Being alone and feeling lonely are not the same, and researchers say addressing that difference can prevent serious health impacts.
Being alone and feeling lonely are not the same thing, and the body knows it.
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The two states may look similar from the outside, but researchers have found that what matters most is not necessarily the number of people in someone’s life but how those connections are perceived.
A study from Cornell University, published in the journal JAMA Network Open, found that participants who felt lonelier than their social circumstances might suggest faced higher health risks.
“Most public health messaging around loneliness focuses on expanding social networks. But what this study suggests is that connection alone isn’t the whole story,” said co-author Anthony Ong, psychology professor and director of the Human Health Labs at Cornell University.
“Two people can have similar social circumstances and face very different health trajectories depending on how they experience those circumstances,” he added.
What are the health impacts?
Social isolation and loneliness have been studied extensively and are growing public health concerns because of their negative impact on both mental and physical health outcomes, the authors noted.
According to the World Health Organization (WHO), around 16 percent of people worldwide experience loneliness.
The research team examined the discrepancy between objective social isolation and subjective feelings of loneliness, which they named “social asymmetry”.
Social isolation refers to limited social contact and participation, while loneliness is a subjective experience of feeling disconnected from others.
Analysing data from 7,845 adults over 50 living in England, who were followed for an average of 13.6 years, the study found that the mismatch between the two was associated with increased risk of disease and death.
Those who felt lonelier than their circumstances indicated, labelled as “socially vulnerable”, faced a higher risk of all causes of mortality, cardiovascular disease, and chronic obstructive pulmonary disease.
On the other hand, participants who were socially isolated but did not feel lonely, described as “socially resilient,” showed little increased risk for most health outcomes.
The study also found that those who felt lonely and were socially isolated had an increased risk of mortality.
“What’s encouraging is that social asymmetry is measurable, which means we can potentially identify who’s most at risk before the health consequences set in,” noted Ong.
A separate study published in the Nature Communications Psychology journal found that people reporting “chronic loneliness” are more likely to perceive the next interaction as threatening, a perception that leads them to withdraw.
The research also found that this cycle was more entrenched among those with higher levels of chronic loneliness, making it particularly difficult to break.
“These findings suggest that intervention may require more than expanding the size of a person’s social network,” Ong said, adding that tackling loneliness requires attention not only to the structural conditions that produce it, but also to the perceptual and behavioural dynamics that sustain it.
How can doctors address loneliness?
According to the WHO, one in five visits to a primary care doctor is for problems that cannot be addressed clinically, such as social isolation, loneliness, and financial hardship.
In response, some medical professionals are turning to social prescribing. This includes non-medical activities that boost the patients' well-being, often community-based activities such as walking groups, volunteering, and gardening clubs.
By linking health services to community resources, social prescribing aims to improve population health, reduce inequalities, and relieve avoidable pressure on overstretched health systems, according to the WHO.
The United Kingdom was the first country to embed social prescribing within national health policy, with over 1 million people referred to social prescribing services each year.
“Social prescribing offers a powerful means of addressing the social determinants of health,” said Nils Fietje, from WHO Europe.
From March 2026, the United Kingdom’s National Academy for Social Prescribing (NASP) will be the WHO Collaborating Centre for Social Prescribing Policy and Development, providing support to WHO member countries to develop and implement social prescribing policies in national systems.
