Raising Awareness of Loneliness: The Role of Social Connections in Health and Wellbeing

As we approach Loneliness Awareness Week (5-11 August), it is crucial to highlight the significance of social connections for our health and wellbeing.

Loneliness is recognized as a major social challenge today. Research underscores that humans are inherently social beings, needing connection not only for support but also to find purpose and meaning in life.

Despite this, 1 in 4 people suffer from problematic loneliness.

Loneliness can be understood as the disparity between the social connections we desire and those we actually have. Although each person’s experience of loneliness is unique, it universally poses a significant risk for chronic health issues such as cardiovascular disease, hypertension, obesity, addiction, substance abuse, anxiety, and depression.

Researcher Julianne Holt-Lunstad found that loneliness has a more detrimental impact on our health than smoking 15 cigarettes a day. Despite social connections being a key predictor of longevity, most people undervalue them as a factor in managing their health.

This highlights the importance of initiatives like Loneliness Awareness Week and programs such as Healthy Me, Healthy Community. Healthy North Coast’s social prescribing program in Port Macquarie is particularly vital in addressing some of the region’s most common chronic conditions.

Understanding Social Prescribing

Social prescribing is a globally recognized, modern approach to healthcare where health professionals consider social determinants of health as crucial to improving health outcomes, addressing the root causes rather than just symptoms.

Patients, where appropriate, are referred to trained link workers who focus on ‘what matters’ to the individual, supporting them in connecting with activities, groups, and services in a person-centred approach.

Global studies indicate that social prescribing significantly improves individual health outcomes, reduces health service usage, and fosters stronger, more connected communities.

Australia’s Primary Health Care 10-Year Plan includes social prescribing as a key strategy to enhance access to appropriate care for those at risk of poorer health outcomes. Currently, there are over 20 social prescribing programs operating throughout Australia.

Understanding Loneliness: From Emotional Distress to Public Health Crisis

Loneliness is a distressing feeling stemming from the perception that one’s social needs are unmet. Traditionally viewed as an emotional and mental health concern, it was primarily studied by psychologists, philosophers, and poets. However, in recent years, health researchers and clinicians across various specialties have recognized loneliness as a social determinant of health—similar to economic stability or access to quality education—that significantly influences overall health outcomes. The COVID-19 pandemic, with its social distancing guidelines, has exacerbated what is now often described as an epidemic and a public health crisis.

Interestingly, not all loneliness is detrimental. According to Liz Necka, a program director in the Division of Behavioural and Social Research at the US National Institute on Aging, about 20% of the population experiences a normal, even beneficial level of loneliness. Necka explains that loneliness can motivate individuals to seek social connections. The real issue arises when loneliness becomes chronic.

Studies in neuroscience and research on isolated animals suggest that unaddressed loneliness triggers an immune response in the body, leading to cycles of inflammation that can cause various illnesses, including depression, anxiety, high blood pressure, diabetes, stroke, and heart disease. This state of hypervigilance is also associated with personality changes and impaired decision-making, increasing the risk of cognitive decline and dementia. Research shows that lonely individuals face a 26% higher risk of premature death, a rate comparable to that of smoking.

Despite these concerning correlations, new evidence suggests potential benefits of even chronic loneliness. Recent neurological research has found that lonely individuals have bulkier and more strongly wired brain regions associated with reminiscing, imagining, and self-reflection.

The complexity of loneliness makes it difficult to measure, and much remains unknown about its precise impact on health and mortality. However, the surge in research, particularly since the pandemic, reflects growing concerns about loneliness globally.

The Prevalence of Loneliness

Research indicates that 15-30% of the general population is chronically lonely. Before the pandemic, about 19% of US adults over 55 were “frequently” lonely, according to the Health and Retirement Study (HRS) conducted by the University of Michigan. Contrary to narratives suggesting increasing loneliness among seniors, James Raymo, a demographer at Princeton University, found that the prevalence of frequent loneliness among older adults in the US remained relatively stable from 1998 to 2016.

Polling data suggests a spike in loneliness among older adults during the pandemic, with younger people experiencing even higher rates of loneliness due to social distancing. While loneliness affects all life stages, older adults are more susceptible to its adverse health outcomes, says Necka. Interestingly, older adults have shown greater resilience to social distancing than younger adults. With the easing of social distancing guidelines, loneliness levels appear to be returning to pre-pandemic norms.

Research Challenges and Future Directions

Loneliness is complex and challenging to measure, partly due to the lack of uniformly accepted terminology. Social isolation—defined as an objective lack of social contacts—is often conflated with loneliness, yet these are distinct concepts. For example, a person can be content with little social contact or feel lonely despite numerous social ties if those connections lack meaning.

Additionally, while loneliness is linked to serious health conditions, these conditions can also increase the risk of loneliness, creating a vicious cycle for patients and posing research challenges. Researchers often rely on survey data to study loneliness, but the method of survey administration (phone vs. written) can influence results.

Certain population segments are more at risk of chronic loneliness. People living in poverty, those with cognitive or mobility impairments, and those with sensory impairments (hearing and vision loss) are at higher risk. A 2020 report by the National Academies of Science, Engineering, and Medicine also highlights immigrants and LGBTQ+ individuals as vulnerable groups.

Medical professionals are increasingly recognising their role in addressing loneliness. For many chronically lonely older adults, a brief conversation with a doctor may be one of the few discussions about their health and wellbeing. Dr. Ashwin Kotwal, a researcher and palliative care physician at the University of California, San Francisco, notes that the pandemic has helped destigmatise loneliness, prompting more clinicians to inquire about patients’ social wellbeing. However, systemic changes are needed to promote social prescribing and secure funding for social programs that significantly impact quality of life.

Broadening Interventions

Because loneliness is experienced differently by individuals, no single intervention is universally effective. Necka compares loneliness to setting a thermostat, where personal preferences for social interactions vary. Before the pandemic, interventions often focused on developing cognitive skills for socialising. More recent approaches have seen promising results from enrolling lonely individuals in volunteer programs, although these findings are yet to be published. Training social support personnel, such as Meals on Wheels delivery drivers, in empathetic listening has also shown potential as a scalable intervention.

The pandemic has pushed many older adults to adopt technologies like videoconferencing to stay connected, leading to increased emphasis on digital solutions. Studies involving direct social contact via videoconferencing and the use of robot companions have shown promise in reducing feelings of loneliness and anxiety.

There is a growing recognition of the need for holistic approaches involving various disciplines and stakeholders. Experts from psychology, public transportation, and the arts have long studied loneliness and its relief methods. Amy McLennan, a senior fellow at Australian National University, cautions against framing loneliness solely as a medical issue, which might stifle broader collaboration. McLennan emphasises the importance of viewing loneliness as a multi-faceted problem requiring diverse solutions.

Dr. Kotwal is optimistic that the pandemic and the increasing volume of loneliness-related research will drive systemic changes in healthcare. He advocates for reallocating some medical care funds to social care to alleviate chronic loneliness effectively. This shift, he believes, will enable clinicians to play a more significant role in improving patients’ social wellbeing.

Recent studies have examined loneliness prevalence, the link between low human contact and poor health outcomes, and the effectiveness of various interventions. Below is a curated list of seven peer-reviewed studies on loneliness and social isolation, highlighting their key findings and insights from some of the authors.

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