As experts in the Midwest and around the world work to address loneliness, one tricky question keeps popping up: even if loneliness is bad for our physical and mental health, what if people just don’t want to be social?
If you’re not from London, riding the subway here can be a little strange.
Waterloo Station is one of the busiest underground stations in the country. During rush hour, tens of thousands of people stream in and out, talking and laughing.
But after the train doors close, everyone goes quiet. They stare at phones or books or off into space. Outside of the occasional whispered remarks between friends, there’s nothing to hear but the sound of cars clacking over the tracks.
When Jonathan Dunne moved to London after living in Durango, Colorado, a few years back, commuting every day to and from Waterloo Station made him feel kind of lonely.
“I think it’s interesting for people who don’t live in a city to realize how anonymous city living is, because you’re surrounded by people all the time but no one sort of pays attention at all,” Dunne says.
So Dunne came up with an experiment. He printed hundreds of buttons that read “Tube Chat?” which subway riders could wear as an invitation to others who might want to talk.
He then spent a day trying to give them away – a very cautious attempt to start a conversational revolution.
“I handed them out at a station that was not near my work ’cause I was afraid if I was passing them out near my work, like they would think that was some sort of cry for help,” Dunne says.
The revolution didn’t happen that day.
Jonathan says he was only able to give away about one in 10 of the buttons. So he forgot about it.
Starting a conversation
That is, until the next day, when he checked his phone and found that the Twitterverse had caught fire as British introverts raged at the American trying to strong-arm them into a chat.
“There was this initial reaction, ‘Oh, this guileless American came over and is trying to tell us what to do,’” Dunne says.
It didn’t stop there. Within days, Dunne was appearing on TV shows, not just in London, but all over the world.
Then the opposition got really aggressive. Commuters on the London Underground started making their own anti-chat buttons and tweeting pictures of themselves wearing them on commutes.
Some of their not-so-subtle messages:
“Don’t Even Think About Talking To Me.”
“No chat, please. We’re British.”
Despite the haters, Dunne considers Tube Chat to be a success. After all, with a few hundred buttons and a few hours of work, he started an international conversation.
And it turns out that at the same time the guileless American was making tight-lipped Londoners foam at the mouth, health experts throughout the country were doing their own experiments to see if Brits could be nudged into sociability.
Compared to 21st century London, Frome’s stone walls and narrow roads look nearly medieval. The artsy town in Somerset County lies in the hills of western England.
Almost every one of the town’s 26,000 residents is a patient at the Frome Medical Center, and about six years ago the city completed a slick new clinic building on the edge of town.
Dr. Helen Kingston, a senior partner with Frome Medical Practice who has worked here for 25 years, says opening the new center caused her to think back on her consultations and do some soul searching about her work.
“Some of the conversations that you have really help you to see that the help that they need isn’t always a tablet or an operation, and the difference that having strong relationships, strong networks of support around someone even in difficult circumstances can make to the quality of their lives,” Kingston says.
This led the medical center to start its own kind of "social prescribing," sort of an early version of what the National Health Service is now creating across the country.
With the help of volunteers and some government innovation grants, Frome Medical Center made some tweaks to the care it offers.
In consultations or follow up calls, caregivers suggest that patients try specific clubs or social activities.
And not just in the clinic; a lot of this work happens outside. Frome and the surrounding area have over 900 volunteers who work as “community connectors.”
Frome resident John Young, who works as one of those community connectors, takes a soft-sell approach, like when he recently invited a neighbor to check out a local program.
‘Come and have a chat’
“I said to him, ‘Well, look, just pop down and see us one Thursday morning. We’re in the Welsh Mill Hub. Just have a cup of coffee or a cup of tea. I’ll be there. You can recognize me. Come and have a chat,’” Young says.
Like the town itself, Frome’s community program seems quaint, but some observers have been amazed by what a powerful weapon it appears to be in combating loneliness and poor health.
In the first five years of the program, Frome saw a 14% drop in unexpected emergency room visits, which many experts see as a measure of overall community health.
At the same time, other towns in Somerset County, which has been hit hard by government austerity cuts, saw emergency room visits increase by almost 30%.
Dr. Kingston says the benefits to Frome extended beyond health.
“That had cost savings,” Kingston says. “That meant that this project was actually saving money rather than costing more, because we were saving more money on admissions than we were investing in the services.”
Kingston was referring to one of the program’s bonuses: in its first four years, the costs of unplanned emergency room visit in Frome dropped by more than 20%.
The Frome study led to some glowing news stories about the power of community, although not everyone is convinced that social prescribing deserves all the credit.
Followup is key
“They offer social prescribing, so that’s definitely part of their offer, but when you look at the evaluation that’s been published, it’s far more interesting than that,” says Paul Wilson, senior research fellow at the University of Manchester.
That’s because, along with social prescribing, the follow-up care Frome Medical Center provides includes help like medical planning, home visits and medication reviews.
Wilson thinks Frome’s big secret may simply be following up with patients and providing the kind of thorough, personal healthcare that few of us actually get from doctors.
And for all the enthusiasm about social prescribing, Wilson says it’s not clear from the research that many people will agree to try something like bonsai trimming or tango lessons.
“When you actually even look at the local evaluations that have been conducted by, essentially, proponents of programs themselves, there was a real lack of evidence of benefit, or, indeed, of value for money,” Wilson says.
Nonetheless, the National Health Service is currently developing its nationwide social prescribing system, which will include 1,000 social prescribers, based on experiments and pilot projects in communities.
“We think the evidence that is emerging is good enough to support this rollout of social prescribing for primary care physicians across England, and that’s what we’re going to be doing over the next couple of years,” says Simons Stevens, chief executive of the National Health Service.
And while Wilson thinks the rollout of the national campaign is outpacing the evidence, he acknowledges that individual loneliness programs may have potential, based on what experts have seen in community choirs, dance classes and garden sheds.
“I think the idea has promise,” Wilson says. “There may be elements within programs that are worth pursuing and investing in for the longer term, and I’m fairly sure that there’ll be elements that we wouldn’t want to continue on. We can only find that out through evaluation, and that needs to be done systematically and rigorously.”
Editor's note: This is the fourth 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 firstname.lastname@example.org