Surviving Loss

In 2023, the US Surgeon General published a report that gained much visibility on the importance of the lack of social relationships as a risk factor in Americans’ health. The report openly spoke of a “loneliness epidemic,” showing how in general the time spent in situations of social isolation has increased significantly in America over the last 20 years, regardless of gender, with higher incidence among ethnic minorities, the poor and within the LGBTQ+ community. Different age groups are affected differently by the phenomenon, with young adults showing higher levels of loneliness than older adults, who, however, are more vulnerable to consequences such as higher mortality and the prevalence of pathologies such as diabetes and cardiovascular disease. Similar evidence, albeit with smaller numbers, was also found for the European Union in a report published in 2024.

In this epidemiological framework, there is still much room for research. Not all literature, for example, agrees in defining an “epidemic” a phenomenon that is certainly relevant, but which has probably always existed (and with equally important numbers) and which we have only now found the courage to confront. Furthermore, it is particularly interesting to try to understand the causes of the spread of solitude. What role do social media play among young people? And what about redesigning the welfare state for the elderly? Is today’s individualistic and hyper-competitive culture that is increasingly dominant at all levels responsible? Even considering its effects on health, the consensus is not definitive. In particular, it is difficult to identify a causal relationship between a subjective sensation such as loneliness and an objective medical condition, a relationship that at the moment is mainly based on evidence of correlations between variables, so that these assessments are more or less sensible conjectures. Finally, if loneliness is really bad for people’s health, the policies and actions to be taken for preventive purposes are not easy to define or even implement, as they require a multidisciplinary vision capable of reasoning and acting at the intersection of the social, medical, psychological and economic spheres of people and communities. 

In a series of works funded by the “Age-IT” program of the Italian national recovery and resilience plan (PNRR), done with the CERGAS and Dondena research centers, we focus on some of these questions in relation to the elderly population in Italy and internationally. The first question we addressed, for example, concerns whether it is possible to identify a chain of causality between loneliness and health conditions. Using two famous international surveys on about 70,000 people over 50, the Health and Retirement Study (HRS, for the US) and the Survey of Health, Ageing and Retirement (SHARE, for Europe), we try to reconstruct the evolution of health of those individuals who, for various reasons, find themselves coping with living alone. Given the age of the sample (over 50), in most cases this sudden isolation is due to the loss of a partner, an event that, especially among the elderly, is a source of acute emotional and psychological stress. Following a shock of this type, it is obviously logical to think that the sense of loneliness increases, sometimes even permanently, creating what we define as "induced loneliness” caused by a relevant event, thus excluding possible cases of reverse causation (i.e. those who are and live alone as a consequence of an illness). In this context, with Irene Torrini (Bocconi) and Maria Sironi (University of Padua) we show how induced loneliness represents a significant risk factor for relevant variables such as mortality, morbidity and psychiatric illnesses. In other words, among American and European elderly, feeling lonely and being alone represent two dimensions that are partially different from each other and only partially overlapping. The pure subjective dimension (loneliness, precisely) makes an elderly person significantly more vulnerable and fragile with causally identified effects on health that are evident starting from the year in which the shock is experienced. Loneliness hurts and, in some cases, even kills.

It remains to be understood how to act to reduce such a subjective risk factor. From the point of view of public policy and health economics in particular, if the social dimension impacts so strongly on the health one, it would be important to understand its interactions and spillovers, optimizing it and overcoming the silo mentality that has for years been dominant in welfare spending in Italy and Europe. For example, it is perfectly possible that investing more and better in social spending to reduce the loneliness of the elderly could save health resources and increase the productivity and consumption of all those families who, at least in part, have to take care of the elderly in some phases of their lives.