Loneliness poses profound public health threat, surgeon general says

Loneliness presents a profound public health threat akin to smoking and obesity, U.S. Surgeon General Vivek H. Murthy warned in an advisory issued Tuesday that aims to rally Americans to spend more time with each other in an increasingly divided and digital society.

Murthy said half of U.S. adults experience loneliness, which has consequences for mental and physical health, including a greater risk of depression, anxiety — and, perhaps more surprisingly, heart disease, stroke and dementia.

His advisory calls for a collective effort to “mend the social fabric of our nation,” including teaching children how to build healthy relationships; talking more to relatives, friends and co-workers; and spending less time online and on social media if it comes at the expense of in-person interactions.

Time spent with friends declined 20 hours a month between 2003 and 2020, according to research cited in the advisory, while time spent alone increased by 24 hours a month in that period. These trends probably intensified during the coronavirus pandemic as Americans were sequestered at home, experts say.

“What covid did is really pour fuel on a fire that was already burning,” Murthy said in an interview. “I want the entire country to understand how profound a public health threat loneliness and isolation pose.”

That threat can prove deadly.

The risk of premature death posed by social disconnection is similar to smoking up to 15 cigarettes a day and even greater than obesity and physical inactivity, according to a review of research on social connection. And socially connected people live longer.

Loneliness can lead to chronic stress, which in turn causes inflammation that damages tissues and blood vessels and is associated with chronic conditions, experts say. Isolation and frayed social connections could make it harder to maintain or develop healthy habits such as exercise and good nutrition.

“This isn’t just people feeling good or bad about their social life,” said Julianne Holt-Lunstad, professor of psychology and neuroscience at Brigham Young University and lead science editor of the advisory. “It truly has an impact on our physical health.”

The surgeon general serves as a chief advocate for public health, using the office as a bully pulpit to sound alarms about issues threatening American lives. Cigarette packaging bears surgeon general warnings, and C. Everett Koop, who became surgeon general during the administration of President Ronald Reagan, advocated for the use of condoms to prevent the spread of HIV, defying conservatives who insisted on promoting abstinence.

Murthy said the federal government could fund research on loneliness to better understand the problem and identify the best interventions. He also urged different levels of government to prioritize social connection in policymaking, such as designing walkable communities that encourage residents to interact. Health-care providers could screen patients for signs of loneliness, Murthy said, while insurers could pay for programs that help people cultivate healthy relationships as a form of preventive care.

Recommendations from the loneliness advisory extend far beyond the confines of the doctor’s office and public health department, with technology companies, schools and workplaces urged to unite behind goals of increasing social engagement and reducing isolation.

Murthy has advocated for treating loneliness as a public health issue for years and wrote a book about the issue published early in the pandemic. Now he’s sharing his own experiences with loneliness as he calls for a national movement to address it.

Murthy largely neglected friendships when he served as surgeon general under President Barack Obama, he wrote in an opinion piece for the New York Times that previewed the advisory. He said he felt ashamed to reach out to old friends and suffered a loss of self-esteem and a sense of identity.

In his second stint as surgeon general, Murthy said he spends time with his children without any devices in reach, visits his parents and sisters as often as he can and answers the phone when friends call, even just to ask if he can call them back.

U.S. Surgeon General Vivek H. Murthy has advocated for treating loneliness as a public health issue for years and has described his own experiences with loneliness. (Ricky Carioti/The Washington Post)
© Ricky Carioti/The Washington Post

“There are days I slip and sometimes a week will go by and I realize I’m feeling more disconnected from family and friends because I didn’t invest in small moments,” Murthy said, adding his situation has improved. “I feel much more connected to them, and I feel like I’m a better surgeon general as a result.”

Research shows loneliness and isolation are most prevalent in people who are in poor health, struggling financially or living alone. Strikingly, older adults have the highest rates of social isolation, but young adults are almost twice as likely to report feeling lonely as senior citizens do.

The surgeon general’s advisory casts the digital revolution as a double-edged sword for social engagement. It has made it easier for people who feel like outcasts in their communities to find others like themselves around the world. But social media and the internet can also replace or degrade in-person socializing.

“In many ways, technology is a really great thing. It connects you to long-lost friends, and you can see faces on your computer screen,” said Kerstin Gerst Emerson, a clinical associate professor at the University of Georgia who studies loneliness. “But it can have a negative side. It can disconnect you while you are with others, you are not present, you are on your phone. You can be in a room with family and friends, but you are not getting the social connections you want.”

One 2017 study cited in the advisory showed that people who used social media more than two hours a day were twice as likely to experience increased feelings of social isolation compared with those who spent less than 30 minutes a day on social media. The report calls on technology companies to avoid algorithms that promote division and polarization, while developing features that encourage healthy dialogue.

Regardless of how institutions respond, experts say individuals can help reshape society in a more collegial and connected direction.

“Probably our most effective way to reduce loneliness is if we take more care of the people in our lives,” said Richard Weissbourd, a psychologist and senior lecturer at the Harvard Graduate School of Education who has studied loneliness. “We have to have parents and schools and communities that put caring for people front and center again, and if they do that, we are going to have a society where people are less lonely but also people are more moral, more justice-minded and healthier.”

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