In the final episode of our Loneliness and Well-being Series, Dr. Julianne Holt-Lunstad discusses the impact of social connections on health and mortality. She highlights the growing concern about loneliness and social isolation, emphasizing the need for interdisciplinary collaboration and effective policies to address these issues. Dr. Holt-Lunstad also discusses her involvement with organizations like the US Foundation for Social Connection and global initiatives aimed at bringing together researchers, policymakers, and community leaders to tackle loneliness and promote social connection worldwide. Throughout the episode, she underscores the importance of social ties for individual well-being and community resilience, particularly during crises. The conversation encourages collective efforts to advance solutions that enhance social connections and overall societal well-being.
Ayla Fudala: Hello and welcome to Frontiers in Health & Happiness, the official podcast of the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. My name is Ayla Fudala, Center Communications Coordinator, and I'll be asking experts how to live a healthy, happy life.
Today, for the sixth and final episode in our loneliness and Well-Being series, I'll be interviewing the renowned Dr. Julianne Holt-Lunstad. Among other positions, Dr. Holt-Lunstad serves as Professor of Psychology and Neuroscience and Director of the Social Connection and Health Lab at Brigham Young University. Her research has been instrumental in the recognition of social isolation and loneliness as risk factors for early mortality.
Dr. Holt-Lunstad, can you tell me about your work as Director of the Social Connection and Health Lab at Brigham Young University?
Dr. Julianne Holt-Lunstad: Yeah. My work focuses on the protective effects of social connection and the risks associated with lacking connection, which can include social isolation, loneliness, poor quality relationships, and many more. So this work takes a very interdisciplinary, transdisciplinary approach to looking at the issue from various perspectives and working with a variety of collaborators to really dive into trying to understand this from not only different scientific disciplines, but entities and stakeholders outside of academia. I'm reminded there was a finding that it takes approximately 17 years to go from evidence to implementation; and trying to close that gap by also identifying how this work relates to practice, to policy. And the translation’s really just ensuring that the evidence goes beyond academia.
Ayla Fudala: You also serve as the founding scientific chair and board member for both the US Foundation for Social Connection and the Global Initiative on Loneliness and Connection. Can you tell me a little about both of these organizations and what they do?
Dr. Julianne Holt-Lunstad: Yeah, so these are sister organizations. The US Foundation for Social Connection was founded to really bring together and serve as a hub for those working in the space of social connection, isolation, loneliness. Too many times we are working in silos, and in order to accelerate progress, we need to really come together and work together. The US Foundation for Social Connection does that on a national level, and then the Global Initiative on Loneliness and Connection does that on an international level. Bringing together the different national organizations around the world who are also working in this space.
Ayla Fudala: Can you discuss your research on the effects of loneliness and social isolation on human health and mortality? Why do you think these effects occur?
Dr. Julianne Holt-Lunstad: Yeah, I've been doing research on mortality related to this for several years, and perhaps the work that you're referring to is my meta-analysis that was done in 2015. We had data on 70 prospective studies and following initially healthy people over time, and I believe it was on average around seven years. We had data from over 3.4 million people, and what we found was that loneliness was associated with a 26% increased risk for earlier death, isolation 29%, and living alone by 32%. And this was, of course, independent of age, initial health status. But it was also adjusted for many other factors that may potentially contribute to earlier death. And most of the studies included adjusted for depression. Interestingly, what we found was that all three of those factors significantly predicted earlier risk for death.
Ayla Fudala: How and why do you think loneliness and social isolation have been increasing in the US over the past decades?
Dr. Julianne Holt-Lunstad: There's some mixed evidence in terms of whether or not loneliness is increasing. There are some meta-analyses that have shown that there is relative stability of loneliness. But if you look at certain time points, we do see increases, particularly more recently. But when it comes to isolation, we do have several indicators to suggest that we are less socially connected as a society.
Of course, there is the data that has been building on social capital, that has been building over decades, that suggests that people are less involved in participating in various groups, clubs and other kinds of organizations. There are also some interesting data from the American Time Use Survey. Over the past two decades that have shown that there have been significant increases in time spent alone, with decreases in time spent with family, both household and non-household family. Significant decreases in time spent with friends and time spent in companionship with others. We also see some demographic shifts that may be more proxy measures. Things like household sizes have declined, marriage rates and number of children have declined. Participation in religion has declined.
These demographics don't necessarily mean that anyone is isolated because they could not participate in religion, but participate in other kinds of things. You could not be married but still have a wide social network. What that suggests is that we may have less availability of these informal supports, which may have important health implications.
I'll also share a few really interesting, less academic kinds of data that we're seeing nationally that are perhaps contributing to the rising concerns we see. For instance, data from the National Crisis line, over a million texts. And what we see is in their report, the number one source of concern among those in crisis is relationships. So 1 in 3 was related to relationships distress. 1 in 5 was lack of human connection. Another one that I think is noteworthy. Google reported search trends, and what they found was that the search for how to make friends was at a historic all-time high.
Ayla Fudala: Is social connection the solution to these issues?
Dr. Julianne Holt-Lunstad: My colleagues and I introduced core components of social connection. These diverse aspects can fall under three broad categories. So that is the structure, function and quality of our social connections. So the structure being more of the size of social network or the variety of relationships in one's life. It's really getting at the presence or absence of others in your life. The function goes beyond just do you have people in your life too? What are the functions that these relationships serve? And this really can get at the extent to which you can rely on other people for various goals and needs. And then finally, the recognition that not all relationships are entirely positive. And so we need to address the quality of our connections. And so the positive and negative aspects, how satisfied or how much conflict or strain is in a relationship across these varied types of measurement approaches.
We see converging evidence that high levels of social connection are associated with better health, better well-being, longer life, and other kinds of outcomes, whereas lower levels are associated with poorer outcomes and greater risk. There are these incredibly powerful protective effects of being socially connected that we need to pay greater attention to. And social connection is so fundamental to human functioning that we really need to do more in the way of promoting social connection.
Ayla Fudala: Why is social connection particularly important in times of crisis?
Dr. Julianne Holt-Lunstad: Social connection can be really important in times of crisis, whether they be more personal crises or community or even societal crises. For example, there's a rich literature on the protective effects of social support during times of stress. And in fact, much of my early career I did a lot of psycho-physiology studies looking at social support and stress responses, and the idea that our relationships can help buffer some of the negative health effects of stress that can ultimately influence our health long term. But we're also seeing evidence at a community level, and how communities that are more socially connected are better prepared for crises.
And so let me back up and share the kinds of crises that perhaps we might be thinking of. Certainly we see all sorts of natural hazards and disasters that are happening, whether that's extreme weather events, floods, hurricanes, but we're also seeing fires, earthquakes, you name it. When communities are more socially connected, they're better prepared for these crises. They're also more resilient when it comes to coping with them in the moment and recovery from them. If we think about it, our neighbors are those who are closest in proximity and are more likely to be there or arrive more quickly compared to first responders.
I'll just share an example of this. Even in my own community. We had a flash flood and many of my neighbors had their homes flooding. It took out one of the streets and the city declared a state of emergency. And so, because one of the main roads had been taken out, first responders couldn't get to many areas. But neighbors came together and quickly mobilized to help each other, put sandbags around their house or start getting some of the water out of the house. But even later, after helping each other with resources, whether that be shop vacs to companies that could help mitigate the issue. I even remember a group text amongst neighbors. I don't know how to help, but I'm willing to bring dinner to anyone who needs it.
And so you can see how social connection can really not only help us cope with a really terrible situation, but in some cases can actually be a matter of life and death. And so social connection, even though we think of it as something that perhaps is important for our emotional well-being, we often underestimate just how important our social connections are in times of crises, for our health, for our survival. Social connections are not only important for us to thrive, but also to survive.
Ayla Fudala: What can policymakers do to promote social connection? What infrastructural changes should be made?
Dr. Julianne Holt-Lunstad: There are so many ways in which policy can play a role. And I'm really glad you asked this, because when we talk about policy, I think that the first reaction I get from people is that, first off, when they think policy, they think government. But we also know that policy can include workplace policies. It can include educational policies. There are many policies that go beyond government. The knee jerk reaction when we think of social connection and policy is that the government has no business in my personal life. But what we're talking about is something somewhat different, and we can see a number of ways in which policy, and even potentially governmental policies may be potentially important.
So I want to just first ask people to think back during the pandemic. This was a time when policy was put in place that was necessary to help reduce the spread of this unknown virus and unknown effects at the time. And what we saw was that when we needed to reduce our social contact with others, that this had an impact on every single sector of society. What this suggests is that literally every sector of society plays a role, and potentially may have policies that are related to social connection. These policies can come in a variety of different ways.
When we look at individuals who are isolated, lonely, we often think of this as an individual problem that individuals need to somehow solve. But in actuality, many times the root cause of that isolation and loneliness is outside that person's control. Oftentimes is related to systematic kinds of barriers that exist in society or in their community. I'll just give you one example. Imagine someone who lives in an area where there's high crime, so it's not very walkable and they don't feel safe. So they don't know any of their neighbors, nor do they feel safe going out and engaging in the community or very safe leaving very often to get together with others, maybe even outside the community. These are factors that are outside this person's control, or at least they're things that are not easily fixed by just the individual.
We can also think of things like workplace policies that maybe are somewhat counter to work and personal life harmony, where these policies don't allow for adequate prioritization of personal relationships. And so we can think about how we can start to address these policies, whether they are policies that are currently barriers to social connection, but also policies that could potentially promote social connection, things like family leave policies. We need to think broadly about not only what we can do to promote connection, but even policies that have nothing to do with social connection. They may be aimed at something else entirely, but may have unintended consequences on social connection. Just like we evaluate our policies for economic implications or environmental implications, we really need to evaluate our policies for social implications.
Ayla Fudala: Can you tell me about your work on the US Surgeon General's Advisory on loneliness?
Dr. Julianne Holt-Lunstad: The US Surgeon General has been interested in this topic for some time. I first became acquainted with him and the office in his first term, where he was working on the Emotional Well-Being in America initiative, and then remained connected between these terms. And they contacted me and asked me to come work on this advisory. I took a leave of absence from my university to work on the advisory full-time, and worked with the science and policy team in the office of the Surgeon General. This was a really incredible opportunity that I'm so honored to have been a part of.
It was really an intense process because the goal was to have a product that was scientifically rigorous while being very accessible to the general public. So that's a tall order and quite challenging. We did have over 50 peer reviewers of this document. We adjudicated over 1,000 reviewer comments, but we also corresponded and met with various agencies. It ultimately went through government clearance, and then also had to be reworked to put into plain language. And so it was a challenging task to make this accurate and accessible to a very wide range of perspectives and backgrounds, and ultimately to the general public.
Ayla Fudala: What were the key messages of the advisory?
Dr. Julianne Holt-Lunstad: The key messages of this product are that our social connections are important to both individual and population, health, safety and prosperity. And so it's important to note that as both individual and community, and it's not just health, it's also well-being. It's also safety. It's also prosperity. Importantly, it goes beyond just the problem but also hope and a path forward with a framework for a national strategy as well as recommendations for various stakeholders. Ultimately, this product was released to help raise awareness but also to catalyze action.
Ayla Fudala: Would you mind telling me about the work you're doing with the World Health Organization?
Dr. Julianne Holt-Lunstad: We are members of the Technical Advisory Group for the World Health Organization and their work on the Social Connection Commission. As part of that, the commission is drafting a report that has several chapters on various aspects of this, and it's all from a global perspective. For example, some of these include report on policies around this issue. Part of that report is on measurement. This report is meant to be a guiding document for nations around the world.
So this Technical Advisory Group has been convened to ensure that the work is scientifically accurate. And they did a very concerted effort to ensure that there was adequate representation from each of the global world regions and that there was equal representation across various demographics, as well as representation across different kinds of scientific disciplinary backgrounds. And it's been an incredible experience to work on this project. We can see how even amongst this group of experts that we do bring a diversity of perspectives. We are working together in order to ensure the success of this document, to ensure that it is informative, but also can help those who read it to guide their future work. My understanding is that this report will be publicly available and, of course, encouraged for policymakers.
Ayla Fudala: What research are you working on now? Are there any new projects in your future?
Dr. Julianne Holt-Lunstad: Yeah, I'll share one of them that is somewhat related to this work with the WHO. And that is the Grand Challenge in Social Connection. So this is a joint initiative between the World Health Organization and the Global Initiative on Loneliness and Connection. We have launched and are currently collecting data. This is an effort to identify what are the biggest challenges that we face when it comes to addressing social connection globally. So we are getting the perspective of people across the globe.
So we've made concerted efforts to try and get perspectives from both low- and middle-income countries, as well as the higher-income countries. We want to get perspectives from not only scientists, but practitioners, policymakers, funders, faith-based communities, people from the tech industry. Anyone who has a potential interest or stake in social connection.
These priorities have been set by, for lack of a better term, crowdsourcing. Where should we be prioritizing our efforts? Where should we be prioritizing our funding? Where should we be prioritizing policy? These should guide the work going forward so that we're not approaching this in a very haphazard way, but rather a very methodical and focused and strategic way that makes the priorities clear on where we should direct our actions.
So I'm really excited about this global Grand Challenge project that's going on. Of course, I have many other projects going on, but I think that this one hopefully should be really impactful. We also have both an executive committee and an advisory committee that also has representation across all of these different groups that I just mentioned to ensure that when we get hopefully thousands of recommendations, we can identify the top themes that can guide this work. So our goal is to narrow this down to approximately 20. What are the things that we keep seeing over and over again, consistently being viewed as the top priorities that we need to really work towards?
Ayla Fudala: This is the last episode in our Loneliness and Wellbeing podcast series. Do you have any final words for our audience?
Dr. Julianne Holt-Lunstad: Yes. If you're listening to this, my guess is that you are interested in this topic. You're working in this topic. This topic has some personal relevance to you. And what I would suggest is that in order for us to really make progress in this area, we can't be working in isolation. It's no coincidence. We really need to be more connected. We need to work together. And so I would encourage people to start convening to collaborate through our shared efforts. We can do more better. And so I encourage you to work with each other. Work with me. Work with you. But let's come together on this and work together, because I think we can do far more together.
Ayla Fudala: Dr. Holt-Lunstad’s research underscores the vital importance of social connections in our lives. It's not just about keeping individuals healthy-- it's about nurturing strong, supportive communities. From her efforts with the US Surgeon General's office to her role in the Social Connection Commission, Dr. Holt-Lunstad is driving change on a global scale. It's exciting to see how policies and infrastructure change can make a real difference in overcoming barriers to connection. She calls on researchers, policymakers, and community groups to work together, reminding us that only through unity can we truly tackle the issue of isolation.
As we wrap up this series, I hope her message encourages you to explore ways we can all work together to build stronger social ties and create healthier, more connected lives for ourselves and our communities. Thank you for being a part of this journey.