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Loneliness Is a Policy Problem. A Big One.

Lack of human connection is bad for your health. Responding to an advisory from the U.S. Surgeon General that a loneliness epidemic is affecting half of all Americans, San Antonio has been pushing out resources to help build bonds between community members.

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San Antonio works to address the needs of its most vulnerable through a collaborative approach, bringing community members together for "difficult conversations" about their concerns and possible solutions to them.
(City of San Antonio)
In Brief:
  • Earlier this year, the U.S. Surgeon General issued an advisory, warning that the U.S. faces an epidemic of loneliness. He called for an emphasis on increasing social connection to address an “underappreciated public health crisis.”
  • San Antonio has an active program that fosters connection and cooperation among community members, built around the concept of compassion.
  • Partnering with the Surgeon General, it created Compassionate USA, along with educational materials that have become resources for hundreds of communities.

  • Communications devices are ever-present, but hardware doesn't equal human connection. Despite its name, social media has proven to be good at isolating people from each other. Earlier this year the Surgeon General issued an advisory warning that even before the pandemic, half of all adults were suffering from loneliness and isolation — forces as harmful to their health as smoking 15 cigarettes a day.
    It’s just about taking care of oneself and others and being a decent human being.
    Ann Helmke knows the problem well. An ordained Lutheran (ECLA) minister, she has never led a congregation, at least not in the usual way. For the last three decades she’s used her training to teach, write and engage members of the San Antonio community in social justice work.

    Seven years ago, she took a job as faith liaison in the city’s Human Services Department. Her focus isn’t bringing religion into government, but bringing the faith community, businesses, nonprofits and residents together to work for the greater good.

    “It doesn't have anything to do with your faith, or even if you have one,” she says of her work. “It’s just about taking care of oneself and others and being a decent human being.”

    In a conversation with Governing, she talks about how she approaches her job and how it led to an opportunity to help others do something about what the Surgeon General calls “an underappreciated public health crisis.”
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    San Antonio mayor Ron Nirenberg (second from left) leads a "Welcome Walk," an annual event for those who have migrated to or taken refuge in the city.
    (City of San Antonio)
    Governing: What is your job?

    Ann Helmke: I [am] employed by the city to intentionally form collaborations between the faith, community, government entities, nonprofits, community groups, businesses, schools, anyone who is willing to work together to meet the needs of the most vulnerable in our city. That's the mission statement for the work that I do.

    Compassion is foundational to the formation of collaboratives, but it’s also the outcome. What we end up with is a compassionate community that cares well for itself, self-compassion, has compassion for others and also knows how to look systemically to see where we aren’t compassionate and can become more so.

    Governing: How is “compassion” defined in this work?

    Ann Helmke: Humans can feel and sense and recognize another person suffering. Empathy is that recognition.

    The difference with compassion is that it has a sense of agency. If I’m sitting with you, and I know you are hurting, I might say, “Have you ever thought about doing such and such with this suffering, this concern? In fact, we could do something together.”

    We come up with an action step, and the idea itself is action. You’re not just sitting in your head. Compassion has that “together” element, which is also social connection.

    Some folks think that compassion sounds soft, but it's skills. I like to compare it to the Spurs [San Antonio’s NBA team]. They practice, practice, practice so that when they get into the real game, they don’t have to think. The skills are honed, they're strong, they've got muscle to them.

    We practice the skills so that when it gets a little more difficult, a little bit more heated — a hurricane comes or 10,000 people migrate through — we can stand stronger and be more resilient as a community.

    Governing: How might you put this idea into action in the community?

    Ann Helmke: It might be that you and I have a phone call once a week for the next month. It might be setting up a collaborative among the faith community to access congregational property that could be utilized to build on, or to refit old buildings that aren't being used for affordable, accessible and available housing.

    Big or small, it's still compassion.
    Ann Helmke.jpg
    Ann Helmke: "I am thoroughly convinced that at least every large city in the country should have somebody like me: somebody that's working intentionally at that intersection between the community and the government, simply getting people to work together."
    (City of San Antonio)

    We have found ways to pull together and have community conversations about difficult issues and community concerns. Out of those conversations, we ask what actions we will take. Who's going to work together? Who's not at the table that needs to be a part of where we're headed, especially people who might be most involved in a concern?

    You can't have a community conversation or collaboration around teen pregnancy unless you have some teens that are pregnant, or people who were the offspring of a teenage mother and father.

    That's how we've been building.

    Governing: When conversations bring problems forward, how do you decide where to focus first?

    Ann Helmke: We start close to the ground. When I say close to the ground, I mean Maslow's hierarchy. [An influential model proposing that basic survival needs must be met before higher needs can be fulfilled.]

    The more we can get into collaboration around things at the bottom of that hierarchy — housing and food, security and safety — community concerns higher up on the hierarchy start to take care of themselves. What comes of collaboration is the formation of community, and as people feel more socially connected, they start working on the more difficult things.

    It's like they start to heal themselves because they've learned how to work together.

    Governing: How does this relate to the loneliness epidemic?

    Ann Helmke: For quite a while, before isolation and social connection became “public” words, we have talked about a “benefits package.”

    When you are working collaboratively, the benefits package is that you get to meet extraordinary people you’ve never met before. The odds of meeting new people are very high. You are connected in purpose, and that purpose is our own community.

    That’s how we go about social connection.

    Governing: How has San Antonio worked with the surgeon general?

    Ann Helmke: He came to Texas in February of 2022. I met with him, along with about a dozen people from nonprofits. He was curious what it was like trying to do the work we do during COVID-19. He also met with Texas mayors in Austin, talking about isolation.

    That started a relationship between the Surgeon General’s Office and San Antonio. Our mayor is the chair of the Mayors and Business Leaders Center for Compassionate and Equitable Cities at the U.S. Conference of Mayors. He helped arrange for the surgeon general to be a keynote at their June 2022 meeting.

    The conference was literally days after the Uvalde shooting. When we got there, it was being talked about more than anything else. It woke people up. We’d become used to those things happening in big cities, but in a little rural community? What’s happening to us? What are we going to do?

    In a hallway conversation, we came up with the Compassionate USA idea. Before we left the conference, we were already having conversations with people who do curriculum development.

    [Compassionate USA was competitively selected by The NewDEAL, a progressive-leaning national network that identifies and supports emerging state and local leaders, as one of 20 finalists in its Ideas Challenge this year.]

    Governing: How did this line up with the release of the advisory?

    Ann Helmke: His office was already working on the advisory. All his stops across the U.S. were gathering information to go into it. The advisory and Compassionate USA were intentionally created to fall near the same time, so there could be a national awareness with something actionable right away.

    Compassionate USA was launched at the June 2023 Conference of Mayors meeting. [The surgeon general’s advisory was released in May 2023.] We put it out to democratize the education of compassion and to give all the mayors, all the cities, all the towns and territories of these United States access to solid compassion skills.
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    Participants in a Valentine's Day collaborative focused on the problem of domestic violence.
    (City of San Antonio)
    Governing: You’ve already got about 300 partners in this effort. What does it mean to be a partner?

    Ann Helmke: It has three aspects. One is affirming the need for this kind of thing. The second is telling people about the materials — get the word out in your networks or systems. The last aspect is implementation.

    Governing: How do people use the materials?

    Ann Helmke: Last week I used a video at a staff meeting from the Department of Human Services. It was on systemic compassion; our leads watched it and we discussed what that looks like in the systems we’ve developed.

    An interfaith group asked me if they could use the micro course at a forum for leaders from different faith traditions. Schools are using them in PTA meetings.

    You don’t have to ask the permission — there’s no cost, and the whole thing is right there.

    Governing: Any last thoughts?

    Ann Helmke: I am thoroughly convinced that at least every large city in the country should have somebody like me: somebody who's working intentionally at that intersection between the community and the government, simply getting people to work together.
    Carl Smith is a senior staff writer for Governing and covers a broad range of issues affecting states and localities. He can be reached at or on Twitter at @governingwriter.
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