The Inequity of Isolation

COVID-19 is exacerbating health inequities, and access to social support is no exception.

At UBC’s School of Population and Public Health (SPPH), a foundation of our work has long been exploring the societal inequities that contribute to health. Social connection – often overlooked as a determinant of our physical health – is crucial to our wellbeing, and much like other determinants of health the risks are not evenly distributed.

“There is significant research going back 30 to 40 years showing very clearly that social connections – having a network you can rely on – and having support in times of stress from that network – are strongly related to indicators of morbidity and mortality, including both mental and physical health” explains Dr. Anita DeLongis, a Professor in UBC’s Department of Psychology.

Thousands of studies looking at measures of health, morbidity and mortality have found that social support is crucial to our health. Notably, a lack of social support has been found to be as dangerous to one’s health as smoking.

It’s no surprise to Dr. DeLongis that the past two months have left many feeling overwhelmed, stressed, or anxious. “The data are clear; we are social animals and as humans we need social contact,” she notes. “The fabric of our lives has been completely disrupted, and one of the issues that we know exacerbates stress is the disruption of a sense of control over life.”

Sound familiar? Dr. DeLongis has a suggestion about how to counter those feelings. “We have to find a way to feel in control of our lives. Whether it’s developing a new routine, or finding new ways to manage stress and anxiety.”

These stressors are amplified by the reduction in our social network for support, due to distancing. “We have to keep in mind that social distancing does not mean social isolation,” Dr. DeLongis cautions.

As British Columbia moves into Phase 2 of its Restart Plan, we all look forward to increasing our social connection while remaining physically distant. This may take some creativity; explains Dr. DeLongis. “We have to go out of our way to find novel ways to connect with people.”

Social isolation poses health risks for everyone. This loss of social connection, however, does not affect us all equally or in the same way. Dr. Bonnie Henry, B.C.’s Provincial Health Officer and Clinical Associate Professor at SPPH, painted a picture of this inequity. “We are all in the same storm, but we are not all on the same boat.”

While the loss of social connection reaches across all age groups, it looks different within cohorts and life stages.

Among new moms and pregnant women, social networks are often a source of comfort in a stressful and transitional time. That crucial support is now missing or reduced for both moms and babies. “What we are hearing from families is that they are missing the connections that happen in live prenatal groups,” describes Dr. Patricia Janssen, SPPH Professor and Co-Lead on Maternal Health. “Often these groups continue well into the early childhood years, providing invaluable social support, information, and help with childcare.”

Additionally, how these groups interact with their care providers has implications, Dr. Janssen notes. “Parents need the reassurance of a live visit with their caregiver, instead of a virtual one, to feel reassured that their pregnancy is proceeding normally, or that their baby is healthy. Face to face time with friends, family, peers and caregivers are vital, especially for first time parents, as they negotiate the uncertainties of pregnancy and early parenting.”

With schools closed, children and youth are missing the important peer-to-peer interactions and relationships they would normally have. Dr. Anne Gadermann, Assistant Professor at SPPH, points out that these relationships are key to social and emotional development, as well as for mental health.

“Social relationships are fundamental, and it is important to be creative and to find ways for children and youth to connect with their friends right now,” Dr. Gadermann explains. “What you can do depends on the age – and one’s circumstances – but children and youth can connect via technology, write letters, and through other means, such as making drawings on the sidewalk, or posters and signs for each other. Now – with the easing of restrictions – children and youth can also find ways to play or be together again while being mindful of the recommended guidelines.”

Her colleague, Dr. Eva Oberle, also an Assistant Professor at SPPH, cautions that while there are benefits to staying in touch through different platforms, some components are difficult to replace. “It is hard for many kids – especially younger ones – to really connect through a screen. Most children also have a need for touch and physical proximity to stay engaged in their play and interaction with others.” For some, she notes, kids being out of school can provide an opportunity to strengthen relationships. “For those who are able to be home with their children, this is a time families can be together and form a strong connection to make it through this challenging time.”

Dr. Oberle and Dr. Gadermann note that not all families have the ability to be at home with their children, or access to electronics and the Internet. For these families, school plays a critical role in providing on-going additional support, but also requires teachers and staff to be able to return to work safely.

Across sectors, many workers are not able to go to their workplaces, whether it is due to job loss, reduced hours, or working from home. In addition to financial stressors these labour disruptions may cause, there is also an associated loss of social connection.

“The workplace can be the major source of ‘built-in’ social connection for people,” explains Dr. Mieke Koehoorn, a Professor within SPPH’s Occupational and Environmental Health (OEH) Division. “While some of us may be lamenting ‘zoom fatigue’, for others video calls offer excellent opportunities for connecting. We should be sensitive to requests from our colleagues to connect in this way – for work and for social engagement – as well as to reach out to those colleagues who we haven’t ‘seen’ in a while.”

For those experiencing unemployment, the health risks associated with isolation are amplified, notes Dr. Chris McLeod, Associate Professor and OEH Division Head. “There is a well established evidence base that shows that the loss of one’s job is associated with poorer health, particularly mental health conditions such as depression and anxiety,” he explains. “Unemployment is associated with an increase in social isolation, loss of role identity and increases in negative health behaviours such as substance abuse.”

Despite this, Dr. McLeod sees an opportunity for connection. “One positive thing that may mediate the negative health effects of social isolation due to unemployment or working remotely is that we are experiencing this collectively and this shared experience may strengthen social bonds.”

Many seniors have also found their means of social connection limited. Those who live alone are increasingly isolated from their networks, since their loved ones have maintained distance due to the increased risk COVID-19 poses for the elderly, and long-term care facilities have restricted visitors in order to control infections. Seniors’ isolation is exacerbated by factors like challenges using technology, dementia, and hearing or vision loss. Similarly, individuals with chronic illness and pre-existing conditions are isolated at the cost of their normal social connections.

Where and with whom people are housed is also contributing to the level of social connection available. Living alone can be incredibly isolating in the best of times – a condition that is currently amplified – but there are also risks associated with shared spaces. Domestic violence rates have increased in B.C., which many experts attribute to physical isolation, increased stressors, and reduced access to services and support.

Dr. DeLongis adds that small, shared spaces also make it difficult to seek out support. “Many younger people are living in apartments without much privacy so they don’t have the opportunity to reach out and get the support that they want unless it is typing a text message.”

Additionally, the financial impact of the pandemic makes social support especially important. “Physical distancing has eroded the economic foundation for many, and made many fear for what happens when they are unable to pay rent or their mortgage,” explains Dr. Paul Kershaw, Founder of Generation Squeeze and an Associate Professor at SPPH. “This is a massive source of stress made more difficult to manage as physical distancing curtails opportunities to connect with, and confide in, close, trusted relations.”

Challenges faced by younger people are a microcosm of a broader issue: the ability to practice distancing is wrapped up in layers of socioeconomic privilege. Factors such as housing, employment, financial security, and access to support are all impacting the ways that individuals are experiencing COVID-19 differently.

As we reopen, it’s important for everyone to find ways to connect and seek out that social support. Some may require more support than others, or need the people in their life to take a more active role in offering opportunities to connect.

Additionally, governments and decision-makers need to consider how the pandemic has created and worsened existing health challenges. Policies around reopening must address – not exacerbate – existing inequalities.

This is why the provincial government is asking British Columbians to fill out the COVID-19 Survey. It’s critical to be aware of the unequal effects of COVID-19 – and our response to it – on different groups of people, so they can be addressed and increase health equity for all.

For more information about COVID-19 research at SPPH, click here. To contribute to the ongoing work in this field, consider making a donation to the SPPH Future of Public Health Fund.

Dr. DeLongis and collaborator Dr. Nancy Sin are currently conducting a study on stress and coping over the course of the COVID-19 pandemic. To participate, take the survey.

By Elizabeth Samuels