What did you find particularly interesting or surprising in this review?

One thing that surprised me in this review was to find national strategies and action plans where governments saw a clear need to do something about loneliness on a national level. That was encouraging, even if there are only few countries at this stage. These were all from high income countries, which may lead us to believe it’s a “luxury” issue or “first world problem”, however it is equally important to support the development of such policies in low- and middle-income countries, as reducing loneliness may demonstrate a strong social return on investment.

Another thing that was interesting to see was how different the various countries were approaching this issue. I’ll give you two examples. Firstly, the Dutch approach focuses heavily on the municipal level, reflecting a long-standing tradition of decentralisation. The national government supports municipalities setting up local coalitions against loneliness by offering advisory assistance. These coalitions involve government, public and private organisations, and operate at both the national and local levels. Secondly, Japan has taken a different approach by setting up a government office dedicated to combatting loneliness and isolation. Japan is the only country to have enacted legislation setting out the basic principles for addressing loneliness. This legislation also delineates the responsibilities of national and local governments and mandates the development of a priority plan to promote relevant policies. This plan is by far the most detailed of all those we reviewed.

What would be the one thing that you would want an Irish reader to take away from this article?

There are many different drivers of loneliness: personal, interpersonal, but also more structural (e.g. marginalisation, inequality, access to/availability of resources). Loneliness cannot only be outsourced to the volunteer sector with a bit of extra funding, but it needs a shift in understanding that addressing loneliness is a social (justice) issue.

As far as we could identify, governments do not really address the structural drivers of loneliness, probably because policymakers lack time and resources and already have a wide range of responsibilities in their portfolios. On top of that they need to navigate many different fields in which they often lack expertise. They must also navigate the complexities of multiple stakeholders within and beyond government which is necessary if we want to achieve cross-sectoral collaboration to address loneliness. On top of that, preventative agendas tend to clash with short electoral cycles. There is also a clash between asks from politics (e.g. “What can we do about it?”) and research (e.g. “We know that some in-person interventions seem to work, but we don’t yet know enough about community-based approaches, which may be a promising avenue”). I see the struggles faced by policymakers and researchers, but unfortunately I don’t have a solution. However, having honest conversations about what works and what could work, and being open to testing out new approaches, may be a way forward. Also, the public should be involved in the thinking about how best loneliness in their community can be addressed, in a dialogue that is on equal terms.

In general, how well do you think policymakers understand the issues of loneliness and social isolation?

From my conversations with policymakers, I would say that they can develop a fairly good understanding of the issue. However, there may be strong disagreements about how it should be addressed, as well as between what they would ideally like to do and the budget they have been given. Developing a strategy or action plan requires quite a bit of background reading. We found that this ‘knowledge acquisition process’ is usually accompanied by consultations with experts on the subject matter, some national non-government organisations who are already working in this area and sometimes (maybe not often enough) involves people with lived experience. We have also heard of policy makers reaching out to their counterparts in other countries that have already established a national policy to gain some insights.

What areas of further research do you believe are needed to inform loneliness and social isolation policies?

I would love to see some work on tracking the outcomes of national policies. This would probably require a multi-method approach to establish both tangible and intangible outcomes. Tangible outcomes might include more and better coordinated interventions on the ground, while less tangible outcomes could include it becoming easier to secure funding for loneliness interventions. For example, we have heard from the US that when loneliness was made a national policy priority through the surgeon general’s advisory, it helped to legitimise the issue, making it easier to obtain funding from government and philanthropic sources.

Therefore, it is important to capture the wider impact of these policies beyond individual outcomes. It’s also important to think about what kind of evidence are we interested in. Do we only want scientific evidence, or are we also open to evidence from practice? If we are interested in the latter, how can we ensure a certain level of robustness and reliability?

Another interesting thing that I would explore further are the conditions under which a government decides to recognise loneliness as a social issue and do something about it. Some initial talks with some policymakers lead us to believe that the right “ecosystem” needed to be in place for a national loneliness policy to emerge. This would typically include national or even regional loneliness data, local (to the country) researchers who can contextualise the data, active civil society organisations addressing loneliness, strong media engagement to raise public awareness of the issue, and political advocacy to champion the cause within the national government.

Do you have any advice for policymakers who recognise that loneliness is linked to structural determinants such as social inequality and austerity, but wish to urgently address loneliness in their jurisdictions?

Try to address the structural determinants within your control. Think about the structural changes you can implement. Here are some examples from my personal experience flavoured by many conversations with people:

• Providing social infrastructure:
• Ensuring there is space available for people and local organisations to meet up for free or for a small fee. This has been a large pain point in some UK local authorities I know.
• Introduce “play-streets” where children can play on the street together without fear of cars. These spaces are also great for “bumping into” neighbours.
• Employers enable their employees to go and volunteer for 4h/month during work hours. (This idea came from a dialog evening I hosted in Switzerland.) It has been shown that volunteering can reduce loneliness, so it would be interesting to explore.
• Providing the physical space for community gardens and similar communal projects.
• Looking after community assets: Ensure that your library/community centre, which is usually the only place where people can meet without spending money, does not close. Be open to ideas on how to keep it open if finances are looking grim. There are many examples of creative ideas, but they can only flourish where they are given the opportunity to do so.
• Funding and bureaucracy: Explore low-level and agile funding options (e.g. micro-funding) to support community developments. Maybe also think how can people in the community be supported with the paperwork, when they do want to establish something new (how to get started, where can you apply for funds, etc) as general paperwork can sometimes be a barrier in itself.