At the annual conference of AHIP, America’s Health Insurance Plans, being held at the Music City Center convention center in downtown Nashville, former U.S. Surgeon General Vivek Murthy, M.D. spoke of the importance of healthcare system leaders, and of U.S. society as a whole, in an onstage conversation with Susan Dentzer, senior policy fellow at the Duke-Margolis center for Health Policy at Duke University.
Under the heading, “Social Determinants of Health: Spotlight on Emotional Health & Well-Being,” Dr. Murthy said that U.S. society must address head-on the tangle of issues around the loneliness and social isolation. Indeed, Dr. Murthy said, during his tenure as U.S. Surgeon General (December 2014-April 2017), as he spoke with countless Americans about their lives and their health in one-on-one encounters, he found that, underlying such issues as substance abuse and addiction, family violence, and even obesity, lurked loneliness and social isolation as important contributing factors.
Going back to his time as a practicing physician, Dr. Murthy said, “I was struck by how many people I treated in our clinics and hospitals struggled with loneliness. I remember once in an urgent care clinic, seeing a patient who told me that winning the lottery was the worst thing he could have done. After winning the lottery, he quit his job, moved into a gated community where he knew no one, and became angry and depressed. As Surgeon General,” he recalled, “I had the opportunity to visit with people in communities across the country, and to ask them what was going on in their lives. And it struck me that the stories of violence and illness actually had much deeper causes. And the tip of that spear is loneliness and isolation.”
As one example of the high proportion of Americans struggling with social isolation, Dr. Murthy said that, as Surgeon General, “I met with a couple whose son had just died because of an opioid overdose, and that because of the shame associated with that type of death, no one reached out to them. And I’ve talked to college students who spend their weekends watching movies on Netflix. Even on radio shows, a man called in and said, my best friend died a couple of years ago, and I’m devastated, but it’s not socially acceptable to say that as a man. Studies find that nearly 20 percent of Americans struggle with loneliness, and the real numbers are probably much higher,” he noted.
What’s more, Murthy emphasized, “Loneliness and social isolation are prevalent in countries across the world, where people are struggling with loneliness and isolation. And, as has been documented, the impact of struggling with loneliness is the equivalent of smoking 15 cigarettes a day. Heart disease risk goes up double, and other forms of illness, including diabetes, also rise. And wound recovery is slowed. And for all of those reasons, I became focused on this as Surgeon General. Gun violence, suicide rates, life expectancy, are all impacted. I started to put the pieces together, and a lot of these things are connected to loneliness and social isolation. That doesn’t mean that loneliness is the sole cause; but it is often a contributing factor. And if we want to improve health outcomes, we have to work on social connection.”
And what is driving this epidemic of social isolation? “A bit part of it,” Murthy said, is the stigma that still attaches to loneliness. When I traveled around the country, people didn’t come up to me and say, ‘Hi, my name is John, and I’m lonely.’ They were struggling with addictions, chronic illnesses, etc. But once I began bringing up the issue of loneliness, there would be a visceral reaction in people’s eyes. I have also struggled with feelings of loneliness, particularly as a child,” he testified. “Even to this day, I haven’t told my parents, because of the shame associated with it. It would imply that I wasn’t likable or lovable, and who wants that? Meanwhile, our mobility has increased dramatically,” he said, speaking of the technologies, including travel and transportation technologies, that have allowed 21st-century human beings to physically travel, and move, with ease. “And that’s amazing, it’s incredible. It’s allowed me to come here to visit with you. But the consequences of increased mobility is that we’ve often left the communities in which we grew up. Meanwhile, he said, “Technology is a tool; and we can use it in ways that connect us with other people, but also in ways that separates us from other people. It often impairs our in-person interactions, and dilutes the quality of our connections. It also allows us to dilute our connections by believing that having 500 Facebook friends is as good as a small number of friends that we can really rely on.”
Further, “Social media adoption has also led to a culture of comparison and condemnation. People feel bad comparing their Facebook ‘likes’ to others’. And it’s become easy to say unkind, hurtful things on social media. And that actually erodes people’s sense of social worth and confidence. And the last thing I’ll draw your attention to is culture,” he said. “As human beings, we evolved to connect. A thousand years ago, if you were disconnected from people, you had a greater likelihood of being eaten or losing your food sources. That was baked into our physiology. So if you’re not connected, it actually affects your physical health. But we live in a culture that often values work, wealth, and reputation above all else. Now, if you ask people what matters most, they’ll often list they’re friends, family, children. But it’s not what people list, it’s what they actually focus on.”
Significantly, Murthy said, “What I would like to see over time is for us to shift from a culture that puts work, wealth, and reputation at the center, to a culture that once again puts people at the center.” Both in the workplace and elsewhere, he said, “It's important for us to create a culture of kindness, and one where people help people in the workplace. And this is not putting this into a mission statement and slapping it onto the wall. To really create a culture of kindness, you have to talk about it all the time, and lead by example.”
Responding to Dentzer’s noting that the United Kingdom now has a Minister of Loneliness, and asking what a national strategy to combat loneliness might look like, Dr. Murthy said that “We need to make loneliness and social disconnection a priority, and we need to fund research and move forward. I ultimately feel hopeful that we can address loneliness in the U.S. and around the world, because the most important element already exists in each of us, the ability to reach out to other people, to be kind, to be authentic. Because at the heart of this discussion is a much more fundamental question about what kind of society we want to live in.”
