Britain and Japan were so alarmed by the health toll of loneliness that they each appointed a government minister whose entire job is to fight it, an idea that would have sounded absurd a generation ago.

The idea of a Minister for Loneliness is easy to misread as a piece of political theatre. A government appoints one senior official to lead the national response to a private feeling most people would not think of as a matter for public policy at all, and the announcement lands with a small flurry of curious international headlines before disappearing into the ordinary background of government machinery. What is worth pausing on, in the case of both the British and the Japanese versions of this appointment, is how carefully each was made, how directly each was responding to something the underlying medical evidence had begun to show, and how quickly what looked like an unusual policy experiment has begun to spread to other developed countries.

The core proposition both governments have accepted is that chronic loneliness is not, on the current medical evidence, simply an unpleasant emotional state. It is a measurable public health risk of comparable magnitude to obesity or heavy smoking. Which means that a government tasked with maintaining the health of its population has, on the same reasoning that supports anti-smoking campaigns and public nutrition guidance, a legitimate reason to intervene.

Britain’s case

According to reporting by the BBC on 17 January 2018, the day the appointment was announced from Downing Street, the United Kingdom became the first country in the world to formally create a ministerial post dedicated to loneliness. Prime Minister Theresa May appointed Tracey Crouch, then serving as Minister for Sport and Civil Society, to take on the additional loneliness brief as part of a cross-departmental strategy the government committed to publishing later that year. Crouch’s role was to coordinate the response across every relevant government department, work with charities and community organisations already active in the area, and oversee the first attempt to measure loneliness as a statistical indicator through the Office for National Statistics.

The appointment was not made abstractly. It was the direct continuation of work begun by Jo Cox, the Labour MP for Batley and Spen who was murdered by a right-wing extremist in her own constituency in June 2016, in the days before the Brexit referendum. Cox had experienced periods of loneliness herself after the birth of her first child, and had come to believe that the isolation reported by her constituents in the north of England, particularly among older people and new mothers, was a significantly under-recognised public health problem. She established a cross-party parliamentary commission to investigate it. After her death, the commission continued its work in her name.

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The Jo Cox Commission’s 2017 report set out the empirical picture that had made the case for an intervention at cabinet level. More than nine million adults in the United Kingdom, roughly 14 per cent of the population, reported often or always feeling lonely. Around 200,000 older Britons had not had a conversation with a friend or family member in more than a month. Loneliness was affecting significant portions of every age group, not merely the elderly, with young mothers, carers, refugees, and people with disabilities showing particularly high rates. The health toll the commission cited was drawn from meta-analytic work in the medical literature suggesting that chronic loneliness carries a mortality risk comparable to smoking roughly fifteen cigarettes a day.

Crouch, speaking after the appointment, described loneliness as a generational challenge and pledged to work across party lines to address it. The Downing Street reception on the day of the announcement was held to honour Jo Cox’s legacy. The strategy Crouch was tasked with producing, “A Connected Society,” was formally published in October 2018 and remains the framework for the United Kingdom’s approach.

Japan’s case

The second country to create the post followed for a considerably more urgent reason. According to reporting by Time Out Tokyo in February 2021 on the appointment, Prime Minister Yoshihide Suga appointed Tetsushi Sakamoto, a sitting cabinet minister already responsible for regional revitalisation and for the country’s falling birth rate, to lead a newly created Office for Policy on Loneliness and Isolation inside the Cabinet Office. The date was 12 February 2021, roughly eleven months into the pandemic, and the appointment came in direct response to a specific mortality signal the Japanese Ministry of Health had reported the previous month.

For the first time in eleven years, the Japanese national suicide rate had risen. The total for 2020 was 20,919 deaths, which was more than three times the number of Japanese deaths attributed to Covid-19 in the same period. The rise was concentrated among women, particularly younger working women whose employment and social lives had been most disrupted by the pandemic’s economic and social measures. Suga’s public instruction to Sakamoto at the appointment was explicit. Women were, in the prime minister’s stated words, suffering more from isolation, and the suicide rate was on a rising trend. Sakamoto’s mandate was to coordinate a comprehensive response across ministries that had not previously spoken to each other about the problem.

The Japanese cultural context made the appointment less unusual than it might have looked from the outside. Japan had been describing the shape of the problem for decades, most notably through the concept of kodokushi, meaning lonely death, the phenomenon of elderly people dying alone at home and going undiscovered for extended periods. More than a third of all Japanese households are now single-occupancy, a figure projected to reach nearly forty per cent by 2040 on the National Institute of Population and Social Security Research’s projections. The specific practical form the Japanese response has since taken, beginning with an emergency forum Sakamoto convened within weeks of taking office and continuing through the 2023 passage of the Loneliness and Isolation Countermeasures Act by the Diet, reflects the fact that the underlying demographic pattern is not going away, and that a coordinated national response was overdue rather than novel.

What both governments are actually treating

The health research the two appointments were responding to has continued to accumulate since. According to a 2015 meta-analysis by Julianne Holt-Lunstad, Timothy B. Smith and colleagues at Brigham Young University, published in Perspectives on Psychological Science under the title “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review”, the mortality risk associated with prolonged loneliness and social isolation is comparable in size to risks that public health systems already treat as major targets for intervention. The meta-analysis pooled data from seventy longitudinal studies covering more than three million participants and found that greater social connection was associated with a substantially reduced likelihood of death across the follow-up periods, at levels comparable to the effects of quitting smoking or losing significant excess weight.

Which is the specific reasoning that has made the ministerial appointments defensible in both countries. Loneliness, on this evidence, is not a soft or purely subjective concern that governments can safely ignore. It is measurable. It carries a real burden on the health system in the form of increased rates of cardiovascular disease, dementia, depression, and premature death. And it is now widespread enough in most developed countries that a coordinated national response is beginning to look less like political theatre and more like an ordinary piece of modern public health administration.

Britain and Japan moved first. Since 2021, versions of the same office have been established or actively considered in South Korea, Denmark, and Australia, and the United States Surgeon General published an advisory in 2023 formally identifying loneliness as a public health priority. What sounded absurd in 2018, when Theresa May announced the appointment from Downing Street, has become, within less than a decade, close to a standard piece of the modern developed government’s health policy toolkit. Neither Crouch nor Sakamoto invented the problem their portfolios were created to address. Their appointments were, more accurately, the first two moments at which a modern government formally admitted that the problem was too large, and too directly harmful, to keep leaving to charities and to chance.

Kiran Athar is a writer, not a public health researcher or a policy specialist. This piece draws on primary contemporaneous reporting from the BBC and Time Out Tokyo, and on peer-reviewed meta-analytic research in Perspectives on Psychological Science.