There is a loneliness epidemic. This has been declared by health authorities, reported in major publications, confirmed by surveys, and addressed by the appointment, in several countries, of ministers specifically responsible for it. The declaration carries the weight of institutional consensus.
The loneliness epidemic is, in the current public health framing, as real and as serious as obesity or sedentary behaviour, a condition of modern life requiring intervention, strategy, targets, and the by now familiar apparatus of managed concern.
I do not doubt that people are lonely. I doubt the epidemic.
Not because the experience is rare—it is clearly common—but because the framing of it as an epidemic performs a particular kind of work that is worth examining before accepting. An epidemic is a condition that spreads through a population, affecting people who would not otherwise have it, whose natural state is the absence of the condition. The epidemic model applied to loneliness implies that people are lonely because something has gone wrong—that there is a pathogen, an environmental change, a disruption of the natural social order that has produced an unnatural increase in isolation. Identify the cause, address the cause, return the population to its natural condition of connection.
The natural condition is the assumption worth questioning.
Solitude and loneliness are not the same thing. Solitude is chosen or at least accepted—a state of being alone that is not experienced as a deprivation. Loneliness is the painful experience of unwanted isolation, the gap between the social connection a person has and the social connection they want. The epidemic framing collapses this distinction. It treats the person who lives alone as lonely, the person who does not maintain an extensive social network as isolated, the person who does not participate in community activities as disconnected. The measurement instruments used to identify the epidemic tend to measure social contact rather than the experience of its absence. Low scores on social contact are interpreted as evidence of loneliness. Whether the person with low social contact is suffering from its absence is a question the measurement apparatus often does not ask.
The result is a measurement of solitude that is presented as a measurement of loneliness, which is then presented as evidence of an epidemic, which requires intervention. The intervention typically takes the form of programmes designed to increase social contact—community groups, befriending services, social prescribing, the organised provision of connection to people who have been identified as not having enough of it. The programmes are real and some of them are genuinely useful for people who are genuinely lonely. The question they do not ask is whether the person being prescribed connection wants it, or whether the absence of extensive social contact reflects a preference rather than a deprivation.
There is a particular kind of person who does not want to join the club. Not because they are incapable of connection—they may be deeply connected to a small number of people—but because the form of connection the club offers is not the form of connection they value or find sustaining. The organised social activity, the community group, the befriending service, the social prescribing referral—these are forms of connection designed for people whose social needs are met by regular, structured, group-based interaction with people they would not have chosen independently. They are not designed for the person whose social needs are met by one or two close relationships of considerable depth, who finds large groups draining rather than sustaining, who prefers the sustained attention of a single conversation to the distributed attention of a social event.
The person who does not want to join the club is not a problem to be solved. They are a person with different social needs from the ones the epidemic model assumes are universal. The epidemic model assumes that more social contact is better—that the person with few social connections is necessarily worse off than the person with many. This assumption reflects a particular cultural valuation of sociability that is not universal and is not obviously correct. The person who maintains one or two relationships of genuine depth and finds that sufficient is not experiencing a deficit. They are experiencing a preference. The measurement instrument that scores them as lonely has measured the wrong thing.
The cultural context of the epidemic declaration is worth noting. The countries that have most enthusiastically adopted the loneliness epidemic framing are, broadly, the same countries in which community structures have been systematically reduced over the past several decades—in which the institutions that once provided organised social connection have been defunded, reorganised, or replaced by market mechanisms that do not produce the same kind of connection. The clubs, the unions, the religious institutions, the civic organisations, the community facilities—many of these have declined, and their decline is real and has produced real losses for people who valued them.
The epidemic framing, however, does not primarily address the structural causes of this decline. It addresses the individuals who are experiencing its effects. The person who is lonely because the community centre closed, the union dissolved, the church emptied, the local pub became unaffordable, is treated as a person with a social deficit requiring intervention rather than a person living in a community whose social infrastructure has been removed. The intervention is directed at the individual. The structural cause is not the subject of the intervention.
This is the familiar pattern of addressing the output of a system while leaving the system unchanged. The homelessness strategy addresses the homeless person rather than the conditions that produce homelessness. The loneliness strategy addresses the lonely person rather than the conditions that produce loneliness. The strategy is real. The concern is expressed. The issue is managed rather than addressed.
The minister for loneliness is a genuine position, currently held in several countries, with a remit to address the loneliness epidemic through policy. The position is well-intentioned. It is also an illustration of the difficulty of addressing a condition that is partly structural and partly definitional through the mechanisms available to a single ministerial remit. The minister can fund befriending services. They can commission research. They can produce a strategy with targets and indicators. They cannot restore the community structures that were removed by decisions made in other ministerial remits. They cannot change the cultural valuation of productivity and efficiency that has reduced the time available for the kinds of slow, unstructured social contact that build the connections the epidemic framing identifies as absent. They cannot persuade the person who prefers solitude that their preference is a health risk requiring correction.
The minister can, however, produce a reply that does not address the issue. Express all appropriate concern. Ask if there is anything else.
The social prescription is the intervention that most clearly illustrates the limits of the epidemic framing. The socially prescribed patient is referred, by their general practitioner, to community activities intended to address their social isolation. The referral is made on the basis of a clinical assessment that has identified loneliness as a health risk for this patient. The activities are real and some of them are genuinely useful. The question the referral process often does not ask is whether this specific person wants this specific kind of connection, or whether their social situation reflects a preference that the clinical assessment has categorised as a deficit.
The person who does not attend the referred activity has failed to engage with the intervention. Their non-engagement is recorded as a challenge, an outcome to be addressed by making the activities more accessible, more attractive, more tailored. The possibility that the non-engagement reflects an accurate assessment by the person of what they actually need is not the primary frame the intervention uses. The intervention was designed to provide connection. The person did not take the connection. The intervention has not succeeded.
But the person may not have needed the intervention to succeed. They may have needed something else entirely—a structural change that is not available through the referral pathway, or nothing at all, because the condition being treated was a measurement artefact rather than an experienced deficit.
The distinction between a preference for solitude and an experience of loneliness is not always easy to make, and the difficulty is real. Some people who prefer solitude are in fact lonely and have learned to describe their situation in terms of preference because the alternative—acknowledging the gap between what they have and what they want—is more painful. Some people who report high social contact are profoundly lonely within it, surrounded by people with whom they have no genuine connection. The measurement of social contact does not capture either of these situations accurately.
What would capture them is the question the epidemic model is least equipped to ask: what does this specific person actually need, and does what they currently have correspond to what they need? This question cannot be answered by a survey. It requires the kind of attention to the individual that the epidemic model, operating at population scale with population-level interventions, is not designed to provide.
The epidemic model is useful for identifying that something is happening at population scale that affects a significant number of people. It is less useful for understanding what that something is, because the category of loneliness it uses is broad enough to include people with genuinely different conditions that require genuinely different responses. The person who is lonely because their community’s social infrastructure was removed needs the infrastructure restored. The person who is lonely because they have not found the kind of connection they value needs a different kind of help from the befriending service referral. The person who scores low on the social contact measure because they prefer solitude does not need help at all.
The epidemic treats them as the same. The intervention addresses them identically. The strategy produces targets and reports and the ongoing expression of appropriate concern.
I do not want to join the club. Not because I am incapable of connection. Not because I have never valued community or found sustaining relationships within organised social structures. But because the club being offered is designed for a model of social need that does not describe mine, and the prescription of connection I have not asked for reflects a measurement of my situation that has measured the wrong thing and arrived at the wrong conclusion.
The epidemic exists. Some people are genuinely and painfully isolated, and that isolation produces real harm, and the harm deserves real attention. The question is whether the attention is directed at the people experiencing the harm, or at the measurement scores of people who have been classified as at risk of it by instruments that cannot distinguish between an absence and a preference.
The strategy is produced. The targets are set. The ministers are appointed. The befriending services are funded. The social prescriptions are written.
The person who simply prefers to be alone continues to receive referrals.
The person whose community was dismantled continues to wait for the infrastructure to return.
All care, no responsibility.
Is there anything else?
The Vorpel Foundation