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Take a ‘Social in All Policy’ Approach to Bring Better Health to More People

Power of Ideas
Take a ‘Social in All Policy’ Approach to Bring Better Health to More People

Globally, simultaneous health crises have prompted a heightened focus on improving population health. Yet the Centers for Disease Control and Prevention acknowledges that medical care and genetics are not the largest contributors to health; it is social factors. The global COVID-19 pandemic brought greater awareness of how important social contact is for our well-being—yet decades of robust scientific evidence demonstrates that social connection is a major contributor to individual and population health. Indeed, one of the strongest predictors of morbidity and mortality across social species in nature, including humans, is the social environment. Experimental studies demonstrate that social interactions can causally alter physiology, disease risk, and life span itself.

The recent US Surgeon General’s Advisory Our Epidemic of Loneliness and Social Isolation points to the far-reaching consequences and emphasizes social connection as a critical and underappreciated contributor to health, well-being, safety, and prosperity.

When it comes to public health, we must move beyond operating in crisis mode to sustained efforts to ensure that individuals and communities aren’t just surviving but thriving.

Social health is more than just a personal issue.

By operating in crisis mode, we tend to focus on the problem rather than the goal. Notably, the evidence points to a social gradient, so instead of a dichotomy of being lonely or not, we are all somewhere along a continuum of social connection. Further, there is a corresponding risk reduction for every unit increase in social connection. In other words, the evidence points to a continuum from risk to protection across the social gradient—which applies to the entire population.

Targeted approaches to reach individuals most at risk are needed; however, tertiary approaches are often the most expensive and least successful. Even if successful, we only reach a small portion of the population. In contrast, larger efforts that focus on the protective power of social connection via population-based prevention efforts, instead of just affecting the extreme ends of the spectrum, may shift population-level risks. We need to go from targeted to broad approaches.

Social health is more than just a personal issue. For far too long, we have viewed social connection as a personal issue. Of course, our experience is deeply personal, so understandably, many may view this as a private matter—believing that the government and other institutions have no business getting involved. While we value our autonomy, it has simultaneously placed an enormous burden on individuals to deal with problems such as social isolation or loneliness alone—when sometimes the underlying cause is outside an individual’s control.

The pandemic demonstrated two crucial clues that can inform approaches to advancing social health. First, an individual’s social connectedness can be profoundly influenced by external factors. Second, social contact is part of almost every aspect of society. These became clear when policies aimed at reducing social contact altered nearly every aspect of our lives. We saw changes in how we work, attend school, travel, shop, get entertainment, and so much more. This collective experience highlights the social relevance of every sector of society and offers important clues to enhancing health by adopting a whole-of-society approach.

To improve the overall health of the population it will be necessary to adopt a "social in all policy" approach. Since social contact permeates every aspect of society, policies across every sector can promote or hinder connections. We must carefully study the social repercussions of a program in the same way that we assess its economic ramifications. Will this residential zoning, telework, transit, curriculum, or workplace leave policy facilitate or become barriers to social connection? This approach should entail a comprehensive strategy that emphasizes fostering a healthy environment through education, employment, health-care access, community engagement, and addressing social disparities.

To truly impact population health, we must extend our focus beyond health care to encompass policy and initiatives that strengthen social bonds, empower communities, reduce inequalities, and ultimately enhance the overall health and well-being of the population.