Have you ever wondered if feeling lonely could be as harmful to your health as high blood pressure or high cholesterol? At this time of year, when many people are gathering with family, friends and colleagues, that question can feel especially important for those who are less connected.
For Dr Rosanne Freak-Poli, a senior research fellow in the Department of Medicine, School of Clinical Sciences at Monash Health and the School of Public Health and Preventive Medicine, that question has guided more than a decade of research into how our social lives shape our hearts, brains and wellbeing.
Now, with a new $530,079 ARC Discovery Early Career Researcher Award (DECRA), she’s turning that knowledge into practical solutions. Her project, Enhancing Social Prescribing, will explore how to embed social prescribing into Australia’s health and social systems so that connection and community are treated as core parts of care, not optional extras.
Social prescribing helps clinicians connect people with non-medical supports in their community, such as walking groups, men’s sheds, arts programs, language classes or volunteering.
The aim is to improve wellbeing and quality of life by building social connection and purpose. Rosanne’s DECRA will co-design data and infrastructure to help services understand what works, for whom and in which settings, so that social prescribing can be adopted, evaluated and sustained over the long term.
Why loneliness is not a simple choice
It can be tempting to think that loneliness is just a matter of “getting out more”. Freak-Poli’s work shows why it's not that simple. This is particularly true around festive periods, when social expectations rise and the gap between those who feel connected and those who do not can feel even wider.
Her research has demonstrated that social isolation, low social support and loneliness are linked to more severe risk factors for chronic disease, poorer quality of life, higher risk of cardiovascular disease and dementia, and worse mental health during recovery from heart problems.
People who are widowed, live alone or experience major life changes often face the highest risks, despite doing their best to stay connected.
Her recent studies go a step further by showing that social conditions such as who you live with, your social network, your income and education, your first language and recent stressful events can be among the strongest predictors of heart disease, sometimes stronger than traditional biological risk factors.
Using advanced computer modelling on large population datasets, she’s shown that health systems need to take these social determinants seriously when assessing risk and planning care, and that men and women can be affected in different ways.
In other words, it’s not enough to tell people to be less lonely. The systems around them need to change so that connection is possible, supported and valued.
“We have very good tools for treating blood pressure and cholesterol,” Freak-Poli explains. “We’re only just beginning to build the same kind of tools for social connection. Social prescribing is one of the strongest options we have so far.
“It already has a solid evidence base and is built into the United Kingdom’s universal healthcare system. Here in Australia, we’re at the start of that journey, which means we have a rare chance to shape how social prescribing is designed and delivered.
“To do that well, we need a minimum dataset that is co-designed with participants and policymakers, and data infrastructure that can support it over time.”
The perspective behind the project
Freak-Poli is a life-course epidemiologist with a longstanding commitment to social justice and prevention. Her work spans the research continuum, from designing studies to translating findings into guidelines, policy and practice.
Her PhD, focused on workplace physical activity, showed that changing how people move at work can improve metabolic health. Those findings helped inform clinical guidelines for millions of people living with obesity, an evidence check for the NSW ministry on workplace programs, and World Health Organisation guidance on how to assess body fat and health risk in South Asian populations.
During her NHMRC Early Career Research Fellowship, she worked in the Netherlands with the Rotterdam Study, following 15,000 older adults over time. There, she challenged some common assumptions about happiness and heart disease. She showed that simply being “unhappy” does not automatically lead to cardiovascular disease, and that high depressive symptoms after a cardiac event often reflect pre-existing distress rather than a new cause of poorer outcomes.
She’s also explored how sexual activity and tenderness in later life relate to wellbeing and health, leading to a special issue on sex and ageing in the Australasian Journal on Ageing and international invitations to speak.
More recently, her focus on social isolation and loneliness has made her a recognised authority in the field, with work cited in major policy documents from the World Health Organisation, the World Bank, the United Nations, overseas governments and Australian agencies.
“Across very different projects, a common thread has emerged,” she notes. “If we ignore social connection and social conditions, we miss a huge part of the story of why people become unwell, and how they recover.”
The ASPIRE Social Prescribing initiative (Australian Social Prescribing Institute of Research and Education) is a national collaborative focused on advancing evidence-based social prescribing across Australia. It brings together researchers, clinicians, policymakers, community organisations and people with lived experience to strengthen models, data, workforce development and equity in social prescribing. ASPIRE aims to build a coordinated, scalable and culturally responsive social prescribing ecosystem that integrates community supports with the health and social care sectors.
