Fostering Social Connection As A New Civic Responsibility: A Bold Public Health Agenda

For over a year, as we have dealt with and now begin to emerge from COVID-19, the thirst for greater social connectedness has become ever more palpable and ubiquitous. Evidence abounds:

• A CEO credits the marketplace turnaround of his faltering retailer to a heightened focus on human connectedness in its customer service training.
• National- and state-level calls are now in play for new training and resources for lay public-sector (for example, National Guard) program personnel in the early identification of service recipients at risk for social disconnectedness and referral to appropriately curated resources.
• A church diocese sponsors online seminars on racial healing with experts from diverse backgrounds dialoguing in ways that promote connections across similarly diverse audiences, while a foundation devoted to art and healing hosts film festivals focusing on loneliness.

Disparate and often in relative isolation, such developments are bubbling up throughout the US with striking synchronicity across the private, public, and nonprofit sectors and in the broader popular culture. They suggest a unique window of opportunity for movement toward a state of greater social connectedness at the population level. 

Capitalizing On This Opportunity

Yet, this window is opening onto a landscape that has been devoid of any coherent macro-level strategy for cultivating potential synergies. At the same time, loneliness and social isolation have become the principal prisms for understanding the need for greater social connectedness. As a public health priority, this emphasis is long overdue. But, it also threatens to potentially limit the scope and inclusiveness of any intervention.

A recent call to action addresses these concerns by proposing a systemic, nonpartisan endeavor for fostering social connection as a new civic responsibility. This endeavor will be best positioned for success if a prominent public health voice backed by the convening capacities of government—such as the US Surgeon General—takes the lead in its rollout.

This call is predicated on an expanded view of social connectedness. In this post, I first delve into a fuller description of this perspective, then propose a framework that realizes new synergies across disparate investments in social connection and incorporates and goes beyond the current focus on loneliness and social isolation. I close by outlining some initial steps for this endeavor that will develop, invigorate, and cross-pollinate new and existing programs and policies for accelerating this movement.     

Broadening The Lens

Mounting evidence and commentary indicate that COVD-19 has helped bring the massive, debilitating deficit in social connectedness to a head. This deficit is manifesting at two levels. On the individual health side, high prevalence and severity levels of social isolation and loneliness are helping to drive increases in adverse mental/emotional and behavioral health outcomes, from depression, anxiety, and cognitive decline to drug overdoses and suicides. These outcomes combined afflict some 40 percent of Americans. 

On the community resilience side, polarizing societal divides are stymieing our capacity to act for the common good. Fault lines range from systemic racism and wealth inequality to climate change and extreme political partisanship. As on the health side, the common denominator underlying these divides is the absence of connectedness with others, in this case across the fault lines creating them. 

To date, the primary lens through which this phenomenon has been viewed is social isolation and loneliness. This lens suggests that the most appropriate interventions are those trained on the interface between individuals and the providers, health systems, and public health officials responsible for delivering clinical support for the health conditions created by social isolation and loneliness.

Incorporating community resilience alters the landscape. It invites a new approach that puts individuals in context, not only within but also beyond the clinical interface. It invites the inclusion of non-health care institutional stakeholders alongside providers of clinical support.

Social Connection And Public Well-Being

Of course, no one criterion defines connectedness other than an awareness that it has been or is being experienced. Nor do all simple acts initiated to relate to others necessarily strengthen individual health and community resilience. Yet, when greater social connectedness occurs, it mitigates the harmful effects of social isolation and loneliness. It helps to promote brain health. Moreover, by building trust, it reduces the polarization dogging our social and political discourse.

At root, fostering social connection as a new civic responsibility to achieve greater connectedness is a simple objective made up of two aspects. Unpacking these aspects with more specificity will be key to developing measures that support this effort. Toward this end:

• “Fostering social connection” is about people participating in acts of relatedness that activate cycles of individual physical and mental/emotional well-being. These cycles are readily achievable whenever we are in physical or virtual contact with others, both within and beyond our tribes.
• “As a new civic responsibility” conveys that we engage in these acts voluntarily as good citizens, not out of obligation. In doing so, we join a groundswell that encourages our rowing together in a new direction to our collective benefit.

Together, these two aspects express a mindset that is on the lookout for that next opportunity—expected or unexpected—to establish and deepen connectedness. It is a mindset that orients individuals, groups, and organizations outward toward forging synergies for greater social connectedness. It recognizes that there is always room for improvement, even for the well-practiced among us.

Loneliness And Social Isolation

Significant public dialogue has suggested that to socially connect is to reduce loneliness and isolation, while to reduce loneliness and isolation is to socially connect. Indeed, empirical research has confirmed high correlations that support these associations and addressing them in systems approaches. Moreover, as interest in social connectedness has increased, those who would intervene in this space are finding precedents that can be readily tapped in the health care delivery and funding infrastructure.

Yet, being socially connected is not necessarily the inverse of being lonely or socially isolated—conditions that often trigger clinical diagnoses of illness, especially as the presenting symptoms intensify. In contrast, while implicated in several disorders, social connectedness sits outside the medical model of health. Neither its presence nor its absence is a diagnosis. As such, treating these terms as (inversely) equivalent runs the risk of over-medicalizing. The focus on social disconnection gets steered toward those who are in poor health. Those in good health, however, can also experience disconnectedness.  

Any endeavor to raise the state of population-level social connectedness is better served by the premise that connectedness benefits all regardless of where one is on the health spectrum, not just the lonely and socially isolated.

Breaking Ground

Some initial steps to consider for breaking ground on this endeavor include:   

Educational Campaign 

A broad-based educational campaign to raise public awareness is an essential first step. On its website, the National Institutes of Health promotes 30 educational programs, for example, Aim for a Healthy Weight, as prototypes for improving decision making on health concerns. At present, insofar as this author knows, no similar prototype for fostering social connection exists. One needs to be created. It should cover the basics such as defining social connectedness and its benefits, conveying the health/societal risks of social disconnectedness, and describing how to initiate and maintain greater social connectedness—all against a backdrop that positions fostering social connection as a new civic responsibility. Employers, governments, places of worship, schools, nonprofits, and the media should be encouraged to adapt and promote this prototype to their respective constituencies.

Highlighting Exemplars

Bringing new visibility to exemplars currently engaging in social connection such as those cited above would yield new avenues for accelerating take-up. One or more professional bodies—such as the Population Health Alliance, American Public Health Association, or Foundation for Social Connection—could collaborate with appropriate entities within the Department of Health and Human Services (HHS) and academia to identify and publicize criteria for evaluating the extent to which various encounters foster social connection. One criterion, for example, may be the extent to which an encounter precipitates cycles of well-being for one or both parties. Other potentially fruitful areas of collaboration include the public recognition of excellence and the development of mechanisms that build on best practices.

Broadening Social Service Delivery

As suggested above, reshaping current public-sector social service delivery programs to incorporate greater social connection alongside other primary objectives would seem to offer “low hanging fruit” for raising population-level social connectedness. HHS should announce a new agencywide embrace of this priority. Its secretary should authorize agencywide development and delivery of training, tools, and resources to identify and support service recipients at risk of social disconnection. These assets should be based on the latest evidence on the prevention and clinically indicated treatment of social disconnection.

Social Connection App

Individual agency is the extent to which people act on their own behalf. It will be a crucial driver of the outcomes in this space. Policy makers should develop or build on tools that facilitate and empower this individual agency. Apps such as Facebook and Clubhouse would seem to have potential but neither distinguish nor document connections that have been newly made or strengthened.

Imagine a new app that asks the user to describe a recent encounter with another person in which a social connection was strengthened or newly made. The app would initially present some example criteria for social connection to help set context. The initiating party would then be asked to indicate to what extent and how her or his own criteria for social connection were met during the encounter. The initiating party, in turn, would send a link to the app and her or his encounter description to the other person. The app would then ask the recipient first to confirm that the encounter occurred. The recipient would then be asked to indicate to what extent and how her or his own criteria were met. 

As initiating parties entered confirmed connections into the app, they would receive points and, eventually, rewards provided by local external parties supporting the effort. As recipient parties followed up their confirmations by entering to what extent and how their own criteria for social connection were met, they too would receive points and, eventually, rewards. In keeping with the fact that both the extending and the receiving acts of relatedness are needed to establish social connection, the app would award each party the same allocation of points and rewards conditional on the provision of the criteria assessments.

Training Modules

The Surgeon General, or whoever leads this endeavor, should also prioritize the development of user-friendly training modules to provide support, guidance, and resources to individuals for cultivating and augmenting social connection in their own lives. Modules should also be designed for educators and facilitators who work with others for this purpose.

Moving Forward

In April 2020, as COVID-19 was first proliferating in the US, colleagues and I argued that our societal need to attend to social connection was getting lost in our undifferentiated use of the term, “social distancing,” for the recommended physical distancing protocols. As the virus now mounts a resurgence, this need is ever more urgent.

To paraphrase President Joe Biden, a sharp departure from established precedent is needed to help guide the growing momentum for social connectedness and “build back better” from COVID-19. The systemic, nonpartisan endeavor I propose for fostering social connection as a new civic responsibility—whose pursuit can be undertaken consistent with recommended protocols—would provide such a departure. It offers a path forward that explicitly acknowledges—and tackles with intention—the deficit of social connectedness that is now affecting many of us individually and all of us collectively. It merits serious consideration.

Author’s Note

The author gratefully acknowledges the support of the Population Health Alliance and the Foundation for Social Connection for many of these concepts as articulated in an earlier, shorter iteration of this piece.