My editorial in the September/October issue of RNJ focused on the value of being connected with others. To recap, research by many (Holt-Lunstad, 2018; Holt-Lunstad et al., 2017; Valtorta et al., 2016; Wang et al., 2023; Yang et al., 2016) have affirmed that there is an increased risk of mortality if one is socially isolated. It has also been said that the mortality of social disconnectedness is similar to that caused by smoking up to 15 cigarettes a day and an even greater risk than the association with obesity and physical inactivity (Holt-Lunstad et al., 2017, p. 524). Social isolation has a 29% increased likelihood of mortality, loneliness has a 26% increased likelihood of mortality, and living alone has a 32% increased likelihood of mortality (Holt-Lunstad et al., 2015). Wang and Zhao's systematic review and meta-analysis in 2023 examined 90 prospective cohort studies worldwide with 2.2 million individuals. Their work demonstrated that both social isolation and loneliness were significantly associated with an increased risk of all-cause mortality and cancer mortality. There was also an increased risk of cardiovascular disease mortality in individuals who were socially isolated.

Kannan and Vezie's (2022) work had warned of increasing social isolation and loneliness prior to the pandemic. In their study, they had noted radical changes in national trends for social connectedness when comparing their study results from 2003 to 2020, only 1 year into the pandemic. In 17 years, there was decreased time in household family social engagement, companionship, social engagement with friends, nonhousehold family social engagement, and social engagement with others.

In 2023, the Office of the Surgeon General, directed by Dr. Vivek H. Murthy, published a report titled Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. The lead science editor was Dr. Juliane Holt-Lundstad, renowned researcher in social isolation. The purpose of the research-based report was to identify the extent of social isolation in the United States, describe its relationship to physical and mental health outcomes, and develop strategies for more connectedness. The Surgeon General's Advisory established the National Strategy to Advance Social Connection to identify actionable steps to increase or enhance social connection. The strategy identified six pillars to advance social connection (U.S. Surgeon General, 2023, p. 47):

* strengthen social infrastructure in local communities,

* enact pro-connection public policies,

* mobilize the health sector,

* reform digital environments,

* deepen our knowledge, and

* build a culture of connection.

Although each of these pillars is important and each has their own set of priorities and actionable steps, this editorial will focus on Pillar 3, mobilize the health sector. There are three priorities associated with Pillar 3: (1) train healthcare providers, (2) assess and support patients, and (3) expand public health surveillance and interventions. Training healthcare providers in the importance of social connection, as well as the risks associated with social disconnection, is paramount. We often talk about the health-related social needs of patients. These social determinants of health are the socioeconomic, cultural, and environmental circumstances in which individuals live that impact their health (Centers for Disease Control and Prevention, 2021). In Deutsch and McMullen's editorial in RNJ this past year, they discussed the assessment of social needs in the Inpatient Rehabilitation Facility Patient Assessment Instrument (Deutsch & McMullen, 2022). The new data elements, which became effective on October 1, 2022, include ethnicity and race, preferred language and interpreter services, transportation, health literacy, and social isolation. Although these social needs data are used to support health equity, responses to each of these elements could indicate social isolation or loneliness (Holt-Lunstad & Steptoe, 2022). Lastly, public health surveillance can provide the data of the prevalence of social isolation. The intent of Pillar 3 is to integrate social connection into the primary-, secondary-, and tertiary-level prevention and care of individuals and communities (U.S. Surgeon General, 2023, p. 50).

The U.S. Surgeon General's national strategy for increasing social connectedness includes recommendations for stakeholders. These stakeholders include a variety of groups from governments to researchers to technology companies to individuals. The following are the recommendations for healthcare workers, healthcare systems, and insurers:

* acknowledge social connections as a priority for health;

* formal training for healthcare professionals on social connection and disconnection;

* insurers to provide adequate reimbursement spent assessing and addressing concerns;

* inclusion of assessment results in electronic health records;

* educate and incentivize patients to understand the risks of and take action to address social isolation;

* integrate social connection into primary-, secondary-, and tertiary-level care;

* work with community organizations; and

* clinicians to partner with researchers to evaluate the application of evidence-based assessment tools and interventions in clinical settings (U.S. Surgeon General, 2023, p. 56).

I ask all healthcare professionals to read this report. The physical health outcomes of being socially isolated are startling. However, there is a plan going forward to address this, and I encourage all of you to be a part of that plan.

Conflict of Interest

The author declares no conflict of interest.

Pamala D. Larsen, PhD, MS, RN, FARN

Editor-in-Chief, Rehabilitation Nursing,

Windsor, CO, USA

Funding

There is no funding associated with this article.

References