"To say something is true is to say that it is the case whether I want it to be so or not. Nothing can be made true by will alone."

Truth? It’s not just about the facts

JULIAN BAGGINI

"In whichever guise we encounter truth, it has the curious property of being everything and nothing to do with us. To say something is true is to say that it is the case whether I want it to be so or not. Nothing can be made true by will alone. It is an all-too common nonsense to say that something is “true for me” but might not be for anyone else. At the same time, what is important about the truth is always relative to the knower. The mathematician, the scientist, the artist, the historian and the religious believer are not always concerned with the same truths or the same aspects of truth. Truth is not relative, but we relate to it in innumerable ways."

"The freedom is grandiose and unreflective, arrogant and Hubristic. It brings great benefits, but also significant costs..."

Psychiatr Danub. 2017 Sep;29(Suppl 3):550-555.

Sexual Freedom vs Sexual Nemesis: Where Is the New Morality?

Fry A1.

Author information

1

Central Stress Management, 9 Coldbath Square, London, EC 1 R 5 HL, England, UK, anthony@frdoc,co,uk.

Abstract

Sexual practice, attitudes to sex, gender roles and attitudes to power between the sexes are changing rapidly. Here a new free, indulgent, pleasure seeking sexuality, driven mainly by young women is emerging. This new order can be seen in conduct, but is graphically portrayed in popular music, film and the written word. It has travelled as fast as light in digital media, as if there was a new brain- not like the pheromonal brain of ants- but the digitalised brain of new humanity. Across history, the control of sex has usually been located in religion or the state, they have dictated not only conduct, but defined deep rooted feelings about personal anatomy, and intimate activity. Women in particular have been influenced by feelings of shame with their genitalia, pride of virginity, and a high degree of secrecy of sexual arousal which has restricted their sexual exploration and satisfaction. Now emerges a new permissive morality which has asserted its presence so rapidly, that few have had time to consider it, but rather have simply accepted it, with little attention to its impact on our society. Like many revolutions it has its own almost anarchic momentum. The freedom is grandiose and unreflective, arrogant and Hubristic. It brings great benefits, but also significant costs- which are far reaching and important, and should not be overlooked. Love, intimacy and sexual relations, and the body that enables all of this are too precious, too delicate to be governed by pleasure alone! As institutional control diminishes, an appropriate set of ethical moral and medical guidelines, should be constructed and the individual encouraged to apply them. "I have the right to decide what I do with my body!" It is this project that is explored in this paper.

Adolescent Obesity Rate Approaches Adult Levels

Adolescent Obesity Rate Approaches Adult Levels In State

National Survey Of Children's Health: 30 Percent Of Wisconsin Kids Ages 10 To 17 Overweight Or Obese

"The 2016 National Survey of Children’s Health shows 30 percent of kids in Wisconsin ages 10 to 17 are overweight or obese.

Utah had the lowest percentage of overweight adolescents at 19 percent. Tennessee had the highest, nearly 38 percent. The national average of obese children and teens was just over 31 percent, according to the survey."

Perhaps the best commercial ever.

Perhaps the best commercial ever.

Tom Price resigns

Health and Human Services Secretary Tom Price resigns after criticism for taking charter flights at taxpayer expense

Texas Tribune: Trump taps two Texans — Willett and Ho — for judicial posts

Trump taps two Texans — Willett and Ho — for judicial posts

President Donald Trump is nominating two Texans to the 5th U.S. Circuit Court of Appeals: Texas Supreme Court Justice Don Willett and Dallas attorney James Ho. 

"Willett, a well-known Twitter user, has served on the state Supreme Court since 2005. During the 2016 presidential race, Trump had named Willett as a potential choice for the U.S. Supreme Court.

Ho is the former solicitor general of Texas. He has also served as chief counsel for Cornyn."

"...when towns and counties lose manufacturing jobs, fertility and marriage rates among young adults go down, too."

Economic forces making US men less appealing partners, researchers say

"These blue collar gigs were and are special: they pay more than comparable jobs at that education level in the service sector, and they deliver way more than just a paycheck. The jobs are often dangerous and physically demanding, giving a sense of solidarity with co-workers. Not coincidentally, these jobs are also incredibly male-dominated — becoming even more so between 1990 and 2010.

But since 1980, a full third of all manufacturing jobs — five million since 2000 — have evaporated, making guys less appealing as potential husbands in the process.

Dorn and his colleagues find that when towns and counties lose manufacturing jobs, fertility and marriage rates among young adults go down, too. Unmarried births and the share of children living in single-parent homes go up. Meanwhile, places with higher manufacturing employment have a bigger wage gap between men and women, and a higher marriage rate.

“On simple financial grounds, the males are more attractive partners in those locations because they benefit disproportionately from having those manufacturing jobs around,” he tells Thrive Global.

It underscores how in the U.S., the norms around money, marriage, and gender remain — perhaps surprisingly — traditional."

"...turned condemning America and reviewing its crimes into a class marker of virtue and sophistication."

Paying the price for breakdown of the country's bourgeois culture

"And those adults with influence over the culture, for a variety of reasons, abandoned their role as advocates for respectability, civility, and adult values. As a consequence, the counterculture made great headway, particularly among the chattering classes — academics, writers, artists, actors, and journalists — who relished liberation from conventional constraints and turned condemning America and reviewing its crimes into a class marker of virtue and sophistication."

HT:MC

US PAYS HEAVILY FOR OBESITY

"Obesity can cause a grown up individual in US where it can cost society thousands of dollars in medical care and lost remuneration. With the help of a computer model researchers appraised the financial toll that obesity can cause at varied ages.  They found out that an obese 50 year old with normal blood pressure and cholesterol levels may cost the society around $36,000."

The U.S. cities where people exercise the most — and least

These are the U.S. cities where people exercise the most — and least

Where does your city rank?

"Of the 189 communities included in the list, Boulder, Colorado came in at no. 1, with almost 70 percent of residents reporting a regular exercise habit — no real surprise there, as the crunchy, mountainous town is a favorite of skiers, hikers and runners. The top five included Fort Collins, Colo., San Luis Obispo–Paso Robles, California, Greeley, Colo., and Santa Rosa, Calif. 

Hickory–Lenoir–Morganton, North Carolina came in dead last, with 41.8 percent of residents exercising regularly. Also in the bottom five: the cities of Toledo and Akron, Ohio, Montgomery, Alabama, and Cedar Rapids, Iowa."

"...putting the prefix 'neuro' to whatever you are talking about gives a pseudo-scientific respectability to all sorts of meretricious rubbish.'"

Compassion, Empathy, Flapdoodle

Against Empathy: The Case for Rational Compassion, by Paul Bloom, Penguin Random House, 285 pp, £14.99, ISBN: 978-1847923158

The Empathy Instinct: How to Create a More Civil Society, by Peter Bazalgette, John Murray, 375 pp, £16.99, ISBN: 978-1473637511

Mirror Touch: Notes from a Doctor Who Can Feel Your Pain, by Joel Salinas, HarperCollins, 307 pp, $26.99, ISBN: 978-0062458667

"Epathy is the latest target of this neo-phrenology. As well as the obligatory fMRI-based neuroanatomy, all contemporary meditations on empathy contain earnest accounts of mirror neurons, described as “the most hyped concept in neuroscience”. These cells were first described in the 1990s by the Italian neuroscientist Giacomo Rizzolatti, who studied macaque monkeys. He found that some motor cells (involved in the control of movement) are activated by the sight of the same movement in others (humans and monkeys). Since then, outlandish claims have been made for these neurons, particularly by the Indian-American neuroscientist VS Ramachandran, who believes these mirror neurons are responsible for empathy, language, even civilisation. A sobering review of mirror neurones written by British neuroscientists JM. Kilner and RN Lemon, published in Current Biology in 2013, concluded that we can’t extrapolate findings from monkey studies to humans, and furthermore, we’re not absolutely sure that these cells exist in humans, and even if they do, we’re not sure what their function is. These doubts haven’t remotely impeded the establishment of the new popular science orthodoxy that mirror neurons are what make us human and empathetic. Neurobollocks has escaped from the laboratory and is now the rickety foundation for popular, and populist, books by writers such as Jonah Lehrer, Malcolm Gladwell and many others. Writing in the New Statesman in 2012, Stephen Poole described this phenomenon as “an intellectual pestilence”, and observed how putting the prefix “neuro” to whatever you are talking about gives a pseudo-scientific respectability to all sorts of meretricious rubbish." 

"The goal of global health should be urgently improving responses toward better access to care and equity in health..."

Hastings Cent Rep. 2017 Sep;47(5):25-26. doi: 10.1002/hast.765.

Urgently Creating the Better in Global Health.

Marlink R.

Abstract

In this issue of the Hastings Center Report, Govind Persad and Ezekiel Emanuel argue that "[t]he provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off." I agree that we should not let the perfect get in the way of the good, but just providing cheaper, less effective treatment for utilitarian or other reasons is not a comprehensive approach to global health. In my experience as an on-the-ground global health practitioner, the choice is never that simple. As time passes, dynamics evolve, and so should the responses to a global health problem. The goal of global health should be urgently improving responses toward better access to care and equity in health, without which the good may become the enemy of the better. In other words, there are places and times in which the approach Persad and Emanuel describe may be appropriate, but their recommendations fail to account for the realities of a population-level medical emergency and for the fact that once an emergency is initially or partially addressed in any setting, time can be the enemy, if it breeds complacency.

"BRITAIN’S obesity epidemic has put hundreds of thousands at risk of heart disease[,] and stroke, analysis shows."

Obesity epidemic puts 240,000 lives at risk each year

BRITAIN’S obesity epidemic has put hundreds of thousands at risk of heart disease and stroke, analysis shows.

“We’re seeing the number of calls about diet and lifestyle steadily increase, which highlights what a wide and growing issue this is. 

“Questions can range from very broad issues about healthy eating in general to very specific questions about particular types of food and how they might affect someone’s diabetes.”

Male obesity linked to lower sperm count

Male obesity linked to lower sperm count

While Raju's team does not know why weight gain affects the quality of the sperm, they want to further investigate whether losing weight has a positive impact. They believe that screening men's sperm before IVF might be helpful in a bid to see if natural conception is possible.

Age is another significant factor in fertility as the older men and women get, the harder it can be to fall pregnant naturally. For women their fertility declines from their early thirties and in men their sperm count starts reducing after they reach 40. 

Commenting on the research, fertility expert Dr Avner Hershlag, chief of the Northwell Health Fertility in New York, said: "The message to men is don't continue to abuse your body. Comfort foods and excess alcohol are bound to make you uncomfortable and put you at a higher risk for diabetes, high blood pressure and heart disease, which are all life-shortening, and may also put a damper on your path to fatherhood."

Steering Committee

Steering Committee

HT:DF

When people make moral judgments, what information do they look for?

Pers Soc Psychol Bull. 2017 Jul;43(7):957-971. doi: 10.1177/0146167217702375. Epub 2017 May 4.

Information-Acquisition Processes in Moral Judgments of Blame.

Guglielmo S1, Malle BF2.

Author information

1

1 Macalester College, Saint Paul, MN, USA.

2

2 Brown University, Providence, RI, USA.

Abstract

When people make moral judgments, what information do they look for? Despite its theoretical and practical implications, this question has largely been neglected by prior literature. The recent Path Model of Blame predicts a canonical order in which people acquire information when judging blame. Upon discovering a negative event, perceivers consider information about causality, then intentionality, then (if the event is intentional) reasons or (if the event is unintentional) preventability. Three studies, using two novel paradigms, assessed and found support for these predictions: In constrained (Study 1) and open-ended (Study 2) information-acquisition contexts, participants were most likely, and fastest, to seek information in the canonical order, even when under time pressure (Study 3). These findings indicate that blame relies on a set of information components that are processed in a systematic order. Implications for moral judgment models are discussed, as are potential roles of emotion and motivated reasoning in information acquisition.

J Med Philos. 2017 Oct 1;42(5):537-558. doi: 10.1093/jmp/jhx015.

Banking on Living Kidney Donors-A New Way to Facilitate Donation without Compromising on Ethical Values.

Martin DE1, Danovitch GM2.

Author information

1

Deakin University, Geelong, Victoria, Australia.

2

University of California, Los Angeles, Los Angeles, California, USA.

Abstract

Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or "regulated markets" in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie-at least in part-in facilitating so-called "altruistic donation;" harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed "chronologically incompatible donation" is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ "banking" from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs.

J Med Philos. 2017 Oct 1;42(5):575-596. doi: 10.1093/jmp/jhx017.

The Body as Gift, Commodity, or Something in Between: Ethical Implications of Advanced Kidney Donation.

Koplin JJ1.

Author information

1

Monash University, Melbourne, Australia.

Abstract

An innovative program recently initiated at the University of California, Los Angeles (UCLA) Medical Center allows people to donate a kidney in exchange for a voucher that a loved one can redeem for a kidney if and when needed. As a relatively new practice, the ethical implications of advanced kidney donation have not yet been widely discussed. This paper reflects on some of the bioethical issues at stake in this new donation program, as well as some broader philosophical issues related to the meaning and moral salience of commodification. I first consider whether the literature on commercial markets in organs--a longstanding topic of bioethical debate--can meaningfully inform ethicalanalysis of kidney voucher programs. Specifically, I consider whether and to what extent common objections to the exchange of kidneys for cash also apply to the exchange of kidneys for "kidney vouchers." Second, I argue that the contrast between the ethical issues raised by these two practices highlights the need to understand commodification as existing on a continuum, with different degrees of commodification giving rise to different ethical issues. Doing so can help sharpen our understanding of commodification as a moral concept, as well as its relevance to broader debates about the moral limits of markets.

J Med Philos. 2017 Oct 1;42(5):559-574. doi: 10.1093/jmp/jhx020.

Kidney Vouchers and Inequity in Transplantation.

Kerstein SJ1.

Author information

1

University of Maryland, College Park, MD, USA.

Abstract

This article probes the voucher program from an ethical perspective. It focuses mainly on an issue of inequity. A disparity exists in US kidney transplantation. Although African-Americans suffer far higher rates of ESRD than whites, African-Americans are much less likely than whites to get a transplant (Ilori et al., 2015, 1). The article explores the voucher program in light of this disparity. It motivates the view that, at least in the short term, more whites than African-Americans are likely to take advantage of the voucher program. The program is, thus, likely to increase the gap in transplantation rates between the two groups. If this is correct, what impact does it have on the moral acceptability of the program?

Australia: support for marriage equality plummets in poll

Morning mail: support for marriage equality plummets in poll

Public support for marriage equality has dropped 4% in a fortnight and opposition is up 3%, according to the latest Guardian Essential poll. With the postal survey campaign now in full swing, the latest poll shows 55% support for changing the law to allow same-sex couples to marry and 34% against. However, there is an upside for the yes campaign – people indicating they will definitely vote in the survey are more likely to support same-sex marriage than oppose it, and of those who have already cast their votes, 59% said yes and 37% no.

"Lafayette officials are considering an ordinance that would restrict restaurants from advertising sugary drinks to children."

Colorado town considers barring sugary drinks from kids menus

LAFAYETTE — Lafayette officials are considering an ordinance that would restrict restaurants from advertising sugary drinks to children.

The Daily Times-Call reported (http://bit.ly/2xtav7s ) on Monday that an ordinance is being drafted to limit beverage options to water, milk and other non-sugary drinks on menus geared for children.

Youth Advisory Committee Liaison Marty Walsh says the ordinance wouldn't ban the sale of soda, but it aims to discourage consumption in an effort to curb childhood obesity. The committee to the Lafayette City Council is behind the initiative.

Under the ordinance, soft drinks could still be served if requested.

TV binging linked to increased risk of inflammatory disease like diabetes

"'We know sitting involves reduced muscle activity, and therefore reduced blood flow. We think this stagnation in the blood vessels may be leading to an accumulation of inflammatory markers in the blood and muscles,' Dr Grace said."

USDA Study Pinpoints Differences In Households With Obese Children And Those Without

"The study found some eating characteristics of obese and nonobese-child household weren’t so different. The number of times both types of households ate dinner out or at home during the week, as well as the time children ate lunch, dinner and snacks, did not differ. However, minors in nonobese-child households ate breakfast 5 percent more often than those in obese-child households. That further suggests the need to take breakfast meals seriously, since they are considered the most important of the day.

Demographics and socioeconomic characteristics were also looked at. The study found minors from obese-child households are more likely to be Hispanic than those who live in nonobese-child households. The study also found children who live in households in which parents are not married, have lower education levels and are tight on money are likely to live in obese-child households. Another characteristic of an obese-child household is if the parents are obese themselves."

Gigha dairy farmer's school milk bid rebuffed

"AN ISLAND dairy farmer is refusing to give up his campaign to get his milk served to pupils in his local primary school.

Don and Emma Dennis run the Wee Isle Dairy on Gigha, off Kintyre, where they produce whole milk from their 60-strong cow herd.

But when the local primary asked them to supply 15 litres a week they were stopped from doing so by a Scottish Government ruling stating that only skimmed, or semi-skimmed milk, can be given to pupils in schools, as part of efforts to counter child obesity."

"...people may engage in self-punishment to right their own wrongs to balance their personal sense of justice."

Pers Soc Psychol Bull. 2017 Jul 1:146167217717245. doi: 10.1177/0146167217717245. [Epub ahead of print]

Truth or Punishment: Secrecy and Punishing the Self.

Slepian ML1, Bastian B2.

Author information

1

1 Columbia University, New York, NY, USA.

2

2 The University of Melbourne, Melbourne, Victoria, Australia.

Abstract

We live in a world that values justice; when a crime is committed, just punishment is expected to follow. Keeping one's misdeed secret therefore appears to be a strategic way to avoid (just) consequences. Yet, people may engage in self-punishment to right their own wrongs to balance their personal sense of justice. Thus, those who seek an escape from justice by keeping secrets may in fact end up serving that same justice on themselves (through self-punishment). Six studies demonstrate that thinking about secret (vs. confessed) misdeeds leads to increased self-punishment (increased denial of pleasure and seeking of pain). These effects were mediated by the feeling one deserved to be punished, moderated by the significance of the secret, and were observed for both self-reported and behavioral measures of self-punishment.

"...lower levels of church attendance were positive predictors of papanicolaou tests and mammograms, while higher levels of attendance were generally associated with poorer screening behaviours."

J Relig Health. 2017 Sep 15. doi: 10.1007/s10943-017-0493-y. [Epub ahead of print]

Mixed Blessings? Religion/Spirituality Predicts Better and Worse Screening Behaviours.

Speed D1.

Author information

1

Department of Psychology, University of New Brunswick, Saint John, NB, E2L 4L5, Canada. dspeed@unb.ca.

Abstract

Some health research suggests that religious and spiritual variables positively predict health-screening behaviours. However, much of the literature on this topic has utilized exclusively religious samples, or has sampled from populations without uniform access to health care. Either of these issues may have artificially inflated the relationship between religion/spirituality and health-screening behaviours. The current study used data from the 2012 Canadian Community Health Survey to examine a general sample of women from New Brunswick and Manitoba (N > 1200). Results indicated that lower levels of church attendance were positive predictors of papanicolaou tests and mammograms, while higher levels of attendance were generally associated with poorer screening behaviours. Religiosity was a uniformly non-significant predictor of screening behaviours. Finally, religious affiliation was inconsistently related to screening behaviours, but tended to favour religious non-affiliation when it was. Religion/spirituality does not appear to have a uniformly positive nor linear effect in predicting health-screening behaviours in women.

"From the physician perspective, overtreatment is common."

PLoS One. 2017 Sep 6;12(9):e0181970. doi: 10.1371/journal.pone.0181970. eCollection 2017.

Overtreatment in the United States.

Lyu H1, Xu T2, Brotman D2, Mayer-Blackwell B2, Cooper M2, Daniel M2, Wick EC2, Saini V3, Brownlee S3, Makary MA2,4.

Author information

1

Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.

2

Department of Surgery and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.

3

The Lown Institute, Boston, Massachusetts, United States of America.

4

Department of the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

Abstract

BACKGROUND:

Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment.

METHODS:

2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment.

FINDINGS:

The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs.

CONCLUSION:

From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.

Eating six meals daily improves obese people's blood sugar level

"Although body weight remained stable throughout the study, the participants who had been following the six-meal plan saw a decrease in their glycated haemoglobin (HbA1c) and post-oral glucose tolerance test blood glucose levels (indicating improved blood sugar control)."

“Otis Redding was the nicest person I ever met..."

Five Magnificent Years

Geoffrey O’Brien

From a biographer’s point of view, a recap of his career risks looking like a pattern of steady patient progress toward ever greater artistry and wider popularity. The unqualified admiration and awe expressed in a wide range of testimonials verges on monotony. From family it might be expected, as when his older sister Louise comments: “I always thought Otis was a kind of divine invention, because nobody ever taught him anything; he just knew everything.” But this sort of statement is typical, whether from Grateful Dead musician Bob Weir after seeing Otis at Monterey (“I was pretty sure that I’d seen God on stage”), MGs guitarist Steve Cropper, Otis’s close collaborator at Stax (“Otis Redding was the nicest person I ever met…. He was always working, always on time, always together, loved everybody, made everybody feel great”), or Phil Walden, the Macon R&B enthusiast who became Otis’s longtime business partner (“he may have been the most original, most intelligent person I ever met in my life”).

Loneliness kills. "...increased all-cause mortality..."

Public Health. 2017 Sep 12;152:157-171. doi: 10.1016/j.puhe.2017.07.035. [Epub ahead of print]

An overview of systematic reviews on the public health consequences of social isolation and loneliness.

Leigh-Hunt N1, Bagguley D2, Bash K3, Turner V4, Turnbull S5, Valtorta N6, Caan W7.

Author information

1

Centre for Primary Care and Public Health, Leeds Institute for Health Sciences, Leeds University, 101 Clarendon Road, Leeds, LS2 9JT, United Kingdom; Health Education England Yorkshire and Humber, Willow Terrace Road, University of Leeds, Leeds, LS2 9JT, United Kingdom. Electronic address: nicholas.leigh-hunt@nhs.net.

2

Health Education England Yorkshire and Humber, Willow Terrace Road, University of Leeds, Leeds, LS2 9JT, United Kingdom. Electronic address: d.bagguley@nhs.net.

3

Health Education England Yorkshire and Humber, Willow Terrace Road, University of Leeds, Leeds, LS2 9JT, United Kingdom. Electronic address: kristin.bash@nhs.net.

4

Health Education England Yorkshire and Humber, Willow Terrace Road, University of Leeds, Leeds, LS2 9JT, United Kingdom. Electronic address: victoria.turner15@nhs.net.

5

Health Education England Yorkshire and Humber, Willow Terrace Road, University of Leeds, Leeds, LS2 9JT, United Kingdom. Electronic address: stephenturnbull1@nhs.net.

6

Institute of Health Society/Newcastle University Institute for Ageing, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, United Kingdom. Electronic address: nicole.valtorta@ncl.ac.uk.

7

47 Hurdles Way, Duxford, Cambridgeshire, CB22 4PA, United Kingdom. Electronic address: wcaan@rsph.org.uk.

Abstract

OBJECTIVES:

Social isolation and loneliness have been associated with ill health and are common in the developed world. A clear understanding of their implications for morbidity and mortality is needed to gauge the extent of the associated public health challenge and the potential benefit of intervention.

STUDY DESIGN:

A systematic review of systematic reviews (systematic overview) was undertaken to determine the wider consequences of social isolation and loneliness, identify any differences between the two, determine differences from findings of non-systematic reviews and to clarify the direction of causality.

METHODS:

Eight databases were searched from 1950 to 2016 for English language reviews covering social isolation and loneliness but not solely social support. Suitability for inclusion was determined by two or more reviewers, the methodological quality of included systematic reviews assessed using the a measurement tool to assess systematic reviews (AMSTAR) checklist and the quality of evidence within these reviews using the grading of recommendations, assessment, development and evaluations (GRADE) approach. Non-systematic reviews were sought for a comparison of findings but not included in the primary narrative synthesis.

RESULTS:

Forty systematic reviews of mainly observational studies were identified, largely from the developed world. Meta-analyses have identified a significant association between social isolation and loneliness with increased all-cause mortality and social isolation with cardiovascular disease. Narrative systematic reviews suggest associations with poorer mental health outcomes, with less strong evidence for behavioural and other physical health outcomes. No reviews were identified for wider socio-economic or developmental outcomes.

CONCLUSIONS:

This systematic overview highlights that there is consistent evidence linking social isolation and loneliness to worse cardiovascular and mental health outcomes. The role of social isolation and loneliness in other conditions and their socio-economic consequences is less clear. More research is needed on associations with cancer, health behaviours, and the impact across the life course and wider socio-economic consequences. Policy makers and health and local government commissioners should consider social isolation and loneliness as important upstream factors impacting on morbidity and mortality due to their effects on cardiovascular and mental health. Prevention strategies should therefore be developed across the public and voluntary sectors, using an asset-based approach.