Social health is a core part of our overall wellbeing 

We know that getting out and about, seeing friends and family can be good for us. But there is a growing understanding of just how vital social connections are for our general health and longevity. 

The slogans are well known. Eat your five a day, get plenty of fresh air and move your body. Take the stairs rather than the lift. 

These snappy lines advising us how to look after our bodies have been floating in the public consciousness for decades. Here’s another one: an apple a day keeps the doctor away. And in the early 2000s, awareness around mental health rose steadily, with nationwide campaigns and major figures talking about their own struggles. 

Now, there is growing attention on the importance of social health, and the crucial role it plays in our overall wellbeing. The term may sound woolly, but as Emily Daniel, chief executive of loneliness charity Together Co, puts it, social health centres on the quality of one’s relationships and a sense of belonging. 

“It’s about the connections that help us feel supported and valued,” Daniel told Healthcare Today. “We talk about our physical health, we talk about our mental health, but social health is the third part of the picture. And it has a huge impact on the other two,” she said. 

Last year, a report from the World Health Organization (WHO) described the consequences of social disconnection, which is when a person doesn’t have enough social contact and doesn’t feel supported by their relationships, as “severe” and called for urgent action. 

The impact of loneliness is profound yet overlooked, the report argued, “despite being just as damaging as other well-known public health risks”. And the scale of the problem is becoming increasingly difficult to ignore. WHO estimates that almost one in six people globally experienced loneliness between 2014 and 2023, while up to one in three older adults and one in four adolescents may experience social isolation.

The Covid-19 lockdowns brought into sharp relief how important meaningful social interactions are, and what is lost when we’re cut off from our communities. We grasped at straws, looking forward to going to the shops, where we could exchange brief words with the cashier and look into their eyes for a few seconds and feel that tiny spark of connection. For some people, Covid pushed them further into chronic loneliness. 

When I became a new mum, I experienced for myself how quickly loneliness can hit you. I craved companionship during the day when everyone else was at work. It felt like an ache in my stomach. Fortunately, there were plenty of groups I could join to meet other mums, but it made me realise how I had taken my social health for granted, and how quickly it can crumble. 

A quick caveat. This article has already referred several times to loneliness and social isolation. Although similar, they are not the same. Someone can see and talk to people every day in their office or at home, and therefore not be ‘isolated’, but they can still feel incredibly lonely if their primary relationships are not fulfilling. This is why your social health is also about the quality of relationships and feeling that you belong somewhere, with your tribe. 

The rise of social health

The concept of social health is gaining traction. Together Co became familiar with the term thanks to the work of one of its ambassadors, US social scientist Kasey Killam. 

In 2024, Killam published The Art and Science of Connection: Why Social Health is the Missing Key to Living Longer, Healthier, and Happier. In a Guardian article to promote her book, the author argued that traditional health advice overlooks the importance of human connection, and while factors like smoking and exercise are well known, we have “a long way to go toward a broad understanding that connection is a vital determinant of overall health, wellbeing and longevity”.

“She opened our eyes,” Daniel explained, “This is what we were doing. Through our work we could see the impact of connections and the quality of relationships on people.”

Research has shown that loneliness and social isolation increase the risk of stroke, heart disease, diabetes, cognitive decline and premature death. 

Chronic social isolation activates a stress response in our bodies, and when we remain in a fight-or-flight state for too long, hormones such as adrenaline raise our blood pressure and heart rate, placing strain on vital vessels. Our mental health is impacted too. The increase in stress triggered by social disconnection can increase the risks of depression and anxiety. 

Robin Dunbar, emeritus professor of evolutionary psychology at Oxford University, has spent decades studying the biological, cognitive and behavioural mechanisms that enable and underpin bonding between primates and between humans. This includes the key role of endorphins, hormones which, put very simply, improve our mood, and are activated by activities such as exercise or being with close friends. But what’s less known is that they also impact how quickly we heal. 

The release of endorphins into the bloodstream, Dunbar explained, triggers the body’s immune system, in particular natural killer cells, which target viruses and some cancers. 

“That’s why you get these physical benefits that appear to come from having friends,” Dunbar told Healthcare Today. “It’s the biochemical effect on the immune system. Just how fast you recover from surgery is affected by the number of friends and family you have.”

But it’s not just about our physiology. There are social and behavioural elements too. Those with a support system are more likely to look after their health and attend check-ups, perhaps with a reminder from their partner. And it feels obvious to say, but the more we go out, the more active we’re likely to be. 

How to fix the problem 

The evidence linking loneliness and social isolation with wellbeing, both physical and mental, is mounting. A recent study led by the University of Bristol, Nesta and Amsterdam UMC, focusing on middle-aged and older adults, set out to establish whether loneliness and social isolation themselves contribute to poorer health. 

The researchers therefore used three different approaches – observational analysis, comparisons between siblings and genetic analysis – to examine the relationship from different angles. The study, published in Nature Communications in the summer, found that loneliness is likely to have a detrimental impact on our mental health and wellbeing. 

Lauren Bowes Byatt, director of Nesta’s healthy life mission, said that while the link may seem obvious, “the topic has long been understudied”. By understanding how loneliness or social isolation may be contributing to ill-health, “we can get closer to new and more effective solutions,” she added.

Charities and local councils provide vital work in helping people connect with each other.

Together Co, based in Brighton and Hove, runs a befriending scheme, matching people with a ‘befriender’ who lives locally and whom they can meet regularly. Last year, 579 people were supported through the scheme. ‘Connector volunteers’ work with service users to help them engage with the outside world, by perhaps joining a choir or craft group. 

But it’s not enough. Daniel wants to see change on a national level, with the government recognising and prioritising social health, in order for people to live more connected lives, and in turn be healthier. That means looking at how towns and new-build estates are planned, with places for people to gather. It means teaching schoolchildren the importance of healthy relationships and the value of engaging with the local community. 

The NHS 10 Year Health Plan, with its focus on prevention and bringing treatment away from overcrowded hospitals and into the community, is an opportunity to address loneliness and social health, Daniel told Healthcare Today. 

“We used to be ahead in the UK. Loneliness is noted in some of the government’s priorities and policies, but it’s not enough,” she said. 

In the 10 Year Health Plan, the NHS says social prescribing is central to shifting care into the community. This is when patients, perhaps someone with a long-term condition or a ‘low-level’ mental health issue, are introduced to activities and groups in their community, such as a running club or art group. And a government report from 2023 on the progress of tackling loneliness highlighted the benefits of the practice. So, watch this space. 

That magic feeling

There is growing recognition, spurred on by the pandemic, that talking to someone on a screen is not the same as meeting them face-to-face. We all remember the draining work drinks over Zoom and the chaotic family quizzes which left us wanting to stare at a blank wall. And it all goes back to when we were primates in trees, bonds created as we groomed each other, patting and stroking one another’s fur in turn. 

As humans have evolved, we’ve found other activities which trigger the endorphin systems and create that warm, cosy feeling, Dunbar explained to Healthcare Today. Laughter, singing, dancing, feasting, religion, telling stories – all these do the trick. Endorphins are triggered when we move our bodies, and when we go through a profound emotional experience with others. Harder to do, perhaps, on a screen. Digital media isn’t a bad thing, Dunbar added, “but it’s no substitute for face-to-face contact. Because there’s something magical that comes out of that.” 

For our relationships, both romantic and platonic, to thrive, we need to keep seeing each other, making memories and having new experiences, although speaking online and on the phone is, as Dunbar put it, a handy “sticking plaster”. 

Most people innately sense that ‘doing something new’ with their partner is a good thing. It shakes you out of a rut and creates a renewed sense of closeness. 

One way of explaining this is the self-expansion theory, developed by psychologists Arthur Aron and Elaine Aron in the 1980s. The married couple suggested that people are motivated to expand their sense of self by gaining new knowledge, perspectives and experiences. And this can happen in couples, as partners absorb each other’s worlds: trying new foods and restaurants, meeting different people. 

But that process naturally becomes less exciting over the years as a relationship becomes familiar. However, one way to recreate some of that early sense of discovery, the theory goes, is to experience new things together. And research led by psychologist Amy Muise, published in the Journal of Personality and Social Psychology in 2018, found that engaging in self-expanding activities with a partner was associated with greater sexual desire, which was linked to greater relationship satisfaction. 

A balancing act

While this article has focused on the many ways ‘real life’ interactions are best for us, technology should not be viewed as the big bad. The digital world can be beneficial for people who are struggling with their mental health and want to take the first tentative step towards receiving support. 

Face-to-face contact is important to many of us, but it isn’t the only way we feel connected with others, Rosie Weatherly, information content manager at Mind, explained. There are lots of reasons why people may prefer different ways of communicating, Weatherly said, “like if we feel anxious, if we have a disability that affects our communication, or if we don’t feel understood by other people.”

Mental health charities and organisations now often run online services in conjunction with face-to-face support, such as Mind’s peer support community, Side by Side. 

Lynne Green is chief clinical officer at Kooth, a mental health platform for young people, where they can access support from practitioners and, like Side by Side, connect with others going through similar experiences. For some, digital support isn’t the compromise, it’s the better fit, Green told Healthcare Today. 

Kooth, for example, reaches around 1.5 times more male users than traditional services. Text-based support removes the eye contact, the waiting room and the requirement to “perform being fine”, Green said, adding that “a lot of boys will type something they would never say out loud.” 

But Green is clear that belonging and being physically in the company of other people are “protective” in a way no digital service can replicate.

A great deal of the work Kooth practitioners do is to support young people to engage with their ‘offline life’, such as repairing a friendship that has gone wrong or walking into a youth club for the first time. “Social health is not just a ‘nice to have’ alongside mental health- it is a core part of it,” Green said. 

There is lots of work still to be done around recognising the integral role of our social health in our general wellbeing. In the meantime, charities like Together Co will keep on banging the drum. As Daniel put it, social health isn’t solely for those who are lonely, it matters to everyone, and we neglect it at our peril.