Surgeon General Raises Alarm About Loneliness and Isolation

WASHINGTON — U.S. Surgeon General Dr. Vivek Murthy has proposed a new national strategy for dealing with what he sees as a growing public health crisis of loneliness and isolation.

The 82-page advisory details the strategy and spells out steps individuals, workplaces, community organizations, health systems and governments can take to increase connections between individuals and improve their health.

“When I first took office as surgeon general in 2014, I didn’t view loneliness as a public health concern,” Murthy admitted in the letter that opens the report.

Then he embarked on a cross-country listening tour, “where I heard stories from my fellow Americans that surprised me.”

According to Murthy, the more he talked to people, the more he found they complained of feeling isolated, invisible and insignificant.

The laments came from people of all ages and socioeconomic backgrounds and occurred in every corner of the country.

“It was a lightbulb moment for me,” he said. 

Soon he found the scientific literature confirmed what he was hearing — social disconnection was far more common than he realized.

Even before the onset of the COVID-19 pandemic, approximately half of U.S. adults reported experiencing measurable levels of loneliness. 

More recently, a 2022 study found that when people were asked how close they felt to others emotionally, only 39% of participants said that they felt very connected to others.

An important indicator of this declining social connection is an increase in the proportion of Americans experiencing loneliness. 

If, as already stated, about half of all U.S. adults report experiencing loneliness, it means that sense of isolation is far more widespread than many of the other major health issues of the day, including smoking (12.5% of U.S. adults), diabetes (14.7%), and obesity (41.9%), and with comparable levels of risk to health and premature death.

Despite such high prevalence, less than 20% of individuals who say they often or always feel lonely or isolated recognize it as a major problem.

According to the surgeon general’s report, loneliness and social isolation increase the risk for premature death by 26% and 29%, respectively.

More broadly, lacking social connection can increase the risk for premature death as much as smoking up to 15 cigarettes a day. 

In addition, poor or insufficient social connection is associated with increased risk of disease, including a 29% increased risk of heart disease, a 32% increased risk of stroke and a 50% increased risk of developing dementia for older adults.

Additionally, the lack of social connection may increase susceptibility to viruses and respiratory illness.

The lack of social connection can have significant economic costs to individuals, communities and society, the report said. 

Social isolation among older adults alone accounts for an estimated $6.7 billion in excess Medicare spending annually, largely due to increased hospital and nursing facility spending. 

Moreover, the report said, loneliness and isolation are associated with lower academic achievement and worse absenteeism, which costs employers an estimated $154 billion annually. 

And the impact of social connection not only affects individuals, but also the communities they live in, the surgeon general’s office said, including population health, community resilience when natural hazards strike, community safety, economic prosperity and representative government.

“Our relationships are a source of healing and well-being hiding in plain sight — one that can help us live healthier, more fulfilled and more productive lives,” Murthy said. 

“Given the significant health consequences of loneliness and isolation, we must prioritize building social connection the same way we have prioritized other critical public health issues such as tobacco, obesity and substance use disorders.”

This surgeon general’s framework for addressing the issues of loneliness and isolation is based on six foundational pillars:

Strengthen Social Infrastructure: Communities must design environments (parks, libraries and playgrounds) that promote connection, establish and scale community connection programs and invest in institutions that bring people together.

Enact Pro-Connection Public Policies: National, state, local and tribal governments play a role in establishing policies like accessible public transportation or paid family leave that can support and enable more connection among a community or a family.

Mobilize the Health Sector: Because loneliness and isolation are risk factors for several major health conditions (including heart disease, dementia and depression) as well as for premature death, health care providers are well-positioned to assess patients for risk of loneliness and intervene.

Reform Digital Environments: Murthy believes everyone must critically evaluate our relationship with technology and ensure that how we interact digitally does not detract from meaningful and healing connection with others.

Deepen Our Knowledge: A more robust research agenda, beyond the evidence outlined in the advisory, must be established to further our understanding of the causes and consequences of social disconnection, populations at risk and the effectiveness of efforts to boost connection.

Cultivate a Culture of Connection: The informal practices of everyday life (the norms and culture of how we engage one another) significantly influence the relationships we have in our lives. We cannot be successful in the other pillars without a culture of connection.

“We are called to build a movement to mend the social fabric of our nation,” Murthy said in the advisory. “It will take all of us … working together to destigmatize loneliness and change our cultural and policy response to it.”

Dan can be reached at [email protected] and @DanMcCue