Minerva . . . and other storiesBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2294 (Published 29 May 2019) Cite this as: BMJ 2019;365:l2294
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Back pain is just as likely to be caused by disc damage in this situation. X Rays are probably only necessary if there is tenderness of the appropriate vertebral spine(s) to percussion, or more specifically pain on applying low frequency vibration from a tuning fork.
Competing interests: No competing interests
Make no mistake: loneliness is a killer. In our systematic review, depression was the most strongly-evidenced consequence for mental health, but many other disorders could contribute to the higher mortality reported. The year following a bereavement is a time of special risk. However, our work at several Sure Start sites uncovered a younger, hidden population of lone parents with preschool children who seemed to have serious, unmet health needs. On a friendless estate, loneliness and low self esteem combined with depression and drink could even render some young mothers vulnerable to a series of violent males. I am still haunted by memories of one small estate where two mothers were murdered by abusive 'partners' within six months.
Better architecture, town planning and transport are all needed to combat loneliness. 'Good Neighbours' and locally accessible Voluntary & Community agencies are even more important. Some activities, from cycling groups to youth football, dancing or choral singing, seem to bring people together.... although there is no One-Size-Fits-All solution. My memories of Health Action Zones are that local residents needed a choice of activities, that were meaningful and culturally acceptable. The Department of Health has finally 'twigged' that gardening can be good for us. Let a thousand flowers bloom - but remember that family and ethnic history shape the meaning of gardens! My personal recommendation is for sociable companion animals (think of a ship's cat or even a pirate's parrot).
 Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, Caan W. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health 2017; 152: 157-171
 Northrop M, Pittam G, Caan W. The expectations of families and patterns of participation in a trailblazer sure start. Community Practitioner 2008; 81 (2): 24-28
 Caan W. Alcohol and the family. Contemporary Social Science 2013; 8: 8-17
 Ashton J. Plants and green spaces provide more than just aesthetic benefits. Perspectives in Public Health 2015; 135: 178-179
Competing interests: Cat owner