These days, staying healthy means staying in and staying apart. Most of us get it, despite the disturbing images of Americans defying shelter-in-place orders. If hunkering down at home and social distancing makes us a little lonely, so be it. This loneliness will pass, we tell ourselves. But the truth is that the loneliness will not pass for all of us, especially not for those who were lonely before COVID-19 and for whom loneliness is not a momentary condition.
As former Surgeon General Vivek Murthy explains in his new book Together: The Healing Power of Human Connection in a Sometimes Lonely World, loneliness is a chronic condition for millions of Americans and, indeed, for millions of people around the world. Indeed, a 2018 Kaiser Family Foundation study found that 22 percent of adults reported that they either often or always feel lonely. That’s much bigger than the number of smokers or people suffering from diabetes, both recognized as huge public health challenges. The loneliness problem is particularly acute among older adults, with a UCSF study finding that 43 percent of people over 65 report feeling lonely.
This isn’t an American phenomenon. Researchers have found similar numbers in England, Japan, Australia, and Italy.
Murthy starts with a simple proposition. “We all have a deep and abiding need to be seen for who we are—as fully dimensional, complex, and vulnerable human beings. We all need to know that we matter and that we are loved.” Loneliness is that lousy feeling that we do not much matter to anyone, that we lack the love and the social connections we need.
Loneliness doesn’t just hurt emotionally, it has a significant negative impact on physical health, as well. As Murthy details, the leading researcher on the health impact of loneliness has shown that people with weak social connections are 50 percent more likely to die prematurely than people with strong connections. Stunningly, the health outcomes of social disconnection are akin to the impact of smoking 15 cigarettes a day.
Murthy served as the U.S. Surgeon General from 2014 to 2017. Previous Surgeons General brought prominence to health issues like HIV/AIDS, obesity, addiction, smoking, and diabetes. Simply put, it’s a big deal when the nation’s top doctor identifies loneliness as a public health problem.
Murthy is so persuasive in his description of the loneliness problem, that he makes it seem abundantly clear that it’s time to advance large-scale, public health-oriented responses. In other words, if loneliness is a public health crisis, there should be a public health response. That’s where Murthy’s book is less strong. While he estimably diagnoses a problem and shows how widespread it is, he doesn’t follow up with compelling solutions.
Still, this book is a major contribution service to our nation’s health officials and policymakers, who will be dealing with the loneliness epidemic long after the COVID-19 pandemic is gone.
One place to start, as Murthy does, is to understand the causes of this growing sense of disconnection. Some are comparatively obvious. There are cultural influences, such as the way we celebrate individualism and independence, and the extent to which we prize our privacy. Moreover, Murthy points out that so many people are overworked and constantly busy that they can’t, or simply don’t, devote time to cultivating the kinds of relationships that make them feel connected. Murthy also recognizes other factors, like the lasting impact of trauma. He takes a deep dive into the prevalence of adverse childhood experiences (ACEs) and how they influence a person’s ability and willingness to trust and connect.
Of course, Murthy gives special attention to the ubiquitous role of technology in our lives. Murthy acknowledges that technology can sometimes make people feel closer by facilitating communication with faraway relatives, or people with shared interests. He is sharp, however, on the corrosive impact of constantly monitoring Facebook or Instagram. Murthy memorably quotes a friend’s observation that “checking your social media feed is like comparing everyone’s best day to your average days—you always come up short.”
Deploying the skills of an empathic doctor—and the spirit of a friend—Murthy has good suggestions for people who are experiencing loneliness: Take part in small acts of reaching out, offer service to others, meditate. Yet these recommendations often felt more like they were coming out of a self-help book than one about a public health crisis. The advice is useful, of course, but an incomplete prescription for how we can respond to widespread loneliness as a society.
In the book, Murthy includes mini-profiles of the innovators who have sought to combat loneliness, including Mayor Tom Tait and his effort to create a “culture of kindness” in Anaheim, California, which entailed promoting small acts of neighborliness and changing the way the local police responded to the opioid crisis. Murthy also features Men’s Sheds—a sort of fix-it workshop provides a place of connection for men who eschew organized activities and gatherings, but who often end up deeply lonely. The Men’s Shed movement has jumped from its origin in Australia to numerous other countries.
All of this provokes big and important questions—most especially, what kind of public policy can be advanced to foster greater social connectedness? It’s a question for which we still need an answer.
I love Murthy’s repeated calls to service as an antidote to loneliness, but how would we create opportunities for everyone to engage in service? Expanding our national service programs, such as AmeriCorps, would be a great start. The good news is that some public officials are already embracing that idea. Senators Chris Van Hollen and Chris Coons recently introduced legislation to do precisely that.
Of course, getting more Americans to partake in service would help, but it’s not a cure. Together doesn’t provide that cure, but perhaps Murthy’s manifesto on loneliness, combined with our broader experience in the time of COVID-19 will be the major catalyst we need to spark a large-scale search for what we can collectively do.
The novel coronavirus outbreak might be the major catalyst we need. In this moment when so many of us feel more disconnected than ever before, it’s a chance to think big. It’s hard to imagine the Trump administration doing anything about loneliness—although one might speculate that Trump himself suffers from a profound kind of loneliness—but a Joe Biden administration could take action upon taking office, assuming he wins in November.
Biden would be wise to establish a national commission on methods and policy prescriptions to combat loneliness and increase social connection. He could have Murthy lead that commission and enlist other leaders who have written about this challenge, including conservatives like Nebraska Senator Ben Sasse and former president of the American Enterprise Institute Arthur Brooks. The commission should also recruit the social innovators highlighted in Murthy’s book, leading scholars on personal and civic connection like Julianne Holt-Lunstad and Robert Putnam, and experts like Julia Freeland Fisher.
Crucially, the National Commission to Combat Loneliness needs to be given the resources to succeed. It should be given an innovation fund to invest in promising ideas and innovations to reduce social isolation and to produce policy recommendations that are equal to the scale of the challenge that Murthy documents.
All in all, Together is a great book to read while social distancing. Like the popular works of Malcolm Gladwell, Dan Pink, Susan Cain, and Adam Grant, Murthy applies the proven formula of combining well-summarized academic research, effective storytelling, and candid personal anecdotes. That results in a smart, highly readable book that takes a timely and urgent issue and gives it the attention it needs. Maybe now we can start to prioritize how to create a less lonely world in the future.