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Doctor’s orders.
QZ&A

“We can be the medicine that each other need”: The 19th US surgeon general on ending loneliness

By Jenny Anderson in London

Vivek Murthy know what it’s like to be lonely.

Growing up, the former US surgeon general says, he felt socially isolated in school. “I dealt with some issues around racism, and it sort of impacted my self-confidence,” he recalled last week at the 10th Annual Campaign to End Loneliness conference in London. “When I would pull up to school in morning, when my parents would drop me off, I would feel that pit in my stomach, that you often feel on the first day of classes or exams … It was worrying about being lonely.” He was too ashamed to tell his parents how he felt at the time. “Saying that I was lonely was saying I wasn’t worthy of being loved, and no one wants to feel that.”

But since his tenure as surgeon general under president Barack Obama, Murthy has been working to end that kind of stigma for good. During his term between 2014 and 2017, Murthy labeled loneliness an “epidemic” and said the government should play a role in trying to confront it—an idea that’s also picking up steam in countries like the UK, Denmark, Australia, and Japan.

At last week’s conference, he spoke with Quartz about why loneliness needs to be taken seriously and what we can all do help one another feel more connected. Below is an excerpt of the interview, condensed and edited for clarity. It can be viewed in full here.

Quartz: We usually associate the surgeon general with obesity, or HIV or smoking. You decided to focus on loneliness. Why?

Murthy: My journey to working on loneliness was certainly not an expected one or planned one. When I went through my confirmation hearing to serve as surgeon general they asked me what my priorities would be and I didn’t list loneliness in that priority list because it was not one at the time.

But I was really taught about this subject by people all across the country in the United States, who, when I visited their communities, would tell me stories of their struggles with addiction and violence, and with chronic illnesses like obesity, with mental illnesses like anxiety and depression. What was often unsaid were these stories of loneliness, which would would take time to come out. They would not say, “Hello, I am John Q, I am lonely.” What they said was “I have been struggling with this illness, or my family is struggling with this problem,” and when I would dig a bit it would come out.

Then I started to surface the topic more deliberately. I started to ask people about loneliness. What I found was that after an initial pause, the stories would come out. And everyone had a story to share, whether it was about themselves or someone else.

Loneliness is having a bit of a moment. A lot of people are paying attention to it now, writing about it. What’s happened in the world that we are focused on this?

I think part of what’s happening, there’s a bit of a snowballing effect. The more we talk about it, the more people feel like they have permission to talk about it.

The second thing that is happening is there actually is more research on this topic, people like Julianne (Holdt-Lunstad) and others who have been studying the field and putting out more research on it.

A third piece that’s weighing in, it’s a very common experience. It’s not new—people have been lonely for hundreds of years. But I think the fact that it is an almost universal experience makes it easier for people to be open to thinking about it, even if they don’t want to talk about it.

Finally I think there are a number of intractable challenges we are dealing with right now—in health and outside of health. On the health front, when I was in office, I was working on the opioid epidemic and working on addiction more broadly, on violence —a few of the serious, difficult challenges we have. Some of these seemingly intractable problems, which seem resistant to our simple solutions, have pushed people to ask the question, Is there something deeper happening here, something deeper contributing to depression? There’s an openness to thinking a little bit more about whats happening under the surface. I think that our social connections fraying is one of the important elements.

Critics of the loneliness movement say social isolation is not rising, there is no loneliness epidemic—there have always been lonely people, and we can’t even measure it accurately. And some people like Eric Klinenberg, who’s a big proponent of social cohesion, also warn us that if we focus too much on loneliness, we’re taking away from necessary resources from other problems bigger problems like poverty, like social housing. I’d love you to address these critics.  

I think we have to be judicious about where we put our time, attention, and resources, and there’s some legitimate criticisms here. We don’t have nearly as much data in terms of quality or quantity on loneliness as we have, let’s say, on diabetes or heart disease.

It is also not clear that that loneliness is rising at a dramatically high rate—it’s not going from, you know a prevalence of 1% to 50% in a matter of a couple years. That’s not happening.

We will not solve the addiction problem in America if we don’t address social connection.

But what is true, even though there’s variation in studies, is that there are millions and millions of people in the United States, millions of people in Europe and in other parts of the world, who are in fact struggling with loneliness. There is no study of loneliness has come out and said, “No, this isn’t an issue.” It’s prevalent, it’s common, and the studies Julianne and others have done have shown a robust association with illnesses that we actually care about, including heart disease, dementia, depression and anxiety, and very importantly, longevity.

If you’re thinking, “How do I divvy up the pie between breast cancer research and heart disease research and diabetes,” what I would say is that our connection with each other is a very much interwoven  into those problems. We will not solve the addiction problem in America if we don’t address social connection. And so if we recognize that, then it becomes part of the solution that we have to invest in, not an alternative to working on addiction.

Do we want the government involved in social connections, and what role should it play? 

I actually do believe there’s an important role for government to play when it comes to addressing loneliness. I don’t say that to mean that government should be the solution to loneliness—I actually think that government is likely to be a minority player, and that the majority of solution will come from outside government.

But number one, government can help us fund the research that we need to understand more about who loneliness is affecting, how it’s manifesting, and how to address it and prevent it.

The second thing the government can do is to lay out comprehensive strategies for how we can address an issue. The government has done this on various other issues, like on HIV. That’s actually a very important function.

And the third thing governments can do is they can convene, they can bring the right players together to take action to execute on that strategy. When Tracy Crouch was appointed to be the minister who would oversee the efforts on loneliness from the from the central government [in the UK], that sent ripple effects all over the world. We received many press calls from the media wanting to know what we thought about the UK appointing a minister and why would this wasn’t being done in the United States. It means something when the government chooses to make something a priority and reflects that at the highest level.

So where do we start?

I think one of the places we need to start and and start early is actually in schools when it comes to addressing loneliness. But that’s not easy, because schools aren’t under the thumb of the federal government. There’s a lot of local control of schools and so that’s a fight that has to go school board to school board, and that’s really challenging.

I think businesses are interesting. We’ve had a lot of conversations with large companies that are worried about emotional well-being in their workplace, recognizing the productivity costs and the retention costs when people are not doing well. I think there’s a lot of receptiveness right now from companies. The question they always ask is, “Well where should we start?” The question is, can we partner with them to actually help them study those programs [they create], so they know what works and what doesn’t work.

The evidence on social programs to tackle loneliness is mixed at best. What evidence do you have that we can do anything about this? 

Unlike many other illnesses, what I find profoundly empowering about addressing loneliness is that the ultimate solution to loneliness lies in each of us. We can be the medicine that each other needs. We can be the solution other people crave. We are all doctors and we are all healers. The question is, do we have the courage to speak up and to stand up for others, to reach out to them when we feel they may be in need.

We have small opportunities to respond when someone is in hardship, to smile when someone passes us on the road.

We have small opportunities to respond when someone is in hardship, to smile when someone passes us on the road, to reach out when we see another person. Those are all small moments of connection that collectively make a big difference. Even making eye contact with a stranger affects how connected you feel. It is these small interactions we have with people in our looser networks, strangers, people in our workplace, that ultimately can make a big difference in how we feel.

That’s why I think it’s important that we start this effort to address loneliness by asking ourselves what can we do in our own lives in our own homes, and our own neighborhoods, to help make people feel connected, even if we ourselves are feeling lonely. Even if we ourselves are feeling lonely, the best way to feel less lonely is to get out of our own heads and into someone else’s life.

We have bigger fish to fry here, don’t we? Addressing poverty, inequality? 

I deeply believe that this is one of the most important issues that we have to deal with. This is a deeply foundational issue because in the end, this is about much more than ensuring that people are connected, it’s about much more than preventing the loss of years of life, it’s about much more than preventing heart disease and dementia and depression.

This, at a really deep level, is about what kind of society we want to be. Are we the kind of society that believes that every life truly does, in fact, have value? Are we the kind of society that will stand up for and speak up for each other, not just when it’s easy but even when it’s difficult? And ultimately, are we the kind of society that will refuse to be governed by fear, which is the disease that’s infecting us right now, but that chooses instead to stand up and to join together and to build a society that is informed and inspired by love?

The choice that we have between love and fear … that choice is the most important question that we have to ask ourselves. Because when we lead with fear, that’s when we see anger and jealousy and insecurity guide and inform and drive our actions. We see that in our personal lives, we see that in our government, we see that everywhere. But when we lead with love, and we are able to lead with generosity, with kindness and compassion, then things are very different. Then we actually do choose the policies that benefit all of us and not just some of us, then we do choose to say the thing that’s helpful and not hurtful, and we end up finding that people are there for us.