‘What Happens Next?’: Are We Lonelier Than Ever?

Dr Susan Carland: Welcome back to What Happens Next?, the podcast that examines some of the biggest challenges facing our world and asks the experts, what will happen if we don't change? And what can we do to create a better future?

I'm Dr Susan Carland. Keep listening to find out what happens next.

Over the next two episodes, we'll take a look at loneliness.

Dr Alan Petersen: I think one of the lessons we've learned from the pandemic is that people crave in-person, face-to-face communications.

Andrew Giles: The evidence that we have in Australia indicates that about one in four of us reported feeling lonely some or all the time before the pandemic.

Dr Suzi Nielsen: Trying to disentangle those things is really complicated, but we do know that there is a link between substance use and loneliness.

Dr Susan Carland: Ironically, if you're feeling lonely, you're not alone.

According to surveys conducted by Melbourne’s Swinburne University, an estimated one in four Australians report problematic levels of loneliness, and 30 per cent don't feel that they are part of a group of friends.

The surveys found that lonely Australians have worse physical and mental health, and are more likely to be depressed. And these surveys were conducted before the COVID-19 pandemic hit. It's likely that lockdown and isolation have only exacerbated the issue.

Rising levels of loneliness are certainly not exclusive to Australia, of course. Around the world, governments and healthcare providers are stepping up to address a global trend of loneliness.

News Reader 1: The British Prime Minister appointed a Minister of Loneliness today. The new role will tackle solitude in the UK where more than one in 10 people feel isolated.

Dr Susan Carland: The United Kingdom has established a cabinet post for a Minister of Loneliness. So has Japan, where so many young people have withdrawn from society that there's a word for the phenomenon: hikikomori.

What happens if we don't take loneliness seriously as a public health concern? How can we address the issue and what can we do to support each other?

First, we've got to define loneliness.

Dr Rosanne Freak-Poli is a life-course epidemiologist working in the Monash University Data Futures Institute. Her research considers the impacts and causes of loneliness and social isolation. Rosanne, welcome to the podcast.

Dr Rosanne Freak-Poli: Thank you for having me.

Dr Susan Carland: How would you define loneliness?

Dr Rosanne Freak-Poli: There's social isolation, which is an objective measure. It looks at the number of social connections or social ties that you have.

And then, there's social support. So this is a subjective measure, meaning that it's how you feel about these supports, and how you use the people around you. Loneliness tends to be a feeling or an unwanted experience about not having support and feeling isolated.

Dr Susan Carland: Right. If I'm feeling okay about maybe being by myself, then that's not loneliness because it's not unwanted. Is that correct?

Dr Rosanne Freak-Poli: That's correct. So quite often, we call that enjoying our solitude. So, some people that are isolated, or have a few supports, aren't necessarily lonely. They might just enjoy being in solitude. While other people who have people around them, that are not socially isolated, and they have lots of support, they can still feel lonely.

Dr Alan Petersen: And that's important to keep pointing that out. One can be alone and not be lonely, and one can feel lonely and be surrounded with people. It's a subjective experience.

Dr Susan Carland: Monash University sociology professor, Dr Alan Petersen, is interested in the value of digital technologies in either overcoming or exacerbating the experiences of loneliness.

Dr Alan Petersen: Digital technologies are seen to provide instant social connection. Mark Zuckerberg recently, in launching Meta – you might have heard of, it's now the parent company of Facebook and Instagram, and all these other holdings – said that, “We're a company focused on connection.” The promise is connection. And for many people, and we found that during the lockdowns, Zoom and other platforms have provided a means for connection in the absence of other forms of connection.

But I think one of the lessons we've learned from the pandemic is that people crave in-person, face-to-face communications. It's not entirely clear that digital media can substitute for that in-face connection. In some cases, it can substitute where there’s no other option, as with lockdowns, but people still want that, and they'll still want to go to a concert, and they'll still want to sit with other people. They don't want to watch it on Zoom. They want that experience. And some say that loneliness is that longing for companionship when it doesn't exist. That's, I think, quite a neat one because if you don't long for it –

Dr Susan Carland: Yeah. Then you're alone, but not lonely.

Dr Alan Petersen: Yeah, you could be. That's right, exactly. But if you long for it and you can't get it in the quantity or the quality of the relationship, I think that's important to make that distinction too, then you could arguably fit that definition of being lonely.

Dr Susan Carland: Do you think loneliness is getting worse?

Dr Alan Petersen: More people are reporting that they feel lonely. So, the phenomenon is difficult to know. I mean, there's a lot of interest in it, obviously. And in 2018 in the UK, they appointed the world's first loneliness minister. And that came in the wake of a series of events, including Jo Cox, who died, that politician, for example. She was a big advocate.

News Reader 2: The government has appointed the first Minister for Loneliness to continue work started by the late MP Jo Cox. Ms Cox set up the Commission on Loneliness before she was murdered by a right-wing extremist in her constituency in 2016. The MP…

Dr Alan Petersen: A lot of other governments have taken that up, too, and there's been some discussion here as well in Australia.

Dr Susan Carland: Federal Labor MP Andrew Giles, along with Federal LMP Minister Fiona Martin, is leading the discussion of loneliness in Australia's parliament. Together, they've set up a bipartisan group, the Friends of Ending Loneliness.

Andrew Giles: In the parliament, there's been, I think, a reasonably long-standing tradition of bringing together groups of people from across the parties to try and raise awareness of particular issues, and to try to – in these cases – either draw public attention to something that we feel isn't being talked about enough, or to show that we are capable of not simply having arguments all the time.

I thought loneliness was the sort of issue that would benefit from the attention of a group of parliamentarians coming together, not so much to solve the problem, but to demonstrate that there is a problem and that it's the business of decision makers to be getting on with solving it.

Dr Susan Carland: Do you think loneliness is getting worse?

Andrew Giles: The evidence that we have in Australia indicates that about one in four of us reported feeling lonely some or all the time before the pandemic, which I think counts as a crisis, something we should be talking about, when we understand that the health impacts on individuals are really quite serious.

The health impacts are becoming more understood, and I think anyone that hears the statistic about loneliness being as bad for your wellbeing as obesity or smoking 15 cigarettes a day… that made me sit up and take notice.

The economic impacts are a bit harder to quantify and I think we need to do more work on this. There have been studies in both the UK and the US, which spit out really big numbers in terms of the economic impact. And I think we're getting a bit of a hint of how that might be so through the experience that Australians are going through right now, as people are forced to isolate and we see the direct impact of that on supply chains and people's ability to access the goods and services they expect to be able to do so.

Understanding how that applies to loneliness, I think is a really important bit of work because there's that whole economy cost of people who are feeling, because of stigma, because of other things that are associated with their loneliness, that they're unable to participate economically or unable to participate in the way they'd like to. We just don't know enough about that, but we do know that it is a drag on the economy.

And I think also there's a bit of a moral challenge here for us as a society. People aren't having the opportunity to fulfil their potential, to feel good about themselves, because, of course, so many of us define ourselves by what we do. If people are being held back in that regard by something that we're not taking seriously as a society, well, I think that is a big problem for all of us, as well as, in terms of the challenge of the cost it has to the functioning of our economy and the drag on our collective prosperity.

Dr Susan Carland: So, what are some of the root causes of modern loneliness? Here's Dr Rosanne Freak-Poli again.

Dr Rosanne Freak-Poli: So the main difference between now and a hundred years ago is the way we live. If we look at just the number of people per household, in 1910, it was an average of 4.5. And in 2016, it was 2.75. So, that's a 40 per cent decrease of people physically around you where you live. And then, you look at the other side of people living alone. And in the late 40s, it was about 7 per cent of people that lived alone. But in 2005, it was up to 30 per cent, or nearly a quarter... at least a quarter of people living alone in Australia.

So we know that this is a particular concern for loneliness as people that live alone are more likely to report being lonely. So it's not necessarily… Like I said, people might enjoy their solitude, but it is a modern consequence of our society.

Dr Susan Carland: I want to ask you about the demographics of loneliness. Do we see patterns with certain types of people? Do we see more loneliness in certain age groups? Do certain genders seem to be more lonely?

Dr Rosanne Freak-Poli: Compared to women, men are generally more likely to report being socially isolated and having low social support. However, men are less likely to report being lonely. And I think that this comes back to sort of a social-historical context, where women have been caregivers and connectors in our society for a very long time. And so potentially, what we need for… around social connection is different between men and women.

However, what we have found in research is that while men and women experience social health differently, their impact on health risks later in life are similar. So we do know that it doesn't matter what the prevalence rates are, or that the percentages in men and women… It still has an impact on their health later in life.

Age, for instance, yes, definitely, there are patterns across the age spectrum. So when I looked at the HILDA study, which is the Household, Income and Labour Dynamics in Australia Survey, the people who were aged from 18 to 65 years didn't really change. The percentage of people that reported being lonely didn't really change. It was fairly stable. So, that's around 16 to 20 per cent of the population between 18 and 65. And that equates to about one-sixth or one-fifth of that category.

But then once people turned 65 years of age, the proportions shot up to nearly a quarter. So, that's 25 per cent of the older Australians are lonely. And that can be… That's quite drastic, right? To think that age has such an effect on loneliness.

And we know that it's mainly because a lot of triggers for loneliness happen around that in later life. So for instance, there's life transitions of poor health, sensory loss, living with a disability, loss of mobility, less income, a divorce or bereavement – so that's where a partner dies, being out of work. So for instance, retiring or redundancy. So even when you retire, you're going through a life transition. Reducing your house or downsizing, moving locations, potentially homelessness is a huge issue in older Australians at the moment, or becoming a carer. So, these are all things that could trigger loneliness.

Dr Susan Carland: Another factor contributing to loneliness is chronic pain, which is often treated with addictive opioids. Unfortunately, addiction itself can worsen loneliness, further isolating patients.

Here's Associate Professor, Dr Suzi Nielsen, Deputy Director of the Monash Addiction Research Centre.

Dr Suzi Nielsen: When we're talking about chronic pain, it affects a lot of different facets of people's lives. So for example, if people have chronic pain, they might be less mobile, it might be harder for them to get out and do those social things that they used to do, or just get out at all and sort of mobilise depending on how someone's experiencing their chronic pain.

We also know that often, people's social circles will contract at that time. We've done a lot of work with chronic pain patients in Australia who are taking opioids and a large proportion of them actually end up stopping work or reducing their work because of their chronic pain conditions. So then, those social contacts through work are no longer there, people aren't necessarily going out as much. And so we see sort of a contraction of social circles.

And we also know that things like depression are really commonly co-occurring with chronic pain. And so, people might not feel as motivated or as able to sort of get out and see people.

And so, you have these kind of factors. I mean, they're just two factors that can be kind of compounding to mean that people have small social circles, they might not feel like getting out. And in addition to that, they're in pain.

Dr Susan Carland: Mm.

Dr Suzi Nielsen: They're not feeling great. So all of these things can sort of compound together to make somebody feel less connected to the world around them, sort of more at home, having more troubles kind of connecting with people.

And we know that chronic pain... And I do a lot of research around opioid use as well. So, opioid use and chronic pain are both incredibly stigmatised.

Dr Susan Carland: Mm.

Dr Suzi Nielsen: So that also impacts how people feel about themselves and how they kind of interact with the world. So a lot of those things can contribute to, I guess, an experience of loneliness or social isolation that can occur as a result.

Dr Susan Carland: Can loneliness exacerbate pain?

Dr Suzi Nielsen: Absolutely.

Dr Susan Carland: And opioid use?

Dr Suzi Nielsen: Yeah. And again, trying to disentangle those things is really complicated. But we do know that there is a link between substance use and loneliness, and that when people feel those really unpleasant feelings of loneliness, that sometimes taking a substance can take away some of that pain and some of that distress.

We also know that, for example, among people with chronic pain, we see an increased likelihood that people also have histories of things like adverse childhood experiences or trauma. And so, some of those things cause that discomfort that substance use can take away.

Now, that's not to say that everybody who's lonely uses drugs – that's absolutely not what I'm saying. But when you have those multiple risk factors together, it does definitely make it a more difficult challenge to treat. And you can certainly understand why somebody might, if they're isolated, they're at home, they have a pain medicine and that medicine also works to make them sort of feel better, it would be a natural thing to do, to continue to take something that takes that pain away and makes you feel less sort of distress or discomfort or kind of emotional pain at the same time.

Dr Susan Carland: If we don't change the way we deal with opioid use, pain, and loneliness, what do you think our society looks like in 50 years?

Dr Suzi Nielsen: Well, I don't think we even have to look that far ahead or that far to see what things could look like.

So we've seen… in North America, for example, we have populations where they've had these high rates of prescription opioid use and chronic pain. And we also saw a whole range of interventions that really clamped down on them and meant that people couldn't access those opioids that they were using.

And what we've seen follow those policy changes, in the context of economic distress – so often what we're seeing is these harms in populations who have low employment and other forms of economic distress. What we've seen there is those opioid-related harms have skyrocketed. They've gone up sort of 300 per cent in a number of years. So we don't have to look very far to see what our future could be like if we're not able to address those things.

But we also have some sort of positive case studies in Australia where, for example, we reduced access to over-the-counter codeine, but that happened in the context of a lot of effort to educate people around what other options are around, to get better pain management, to resource some of those things. And so we have seen that you can have a positive outcome from trying to reduce harms with opioids when it's implemented in a way where there's lots of support, there's lots of upskilling of health professionals, and there's lots of community messaging so people understand how they can better manage their pain.

So we have these two kind of, I guess, examples of things that can go well, and things that can go really badly. And so, I guess we don't want to see things that have happened in North America, where we have large kind of economically disadvantaged populations with skyrocketing sort of opioid use and harms, massive increases in opioid-related death.

And there've also been discussions of what they've termed sort of “depths of despair”, which is kind of this conglomeration – [laughter] tripping over my tongue there – of risk factors where people are depressed. They have risk factors, they have pain, they have unemployment. Things get very difficult for people, and in that context, we do see these increasing harms.

Dr Susan Carland: So, what does our future look like if we don't take the issue of loneliness seriously? Here's Andrew Giles.

Andrew Giles: I don't want this to be a... I'm sure you don't want this, more to the point, to be a deeply, big 'P' political, or ideological conversation. And I hope I haven't tried to make it that way, but there is a big debate about the relationship between austerity and neoliberalism, and increased loneliness. And I just want to make that point briefly because the more atomised we are in an economy, I think it follows the more atomised we are as a society.

And without extending this to be too big a political argument, I think there's a big question for us all to ask about whether we are willing to give more primacy to our social connections, whether we are interested in valuing them more – not just in terms of the conversation that we might have at the dinner table or at the school gate with our friends, but as something we think should be a big part of how we conduct ourselves as society.

So I think that the onus is on decision makers, in the first instance, to talk more about our social connectedness and the consequences of it not being prioritised, but on all of us to put pressure on people like me to treat this as something that matters, because the curve is towards more loneliness. We are already at a level that I think is a crisis. We know the impact on individuals is quite terrible and the impact across our society is also something that is deeply concerning.

So we've got an opportunity to turn this around, and it ought not involve too many really tough conversations. It really is about reflecting the good things in our lives, our connection to the people who matter most to us, and trying to ensure that those connections are more available to more people.

Dr Susan Carland: It appears more people are reporting loneliness, but will greater awareness of the issue lead to action? How is Australia addressing the issue? What's working and what still needs to be done? Find out next week on What Happens Next? when we conclude our series on loneliness.

A big thanks to all our guests on today's episode, including Dr Suzi Nielsen, Dr Rosanne Freak-Poli, Dr Alan Petersen, and Federal Member for Scullin Andrew Giles. Visit our show notes to learn more about our guests and their work.

Thank you also to the Monash University Performing Art Centres David Li Sound Gallery, where a portion of this season was recorded.

If you're enjoying What Happens Next?, don't forget to give us a five-star rating on Apple Podcasts or Spotify, and share the show with your friends. Thanks for joining us. See you next week!