“I think we have largely failed so far in dealing with loneliness because our definition is too narrow.” Dr Zohar Lederman When Dr Zohar Lederman was an emergency medicine doctor in Israel, he was struck by how many patients did not want to go home because they had no one to go home to. They often ended up in the hospital longer than their condition warranted, but medical staff were not trained nor evaluated on how to help such people. “It was heartbreaking. These patients were really out of the realm of emergency medicine,” he said. The situation inspired him to delve deeper into the problem of loneliness. The results, in both Bioethicist Dr Zohar Lederman has been exploring the philosophical implications of the individual and social harm caused by loneliness, and practical solutions. MORE THAN A FEELING philosophical and scientific terms, were stark: loneliness puts people at higher risk of stroke, anxiety, dementia, depression, suicide and other diseases, and it is common. “Loneliness makes you sicker and increases your risk of premature death. Basically, it’s a kind of social determinant of health,” he said. Dr Lederman, now Clinical Practitioner in HKU’s Department of Emergency Medicine in the School of Clinical Medicine and Research Fellow in the Centre for Medical Ethics and Law, has been investigating how to mitigate the problem and better understand the implications for society from medical and bioethics perspectives – particularly as surveys show that loneliness affects onethird of people in Hong Kong and Mainland China, about 40 per cent in Japan and one in two in the US. “I believe there is an ethical case to engage more systematically with loneliness, first of all as a public health issue and secondly, as a deeply fundamental issue for human beings that goes beyond human health. I think we have largely failed so far in dealing with loneliness because our definition is too narrow,” he said. Lots of kinds of loneliness Traditionally, loneliness has been considered a distressful mismatch between expected and perceived social relations. But social scientists have proposed that it can come in many forms, he said. Political theorists such as Hannah Arendt talk of political loneliness in which people are deprived of political participation and feel alienated from the process, such as Palestinians in the West Bank and Gaza. There is also ethical loneliness, where someone suffers a great injustice such as the Holocaust but does not feel heard or understood when they talk about the experience. And there are things like a lonely death, sexual loneliness or the loneliness of people with disabilities that hinder their communication with others. Caretakers can also feel lonely. Dr Lederman said these are not simply alienating experiences. Since people have evolved to be social and interdependent, loneliness should be seen within that context. “If one recognises that not being lonely is important to human life and human flourishing, and that people have an entitlement or right not to feel lonely in much the same way they have a right to health, then there are ethical implications for governments and society,” he said. The World Health Organization has recognised some of the implications with the establishment of the Commission on Social Connection in November 2023, which is intended to galvanise countries to act. Some have already started. The UK and Japanese governments both have ministries of loneliness. Examples of government actions include mobile cafes that bring people together, subsidised socialisation classes and investment in social robots. Investigating the problem and solutions Dr Lederman has also been investigating how to mitigate loneliness. One project has focussed on social robots that interact and chat with people, although he thinks these are a far from perfect solution. “Intuitively, it feels wrong that human society should decide to care for the lonely by throwing technology at them. But from an academic perspective, we try to be more generous. We have done some work on them and it’s plausible they can help some people as a last resort or a temporary measure,” he said. He also hopes to dovetail his two interests – emergency medicine and bioethics – to investigate loneliness in the emergency departments of Hong Kong hospitals. The yet-to-befunded project aims to determine whether people coming to the hospital are lonelier than those in the community and whether there are correlations between feeling lonely, hospitalisation, mental health outcomes, recurrent visits and the use of healthcare services. The project also hopes to map the available social services for mitigating loneliness. “Loneliness is not only bad for human beings. It can be bad for the economy. If we want to promote public policies that are effective and cost-effective, that’s another reason to engage more seriously with the problem of loneliness,” he said. COVER STORY HKU BULLETIN | NOV 2024 04 05
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