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What 3 years of data reveals about a large regional health plan’s employee compliance wellbeing program

WellSpark would be hard-pressed to find a client with a better understanding of the importance of supporting employee health and wellness than a large regional health plan. WellSpark has engaged the health plan’s eligible workforce in a custom wellness program focused on early intervention to address emerging health risks and support chronic condition self-management.

Building an organizational culture that supports employee health and wellbeing takes consistent effort to educate and engage eligible participants in the wellness benefits available. Employee participation is an important key to success for any employee wellness program; and medical checkups and wellness screenings are an important part of preventive care. Over the past three years, the data validates the significant increase WellSpark has achieved in the participation, completion of recommended screenings and engagement in health coaching programs for this health plan client.

About the client and the program:

• This program is administered across several business units of a large regional health plan provider for its more than 2000 eligible employees.
• The compliance program includes 24/7 access to a digital wellness platform, individual and group health coaching, group challenges, webinars, and diabetes and chronic condition prevention programs.
• Prior to 2023 for the majority of its business units, the health plan offered money-back incentives to employees for participating in the wellbeing program and completing certain activities.
• Beginning in 2023, the health plan offered preferred health insurance premiums to the eligible population in all of its business units. Additionally, with the help of WellSpark, the health plan increased the communications promoting the program and added one-to-one outreach to those at risk of chronic conditions.
• Registration in the wellness program has increased yearly by an average of 22%.

What picture does this data paint?

It’s not an exaggeration to say that employers who provide employees with health and wellness programs that support the employee’s desire for behavior change save lives. This aggregate data across three years shows this health plan provider has increased the number of its employees who have completed preventive care screening. At the end of 2023, an average of 80% of the program participants completed a preventive care visit with a primary care physician (PCP).

The Centers for Disease Control and Prevention estimates preventive care services could save more than 100,000 lives in the U.S. each year.¹ A new study announced in July led by researchers at the American Cancer Society found that 40% of cancer cases and about one-half of all cancer deaths in adults 30 years old and older in the United States are attributable to modifiable risk factors.²

An article in the February 2024 Mayo Clinic journal PROCEEDINGS: Innovations, Quality & Outcomes highlighted the burden of chronic disease on society. The cost of chronic disease worldwide is estimated to reach $47 trillion by 2030. Many preventable chronic diseases can be modified by addressing four major risk factors: physical inactivity, poor nutrition, tobacco use, and excessive alcohol. Lifestyle behavior change and nonmedical factors that influence health (social determinants of health) are critical to addressing rising rates of chronic disease.³

The National Association of Chronic Disease Directors estimates that 60% of American adults have at least one chronic condition, and the average annual spend for one employee with at least one chronic condition is $6,032.⁴

Providing support to those employees who are ready for the type of lifestyle change that can positively impact their health and wellbeing benefits not only those employees but also the communities where those individuals work, live and play.

About WellSpark

WellSpark Health is a national wellbeing provider headquartered in Farmington, Connecticut that couples health coaching with the virtual modalities desired by today’s workforce. Since 2013, WellSpark has partnered with a broad range of public and private sector employers, providing engaging coaching and disease prevention programs through a life-dimensional approach that supports the whole employee while creating a supportive workplace culture. Employee participation from those who need it most is what matters. That’s where WellSpark’s consultative and customizable approach truly delivers.

Sources:

[1] Center for Disease Control and Prevention (2020) Access to Health Care. Retrieved August 6, 2024, from https://archive.cdc.gov/#/details?q=cdc.gov/vitalsigns/healthcareaccess/&start=0&rows=10&url=https://www.cdc.gov/vitalsigns/healthcareaccess/index.html

[2] American Cancer Society (2024). Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. Retrieved August 6, 2024, from https://pressroom.cancer.org/releases?item=1341#

[3] Mayo Clinic Journal PROCEEDINGS. The Burden of Chronic Disease. Retrieved August 6, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10830426/#

[4] National Association of Chronic Disease Directors (2022). Commentary on Chronic Disease Prevention in 2022. Retrieved August 6, 2024, from chronicdisease.org/commentary-chronic-disease-prevention-2022-david-hoffman/

Any examples are not intended to guarantee that an organization or individual will achieve the same or similar results. Each organization’s or individual’s success depends on many factors.

Feeling lonely? Well, you’re actually not alone. According to the US Surgeon General, it’s the most widespread major health issue in America today.

Loneliness has pervaded our society, despite the illusion that we are more connected than ever thanks to things like the internet and social media. Social connection is embedded in the fiber of our health and wellbeing, and a lack of it can have serious biological, physiological and behavioral impacts, according to a 2023 advisory from the US Surgeon General, which classifies the current state of loneliness and isolation as an epidemic.

“Social connection is a fundamental human need, as essential to survival as food, water, and shelter,” the report states. “Throughout history, our ability to rely on one another has been crucial to survival. Now, even in modern times, we human beings are biologically wired for social connection.”

In 2022, a survey of US adults revealed only 39% felt “very connected to others.” Other research suggests nearly half of all American adults experience loneliness, making it the most widespread major health issue in the country today — surpassing smoking, diabetes and obesity — according to the report.

It’s also important to note that just 20% of those who said they often or always feel lonely or isolated recognize this as a significant issue.

What exactly happens when a person feels desperately lonely or isolated? While these things may seem like mere inconveniences or misfortunes, they actually pose significant threats to our health and wellness. Research has suggested that loneliness can increase risk of premature death by 26%, and social isolation causes as much damage to health as smoking up to 15 cigarettes per day. A poor sense of social connectedness can heighten a person’s risk for heart disease or stroke by 29% and 32%, respectively. It can also make a person more susceptible to viruses and respiratory illness, and has been associated with anxiety, depression, and dementia.

On an individual level, there are several opportunities to make small changes each day that foster connectedness and belonging for yourself and those around you. This starts with understanding the power and importance of social connectedness. From there, individuals can focus on nurturing relationships, addressing and pivoting away from behaviors that lead to feelings of disconnectedness, and becoming more involved in their communities.

Here are a few tips from the US Surgeon General on sowing social connection:

• Be intentional when speaking or spending time with someone by minimizing distractions, reaching out to friends and family, being responsive and practicing gratitude.
• Expand your comfort zone to include people with different backgrounds, beliefs and interests.
• Join a club in your community, or sign up to participate in a civic engagement like a local town hall meeting or volunteer opportunity.
• Be open with your doctor about feelings of loneliness or isolation, and seek help if you’re struggling.

Loneliness may be widespread, but it doesn’t have to be a life sentence. By recognizing the importance of social connection and taking steps to build stronger bonds with others, we can all improve our physical health and mental wellbeing. Remember, even small changes in your daily routine, like the ones above, can make a big difference. These small actions, compounded and multiplied across the population, can help create a more connected and healthier society.

Source:

U.S. Public Health Service (2023). “Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community” Accessed June 30, 2024, from https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf.

Disclaimer:

This is for resource purposes only. It should not be considered a substitute for medical advice, diagnosis, or treatment by a medical professional.

Proper protection from UV rays could be the difference between developing skin cancer later in life, or not.

For many of us, summer means longer days and more time spent outdoors. Science tells us that spending more time in nature can be an excellent way to support physical, mental and cognitive health. These benefits are moot, however, without proper protection from the sun’s strong ultraviolet (UV) rays.

Skin cancer is the most common type of cancer across the United States, despite it being one of the most preventable, according to The Skin Cancer Foundation¹. Most of these cases have to do with overexposure to — and lack of protection from — the sun². Around 80% of skin aging is attributed to sun exposure, and it’s estimated that one in every five Americans will develop some form of skin cancer before they turn 70¹.

While summer months rightfully spark conversations around sun safety, the risk remains all year long. UV rays from the sun shine on us through all seasons, reflecting off various surfaces and permeating even the cloudiest days². Keep reading for tips from the US Centers for Disease Control and Prevention (CDC) and other sources on how to stay protected year-round.

Understand when you’re most exposed. According to the CDC, the sun’s rays are strongest between 9 a.m. and 3 p.m. during standard time (which falls in the summertime for most states) and 10 a.m. to 4 p.m. during daylight savings time (from early November to early March)².

The UV Index changes day by day and is tracked and shared by the Environmental Protection Agency (EPA). The UV Index scale runs from 1 to 11, with 1 representing the lowest risk of UV radiation and 11 representing extreme risk³. The index is also associated with time of day — for example, if the UV Index is 8 or more, it would be wise to either stay inside during midday or take extreme precaution to protect yourself and loved ones from sun exposure.

Sunscreen is your friend! The CDC recommends that people apply broad-spectrum sunscreen with 15 SPF or higher before spending time in the sun, and reapplying every two hours. You may need to reapply sunscreen in shorter intervals if you’re swimming, sweating or drying off.

Seek shade, especially on sunnier days. You can find shade under a tent, tree or tall structure, or create your own by wearing protective clothing including hats and sunglasses. Long sleeved shirts and pants or skirts that provide protection without overheating your body are great choices, as are protective headwear and eyewear, for those spending long amounts of time in sunny weather².

Stay away from indoor tanning beds. The UV radiation that powers indoor tanning beds is a proven carcinogen¹. In 2014, the US Food and Drug Administration (FDA) reevaluated its classification of UV tanning devices, upping their status from Class I, or low risk, to Class II, or moderate to high risk, for human health¹. Additionally, more than 419,000 cases of skin cancer in the United States annually are linked to indoor tanning¹. Is a temporary tan really worth permanent damage?

Talk about sun exposure with your doctor. Annual checkups with a dermatologist are recommended to stay on top of skin health and identify potential issues early.

Regardless of how you enjoy sunny days this season and beyond, staying protected is paramount. Check out more sun safety tips from the EPA here.

Sources:

[1] The Skin Cancer Foundation (2024). “Skin Cancer Facts & Statistics: What You Really Need To Know.” Accessed June 9, 2024, from https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/.

[2] U.S. Centers for Disease Control and Prevention (CDC). “Sun Safety Facts.” Accessed June 9, 2024, from https://www.cdc.gov/skin-cancer/sun-safety/?CDC_AAref_Val=https://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm.

[3] Environmental Protection Agency (2024). “UV Index Scale.” Accessed June 9, 2024, from https://www.epa.gov/sunsafety/uv-index-scale-0.

The pursuit of health and wellness doesn’t need to be “every man for himself.” Small lifestyle changes can make a big difference for mens’ health.

June is Men’s Health Month in the United States, serving as an important opportunity to highlight the health risks unique to men and ways in which they can be addressed through simple, everyday actions and a little intention.

According to the US Department of Health and Human Services, men are more likely than women to smoke, drink alcohol in excess, make risky or unhealthy life choices, and procrastinate routine or situational medical care¹. These likelihoods are in part responsible for the 13.8% of American men ages 18 and over who are considered “in fair or poor health,” according to the Centers for Disease Control and Prevention (CDC)².

More specifically, studies have shown 30.9% of men had consumed five or more drinks in a single day at least once in the previous 12 months, and 13.2% currently smoke cigarettes. Obesity and hypertension rates among US men are also high at 41.6% and 50.5%, respectively².

A 2017 study on mortality in the United States revealed men die five years earlier than women on average³. According to the CDC, the leading causes of death for men are heart disease (similarly to women), cancer, and unintentional injuries resulting from accidents².

Luckily, these risks are relatively easy to assuage for men who take their health and wellbeing into their own hands. This includes actions like being mindful about eating more healthfully, regularly moving the body, avoiding smoking or secondhand smoke and limiting alcohol intake, scheduling annual medical exams and getting screened for health issues early on, and taking steps to manage stress, which can contribute to heart and mental health issues, weight gain and high-blood pressure⁴.

All in all, health and wellness is very much a reciprocal process — you get out of it what you put in. Implementing small changes, like the ones above, is a great way for men to start prioritizing their own health and wellbeing, and to inspire other men around them to follow suit.

Sources:

[1] US Department of Health and Human Services (2024). “Men: Take Charge of Your Health.” Office of Disease Prevention and Health Promotion. Accessed May 14, 2024, from https://health.gov/myhealthfinder/doctor-visits/regular-checkups/men-take-charge-your-health.

[2] Centers for Disease Control and Prevention (CDC). “Mens Health.” US Department of Health and Human Services. Accessed May 14, 2024, from https://www.cdc.gov/nchs/fastats/mens-health.htm.

[3] Murphy, Sherry L. et al. “Mortality in the United States, 2017.” NCHS Data Brief No. 328. Hyattsville, MD: National Center for Health Statistics. November 2018. Accessed May 14, 2024, from https://www.cdc.gov/nchs/data/databriefs/db328-h.pdf.

[4] US Department of Homeland Security (2023). “June is Men’s Health Month.” Accessed May 14, 2024, from https://www.dhs.gov/employee-resources/news/2023/06/14/june-mens-health-month.

Three years of data shows lowered A1c levels, improved adherence to preventive care screenings, and decreases in diabetes distress scores.

WellSpark Health’s Diabetes Self-Management Education and Support (DSMES) programs connect individuals diagnosed with type 2 diabetes to health coaches who focus on weaving effective diabetes self-management practices into daily habits, which can lead to sustainable improvements.

Annually, WellSpark evaluates the aggregate results of the company’s diabetes management programs for all participants from its employer client groups. Across three years of data, from the beginning of 2021 through the end of 2023, these health coaching programs demonstrated consistent improvement in health and wellbeing for people living with diabetes, including mitigating the potential negative effects of this chronic condition.

Lowering A1c for the win
According to the Centers for Disease Control and Prevention (CDC), A1c is a blood test that measures a person’s average blood sugar levels over the past three months. It’s a common test for diagnosing prediabetes and diabetes and is one of the main tests to help individuals and their health care team manage diabetes¹. Even a slight reduction in A1c levels translates to lower medical costs and fewer deaths. A 1% drop in A1c translates to a 15-20% decrease in the risk of heart attack or stroke². A 1% drop in A1c also translates to a 25-40% reduction in the risk of diabetes-related eye or kidney disease².

More than 60% of participants in WellSpark’s 12-month diabetes management programs improved their A1c over the last three years, lowering it by an average of 1.4%.

“I have been able to lose a total of 44lbs incorporating healthy food and exercise on my own. I have learned about my diabetes and decreased my A1c from 8.9 to 5.9 over the past year. I’ve learned a lot about reducing carbohydrates which had been a problem for me, because rice was a huge part of my life and my culture. It was great to ask questions and have the nurse wellness coach available to me without judging me.”

A participant in WellSpark’s one-on-one DSMES health coaching program

Prioritizing preventive care
The CDC states that preventive care services could save more than 100,000 lives in the U.S. each year³. Chronic diseases alone, such as diabetes, heart disease, and cancer, are responsible for 7 out of 10 American deaths annually⁴. Yet, many people in the United States don’t get recommended preventive healthcare services, even though these services are often available at no charge for individuals who have health insurance.

Diabetes presents daily demands – managing blood sugar levels, diet, and a complex medication routine – making adherence to recommended preventive care screenings additionally challenging.

Because preventive care is an important part of overall wellbeing, adherence to recommended screenings is an important data point to track. Over the past three years, WellSpark’s diabetes management program participants’ overall adherence to diabetes-related preventive care services was above average at 93% or more. These services include physician follow-up visits, foot care visits, retina eye screenings, and kidney function screenings. National averages for these services range from 51% to 91%.

Decreasing diabetes disease distress
The most common psychological issue among those with diabetes is Diabetes Disease Distress – an emotional response to diabetes, including increased worry, stress, concern, and fear among people struggling to manage the disease. According to the National Institute of Health, individuals with a reduction in diabetes-related distress had significantly greater improvement in A1c, medication adherence, self-care activities, and self-confidence⁵. And a 1% reduction in A1c was associated with a 13% reduction in diabetes-related total healthcare costs⁶. Over the past three years an average of 32% of WellSpark program participants reported reduced disease distress because of the program’s support.

Future cost avoidance
Diabetes can be costly to individuals with the disease as well as for employers who provide health insurance coverage. WellSpark’s accredited diabetes management programs, verified by the Association of Diabetes Care and Education Specialists (ADCES), are focused on future cost avoidance, help individuals make lifestyle and behavioral changes that improve their overall wellbeing, and can lower their cost of care. WellSpark works closely with employers to tailor programs to the unique needs of each workforce, incorporating variations of one-on-one and group health coaching options.

“While not exclusively a workplace problem, employers have a unique opportunity to address diabetes and its biological, psychological, and social factors that impact the health of their workforce. By taking action and bringing essential diabetes resources to their workforce, employers can improve overall employee health and wellbeing while also better managing healthcare costs.”

Andi Campbell, President of WellSpark Health

In addition to tracking the data shared here ― A1c levels, preventive care adherence, and diabetes disease distress ― the majority of WellSpark disease management participants also improved their blood pressure, lost weight, and adhered to diabetes self-monitoring guidelines.

By taking time to really understand the sum of everything in a person’s life ― the biological, psychological, and social factors ― WellSpark’s health coaching programs help individuals unlock the barriers that prevent them from making lasting change, give them the support they need to form new health and wellbeing habits, and better manage their diabetes.

Learn more about the disease management health coaching programs WellSpark offers: https://www.wellsparkhealth.com/solutions/

Sources:

[1] Center for Disease Control and Prevention, Retrieved March 21, 2024 from https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
[2] A −1% change in absolute % HbA1c translates to 21% fewer deaths from stroke, 37% fewer eye and kidney complications, and 14% fewer heart attacks. Using the Milliman model; this −1.6% change in mean A1c (in the study population) converts to an estimated cost savings of $192,110 for a 12-month period or $1,256 annual savings per member in program; Diabetes management with a care coordinator improves glucose control in African Americans and Hispanics, Wayne S. Rawlins, Michele A. Toscano-Garand, and Garth Graham; J Educ Health Promot. 2017 May 5;6:22.
[3] Center for Disease Control and Prevention (2020) Access to Health Care, Retrieved March 21, 2024 from https://www.cdc.gov/vitalsigns/healthcareaccess/
[4]Center for Disease Control and Prevention (2023) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Retrieved March 21, 2024, from https://www.cdc.gov/chronicdisease/center/index.htm
[5] National Institute of Health, Retrieved March 22, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398174/
[6] Nation Institute of Health, Retrieved March 22, 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873294/

Burning the candle at both ends? Research says poor sleep habits could cost your health.

The term “beauty sleep” may sound like just a posh way to refer to a good night of rest, but the origins of this idiom actually relate to the restorative health benefits of getting quality shut-eye. These benefits go beyond a physical sense of well-restedness to include improved mental processing, weight management, a stronger immune system, reduced stress and improved mood¹. Consistently getting enough sleep could even lower a person’s risk of high blood pressure, cardiovascular disease, diabetes, depression and anxiety².

There are many factors that could impact someone’s ability to sleep, and they vary from person to person. Some of them are simply demographic, while others are occupational or socio-economic. Some are preventable, like late-day consumption of caffeine or alcohol, while others are caused by sleep disorders, underlying health issues, or chronic stress and anxiety. In a 2017 study published in International Journal of Environmental Research and Public Health, researchers Nicola Magnavita and Sergio Garbarino suggest loneliness could lead to problems sleeping, as well³.

“In the complex relationship between wellbeing, health and productivity, sleep impairment can act as a moderator,” Magnavita and Garbarino wrote. “Sleep disturbances may be both the cause and the consequence of reduced wellbeing and may therefore set up a vicious circle with relevant consequences for productivity and, in the longer term, the safety and health of workers.”

Taking steps to regain control of your sleeping habits could help break this cycle and set you up mentally and physically for better health and wellbeing. The National Institute of Health’s Office of Disease Prevention and Health Promotion provides several tips for individuals looking to improve their sleep¹:

• Establish a consistent schedule for waking and sleeping
• Avoid exercising a few hours before bedtime
• Avoid caffeine and nicotine later in the day, and alcohol right before bed
• Get in the swing of a relaxing before-bed routine, such as a warm bath, reading, or something else you find calming
• Avoid bright lights and loud noises (i.e. from the TV, computer or phone) in the bedroom

For those who have tried these tips and still have trouble falling or staying asleep, the Centers for Disease Control and Prevention (CDC) has detailed common sleep disorders on its website.

In the end, research has drawn a clear line connecting healthy sleeping habits with healthy people, and vice versa. If you feel that you could be getting better sleep, try implementing small changes to your morning and nighttime routines to determine what works best for you. Or meet with a WellSpark Health Coach to find some strategies to improve your sleep habits.

Sources:

[1] Office of Disease Prevention and Health Promotion (ODPHP). “Healthy Living: Get Enough Sleep.” US Department of Health and Human Services. Accessed April 15, 2024, from https://health.gov/myhealthfinder/healthy-living/mental-health-and-relationships/get-enough-sleep.

[2] National Institute of Neurological Disorders and Stroke. “Brain Basics: Understanding Sleep.” Accessed April 15, 2024, from https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep.

[3] Magnavita, Nicola, and Sergio Garbarino (November 2017). “Sleep, Health and Wellness at Work: A Scoping Review.” International Journal of Environmental Research and Public Health, Vol. 14, No. 11, 6, p. 1347. Accessed April 15, 2024, from https://doi.org/10.3390/ijerph14111347.

Loneliness has been deemed an epidemic, and its effects are associated with increased health risks and reduced employee performance. How can employers cultivate a culture of connection in the workplace?

The COVID-19 pandemic may be behind most of us, but according to US Surgeon General Dr. Vivek Murthy, there’s another epidemic sweeping the nation: one of loneliness. In fact, this condition preceded the pandemic, with more than 50% of American adults reporting feelings of loneliness pre-COVID, according to the US Department of Health and Human Services. Forced isolation during the pandemic only served to exacerbate the issue, which continues to run rampant today.

This feeling of disconnection and isolation can have serious ramifications for mental and physical health and, in turn, the health of our society as a whole. A lack of social connection can increase the risk of heart disease, stroke, anxiety, depression, dementia, susceptibility to illness, and even premature death. For example, the negative health effects of loneliness can be compared to smoking 15 cigarettes per day¹.

“Given the significant health consequences of loneliness and isolation, we must prioritize building social connection the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders,” Dr. Murthy said. “Together, we can build a country that’s healthier, more resilient, less lonely, and more connected.”²

In an advisory shared by Dr. Murthy in May 2023, numerous studies were cited as evidence of how social connectedness benefits all of us. Specifically for working Americans, fostering inclusivity has been linked to lower levels of chronic stress and burnout in the workplace. Additionally, connectivity has been shown to enhance employee engagement and satisfaction, creativity, competence, innovation and job performance¹.

So, what can employers do to cultivate a culture of connection in the workplace? The US Surgeon General offered many suggestions, starting with prioritizing socialization at all levels of an organization¹. Employers can also:

• Empower company leaders and managers to nurture connection across teams and initiatives
• Use existing support programs to educate employees on the power of social connection at work
• Promote a workplace culture that addresses whole-person wellness and inclusion
• Enact policies that respect work-life balance
• Explore ways to keep employees connected amid hybrid or remote work¹

For employers to succeed in fostering social connection in the workplace, it’s important to tailor efforts to specific work environments and cultures. Additionally, striving for continuous improvement will help ensure employees are supported through this epidemic of loneliness now and in the future.

Helping employees foster better human connections in their lives is good business. Learn how WellSpark helps employers improve the health of their workforce through employee support ― individual, group and text ― to promote a culture of wellbeing.

Sources:

[1] Surgeon General’s Advisory (May 2023). “Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community.” US Department of Health and Human Services. Accessed March 31, 2024, from https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf.

[2] US Department of Health and Human Services (May 2023). “New Surgeon General Advisory Raises Alarm about the Devastating Impact of the Epidemic of Loneliness and Isolation in the United States.” Accessed March 31, 2024, from https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-devastating-impact-epidemic-loneliness-isolation-united-states.html.