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The Friendly Midwest Is In A Loneliness Crisis And The British May Have The Solution

Alex Smith
KCUR 89.3
Hundreds of people line up to watch the daily changing of the guard at Buckingham Palace in London, where the government recently launched a national campaign to address loneliness.

In the heart of London, at Buckingham Palace, the daily changing of the guard reminds crowds of tourists that the United Kingdom is a country with staying power.

Over the centuries, the British have fought off famine, plague, economic depression and the Nazis. More recently, a few blocks away at Ten Downing Street, Prime Minister Theresa May announced plans to take on a new threat to the lives of Britons.

“In a country of more than 60 million people, and in an age where we can instantly connect with friends, relatives and even strangers around the world, it may seem counterintuitive that any of us could find ourselves feeling lonely,” May said in a speech in early 2018.

Loneliness is a topic that’s mainly been left to pop song writers and poets over the centuries, but in the past few years, scientists have been warning that feelings of loneliness can be harmful to our health. It may even be a factor in growing problems like drug use, suicide and declining life expectancy, which are especially prevalent in the Midwest.

May’s announcement marked the start of the first national campaign to address loneliness across an entire country. It includes spending millions of dollars for community programs and a new long-term strategy for the National Health Service.

She also created a new government post – the minister for loneliness.

The reaction was probably not what the prime minister had hoped for.

“That really sounds like a Victorian euphemism for a gigolo. I’m the minister for loneliness!” said American comedian Stephen Colbert in his opening monologue on the night of May’s announcement.

But Tracy Crouch, a Conservative Member of Parliament for Chatham and Aylesford and the first minister

Credit Alex Smith / KCUR
Conservative MP Travey Crouch was the United Kingdom's first minister for loneliness.

for loneliness, says she was happy for the issue to get the attention.

“Although I was initially kind of shocked, I was actually quite flattered by it,” Crouch says.

Awareness of loneliness as a health issue hasn’t filtered through to many people in the U.K. or United States, and May’s announcement seemed to be a gift to comedians. But the campaign, and the phenomenon of loneliness itself, is no joke, as scientists are finding out.    

Downward spiral

In the remote town of Ellington in southeastern Missouri, Debbie Tarvid, chief operations officer for Missouri Highlands Health Care, a network of safety clinics, drives by the town hospital, which closed in 2016.

Tarvid, whose daughter was born and mother’s life was saved here, shows areas where the building has already been infiltrated by creeping Ozark vegetation.

“It doesn’t take long for an unused building, unoccupied, I guess, to start deteriorating, and it has,” Tarvid says.  

Credit Alex Smith / KCUR
Karen White, CEO for Missouri Highlands Health Care, stands in a recently closed hospital in southeastern Missouri.

Ellington has been losing population over decades, and the area has some of the worst health problems in Missouri, including growing rates of obesity and high rates of death from preventable diseases, drug overdoses and suicide.

Karen White, CEO of Missouri Highlands Health Care, says that Ellington sees few outsiders other than fishing and canoe tourists and health researchers, who are trying to understand why the area seems stuck in a downward spiral.

“It’s just disheartening sometimes when you get the latest stats, and you look at them, and you’re like, ‘Why can we not make this change?’” White says.  

Ellington is part of a swath of mostly lower-income, white communities stretching from southern Missouri up through parts of Tennessee, Kentucky and West Virginia that exhibit similar trends.

Many experts think lack of access to healthcare plays a big role in what’s going on there, but it doesn’t explain everything. They suspect that many health problems may be connected to social isolation.

Research over the past decade suggests that our brains may be wired to crave social connection. When we talk to friends or hold newborns or even sing with other people, our brains release oxytocin, a brain chemical that helps us relax and strengthen social bonds.

Credit Alex Smith / KCUR 89.3
KCUR 89.3
In the center of Ellington, Missouri, which was been losing population, a storefront sits abandoned and overrun with Ozark vegetation.

Without those connections, our health can suffer.

Professor Pamela Qualter, a University of Manchester psychology researcher, explains that loneliness isn’t necessarily the same thing as being physically isolated from other people. 

“It’s about you feeling that you are disconnected from other people,” Qualter says. “You might feel lonely because you haven’t got as many friends as you would like. Or you might feel lonely because you haven’t got that quality relationship with another person.”

There are cultural and genetic differences that influence how loneliness affects people, but scientists suspect that when many people feel lonely, their brains switch into fight-or-flight mode.Their  nervous systems get flooded with the stress hormone cortisol, and that can be hard to shut off.

“Cortisol’s really good in short doses. It’s really bad for us in long doses,” Qualter says. “It impacts in the inflammatory process. That’s why we start seeing effects on coronary heart disease, hypertension, because we’ve got too much cortisol in our system.”

Researchers also have found links between loneliness on the one hand and mental health problems and sleep disruption on the other. Some say loneliness could be as risky to our health as smoking or obesity.

One study estimates that social isolation among older people costs Medicare more than $6.5  billion every year. But the effects of loneliness could be much larger even than that, reaching everyone from urban teens to middle-aged suburbanites to rural retirees.

That’s especially the case in places like southern Missouri and similarly remote areas in the U.K., where experts have been alarmed by the recent phenomenon of decreasing lifespans.

Unlike almost everywhere else in the developed world, people in these areas have been dying earlier of preventable diseases, substance abuse and suicide.

‘Deaths of despair’

Dr. Stephen Wolff, a professor and director emeritus at Virginia Commonwealth University’s Department of Family Medicine and Population Health, has studied the phenomenon in Missouri and thinks loneliness could be a root cause of what some have called “deaths of despair.”

“Social support [has] tended to deteriorate in many communities, and there’s less of a support system to help struggling families in neighborhoods cope with these problems in these communities,” Wolff says.

Scientists in the U.S. are developing drugs to fight the effects of loneliness, but in the U.K., experts think they have a better solution. 

In a bright, sunny common room of Charing Cross Hospital in the London neighborhood of Hammersmith, Georgia Cornwall, a cheery young teacher of Indian dance, greets a dozen elderly patients in wheelchairs who are recovering from falls or strokes.

She explains she’s there to teach Bollywood dance, the style featured in Indian movies that can be almost comically energetic. The faces of her quiet patients seem to flash with expressions of both curiosity and terror.

But dance classes, and similar social activities, could soon be as commonplace in British healthcare as blood pressure medications.

This year, the National Health Service, which provides free healthcare to all residents of the U.K., announced the creation of a new kind of healthcare worker – “social prescribers” – whose job will be to recommend to patients new social activities.

“It could be ranging from gardening through to knitting through to dancing through to all kinds of activities that overcome the isolation and the loneliness and help people remain active, help them with a sense of purpose and a sense of social connection,” says Simon Stevens, chief executive of the National

Credit Alex Smith / KCUR
Georgia Cornwall teaches the basics of Bollywood dance to patients in a rehabilitation ward of a London hospital.

Health Service.

The NHS plans to have 1,000 social prescribers within the next two years, but interest in addressing loneliness is already taking off in the country and steering healthcare into some uncharted territory.

Despite their initial shock, the hospital class quickly warms up to Bollywood dancing, and within about a half an hour, they’re doing bouncy shoulder shrugs and kicks from their wheelchairs. What’s more, they look excited about what they’re doing. 

Ward manager Diana Belcher says the class is a kind of physical therapy, but that’s almost an afterthought to its larger purpose.  

“It helps them socialize,” Belcher says. “It cheers them up. If you look at a patient before they go to the dance class, and if you look at them after, they are so much different.”

Editor's note: This is the first part of Loneliness Is Killing You, a five-part series on the health effects of loneliness and social isolation. KCUR reporter Alex Smith traveled to the United Kingdom to see how that nation is addressing the problem and what lessons the United States can learn from it. This reporting was made possible in part by a fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. 

Alex Smith is a health reporter for KCUR. You can reach him by email at alexs@kcur.org

As a health care reporter, I aim to empower my audience to take steps to improve health care and make informed decisions as consumers and voters. I tell human stories augmented with research and data to explain how our health care system works and sometimes fails us. Email me at alexs@kcur.org.
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