heart disease (CHD) by 29% and stroke by 32%
1). The same has been reported on
dementia. According to Kuiper, " poor social participation" increases incident risk of dementia by 41%, 57% for "lack of social contact", and 58% for "loneliness"
2). Furthermore, Pinquart observes that the mortality rate of
cancer decreases by 20% when the patient has a "larger social network", and 25% if they have "higher levels of social support"
3).
Isolation and loneliness do not only affect incident risk of diseases, but also mortality rates. According to Holt-Lunstad's meta-analysis, "living alone", "social isolation", and "loneliness" increase mortality rate by 32%, 29%, 26% respectively. (
Graph 1)
4). We can say that there is solid evidence, which proves social isolation and loneliness can increase incidence of different diseases and mortality rates.
Graph 1. Lack of social relationships affecting mortality rate (meta-analysis)

(Holt-Lunstad J,et al.Perspect Psychol Sci 2015;10: 227-237)
Social isolation is objective, loneliness is subjective
ーー”Can you define the terms: social isolation, loneliness, social support etc.?”
Social isolation is "a condition where there is little to no interaction with the family or the community." It is objective because it depends on the number of people you are living with and the frequency of social contact.
Loneliness, on the other hand, means "the undesirable emotion that comes with the lack of social interaction." Because of its subjective nature, UCLA evaluates loneliness with a psychological scale, like a loneliness scale.
In the same way,
social network is a measurable set of relationships while
social support is a psychological and tangible assistance you can obtain from relationships. There is also
social capital, which is defined as "the resource obtained from being affiliated with a group."
Organizational relationships are divided into
communities and
associations. The former is a union that naturally comes with territory. The latter is formed based on the hobbies, special interests, and goals of its members.
ーー “Which poses more of a risk, social isolation or loneliness?”
There is overlap between the two. On one hand, loneliness arises from social isolation, but on the other hand, people who are feeling lonely tend to isolate themselves more. Many epidemiological researches have reported different results from investigating both. Judging from the results of the meta-analysis, we should perceive both as serious health risks.
Loneliness, a distress on the brain
ーー “How can social isolation and loneliness be damaging to our health?”
There is not a lot of medical research on what happens inside the body when someone is in social isolation or feels loneliness. However, various psychological research has been conducted on the topic, such as "The Science of Loneliness," written by J.T. Cacioppo, an American researcher
5).
"Human beings are social beings. Social isolation, for us, means danger. Therefore, fearing loneliness is an instinct," he impressively points out.
For example, using an MRI scan, researchers have observed that
social rejection is the same as the physical pain signalled from the dorsal anterior cingulate cortex
6). In other words, day-to-day loneliness is the same as chronic pain. In this way, we can see how social isolation and loneliness can have severe negative effects on our mind and body.
Loneliness
builds up stress, which leads to increasing the chances of developing ailments such as CHD and stroke. Also, there are reports that it can
weaken immunity and make you more susceptible to infections, so the risk of contracting pneumonia increases.
Inversely, having plenty of social connections can become a huge benefit to your health. You can receive support from your surroundings and be encouraged to socially participate. Getting sufficient support is thought to help produce oxytocin, which helps alleviate stress.
Isn't that just a personal problem?
Right now, social isolation and loneliness has become a worldwide issue.
Unmarried and individuals who live alone have increased in developed countries because of the aging population and the ever-changing views on family values and marriage. Opportunities to work with everyone for one project have decreased at the workplace due to job specializations. Furthermore, there has been an increase of people who have observed the division and segregation in society based on social disparity and discrimination. For many people, building relationships has become harder.
――“The appointment of the Minister of Loneliness in the UK has become quite a topic.”
In the UK, 1 in 7 people experience loneliness. For those who are 65 and older, it is 3 in 10 people. Because of this, the economy suffers a 4.9 million yen loss annually. Looking at these points, we can say that l
oneliness is no longer a personal problem in the UK and it must be dealt with as a countrywide issue. Specific strategies have started to be put into place. They are planning to gather more research, create cross-cutting solutions for loneliness, and increase public awareness. They are also thinking of developing social prescription programs and improving services for mobility.
Japan ranks 1st in the world for social isolation and loneliness
―― “How is the situation in Japan?”
The situation in Japan is just as serious. People who are living alone exceed one-third of the overall population. The rate of unmarried people (at the age of 50) is rapidly increasing among men and women by 27% and 18% respectively
7). The data is a little old, but the Organization for Economic Co-operation and Development (OECD) conducted a survey where
Japan ranks the highest out of 20 countries on the percentage of people who "have little to no interaction with friends and colleagues" (
Graph 2)
8). The Cabinet Office conducted another survey where Japan ranked highest again out of 4 countries with a percentage of 16% for people "who do not have people outside of their family to rely on"
9).
Graph 2. "People who have little to no interaction with friends and colleagues"percentage for various countries

(OECD. Society at Glance. 2005 edition)
Up until now, Japan has been keeping strong
communal, familial, and corporate relationships, without consciously creating other types of associations and social groups. It has been said that it can be good to start a community based on "relationships." However, on that note, once that "relationship" falls apart, it is easy to fall into the trap of isolation. Presently, the Japanese might be more strategic in creating connections.
This means that they prefer more relationships born out of association, which is another problem. You can make friends around the world on social networking sites (SNS), but they are not the people in your immediate vicinity who can help you during disasters like earthquakes and storms.
People living in your community are also essential, so having a balance of both is very important.
Weak and diverse ties
ーー “What direction should we take if there is a decline in existing relationships in the community and relationships based only on association are not enough?”
An American sociologist, M. Granovetter points out the significance of
"weak ties." Occasionally meeting people who hold different values from you is actually very helpful. Of course, strong bonds are important, but weak ties can also improve your health and quality of life (QOL). Having routines and doing activities such as
volunteering and participating in local community events, more than 5 times a week can be beneficial to your health.
ーー “You're also researching on building relationships within one's area, right?”
I am investigating what type of social exchanges
"available within the vicinity" are effective for the elderly who are living in the city.
Some examples are exercise, tea parties, and interacting with younger folks.
ーー “Are there any results from interventions?”
It will take time to inspect the efficiency of interventions if we consider the large scale of surveying a specific area. However, the present administration has been actively conducting diverse and interesting programs in various places. I am also expecting to see more results.
Social relationships have also changed because people have been forced to self-isolate due to the COVID-19 outbreak in 2020. It is precisely in this time that we have
the chance to examine the importance of our relationships. As a doctor, I advise patients, especially the elderly,
to keep a close eye on social isolation and loneliness.
Source:
https://medical-tribune.co.jp/rensai/2020/0729531070/