Ep. 178: The Cost of Loneliness with Lucy Rose

Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast, produced by Nemours Children's Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube. Each week, we'll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar, and now that you're here, let's go. Let's go, oh, oh, well beyond medicine. Hi, everyone. Welcome to the Nemours Well Beyond Medicine podcast. We're in Las Vegas at Health, and I am so pleased to have with me the dynamic Lucy Rose. She is founder and president of the Cost of Loneliness Project. Welcome, Lucy. I am indeed. Thank you for having me here. It was a pleasure. Let's talk about loneliness. How do you define loneliness in general, and especially in today's world? What a great question. Let me just clarify first, when I talk about loneliness, I'm talking about chronic loneliness. Okay. Not the loneliness that someone may feel when they're at a dance and they've worn the same dress somebody else has. Okay. They kind of stand in the corner, you know what I mean? Yes. I feel lonely at the party. I've been there, done that. We've all done that, I'm quite sure. But this one, we talk about loneliness in the way I talk about it. I'm concerned about chronic loneliness, which is the negative emotion that someone may feel over time when they're not being fulfilled with the emotional needs that they have. They don't feel seen. They don't feel like they belong. And it aches inside. You've talked about this as an invisible public health issue. And I think one of the former Surgeon Generals has identified it as a public health issue. Talk about why it's not visible. Okay. And yes, Dr. Murty really did. He did. And I really am grateful for him doing that. It's not visible because of the way I think this country was founded, in all honesty, and the societal constructs that we've put together over time. As you think about it, just think of what you heard as a child. You're okay. You don't need any help. Pull yourself up by the bootstraps. You know, all is fine with you. And society has made us in kind of rugged individualism, thinking we don't need others. The fact is, we do need others. And so there's actually a stigma attached to saying I'm lonely. It's like you're weak. You're not strong enough. What's the matter with you? So to me, the importance here is it has been silent. We're now hearing more about it. But when are we going to do something about it? And how do we get to the people that need it most? There are lots of them. Why is now the time to address it? I think there are a lot of reasons now is the time. But, you know, we are in a paradox situation right now where we're probably the most connected we've ever been in terms of technology. There's no probably. We are. in the history of the world, the most connected we've ever been in terms of technology, being able to find a friend you haven't seen in years, all of those things. And yet at the same time, that technology and other things are driving us towards not being connected. Folks are not joining clubs as much as they used to. They've turned away from churches to some degree. We had, if everyone remembers, a large epidemic recently where we can get outside. And one of the results of that, and maybe one of the longest lasting negative results, is the fact that we often no longer gather in community at work either. And that's a good thing for some and for others. You lose that place of belonging, talking with folks at the water cooler and all of that stuff. So it's a paradox time, I think, right now. What's at stake if we don't address chronic loneliness? There's so much at stake. And that's exactly why my project is called The Cost of Loneliness, because there are costs to the individual clearly. and those costs are physical and emotional. And in fact, the cost of the individual could be earlier onset of dementia, as a matter of fact, that folks don't think about. One of the things that chronic loneliness causes is an increase in inflammation because of that constant cortisol release, kind of that fright and flight that we do when we get stressed and nervous and all of that. And that chronic exuding, basically, of cortisol causes chronic inflammation, which causes things like increased heart disease, increased GI issues, and then the soothing behaviors that we may do to help ourselves feel better when we're lonely that could include everything from over-shopping to over-eating perhaps as a soothing behavior to alcoholism to all of those only in many ways kind of tend to reinforce the vicious cycle that we already feel. And they're costy as well to all of us. So there are costs to the individual, there's costs to society, because we have to pay for all of those things as well through all of that. Productivity goes down, retention is hard for corporations. Now is the time, and frankly, I believe if we don't do something now, because humans are wired for connection. I think all of us know. We feel it in our souls, don't we? We're wired for connection. If we don't now seize this moment and learn what meaningful, authentic connections mean, it'll be a major issue for this country. You talked about the paradox, and I think that paradox laid out is we're very digitally connected. We talk to each other on social media. We talk to each other through apps like WhatsApp and that kind of thing. And yet people still feel isolated. in what's the difference between communication which we do through social media which we do through whatsapp and discord and that kind of thing and connection in terms of uh defining it seems to be a defining feature of it is a defining feature because communication yeah you and i are communicating right now as we look at each other you may be we communicated yesterday right via text and email and things like that to get together so that we've found a time. Real authentic connection, though, has to do with all five of our senses. It's us looking at each other, seeing our micro expressions, having mutual vulnerability with one another. It's being seen and heard in a way that is meaningful for the person that wants to be seen and heard, which frankly is all of us. But that connection involves all of our senses, smell, sight, taste, all of that. And again, how we communicate effectively and therefore go to connection is dependent on being together. Touch is one of the most important. We can't hug each other as hard as we might want to through the virtual ways that we have. We have to be there to do that. Absolutely. Let's talk about the most common group that is reporting this chronic loneliness. And most people, I think, would think it's the elderly. But it isn't, is it? It's not. Who is it? Almost everybody thinks that. It's the group from 18 to 34. And I'll also say I want to take it down even lower if we look at young children. It's an elementary school. There's between, and the studies vary, all of them always will, I think, depending on what you do. But somewhere between 15 and 20 percent of young children are elementary age children, report feeling chronically lonely in school, at home, wherever they may be, that to me, between that and 18 to 34, bids for a very challenging future if we don't do something today Because those predictors early on last throughout lifetime three times more potential for being depressed in later life if you depressed as a child I mean if you lonely as a child as an example I curious that older end of the 1834 some of them are the parents of the children that you just referenced. How do we help the parents in that older 33, 34, 35, who have the younger children, overcome this kind of loneliness if they themselves are affected by it. Wow, it is intergenerational, isn't it? It is. Starting all the way down and passing through often, because if a parent is lonely and hasn't figured out a way to soothe themselves and fill their own need for connection, then it's very difficult for them, I think, to model that behavior for children. And that modeling behavior is critical for their children, setting things like rituals in the home that makes kids feel safe and comfortable and seen. It's difficult to do, making yourself vulnerable if you yourself are lonely. So I think the first situation we all have to have is recognition. We have to look at ourselves and say, am I lonely? And if so, what might I do about my own loneliness? What do I need to fill that? Is it that I need to go out with friends more often? Do I not have a best friend? And how might I cultivate that? But you can start small in terms of starting to fill your bank, so to speak, with feeling good. You can start with noticing micro expressions, saying hi to people on the streets. I know that sounds oversimplified. I know it does. But so many of these things add up to folks feeling better. Maybe one would love to have a pet, and that would make them feel better. You know, whatever it is, but you're right, the parent needs to know that, see it in themselves. And one other last thing, thought here, one can't anticipate often that loneliness may happen as a result of something. When we lose an important person to us through death, we have rituals for that. We have funerals. We have celebrations of life. We take food if you're from the South like I am. You take care of things like that. What we don't necessarily have is rituals for all the other things that cause grief and loneliness. For example, moving from one place to another when you were really happy where you were, and now you have no new friends. losing a job where you were really happy in your job and that job no longer exists. Those folks are set up for loneliness because of the grief they're going to experience. We can see that. We can probably know that and understand it. So what can we do to anticipate and help prevent that as well? What can we do if we know someone is experiencing this kind of chronic loneliness, be they a child or somebody in that 18 to 34 age range? Maybe they're the parent of one of these 18 to 24-year-olds, the young adult-aged folks. What can they do? First thing, again, is to recognize that that's going on with them. And you can anticipate it, perhaps, based on what we just said. Or you may not, because maybe that didn't happen. But if you do anticipate it, I think the important thing is to talk about it. Make it a normal conversation to say, have you made any new friends in your new place? Are you feeling connected? Have you found a way to feel like you're embedding in the new community and that you belong? What does it feel like? So that we talk about it, we put words around this, we understand that loneliness can cause, that connection is vital. I want to really focus on connection because I think that's the antidote and it's free. It's for us to connect. But talking about it, anticipating and asking them how they're feeling, being there for them, checking in, doing routine check-ins may help prevent that. giving them resources that would guide them to another source that perhaps making sure they join a new club if they're runners maybe they join the new local runners club whatever it may be that fills them helping them connect in that way in their new environment may also help prevent some of this loneliness but I want to go to children just for a second because I know that's where you are as well as we think about children how can we notice that children might be lonely as parents What does that look like? And I think what we look for is any changes in behavior and in what they're doing. A child who has been really academically strong, that suddenly is not doing nearly as well academically as they were before. A child who has suddenly become clingy. Mom, I don't want to let go. Or the exact opposite. Doesn't want you to touch them anymore. And they sit in their room all day. A child who is not scrolling all the time. that's suddenly just kind of scrolling mindlessly, or who was an athlete and now they don't want to play anymore, or played the piano and now they don't want to practice anymore. Those kinds of things could kind of cue us in that something's changed with our child, and at that point we need to start asking questions and provide interventions and help make sure that they know we see them and that we care about them and that they belong. As we sit here at a technology conference, AI is the word of the day, the word of the conference, the word of the decade, seemingly. We have seen many people turn to chatbots, AI-enhanced friends. What's the advantage of that? What's the disadvantage of that in terms of alleviating chronic loneliness and other issues? And they are both. You're right. So I don't want to sound like I'm dishing on AI or any other technology, okay? Because I think the possibilities for AI and for all technology, whether it's AI generated or not, is quite positive. There are ways that AI particularly can help us connect better. We could talk with AI and say, here's how I'm feeling. What examples might you have or what do you bring to me that you can help? Bots can be helpful in that, again, they can be supportive. They're not going to mitigate loneliness necessarily, though I think there are folks who would love that to happen. But they can be supportive in terms of helping us again, perhaps with reminders, perhaps helping us understand where to go and our needs and feelings better, etc. And for children, they expose them or the Internet itself. We don't even need AI if we can just go to the Internet or through their schooling things. Expose them to opportunities for learning and for seeing other people who are uncomfortable and how they deal with it. On the other hand, AI, Internet, none of that can ever substitute for the need for human care and for being mutually vulnerable with each other and for looking directly into someone's eyes and for giving those hugs that we all need. so it's vitally important that these are both ands not either or necessarily because they do think ai can supplement the other in some ways but we can't walk away ever from human connection it's too basically primal and necessary for us as humans to provide that so it's a it's a tool of the toolkit it's not the it's not the cure-all it's not in not the answer to this the answer is for all of us to work together to create systems, to create cultures of connection that really make all of us as individuals feel seen and that we belong in the way we want to feel seen and belonged so that we feel it in our hearts and hear. Empathy is a large part of that. Can empathy be trained into these AIs or can that only really come from human beings AI can help I think provide the initial kind of feeling or some more superficial empathy, and there are ways folks are working to build some of that in. But because the real definition of empathy is mutual vulnerability, so that, again, you and I are looking at each other, talking and sharing, and I can see the sparkling near eye as we talk. That's so meaningful to me. And training AI to do that, to see my micro expressions, to know that right now is that moment for the hug and be able to give it to me. We can't ever get there with AI. It just won't be there. So I think the five senses we talked about earlier is so critical in that mutual vulnerability that we all need. So AI can come up with a certain closeness to the line, But to cross the line and really provide the empathy that we all need is still going to take humans to do that. Our kids need us. They sure do. Let me ask this. When kids are going across the Internet, discovering ChatGPT, maybe chatting with a bot of some kind that's AI enhanced, are they able to tell the difference between what's a real connection and what's virtual AI generated connection? You know, I will have to say I don't know that any of us can anymore, hardly. If you look at what's possible now, I mean, you've seen it. You've seen celebrities there that say, I didn't say that. That wasn't me. Right. You know, so I think it is hard for all of us. It's particularly hard with young children whose brains are still developing. They can see a mask of a clown and think it's a real person. Right. That's true. So as you think about this, as we've got developing brains, it is up to us as adult guiders, be it parents or teachers or whoever it is to help them understand this is not real this is not your real friend that you can reach out to and touch there's danger there if we don't too because obviously they can get sucked into things that are very challenging and very negative very quickly so I think it's up to us to help them learn what to look for to help them to help guide them through a process of being able to delineate this from that. But it gets harder and harder, I think, as we move forward for us to do that as well. If it's a bot, you can tell them this bot's not real. Anything you see here is not real. Do you worry that there should be some sort of ethical guidance in the creation of these kinds of bots that say, okay, you understand now that I am not real. Is that happening? Do you know if that's brought to bear? I don't know, but I'm really concerned it's already too little too late with that from a regulatory standpoint. Talk about that. Because we developed AI and robots, bots themselves, I mean real robots that are going to go into assisted living communities instead of nurses. And what does that do with our elderly as well. But as we've done this, I went to a TED, the big mother TED, I call it, in Vancouver, about seven or eight years ago, and it was all about robotics back then. And they were asking that same question you just asked me back then. Is there enough regulation around this and consistency and expectations and care from an ethical standpoint? And the answer even seven years ago was we have gone so fast, we haven't been able to keep up in terms of thinking about the impacts this is going to have and how we create regulatory consistency. So no, I don't think we're doing a good job of that. And you can see that here when you walk around and you hear all of the different things being developed. You don't hear anybody necessarily talk about regulations or consistency. Some are at least talking about ethics. So I think, you know, clearly if I were developing one today or if I were thinking about regulatory importance, I would certainly be thinking about that disclosure that, you know, people are told right up front that whatever it is they're doing, if it's not real, then it's not real. But I think particularly as we think about children, that's not enough because we need to make sure that we've built in all the privacy issues and we need to do that for everybody. but with children even more I think layers of perhaps of requiring parents to go in with them depending on what it is they're looking at or certain standards that say going past here is a tipping point where parents have to sign in with them or whatever that needs to be but certainly patient privacy is critical or not patient but consumer privacy is critical as well where does it go what's done with it so that all of us understand let's take this back into the human realm. Take it out of the AI realm. Thank you. What are some of the maybe structural or environmental barriers that kind of make loneliness worse, particularly for kids? How does that compound for them? Yeah, I'm really concerned about that. And thank you for asking, because there are a lot of barriers today that were not barriers when I was a child. Things like how safe are our playgrounds and how are people going out and enjoying being outside together in community, like perhaps we used to do. And that's one reason the term connection recession kind of relates to me as I think about that because some of the things that we used to take for granted are no longer there in terms of structures around us. I think, again, that there are not as many after-school programs as there used to be. You know, that more and more kids are not necessarily playing sports but are doing other things up to and including coming home and scrolling all afternoon. In homes where both people work, which is a necessity and a desire by lots of us. I worked the whole time. My kids were young. I wouldn't trade that for anything. But it's balancing. It's how do we ensure that our kids, and if you did too, I know you know how hard this is. So I'm thinking about our working parents right now and families where they both work. And I know that it's not easy. How do we find a way to show our own kids that we belong as we're choosing daycares or after school care? What does that look like? And are there good enough ones that are out there today that are teaching children these social skills, that care about teaching empathy and kindness and all of those things? So how are we letting kids or ensuring kids, is a better way to say that, feel seen and that they belong? And those are the issues. There are lots. I could go on all day probably about these kinds of things. But I think we as a society need to pay attention. Are we creating safe communities after school? Are our playgrounds safe places for kids to play and parents to interact? What does that look like? What kinds of solutions would you like to see brought to bear? I know it sounds like more playgrounds, more safe playgrounds, more sports participation, more club participation. What else do you think would help kids in particular with the chronic loneliness issue? Oh, I think there's so many things. I think, as an example, our teachers need to be better equipped. And this is not meaning they're not doing a great job. They are. They are. They are. And we don't compensate them enough, and we don't give them enough credit. And that's a story for another day between you and me. But I feel very strongly about that. But I do think that it is vital. And one of the things that this project I working on is going to be doing is providing toolkits for all kinds of different professionals as an example to help them how do teachers identify children at risk or who already are lonely What can they do in the classroom to create spaces of belonging to help folks develop those social muscles so that they understand how to support one another and how to ask for help when they need it? Are they given the tools and the language to say, this is how I feel today and I need you? Are we creating spaces that kids can comfortably go to to ask for more social environment All of those things. So I think teachers is one place, or schools, I should say, not the individual teachers, but schools committed to creating cultures of connection in addition to and building all the social skills that are necessary. And again, please know, I know lots of schools are doing this. And there's always room for doing things even better, I think, and for incorporating the lessons that we learn from research as we go. I think another place, another really important place we have an opportunity is our physicians. Our physicians who see these wee ones as they come in their offices. Are they asking the questions? You know, are they saying, how are you feeling at school? Do you have enough friends? Whatever it is they need to ask to get at this. Again, emotional stability and emotional support are every bit as important as our physical needs, if not more so. because our emotional support also guides so much of our physical needs. So being aware, asking the questions, creating a this-is-normal situation for us, we're going to ask about this, I think is another place we could insert some additional help and more early, I'm going to say diagnosis for lack of a better term, more early awareness, maybe I want to say, of this whole situation. Lucy, I'm curious, why did you decide to pursue this project? Because I was lonely. Yeah, really? Yeah, I was. It may come as a surprise to you. I probably don't seem to be. You see, very outgoing and very... Exactly. And there are millions of us, just like me, a little army of people who know, as Brene Brown would say, how to get up in the morning and put the armor on. Yes. Know what I mean? That is true. There are lots of us out there. We're not bots. We're real people who have real feelings just like everybody else. But I traveled, just so you know, and the reason, of course, I was lonely, I can share that. I traveled for 20 years, six days a week alone. I am the proud owner of the incredibly dumb in some respects. So I'm not bragging about this, but I have 5 million air flight miles and 8 million hotel points, as an example. That's lots of nights on the road alone with no input from others. And so I knew what the impact was. You know, I felt it very much myself. And I started doing research and I realized I wasn't alone. that lots and lots of people felt exactly like I do. And I became passionate to do something about that for others and to help other people be able to identify this as early as possible, prevent it if we can, by really calling the whole country as a call to action to say, what can we do together? How can we understand and catalyze and convene ourselves to really deal with this silent epidemic of loneliness? So that's what I'm doing. One step at a time. One step at a time. Where do you imagine this project being in three years, five years, ten years? Well, it's one person at a time right now is the way I see this. You know what I mean? And each day, if someone feels better because of this, is a win in that way. But where I see this, if I think about vision, okay, where I see this is something different in our country and hopefully in the world where people are paying more attention. not just reading the articles, because there are a lot of articles out there now about loneliness. We've acknowledged this is an issue. Yeah, I think we've acknowledged that, but what are we doing about it? Are our schools doing something different? Are our physicians asking that on a routine basis? Do we have more playgrounds that are safe? Have we come together in a unified way to create a culture of connection? Are we intentionally paying attention to this now as a society and doing something about it together? So we'll be convening folks from nonprofits, folks from corporations, teachers, the folks who design city planners, who design how cities are designed, architects, all of those folks in a call to action kind of way to help all of us begin to work together to create this nationwide community that is not just talking about it, but doing something about it. And that's how I hope to measure this. Do we actually see a difference in how we create our systems, how we are supporting one another? And hopefully at that point, we'll also be able to see the loneliness scores on the validated instruments begin to go down. And people talk more about being fulfilled than they do about being lonely. People listening today, inspired to be part of this, where do they go? How do they get a hold of you? They can find me on our website, thecostofloneliness.org. And I would love to connect with anyone who'd like to be a part of this. We all have a role to play in our families, with our friends, in our society, in our corporations, wherever that is. And it is free, again, best preventive medicine we could ever get. We'll put that link in the show notes. And I can't thank you enough. You are a dynamo. I think that's how I started. Lucy Rose, founder and president of the Cost of Loneliness Project. Thank you so much for being here. This has been so enlightening, inspiring. It has been a pleasure. Thank you so very much. Lucy Rose is the founder and president of the Cost of Loneliness Project, which aims to create a national imperative to spark commitment to and investment in combating the emotional, physical and economic consequences of the loneliness epidemic. Well beyond medicine. Our interview with Lucy Rose was recorded in October 2025 at Health in Las Vegas and is part of a series of podcast episodes recorded at that time featuring health care leaders from across various sectors speaking to the work they're doing that positively impacts children's health. Still more of those interviews and episodes to come right here on the Nemours Well Beyond Medicine podcast. Check out this series and all of our podcast episodes on your favorite podcast app and smart speaker, the Nemours YouTube channel, and on our website, nemourswellbeyond.org. Visit there to leave a podcast episode idea, a review, or subscribe to the podcast and our monthly e-newsletter. That address again is nemourswellbeyond.org. Our production team for this episode includes Susan Masucci, Lauren Tata, Cheryl Munn, and Alex Wall. Video production by Sebastian Riella and Britt Moore. Audio production by yours truly. On-site production assistance provided by Robbie Darius and his team from Health. And to them, we are grateful. I'm Carol Vassar. Thank you so much for listening. Join us next time as we hear about a cross-cultural children's health collaboration that took the Nemours Ginsburg Institute scholars for an eye-opening trip to Uganda. Don't miss it. Until then, remember, we can change children's health for good. Well beyond medicine.