Surgeon General Sounds the Alarm on a New Epidemic: Loneliness

On May 3, 2023, U.S. Surgeon General Vivek Murthy published a new advisory raising concern about what he referred to as a new public-health crisis: loneliness, isolation, and lack of connection. He began the report by describing a listening tour of America on which he embarked when he took office.

People began to tell me they felt isolated, invisible, and insignificant. Even when they couldn’t put their finger on the word “lonely,” time and time again, people of all ages and socioeconomic backgrounds, from every corner of the country, would tell me, “I have to shoulder all of life’s burdens by myself,” or “if I disappear tomorrow, no one will even notice.”

He learned in his research that even before the COVID-19 pandemic caused further isolation from family, friends, and co-workers, adults in America were struggling with loneliness. This disconnection affects mental, physical, and societal health. He shockingly compared the harm of isolation to that of daily cigarette smoking stating that limited social connection increases risk of premature death by more than 60 percent. The physical health consequences of poor or insufficient connection include a 29 percent increased risk of heart disease, a 32 percent increased risk of stroke, and a 50 percent increased risk of developing dementia for older adults. Evidence shows that increased connection can help reduce the risk of serious health conditions such as heart disease, stroke, dementia, and depression. Communities where residents are more connected with one another fare better on several measures of population health, community safety, community resilience when natural disasters strike, prosperity, and civic engagement.

Reminding us that social connection is beneficial for individual health and improves the resilience of our communities, he lays out recommendations that individuals, workplaces, healthcare providers, and others can take to increase connection and improve health. He refers to the following as the “Six Pillars to Advance Social Connection”:

1. Strengthen Social Infrastructure in Local Communities
   Social infrastructure refers to the programs (such as volunteer organizations, sports groups, religious groups, and member associations), policies (like public transportation, housing, and education), and physical elements of a community (such as libraries, parks, green spaces, and playgrounds) that support the development of social connection.
2. Enact Pro-Connection Public Policies
   Government has a responsibility to use its authority to monitor and mitigate the public-health harm caused by policies, products, and services that drive social disconnection. Diversity, equity, inclusion, and accessibility are critical components of any such strategy. It must be recognized that everyone is impacted by social connections, but that some groups may be more disproportionally impacted by some policies. Thus, policymakers should give focused attention to reducing disparities in risk and ensuring equal access to benefits.
3. Mobilize the Health Sector
   It is critical that we invest in healthcare provider education on the physical and mental-health benefits of social connection, as well as the risks associated with social disconnection. Systems that enable and incentivize healthcare providers to educate patients as part of preventive care, assess for social disconnection, and respond to patients’ health-relevant social needs are critical.
4. Reform Digital Environments
   Technology has created incredible benefits and global connections, but these benefits come at a cost. Technology can also distract us and occupy our mental bandwidth, make us feel worse about ourselves or our relationships, and diminish our ability to connect deeply with others. Some technology fans the flames of marginalization and discrimination, bullying, and other forms of severe social negativity.
5. Deepen Our Knowledge
   Additional research is needed to further advance our understanding of the causes and consequences of social connection, trends, populations at risk, and the effectiveness of interventions and other efforts to advance connection.
6. Cultivate a Culture of Connection
   While formal programs and policies can be impactful, the informal practices of everyday life—the norms and culture of how we engage one another—significantly influence social connection. These shared beliefs and values drive our individual and collective behaviors that then shape programs and policies. We cannot be successful in the other pillars without this underlying culture of connection. Such a culture of connection rests on core values of kindness, respect, service, and commitment to one another.

The advisory provides specific strategies for all stakeholders to advance the cause of better connection. Of particular significance to this article are the roles of workplaces and individuals. Many of the suggestions for workplaces are not new to us. They include making social connection a strategic priority, training and empowering leaders and managers to promote and foster connection, putting in place policies which will allow people to connect and nurture relationships outside of work, and promoting flexibility in work hours and arrangements.

For individuals, the advisory suggests gaining knowledge about how social connection and disconnection can impact relationships, health, and mental health. We should also nurture these relationships by investing in them and increasing the frequency, duration, and quality of the time we spend with others; this includes minimizing distractions such as technology during these interactions. Increasing participation in social and community groups, volunteering, engaging with people of different backgrounds and experiences, and civic engagement are all beneficial. Finally, it is critical to be open with family and healthcare providers and to seek help when needed.