Benchmarking social isolation, loneliness and smoking: challenges and opportunities for public health.

Over the past decade, the health implications of social isolation and loneliness garnered global attention due in part to a widely cited meta-analysis that benchmarked associations between cigarette smoking and mortality with associations between several social relationships measures and mortality. Leaders in health systems, research, government, and popular media have since claimed that the harms of social isolation and loneliness are comparable to that of cigarette smoking. Our commentary examines the basis of this comparison. We suggest comparisons between social isolation, loneliness, and smoking have been helpful for raising awareness of robust evidence linking social relationships and health. However, the analogy often oversimplifies the evidence and may over-emphasize treating social isolation or loneliness at the individual level without sufficient attention on population-level prevention. As communities, governments, and health and social sector practitioners navigate opportunities for change in a post-pandemic world, we believe it is time to focus greater attention on the structures and environments that promote and constrain healthy relationships.