Loneliness kills

One of the biggest risks to health is loneliness, which can pose a greater threat than well-known factors such as poor diet or insufficient exercise. With COVID-19 physical distancing restrictions affecting our ability to maintain social ties, it’s more important than ever to be aware of the dangers of social isolation. Men are at particular risk, with nearly one in four men experiencing low levels of social support. Research from Oxford University Professor Robin Dunbar shows that men tend to bond through group experiences and in-person activities, while women are better at maintaining long-distance relationships. This Men’s Health Week, in a time when many can’t take part in their traditional social groups, we talk to University of Queensland School of Psychology researcher Professor Alex Haslam about the value of social connections.

An illustration of a man with white hair walking. Above him a cloud is raining on him.

Being lonely is one of the biggest markers of mortality – but we don’t know it.

Professor Haslam led a study which surveyed more than 500 people across the United Kingdom and the United States, asking them to rank how important various factors were for health.

“We asked: ‘What do you think are the most important determinants of health and wellbeing and mortality? What keeps us alive? Pick out from this list what you think are the most important things for staving off the grim reaper’.”

· Not smoking

· Quitting smoking

· Not being obese

· Not being exposed to air pollution

· Receiving social support

· Taking appropriate medication

· Exercising

· Being socially integrated

· Being physically active

· Not drinking excessive alcohol

· Flu vaccinations

“The two most important predictors of staying alive are actually receiving social support and being socially integrated,” Professor Haslam says.

An illustration of a man wearing a turban, sitting on the ground and looking sad.

An illustration of two people reaching out from their phones to touch.

"Our survey found that only about 15 per cent of people knew this.”

“Traditionally when we think about health, we think about a whole range of medical and physical ‘states’.

“However, loneliness increases the risk of death even more than things such as obesity, alcohol consumption, lack of exercise, and so on.”

The dangers of loneliness are well documented: a meta-analysis collated almost 150 studies that showed the significant health impacts of social isolation. These impacts include about a 30 per cent increase in the risk of premature death.

However, health literature and common perceptions around health don’t focus on these areas.

“People are pretty good at understanding the physical factors for health. They realise that low physical activity and smoking are bad,” Professor Haslam said.

“But they don’t realise that being socially isolated and disconnected is bad. That’s a problem. We need to initiate a conversation that tunes people in to the importance of social connection, lack of isolation, lack of loneliness.

“These problems, rather than shrinking, are actually growing.”

A person peering through a gap in a brick wall. They look sad.

Last year’s ABC Australia Talks project – a survey of 54,000 Australians – found about half of all Australians felt lonely always, a lot of the time, or frequently. The uncertainty of COVID-19 and physical and social isolation will likely have increased these numbers, especially as issues such as unemployment increase.

“Social determinants of health include things such as: don’t be poor, don’t be a single parent, don’t be Aboriginal, don’t live in a marginalised community, own your own house, and so on – they’re not part of that public health messaging discourse either,” Professor Haslam says.

“Humans are social animals. We live and we’ve evolved to live in social groups, religious groups, sporting groups, ethnic groups, family groups, work groups, interest groups and so on. As a result, a large part of our identity, our sense of self, derives from group memberships. Who we are as human beings is not just about individuals. It’s not just about I and me. It’s about us as group members, the we of the self.

“Us-ness is every bit as important for our sense of self as I-ness and, indeed, our sense of self derives from our connections to groups. Take away somebody’s groups and you destroy their I-ness.

“Social identity is a basis for connection, organisation and community. It’s a basis for giving and receiving support and for actively coping with one’s circumstances. A basis for agency, purpose, meaning and mental health and resilience.

“Loss of social identity leads to disconnection and loneliness, alienation, lack of support, disempowerment, anomie, and then distress, dysfunction and vulnerability.

“As Australians, we have lost a sense of how to do that naturally. I come back to the traditional custodians of the land to whom that is anything but news.”

Professor Alex Haslam

An illustration of a man wearing a white mask over his mouth. He is trapped in a jar.

An illustration of a group of friends talking. One of them is in a wheelchair.

An illustration of a group of friends with their arms around one another.

So how can we build social connection and identity?

An illustration of many different people standing together.

An illustration of a group of friends with their arms around each other.

An illustration of a video conference call.

An illustration of a group of friends gathering for a meal.

So how can we build social connection and identity?

“If we’re interested in humanity, then we need to recognise that group life is critical to that,” Professor Haslam says. “So we need to celebrate it, we need to embed it, and we need to provide the social scaffolding that supports it.

“Social group memberships are the basic building blocks of a healthy, meaningful life. By building and sustaining group memberships, you’re working with the foundations of good mental health.”

Professor Haslam advises people to find groups that are meaningful to them, noting that not everyone wants to join a book club or take up sailing.

During COVID-19, it’s important to try to find a way to continue these groups even while being physically distant: make phone calls, join online groups, check-in on people who you used to interact with physically – consider moving your soccer team to an online game or having a weekly video chat.

Professor Haslam encourages ‘social prescribing’ as part of the treatment plan for people with conditions such as stress, trauma, depression, substance misuse, and eating disorders. Social prescribing means GPs and healthcare professionals help their patients find groups that would be meaningful to them, and teach them the skills to join these group, focusing on confidence and engagement.

Social scaffolding is also important. This includes access to technology, transport, free time, wealth and other factors that allow people to take part in groups.

“Retired people are very vulnerable to loneliness. All we ever talk about is having a financial plan for retirement. We put very little into the social plan, the social architecture, that might support meaningful connection,” Professor Haslam says.

“Everybody can benefit, not just people who are vulnerable or at risk.”

Professor Alex Haslam.

Queensland groups:

Australian Men’s Shed Association.