In the fifth episode of Frontiers in Health & Happiness, we speak with Dr. Ichiro Kawachi, John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology here at the Harvard T.H. Chan School of Public Health, where he has taught for more than 30 years. Dr. Kawachi discusses the correlation between loneliness and socioeconomic status and race, his involvement with the World Health Organization’s new Commission on Social Connectedness, and his advice for finding happiness.
Ayla Fudala: Hello! And welcome to Frontiers in Health & Happiness, the official podcast of the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. My name is Ayla Fudala, Center Communications Coordinator, and I’ll be asking experts how to live a healthy, happy life.
Today, for the fifth episode of our Loneliness and Well-being Series, I’ll be speaking with Dr. Ichiro Kawachi. Dr. Kawachi comes from our home department, the Department of Social and Behavioral Sciences, right here at the Harvard T.H. Chan School of Public Health, where he has taught for three decades. He is a Professor of Social Epidemiology—a field which he has helped to define. Dr. Kawachi co-authored the first ever textbook on Social Epidemiology, and currently serves as the Co-Editor in Chief of the International Journal Social Science and Medicine.
Like his former student Dr. Koichiro Shiba, one of Dr. Kawachi’s specialties is the intersection of loneliness and health equity. I began by asking him, how do socioeconomic status and race relate to isolation and loneliness?
Dr. Ichiro Kawachi: We tend to assume that everybody has the same chance to be connected to other people, but because of inequalities in society, that's not the case. And when we look at people's characteristics, whether it's by a social class, race, ethnicity, gender, immigration status, disability, sexual orientation; all of these characteristics, tend to structure or stratify the way in which we're connected to other people. If you take an example of socioeconomic status and race and ethnicity, and you look at our society, we see that our neighborhoods, for example, are highly segregated. Rich people tend to cluster in their own enclaves and lower socioeconomic people tend to cluster in their neighborhoods. And it's the same with racial residential segregation. And this means that there are fewer opportunities for people to interact across these boundaries. And that ultimately results in an inequality in social connection.
Ayla Fudala: How can policy begin to close the gap in access to social connections by socioeconomic status and race?
Dr. Ichiro Kawachi: I think that there are two broad means of trying to resolve this problem. One is what we call more integration. And the second is through more interaction. So with regard to integration, I think we need a societal approach that integrates neighborhoods and places where people work. So, for example, there's been lots of work on how to desegregate neighborhoods and desegregate our schools so that we give people greater opportunity to interact across social class and racial lines. An example of a desegregation policy would be reforming the zoning laws that exist in this country. Ever since redlining was banned by the Supreme Court in 1968, this country has maintained segregation through what we call exclusionary zoning regulations. In this country, local zoning laws dictate, what sort of houses can be built on land. And only about 17% of available land in this country is available for multifamily housing, for example. And that results in the kind of segregation we see where the vast majority of land is reserved for single family housing. Which drives up the price of real estate and makes it very difficult for people with less wealth to move into suburbs and places where they would have the opportunity to interact with wealthier people.
So one approach is through integration. The other is through interaction. Namely, the neighborhood may be integrated, but there's not much opportunity for people to interact because of the lack of public spaces where people can come together. And that's where the policy of trying to build social infrastructure comes in across our neighborhoods. We need more investment in public spaces, green spaces, parks, libraries, community centers, and so forth. These are intended to encourage interaction between diverse people.
And the last thing I would mention is, this country needs to invest in safe and affordable public transit, which enables people to travel between neighborhoods. And, unfortunately, the history of this country has been very much concentrating on the automobile as a means of transport. And there are many people who can't afford to drive a car. And we already know that there are strong socioeconomic differences in who relies upon public transport. And so we need to do a much better job, including towns and cities like Boston in investing in safe, convenient, and affordable public transit.
Ayla Fudala: Do you have any other thoughts on policies for promoting social connection that you’d like to share?
Dr. Ichiro Kawachi: One thing I haven't mentioned is leveraging or mobilizing the health care sector. So there's some things that people in health care can do. One model is what we call social prescribing, which is something used in other countries, particularly the National Health Service in Britain, where if you're a general practitioner and you want to help a patient who is isolated or lonely, you can refer them to someone called a “link worker”, whose job it is to connect that individual to resources in the community that will offer social connection. In the British National Health Service, people are paid to be link workers, and they are professionals who know the organizations and services out in the community that isolated people can be connected to. It could be a volunteer group, a religious organization, a sports association, these kinds of things. And the link worker's job is to make those connections.
Ayla Fudala: That's fantastic. I wish we had that here. I would definitely want a link worker.
Dr. Ichiro Kawachi: Yes. The wonderful thing is that it's actually financed by the British National Health Service. And I think it's a model for other countries to take up.
Ayla Fudala: Are there any policy solutions specific to Boston that you would implement if you were in charge?
Dr. Ichiro Kawachi: I think the Boston mayor, Mayor Michelle Wu, has been doing quite a few of these things, actually. She's trying to increase the affordability of housing. There's a legislation, I think, working its way or about to be implemented, which would allow many owners of single family units to convert their garages, for example, into accessory rental units. That kind of thing would enable people to move into what was once an incredibly expensive neighborhood. And I know that the mayor is also working on solutions to improve public transit as well. I think maybe it could be a model for the rest of the country.
Ayla Fudala: What types of social connections should we seek to strengthen? What are strong versus weak ties, and why do they matter?
Dr. Ichiro Kawachi: When the surgeon general put out the advisory on social connectedness last year, they called for measures to strengthen social connections, but they didn't really go into a whole lot of detail about what types of connections we should be strengthening. And I can think of two distinctions that matter. One is whether we should be strengthening what we call strong social connections versus weak ones. Strong connections, as the name suggests, are those kinds of intimate ties that we have in our daily lives, our close friends and confidants; whereas weak social connections are what we refer to as our outer layer of people we’re acquainted with. And the epidemiological evidence suggests that weak ties can be just as important for people to be able to handle the exigencies of daily life, to go ahead and to seek help when it's necessary, as strong connections. And so, we should be thinking not only of advice, like telling people to make more close friends. We should be encouraging more weak connections between people in society.
And on that topic, when we think of extending our social connections, the other distinction we make is between bonding social connections and bridging social connections. Bonding connections refer to those connections between people who are similar with respect to social class and race, for example, whereas bridging connections are those that are literally bridging the gap between people of different social classes and different race and ethnic backgrounds. And we need to have a lot more bridging social connections in society to get the most out of the benefits that social connections can deliver. For example, a national poll in 2022 showed that two thirds of white people in this country do not have friends who are outside their own race, two thirds. So their friend groups are composed entirely of other white people. And that's a kind of inequality. We need to think of the policies I talked about. More integration, more interaction. In order to make those connections, we need to have integrated policies like neighborhood desegregation. And we need to have policies that increase interaction through investing in places where people can congregate and mix, building more social infrastructure, improving public transit, and so on.
Ayla Fudala: Why does having a socially connected society matter in times of crisis?
Dr. Ichiro Kawachi: When we think about a society's resilience to crisis, people think of preparedness in terms of stockpiling food and emergency rations and so forth. Well, a lot of studies now suggest that one of the strongest predictors of societal resilience is the strength of social connections between people who are affected by crises. If you think back to the start of the Covid-19 pandemic, what really helped communities to withstand and recover from the pandemic crisis was the pre-existing social connections that people had in their communities. Having social connections meant, for example, that you could rely upon your friends to drive you to a vaccine clinic when you didn't have transport. And having friends who could tell you accurate information about how to protect yourself. And it meant having neighbors and people at work who could adhere to social distancing and consistent masking, in order to be helpful to others who were more vulnerable. And these are all benefits of social connection that helped society to withstand the burden of disease caused by Covid-19.
Ayla Fudala:I believe Dr. Koichiro Shiba, who spoke earlier in this series, is your former student, and that the two of you work together on research into the importance of social connection in times of crisis. Can you speak a little about that work?
Dr. Ichiro Kawachi: So with Koichiro, I have been primarily working on disaster resilience. I have a rather unique cohort study of people who experienced the 2011 Japan earthquake and tsunami. And so in the study, we happened to have information about people's social connections both before and after the tsunami. We have the information before because, just by pure accident, we had completed a survey of individuals who happen to be living close to the epicenter of the 2011 earthquake. And so we have an unusual design where we are able to track people and how they recovered from this event based upon the pre-disaster levels of social connection.
One of the things that we've discovered is that after the earthquake, people suffer all kinds of health problems like PTSD obviously, but also in our case, worsening cognitive function. There's a big rise in dementia symptoms among older people. And one of the reasons is because what earthquake and tsunami does is displace people. People lost their homes due to damage from the tsunami. And they were then relocated to temporary housing where they essentially lost contact with their neighbors and friends. And so what we've discovered is that one of the strongest factors which helps people to prevent becoming cognitively disabled, and suffering mental setbacks, is that they lived in a neighborhood where there were strong social connections beforehand. So that's the sense in which social connections promote disaster resiliency. If you happen to be living in that kind of neighborhood, you're much more likely to maintain social connections with your neighbors and friends and therefore able to withstand the effects of residential dislocation.
Ayla Fudala:How have pandemic restrictions affected social capital in cities?
Dr. Ichiro Kawachi: Yeah, that's a great question. So one of the things that we're only really starting to think about now is the trade off in the policies that we enacted, like shelter in place, directives like school closures, and so forth. On the one hand, these policies certainly helped to stem the spread of the infection. But on the other hand, it is becoming apparent now that it has had lasting consequences on people's ability to be connected to others and especially in the form of eroding that bridging social capital that I talked about. But the evidence now suggests that because of the shelter in place policies, even after the restrictions were lifted for up to 2 to 3 years afterwards, people's connection to others might have been adversely affected. And so I think one of the things that we need to consider going forward is the cost of these control measures in terms of people and social connectedness; and try to figure out the line between helping the public health versus harming something in the long term.
Ayla Fudala: What is your opinion on that?
Dr. Ichiro Kawachi: We still need to do the studies to understand just how long and how widely these impacts spread. I do believe that, now we look back on it, school closures were maybe implemented too far and for too long, so that it has had lasting impacts on children's ability to connect to other children, and as well as to their development. And my infectious disease colleagues tell me that with adequate ventilation and a few other things, schools could have been reopened sooner. Similarly with restrictions about people's mobility. We need to look back and figure out what is the optimal length of time that such mandates should be put in place.
Ayla Fudala: So people's social connectedness still hasn't recovered to pre-pandemic levels.
Dr. Ichiro Kawachi: At least as of 2 to 3 years after the restrictions, it remains the case that they dropped precipitously and they haven’t recovered to pre-pandemic levels. So it does have a lasting impact on people's patterns of connection. And we know from epidemiologic evidence that social connections promote health-- they promote mental health, and in the long term, physical health. So we have to weigh up the balance of preventing the burden of ill health by restricting the spread of infection versus the price we pay for health by making people less socially connected.
Ayla Fudala:You are working on a World Health Organization Commission on Social Connectedness, alongside previous podcast speaker Dr. Louise Hawkley, and guest speaker for the Lee Kum Sheung Center for Health and Happiness Seminar Series Dr. Julianne Holt-Lunstad. Can you tell me about that? What is your goal, and how do you plan to achieve it?
Dr. Ichiro Kawachi: I'm glad you mentioned that. So the World Health Organization, earlier this year in March of 2024, announced the establishment of a Commission on Social Connectedness. The WHO now has woken up to the crisis in social connectedness, which affects not just the United States, as the US Surgeon General warned us about last year, but is a worldwide phenomenon that needs urgent attention from policymakers. So there's been a commission established with political leaders from around the world. And supporting this commission is a technical advisory group that is composed of researchers like myself, Dr. Julianne Holt-Lunstad, and Dr. Louise Hawkley. Our job is to try to back up the recommendations of the commission with good science. And the ultimate aim of this commission is to come up with both a diagnosis of the situation worldwide and to come up with suggested policies that governments might adopt in order to solve this problem.
Ayla Fudala: And where are you at in that process?
Dr. Ichiro Kawachi: We've just established the commission. So we're only a couple of months into the work that needs to be done, but we will be reviewing global and regional evidence on the prevalence of social connectedness or disconnectedness, and then reviewing the evidence on the policies that we think will help to alleviate the situation. So watch the space because we haven't arrived at the set of conclusions. We're still in the fact-finding stage.
Ayla Fudala: When do you expect the findings to be made public and the policies to be implemented?
Dr. Ichiro Kawachi: I believe the final report will be coming out next year in 2025. And then, the process is that the report of the commission will be presented to the World Health Assembly, where world governments may consider it and choose to adopt it in their respective countries.
Ayla Fudala: I have to say, after hearing so much about the negative mental and physical health impacts of loneliness and how widespread of a problem it is globally, it's really reassuring to know that the World Health Organization is taking direct action to address this issue.
Dr. Ichiro Kawachi: Yes, I think it is. The science of social connectedness has been around for many decades, but it hasn't really received attention from policymakers until now. And I think one of the things that has prompted this renewed attention is what we all noticed during and after the pandemic. That is because of the things I mentioned at the outset, like the rise in telework, and the increasing digital space in which people are spending their lives, people have awoken to the potential consequences health consequences of social disconnectedness.
Ayla Fudala: Do you have any thoughts about the Lee Kum Sheung Center for Health and Happiness and our Loneliness and Well-Being series?
Dr. Ichiro Kawachi: Well, I think it's great that you're focusing on this theme and, you certainly have a terrific lineup of people who are doing cutting-edge work on the topic of social connections, loneliness, and isolation.
Ayla Fudala:Do you have any closing remarks for our listeners?
Dr. Ichiro Kawachi: Social connection is fundamental to well-being and happiness, isn't it? I mean, there's a great deal of evidence that what makes people happy, content, satisfied is social connections. People often mistakenly think that it’s things like money and status and so forth, but it’s the invisible things, like our connections to other people, that really contribute to enduring happiness.
Ayla Fudala: In the fifth episode of our Loneliness and Well-being Series, Dr. Ichiro Kawachi shed light on the profound impact of socioeconomic status and race on isolation and loneliness. He advocated for integrated policies to address segregation and enhance public spaces, fostering interaction among diverse communities. Dr. Kawachi emphasized the importance of both strong and weak social ties and the necessity of bridging connections across societal groups. Reflecting on the pandemic's effect on social capital, he underscored the vital role of social connections in crisis resilience.
After speaking with Dr. Kawachi, I find myself relieved to know that while the loneliness epidemic is a serious threat to health and happiness worldwide, it is not going unnoticed, or unchallenged. The World Health Organization is taking steps to address the issue, bringing together experts to develop evidence-based policies.
As the episode concludes, I’d like to reiterate Dr. Kawachi’s final words. Remember, it is our connections to other people that really contribute to enduring happiness.
The next episode in this series will also be the last. I’ll be speaking with Dr. Julianne Holt-Lunstad, pioneering expert in the field of loneliness research. Dr. Holt-Lunstad served as the Lead Scientific Editor for “Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community”, a document which drew significant attention to this growing issue.
Dr. Holt-Lunstad is Professor of Psychology and Neuroscience and Director of the Social Connection and Health Lab at Brigham Young University. She is also the founding scientific chair and board member for the U.S. Foundation for Social Connection and the Global Initiative on Loneliness and Connection. Tune in to our next episode to hear what she has to say!
This has been another episode of Frontiers in Health & Happiness, the official podcast of the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. To learn about upcoming events, visit our website, sign up for our mailing list, and follow us on LinkedIn, X, Instagram, and Facebook. Thank you for listening!