Loneliness: A Public Health Concern

Recently, World Health Organisation (WHO) declared a pressing, albeit underappreciated, global health threat ‘loneliness’ in its report.

What is loneliness?

• Definition – It is largely understood to be “the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way, either quantitatively or qualitatively,” and is computed as an experience other than ‘social isolation.
• Vulnerable population
  • World Health Organisation (WHO) – At least 10% of adolescents, and 25% of older people are lonely.
  • The Global State of Social Connections– At least 25% of 4.5 billion people felt ‘lonely’ or ‘very lonely’ in 2023.
• Spread – WHO clarified in 2023 that loneliness impact the health and well-being of all age groups across the world.
• Reason for higher levels – Wars, climate change and social inequality have only accelerated this ‘silent’ threat.
• Impact of Covid pandemic – It have calcified loneliness as a feature of daily life, with implications on people’s long-term mental and physical health, longevity and well-being.
• Measure - The WHO has established a Commission on Social Connection (2024–2026) with the intent of addressing loneliness from a public health lens.
• It will propose a global agenda on social connection and work to develop solutions targeting loneliness as a medical and social condition.

During the course of the UN Decade of Healthy Ageing (2021-2030), the Demographic Change and Healthy Ageing Unit of WHO will be addressing social isolation and loneliness.

What is India’s status in Loneliness?

• Loneliness in India
  • 2004 NSSO study – About 49.1 lakh people (12.3 lakh men and 36.8 lakh women) were living alone and suffered from loneliness.
  • In 2012, self-reported loneliness was found to be 17.3% and 9.5% in urban and rural adolescents, respectively.

• Loneliness among younger people – The Centre for the Study of Developing Societies (CSDS) in 2017 studied 6,000 people aged 15-34 years across 19 States.
  • 12% of India’s youth reported feeling depressed often, and about 8% frequently felt lonely.
• Loneliness among the elderly – The Longitudinal Ageing Study in India (LASI)in 2017-18 surveyed 72,000 people from 35 States and Union Territories.
  • 20.5% of adults aged 45 years and above reported moderate loneliness, and 13.3% were severely lonely.
• Gender vulnerability – The odds of loneliness were higher among females as compared to males.
• A taboo in our society – There is lack of acknowledgment of mental health issues as people see poor mental health as a “collective problem” that reflects badly on the family, even impairing one’s marriage eligibility.

Why loneliness as a public health concern in India?

• A fertiliser of other diseases – It can thus inflame India’s rising communicable and non-communicable disease burden.
  • The 2017 LASI found that loneliness also increased the odds of major depressive disorder and insomnia symptoms.
• Emerging dementia epidemic - Mental health disorders like depression, anxiety disorders, bipolar disorder have risen steadily over the last few years.

What are the reasons for India’s loneliness epidemic?

• Social inequity – People belonging to marginalised communities go through loneliness intensely.
• Socioeconomic challenges – High poverty, income inequality, low education, high dependency ratio is making people depressed.
• Higher dependence on monsoon – There is rising farmer suicides due to the burden of seasonal droughts.
• Rapid urbanisation and changing family structure – The suicides of daily wage or migrant workers is more due to their disintegration at their village home as well as the lack of any family structure in the urban setting.
• Reduced social cohesion and support – Changing lifestyles erode kinship ties and interpersonal relationships.
• Slum rehabilitation issues - The 2022 study in Mumbai reported that slum rehabilitation dwellers loneliness was partly due to random allocation of flats.
  • It hampered their collective identity, weakened their social support network, and significantly led to loneliness.
• Attachment to Social media – Social media has uniformly been linked to rising loneliness.
• Impact of COVID-19 pandemic – Loneliness among young people is on the rise.
• Chronic illnesses – It exacerbate loneliness among people.
• Institutional deficiencies – According to a 2023 report by a Standing Committee on Health and Family Welfare, India lags with inadequate staff, medical infrastructure and budgetary allocation.

What should India focus on?

By 2030, India wants to reduce suicide mortality by 10% under the National Suicide Prevention Strategy (NSPS).

• Change perspectives – Treat loneliness as a conditions itself rather than considering as a symptom or state of mind.
• Tailored treatments – Treat loneliness as a distinct social and medical condition to develop targeted interventions specific to people’s cultural context.
• Capacity building – Investing in mental healthcare facilities, training doctors and setting up health provisions in AIIMS.
  • India has launched suicide and mental health helplines.
• Scale up digital infrastructure – Develop and improve digital mental health programming infrastructure.
• Efficient diagnosis and treatment – Find the root cause of loneliness and suggest physical exercise and spending time socially.
  • Develop healthcare dedicated to addressing loneliness.
• Promote community intervention – Address deficits in communities by building safe spaces like community facilities, effecting anti-discrimination and equality laws, and tackling the causes and consequences of poverty.
• Conduct national-level survey – It should be conducted in local languages, and questions modified to match people’s cultural context as almost 60% of India which lives offline remains beyond the purview of research paradigms.