Good advice? No! Why the RVS report Gezond Verbonden misses the most critical piece of the puzzle
By Jeannette Rijks
The Raad voor Volksgezondheid & Samenleving (RVS) published its advice Gezond Verbonden in January 2026. The core message is right: social connectedness is a health determinant that deserves a central place in healthcare. People with strong social bonds live longer, recover faster, and experience fewer health complaints. The effect of social isolation on mortality is comparable to smoking fifteen cigarettes a day. That is not a marginal finding. It is a public health emergency.
The RVS deserves credit for making this case to a medical establishment that has long treated patients as isolated biological units. The advice calls for group treatments instead of individual consultations, peer contact in care pathways, and meeting spaces in hospitals and rehabilitation centres. These are sensible recommendations. They come from a place of genuine concern.
And yet, something essential is missing. Something that, without attention, will cause these well-intended recommendations to fail for exactly the people who need them most.
The assumption nobody questions
The entire logic of Gezond Verbonden rests on an implicit assumption: that people who are socially isolated are, in principle, capable of benefiting from social opportunities, provided those opportunities are made available to them. If only the healthcare system would stop treating patients as individuals and start creating connection, social isolation would diminish and health would improve.
It is a reasonable assumption. It is also wrong. At least for a significant portion of the people we are talking about.
Loneliness, when it persists over time, is not simply a shortage of social contact. It is a neurological condition. The brain of someone who has been chronically lonely does not function the way the brain of a socially connected person does. It has changed. And those changes are precisely what makes the RVS recommendations, however well-designed, inaccessible to the people who feel most isolated.
What the lonely brain does
When loneliness becomes chronic, the brain enters survival mode. The hypothalamic-pituitary-adrenal axis (the body’s stress system) becomes dysregulated. Cortisol levels remain chronically elevated. Inflammation increases. The immune system is compromised. These are not metaphors. They are measurable, documented changes.*
But the social consequences are what matters most here. Chronically elevated stress hormones alter the brain’s response to social signals. The prefrontal cortex, which is responsible for social cognition and decision-making, shows reduced activity. The amygdala becomes hyperactive, scanning constantly for social threats. Neutral interactions are interpreted as hostile. A friendly gesture can feel suspicious. A group setting feels dangerous.
This is what I have described as the loneliness paradox: the moment you most need connection, your brain is least able to create it. The very organ you need to build relationships has been changed by the absence of them.
There is more. When parts of the brain are not used, they atrophy. Social skills are not exempt from this principle. Someone who has been isolated for a long time gradually loses the neurological fluency to read facial expressions accurately, to interpret tone of voice, to pick up on subtle social cues. They become, in the most precise sense of the word, socially impaired. Not because they lack the will to connect. Because their brain, through no fault of their own, no longer knows how.
Why this makes the RVS advice insufficient
Consider the RVS recommendation for group treatments and peer contact in healthcare settings. For patients who are socially connected, or even mildly lonely, this is an excellent idea. The presence of others in similar circumstances, a shared experience, the normalisation of vulnerability, these do work. There is good evidence for this.
But for the chronically isolated patient, the one who has not had meaningful contact for months or years, the one for whom loneliness has already become a neurological reality, a group as such does not offer connection. It offers a threat. A room full of strangers is not an opportunity their brain recognises as such. It is a challenge their compromised social cognition cannot meet. They attend once or twice. Then they disappear. And professionals scratch their heads, wondering why the intervention did not work.
The same applies to peer contact programmes and meeting spaces. They are excellent structures. But a structure cannot reach a brain that is in defensive mode. You cannot design your way around a neurological barrier with architecture and scheduling.
I am not being pessimistic, I am realistic. If we want the RVS recommendations to work, we need to understand why, for a very large group, they currently cannot. I want to tell you what needs to happen first.
Two tracks, not one
Effective help for chronic loneliness requires two simultaneous tracks. The first is neurological: helping the brain to de-escalate. Reducing the chronic stress response. Creating conditions of psychological safety before social interaction is attempted. This is not therapy in the conventional sense and it does not require a diagnosis or a referral. But it does require knowledge: knowledge of what loneliness does to the brain, and deliberate techniques to work with that reality rather than against it.
The second track is social: learning, step by step, how to build relationships that fit the person’s life and circumstances. Not generic socialisation. Specific skills for specific situations, practised incrementally, in conditions the brain can tolerate. An individual approach.
These two tracks are not sequential. The neurological de-escalation and the social skill-building must happen in parallel, reinforcing each other. But neither can be skipped. And you cannot begin with the social track, with group sessions and peer meetings, if the first track has not been initiated. That is precisely the mistake that most well-meaning interventions make, including, implicitly, the ones recommended by the RVS.
What professionals need to know
The RVS is right that healthcare professionals currently underestimate the health impact of social isolation. But the gap is not only in awareness of the problem. It is in understanding of the mechanism.
A doctor who knows that loneliness is as dangerous as smoking fifteen cigarettes a day is better informed than one who does not. But if that doctor then refers a chronically isolated patient to a peer contact group without understanding what the patient’s brain will do with that experience, the knowledge has not translated into effective action. Good intentions have met a neurological wall.
What professionals need and what the RVS advice does not provide, is training in the specific neurology of chronic loneliness. Not at a specialist level. At a practical level. Enough to understand that a patient who declines social activities is not being difficult or uncooperative. Enough to know that “just go and meet people” is the equivalent of telling someone with a broken leg to walk it off. Enough to recognise that the first step is not social but neurological.
This knowledge needs to be embedded in the training of GPs, nurses, social workers, and the many other professionals who come into contact with isolated people at moments of vulnerability. The healthcare system that the RVS wants to transform is full of people who care, who want to help, and who are working with an incomplete picture.
The recommendation the RVS did not make
Gezond Verbonden calls on healthcare providers to treat patients as socially connected beings rather than isolated individuals. That is the right call. But it needs an additional layer: treat the chronically lonely patient as someone whose brain has been changed by their isolation, and whose recovery requires, as a first condition, that that change be understood and addressed.
Without that layer, the best-designed group treatment will empty out after two sessions. The most thoughtfully furnished meeting space will go unused. The peer contact programme will struggle to retain the people most in need of it.
More knowledge about what loneliness does to the brain is not a refinement of the RVS advice. It is the precondition for making that advice work.
Jeannette Rijks is a specialist in the approach to loneliness and the developer of Creatief Leven, a methodology for tackling chronic loneliness. She has written extensively on the neurology of loneliness and has trained professionals through Faktor5.
* Van Bogart, K., Engeland, C. G., Sliwinski, M. J., Harrington, K. D., Knight, E. L., Zhaoyang, R., Scott, S. B., & Graham-Engeland, J. E. (2022). The Association Between Loneliness and Inflammation: Findings From an Older Adult Sample. Frontiers in behavioral neuroscience, 15, 801746.
Zilioli S., Jiang Y. (2021). Endocrine and immunomodulatory effects of social isolation and loneliness across adulthood. Psychoneuroendocrinology 128:105194.
Steptoe A., Owen N., Kunz-Ebrecht S. R., Brydon L. (2004). Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology 29, 593–611
