U.S. Surgeon General on America’s Epidemic of Loneliness

GOLODRYGA, HOST: Well, America’s top doctor is warning the U.S. faces an epidemic of loneliness. U.S. Surgeon General Vivek Murthy says, even though the COVID

global health emergency is officially over, the virus and the lonely world it cultivated are far from gone. Hari Sreenivasan speaks with him about his

mission to foster a culture of human connection.

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HARI SREENIVASAN, CORRESPONDENT: Bianna, thanks. Surgeon General Vivek Murthy, thanks so much for joining us. First off, this week marks the official end of some of the pandemic era benefits that citizens have been enjoying. Even down to, sort of, snap benefits. And I’m wondering if you’re worried that there might be any negative byproducts of ending this nationally.

DR. VIVEK MURTHY, U.S. SURGEON GENERAL AND AUTHOR, “TOGETHER”: Well, Hari, I’m glad you asked. You know, we’ve certainly come a long way in the last three years in our fight against COVID-19. And the end of the emergency declaration is evidence and one more marker of the progress that we’ve made. But it does not mean that COVID is gone. It doesn’t mean that we don’t need to think about it anymore. What it does mean is that we have to use many of the tools we have built over the last three years, tools like vaccines, and treatments, and tests. And ensure that we are utilizing these tools.

So, with vaccines, we want people to stay vaccinated, to stay up-to-date with their vaccines. We want them to reach for treatments if they’re in a high-risk group and they do in fact get COVID. And if we do these things, my hope is that we can manage COVID the way we manage other respiratory illnesses.

SREENIVASAN: You know, I was looking back at the stats and I want to say somewhere around 1,000 people died just about a week ago from COVID-19 infections, and about 4,500 were hospitalized. Is this going to be something that we just accept as the new normal? Do we see any forecast that these numbers could trend downward or similar to the flu? Is this, kind of, what we’re going to have every year?

DR. MURTHY: Well, that’s a good question and that story remains to be written. It depends in time, in part, on what we all do collectively. You know, we have these in two — lifesaving tools available, like vaccines and treatments, but we now need to make sure that everyone avails themselves of these tools. And, you know, over the last three years, we’ve had over 700 million doses of vaccine administered in this country, and we have saved hundreds of thousands of lives. That’s a good thing.

But what we’re seeing, Hari, is that many of the people who are losing their lives to COVID today are people who are under vaccinated, or who are at high-risk groups and not getting treatments. So, we are going to continue our work to make sure that people know about these tools. We’re certainly continuing work to make sure that these are covered by insurance, and that even those uninsured that there are provisions for them to get access to vaccines and treatments. In fact, that program was announced for the uninsured just a few weeks ago.

So, we’re going to continue to work on COVID. And we want people to know that even though we’re at a better place right now, we — it’s important for all of us to know that these tools are out there and to use them because it can make the difference between getting something that feels like it’s a mild illness or worse as ending up in the hospital or losing your life.

SREENIVASAN: Do you see — I mean, do you hear from either the pharmaceutical industry, the CDC, others that you speak with that there will be more vaccines or booster shots that say, for example, senior citizens or people with compromised immune systems will want to keep getting?

DR. MURTHY: Well, the CDC and the FDA are still going to work together to make sure that when there are new recommendations for when people should get additional doses of the vaccine that they will know that. Right now, we anticipate is that for most people they may need an annual shot, similar to what you get with your flu shot. But they have already announced, the CDC and FDA, that for people who are in higher risk categories that their, you know, six months or so out from their last shot that they can, in fact, get an initial dose of the vaccine. And that’s a conversation they can have with their health care provider as well or if they have additional questions. But as new recommendations come out, the CDC and FDA will make those known to the public.

SREENIVASAN: you know, speaking of one of those impacts, you have been writing for some time now, and recently have made some statements in an op-ed about loneliness. And what’s interesting to me is, in your essay that you had in “The New York Times”, you talked about loneliness in a way that I don’t think most people would get. Say — like, he’s a public figure. He is surrounded by family and friends. And has, sort of, a private high- profile job where he’s constantly meeting people. And yet you say, after your first-time as surgeon general, when you finished, you experienced something that you didn’t expect. Tell us a little bit about that.

DR. MURTHY: Well, Hari, I wrote this story about my personal experiences because I realized that so many of us feel a sense of shame when we talk about loneliness. In our extroverted society, to say you’re lonely is almost like saying you’re not likable or you’re not lovable or something’s wrong with you. Yet, what we now understand is that one in two adults are actually struggling with loneliness at some level. And that kids, young people in fact, are experiencing the highest levels of loneliness in the population. You know, I’m no stranger to this either. You know, as a child, I struggled a lot with loneliness when I was in grade school. And then there’s various points as an adult. And when my first tenure as surgeon general ended, I went through this very deep period of loneliness and isolation where I found myself withdrawing further and further with the community that I had at work. I no longer had — I wasn’t doing the work that I also found to be so meaningful to me. But I had also made this critical mistake, Hari, that I write about which is that I had, during my job, when I was surgeon general last time, I had marginally neglected my family and my friends.

I had — sure, I was spending time with them at dinner or around the table. But I was always distracted by my phone. I had lost touch with a lot of friends who had really supported me over the years. And I felt their absence so deeply during that lonely period. And so, I had to really rethink my life in many ways. And with the help of my wife and my parents and a few good friends, I really tried hard over the last few years to build a life that centered around people and around my relationships. And focusing on that has actually made my second tenure as surgeon general, not only more enjoyable and sustainable for me but ultimately, I think, has made me more effective in my work.

SREENIVASAN: Is there a distinction between how you’re describing loneliness and how people might here those symptoms and say, it sounds like he was depressed? And how do you measure, you know, when you say, almost one and two people are feeling this? Is it through surveys? How is that measured?

DR. MURTHY: Yes. It’s a good question. And it starts with how we define loneliness. So, loneliness is a subjective feeling, it’s a feeling that the connections I need in my life are actually greater than the connections that I have. And in that gap, I experience loneliness. And you can experience loneliness if you have a lot of people around you. It’s really about the quality of your connections. I mean, when I talk to college students on college campuses who are surrounded by hundreds and thousands of other students, they tell me that they’re feeling lonely it’s because they don’t have people who they feel they can truly be themselves with, who they can be open with and vulnerable with. And so, that’s really important for us to have in our lives.

And in terms of the relationship with depression and anxiety, we know that people, when they struggle with loneliness, especially for long periods of time, that increases their risk of depression, anxiety and suicide. Interestingly, and this may surprise some people, but it also increases their risk of physical illness as well, of heart disease, stroke and premature death, as well as dementia.

And so, the powerful effects of loneliness and isolation on our health, both mental and physical, are really not fully — are not well understood, you know, by the better public and that was one of the reasons why I issue a surgeon general’s advisory on loneliness and isolation. I wanted people to know how common this was, I wanted them to know how consequential it is for our health. But I also wanted them to know that this is a problem we can address, and that’s why lay out, for the first time, a framework for national strategy to address loneliness and rebuild social connection and community in America.

SREENIVASAN: You know, one of the pillars that you’ve laid out in this advisory is about reforming digital environments. Tell us a little bit about it. I mean, we’ve heard in different dribs and drabs about the impacts say, for example, screen time or social media has on young people. Is this also the same for adults and how do we reform those environments?

DR. MURTHY: Well, we’ve seen is that, the introduction of, not just, you know, digital environments more broadly, but social media in particular, has impacted on how we communicate with one another and our relationships. Too often, what has happened is that people have substitute what used to be in-person face to face relationships for online connections. We’ve come to value quantity of connections over quality of connections. And too many people, especially young people, have been subject to bullying and other exposure to harmful content as well, you know, through their experience on social media. All of this together has had an impact on how people feel about themselves.

Keep in mind, when you’re scrolling through your feed and you’re constantly comparing yourself to other people, especially for young people whose brains are at sensitive period of development in early adolescence, that can really negatively impact yourselves esteem and sense of self, which can make it harder to go out and build friendships with others. I mean, young people also very commonly tell me that in addition to feeling worse about themselves when they use social media, they also feel world worse about their friendships. As they see all the activities people are doing without them, and they feel left out. So, part of what we have to do is, on a policy perspective, we need to establish the kind of safety standards and — that we have for many other tools and products and platforms that kids use, but we also have to make some changes in our personal life and try to draw boundaries, you know, in our life, where there are spaces that we have in our day-to-day experience that don’t necessarily involve technology. Think about time at the dinner table, when you’re with your family, being able to focus on them without the distraction of technology is very important. Bed time, also, is essential. We have so many people, young people and older people, who lose hours of sleep as they are on their phones and — they go to bed at 11:00, but yet come 12:00, 12:30, 1:00, they’re still on their phones, because it’s hard to get off of them. So, we have to carve out time and space in our days that our tech free so we can enjoy each other’s company, have a deeper more higher quality interactions with one another and protect activities that support our health and wellbeing like sleep and exercise.

SREENIVASAN: You know, several of the other pillars that you’re looking forward to were hoping for, you know, are — you know, build a culture of connection, rebuilding social infrastructure in communities, much of that seems like, OK, these are sort of abstract ideas. How would I put that into practice if I would say a small-town council or a city that actually has the ability to create policies in a region?

DR. MURTHY: So, let’s take social infrastructure, and it’s a great question, because this is a place where community leaders and policymakers have a role to play. We’re used to thinking about infrastructure meaning roads and bridges and highways, but there’s also social infrastructure. These are the policies, the structures and the programs that support the building of healthy relationships. Think about the spaces and programs that bring people together to learn about one another and build relationships. Think about the built environment in cities which can facilitate people actually seeing and interacting with one another versus certain types of built environments can cut up cities and make it hard to have people come together.

Think also but what we do in the workplaces and schools. The school-based programs that teach children about emotions and about healthy relationships, the workplaces which help build a culture of connection and support. Again, people coming together to learn about one another in the workplace. These are all elements of the social infrastructure that, as school or workplace leaders, as community leaders, we can invest in. And this is so important because in the last half century or so, we’ve seen a decline in participation in recreational leagues, in faith organizations, in other community and service organizations that used to bring us together and help us build relationships, and that’s how we know how to proactively rebuild that social infrastructure in our communities.

SREENIVASAN: You know, it’s interesting, I’ve heard in the context of the pandemic that a lot of people lost that third place, especially sometimes people lost that second place if they weren’t going into the office and connecting with human beings on a daily basis there, whether it’s the security guard that you say hi to on the way in or the — you know, some — one of your co-workers. And I wonder, when you’re talking about rec leagues and, you know, church groups and so forth, those are spaces that are not either work or home, but where you can form deep connections with people.

DR. MURTHY: That’s absolutely right. And a lot of people did lose those spaces during the pandemic, in addition to losing the opportunity to see colleagues at work. But the truth is, we have been losing those spaces, places in your community, your neighborhood where you could meet people and build relations. So, we’ve been losing those for years now. And it’s been, again, the consequence of declining participation, but also, we have so much convenience that technology has afforded us.

I don’t need to go to grocery store anymore, I can have groceries delivered to me. I don’t need to go to the mall or the store anymore, I can have packages delivered to me after I shop online. And this can all be really convenient, because they are products all of us use. But we have to just understand that this consequence that comes with that, which is that we have fewer and fewer unplanned interactions with people, we’re not bumping into one another, we’re not having the short but, you know, pleasant conversation that can give us a little boost in our day. We have to now, intentionally and proactively, build the infrastructure for connection in our communities and our day-to-day lives, and that’s why I issued this advisory because it’s time for us to take that proactive approach, because otherwise, I worry that we will move deeper and deeper into what I think of as a social recession, where we experience fewer and fewer connections with one another and that has profound impacts on our health.

SREENIVASAN: You’ve already written a book called “Together: The Healing Power of Human Connection in a Sometimes Lonely World,” and wonder when you are out there kind of researching the book, what did you find that surprised you?

DR. MURTHY: Well, what was so interesting to me, Hari, about, you know, doing the research on this subject is, one, just understanding how many people were actually affected by this but didn’t feel comfortable talking about it.

Loneliness exists behind the curtain, if you will. And we have to draw it out of the shadows and help people talk about it. But what I also saw, Hari, that was actually very hopeful for me is I saw examples in communities all across the country of people who recognize that loneliness was a problem, and we’re trying to build programs to address it. So, for example, I met a mom and a dad who actually lost their daughter years ago to an illness, and after her death, came to realize that she had been struggling with loneliness in school. And so, they decided to create a program in middle schools and high schools where students would actually help each other to address loneliness, where they would find people who may have been struggling maybe on their own and create a place where they could come and feel accepted and where they can build friendships. I even encountered individuals who were making changes in their own lives, which I found to be inspiring. I remember a woman, Sarah in Texas, who I encountered, who had just moved to Dallas and she felt really alone, she didn’t know anyone, and she didn’t have family, she wasn’t in a relationship, didn’t have friends there. But she made this bold and courageous decision that she was going to invite her neighbors over for a meal. And she was really nervous about it. Didn’t know if anyone would come.

But her father actually helped her build a wooden table, because her place was really small, and that big wooden table they placed outside and had an outdoor potluck and so many people came. Because what she came to realize is that even though some of her neighbors had been there for years, they also felt isolated, they were struggling with loneliness. And her neighbors’ table, as it came to be called, became a gathering point for people all around her community and, really, a place where many beautiful friendships were built. This is a time when a lot of people are struggling with loneliness, but we can’t tell from the outside because we’re really good at covering it up. So, just choosing to check on one another, to reach out to a friend to say, hey, I’m thinking of you. I just want to see how you’re doing. Just stop by a co-worker’s desk at the end of day and end of a meeting, just say, hey, how are you doing? I just want to know what’s going on in your life. These are small, small moments which can make a world of difference to somebody who may be struggling with loneliness and that’s the power that we have now to be healers and to help each other address our loneliness.

SREENIVASAN: Surgeon General Vivek Murthy, thanks so much for joining us.

DR. MURTHY: Thank you so much, Hari. Good to be with you.

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