Social Isolation: A community based health promotion intervention
I Introduction – Social Isolation
II Health Effects
III Community Organizing
IV Case Study – Metro Vancouver Alliance
-- Submitted by Claire Lepine, masters of public health student at the Dalla Lana School of Public Health at the University of Toronto
I Introduction – Social Isolation
Social isolation and loneliness have come to be recognized as important social determinants of health for practitioners of public health and health promotion in Canada. Diverse groups of people experience isolation, and it is manifested in various ways and has been linked to a variety of determinants (Cacioppo & Cacioppo, 2014; Wilson, Harris, Hollis, & Mohankumar, 2011). For seniors, the likelihood of experiencing isolation is linked to income, gender, and health (Wilson et al., 2011; Hall & Havens, 1999). Post-secondary students have reported feeling isolated and alone as well (American College Health Association, 2013). Immigrants and newcomers experience social isolation through the process of social exclusion, which isolates them from Canadian culture and opportunities within the Canadian labour force (Lightman & Gingrich, 2012; Hall & Havens, 1999).
II Health Effects
Loneliness and social isolation can be thought of as two sides of a coin: loneliness is conceptualized as the subjective experience of social isolation, which is considered to be a more objective construct (Cacioppo et al, 2014; Hall & Havens, 1999). Loneliness is the perception of social isolation as something that is negative or unwanted (Hall & Havens, 1999). Isolation, although a social construct, affects physiological processes. As Cacioppo and Cacioppo note, humans are social creatures by nature and social interaction is a core need, similar to food, water, and shelter (2014). It is not surprising that loneliness affects health. The impacts of social isolation on individual health include increased blood pressure, development of depression and other mental health conditions, decrease in quality of sleep, effects on gene expression, and an increased risk of mortality and morbidity overall (Cacioppo et al., 2014). Interestingly, loneliness has been found to be a contagious social trait (Cacioppo et al, 2014).
In light of the significant effects of loneliness on health, it is important for health care providers to be equipped to identify loneliness in an individual. Primary care providers typically use scales or questionnaires, such as the University of California, Los Angeles (UCLA) Loneliness Scale or the Social and Emotional Loneliness Scale for Adults (SELSA) instrument. Of course, it is important to address the upstream factors that cause or are linked to isolation and loneliness as well. There are suggestions for health promotion approaches to isolation in the literature.
One useful example is nurses as bridges for isolated seniors to their community, where nurses act as a friend and support, and can connect seniors with the various supports in the community, and they can also be advocates for isolated seniors in general (Wilson et al., 2011).
As Wilson et al.’s example demonstrates it may be possible to address many determinants and also support many isolated groups with one approach. This article outlines an example of exactly that: an effective health promotion method that incorporates community organizing and community building, political action, and relational organizing at the individual, organizational, and international level to address social isolation in the Canadian context.
III Community Organizing
Across the globe, there is a network of civil society organizations using a particular style of community organizing that is proving to be very effective. The method is derived from Saul Alinsky’s work, and uses a non-partisan yet political approach to bringing communities together developed by the Industrial Areas Foundation. In London, England, London Citizens is a great example of such an organization. It was created in the early 1990s to address various challenges faced by Londoners of diverse backgrounds. The organization has been incredibly successful, achieving the adoption of a living wage for the 2012 London Olympics, the creation of a safety network by and for youth commuting to and from school, and a welcoming center for newcomers waiting to be seen regarding their application at an immigration centre.
In 2009, a group of active citizens created the Metro Vancouver Alliance (MVA) in Vancouver BC, which is based on the same principles as the London Citizens. The MVA is part of a larger network of similar organizations called the Industrial Areas Foundation (IAF), which created this particular style of organizing and serves as the umbrella organization for community groups from the United States, Canada, Australia, the United Kingdom, and Germany (Industrial Areas Foundation, 2014). The MVA brings three major sectors of civil society (faith, labour, and community) together to strengthen connections and bridge the gaps in social engagement that existed in Vancouver and the Greater Vancouver Area. The foundation of all IAF organizations is the relationships built between individuals, local civil society institutions, and the international IAF network.
The core process used by the MVA to create these integral relationships is called “relational organizing.” As mentioned, the power of an IAF-style organization is in the people and friendships that exist between and within the diverse member institutions. It is key that leaders ensure relationships are founded on trust and mutual understanding in order to be sustainable. Relational organizing is the perfect tool to do this. It involves the nurturing of relationships through face-to-face meetings, either on a one-to-one basis or in groups of eight to 12 people. People come together on common ground, creating shared experiences. Members learn to identify with each other through the stories communicated at MVA events. At all MVA events, guests are given permission to talk to strangers and ask deeper questions that serve to connect across differences and uncover the top priority issues in the region.
IV Case Study – Metro Vancouver Alliance
In May 2013, the MVA started a nine-month process of discerning what issues would be addressed by the organization and its member institutions. MVA members and member institutions connected with and listened to one another in a variety of settings. Churches, halls, and homes were used to foster the process of listening. Through the relational organizing process, the MVA learned about the broader issues that members wanted to tackle together.
At the end of the nine months of “listening,” the MVA discovered that social isolation was a top priority for members. Social isolation cut across the other priority issues of housing, poverty, and transit. As well, it was an issue identified in a variety of institutions, and was not specific to any particular demographic, ethnic group, gender, religion, occupation or other community of people. Social isolation had already been acknowledged as a challenge for Vancouverites (Vancouver Foundation, 2012), and the fact that MVA members had identified it as a top priority came as no surprise.
Once officially adopted as a priority issue, members started to work on creating an action plan in March 2014. Members of the MVA’s Social Isolation Committee (SIC) reached out to people in the MVA who felt isolated, talked to organizations in the community addressing isolation such as the Neighbourhood Houses, immigration centres, programs directly tackling isolation like “Just Say Hi” and they explored a variety of potential barriers to connection and community building in Vancouver. Over the course of the summer, the members researched and learned about the root causes of isolation in Vancouver and potential solutions that were within the capacity of the MVA to undertake.
The SIC is now in the process of taking action on social isolation (Metro Vancouver Alliance, 2014). An idea from the research completed over the summer was to create neighbourhood clusters composed of MVA member institutions. For example, in North and West Vancouver, a group of churches already working on social justice issues has been connected to other organizations such as community centres through the MVA. The clusters are diverse and well connected, and can mobilize around a local issue quickly. The SIC also determined that one of the barriers to community building was the process required to get a permit for an event in Vancouver. In October 2014, the SIC was successful in gaining support to reform the permit process from all four major mayoral candidates.
The approach used by the MVA to build and enhance community addresses loneliness and isolation from beginning to end. Broader alliances were formed, which in this case were between influential organizations from labour (e.g., Vancouver District Labour Council, BC Government Employees Union), faith (e.g., Catholic Archdiocese, Anglican Diocese of New Westminster) and community (e.g., Vancouver Community College, Association of Neighbourhood Houses) sectors in Vancouver and the Lower Mainland. Relationship building happens between members of organizations. Leaders are identified and trained from within member institutions, further reinforcing the trust and relationships that are created. Finally, the fact that social isolation was brought forth as the top challenge in Vancouver put emphasis on addressing it across the region.
What is novel about and sets the MVA’s approach apart from traditional health promotion projects or programs are the tools and processes used, as well as the political action component. The MVA uses a grassroots approach that starts with building relationships and creating shared experiences, uses the power of these relationships to identify leaders and issues and take action on challenges in a community, and then evaluates the success of these actions. It brings together many sectors of civil society that may not otherwise work together, and that have very different approaches to taking action on community issues. The core concept of relational organizing has many practical and more direct applications in the field of public health. For example, the REACH Community Health Centre (CHC) in Vancouver implemented this approach to connect with its catchment and to better understand the needs of the community it serves through the Listening for Direction project. It brought together a group of volunteers who reached out to organizations in REACH’s catchment, and sat down to listen and learn about the health challenges (both individual and broader factors) affecting community members. This information was used by REACH to ensure matching of services where possible, and to identify gaps in care that could be addressed within the community.
If you’d like to learn more, please connect with me via email at [email protected] or check out MVA online at http://iafnw.org/canada/metrovancouveralliance, on Twitter at @MetVanAlliance or on Facebook at Metro Vancouver Alliance.
American College Health Association (ACHA). (2013). Canadian Reference Group Executive Summary. Retrieved from: http://www.cacuss.ca/_Library/documents/NCHA-II_WEB_SPRING_2013_CANADIAN...
Cacioppo, J.T., & Cacioppo, S. (2014). Social relationships and health: The Toxic effects of perceived social isolation. Social and Personality Psychology Compass, 8/2, p.58-72.
Hall, M., & Havens, B. (1999). The effect of social isolation and loneliness on the health of older women. Prairie Women’s Health Centre of Excellence: Winnipeg, MB. Retrieved from: http://www.pwhce.ca/effectSocialIsolation.htm
Lightman, N., & Gingrich, L.G. (2012). The intersecting dynamics of social exclusion: Age, gender, race, and immigrant status in Canada’s labour market. Canadian Ethnic Studies, vol. 44:3, p.121-145.
Metro Vancouver Alliance. (2014). Our proposals are complete! Metro Vancouver Alliance is ready for the municipal accountability assembly. Retrieved from: http://iafnw.org/canada/metrovancouveralliance/news/our-proposals-are-co...
Vancouver Foundation. (2012). Connections and engagement: A survey of Metro Vancouver. Retrieved from: https://www.vancouverfoundation.ca/sites/default/files/documents/VanFdn-...
Wilson, D.M., Harris, A., Hollis, V., & Mohankumar, D. (2011). Upstream thinking and health promotion planning for older adults at risk of social isolation. International Journal of Older People Nursing, 6, p. 282-288.