Feeling lonely? You’re not alone. According to U.S. Surgeon General Vivek Murthy, the 19th and 21st U.S. Surgeon General during both the Obama and Biden administrations, even before the onset of the COVID-19 pandemic, about half of US adults reported significant experiences of loneliness, including Murthy himself at various points in his life. In his recent Surgeon General’s Advisory on Our Epidemic of Loneliness and Isolation, as well as his captivating book Together: The Healing Power of Human Connection in a Sometimes Lonely World, and his wellness-centered podcast House Calls, Murthy makes the case for viewing loneliness as a significant public health issue. Loneliness affects not only our emotional health, says Murthy, but also physical health, increasing the risk of heart disease, stroke, and premature death, as well as depression, anxiety, and dementia. Loneliness significantly drives up health care costs and other economic costs. Fortunately, Murthy also outlines many things we can do as individuals, community organizations, workplaces, health systems, and governments, to facilitate improved social connection and lessen what he describes as our epidemic of loneliness.
Born in Northern England to a family of Indian descent, Murthy emigrated with his family in early childhood first to Canada and then to Miami when he was 3 years old. Valedictorian of his high school class, Murthy went on to attend college at Harvard University, graduating magna cum laude with a Bachelor of Arts (BA) in biochemical sciences. He earned a Doctor of Medicine (MD) degree from Yale School of Medicine and a Master’s of Business Administration (MBA) from Yale School of Management, then completed residency training in internal medicine at the prestigious Brigham and Women’s Hospital and Harvard Medical School.
Public service was an early focus for Murthy, even before he was clear about his future path in life. As a college freshman in 1995, Murthy co-founded VISIONS Worldwide, a nonprofit organization focused on HIV/AIDS education in the US and India. Two years later, he co-founded the Swasthya Community Health Partnership, which trained women to work as community health workers and educators in rural India. In 2008 – just around the end of his residency training — Murthy founded Doctors for America, now a nonprofit organization of more than 27,000 physician and medical students advocating for improving affordable healthcare access. Prior to his first term as US Surgeon General, Murthy served during Obama’s first presidential term on the Presidential Advisory Council on Prevention, Health Promotion, and Integrative and Public Health, advising on strategies and partnerships to advance the nation’s health through prevention measures. In November 2013, Murthy was nominated by President Obama to assume the post of US Surgeon General, the nation’s top doctor and operational head of the US Public Health Service. Murthy’s nomination received the public support of more than 100 US medical and public health organizations, and the endorsement of two prior surgeons general.
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Murthy recently sat down with ABILITY Magazine’s Chet Cooper and Gillian Friedman, MD, to discuss his route to discovering the scope and significance of loneliness, as well as how we can combat it.
Cooper: Did you always know you wanted to be a doctor?
Surgeon General Vivek H. Murthy: My parents are doctors and had a private practice. As a kid I would spend a lot of time there, greeting patients as they came, sorting papers, cleaning the office. I really fell in love with what they were doing, which was building beautiful relationships with patients. And even though I was too young to understand the science of what was happening, I did understand the humanity that the patients were experiencing, and that my parents also benefitted from the beautiful connections they were creating. So that inspired me to go into medicine.
But then there was a phase for about five or six years where I went in a different direction. I got really interested in history and in English literature and economics. I was thinking maybe I would do something in one of those three fields. It was my work in HIV when I was in college — my sister and I built a nonprofit organization that focused on HIV education in India at the time and later in the US — that brought me back to health and to medicine, because I realized how much I really did want to be a part of improving people’s health and learning about their lives in the process.
Cooper: What does your sister do? Is she also a physician?
Murthy: She is, yes. She’s a family medicine doctor in Miami. In fact, she and my dad practice together. He also does family medicine. Some years ago they wanted me to move to Miami and to practice with them so we could be a family family practice, you know? I actually applied for a medical license in Florida and I was thinking about it seriously. It was right around that time that the White House called me and asked me if I wanted to be considered for the position of Surgeon General, and I ended up going down a very different path. Had it not been for this job, I could be in Miami right now practicing medicine with my dad and sister.
Cooper: So the Zoom background would be different from what I’m seeing now, more of a palm tree setting?
Murthy: (laughs) That’s right! I’d be on the beach, perhaps.
Cooper: I would love to continue this — you’re very personable — but I’ll let Gillian, Dr. Friedman, ask some questions. There’s a connection between the two of you that she’ll talk about in a second.
Dr. Gillian Friedman: I was an English and economics major who always thought as a kid that I would go to medical school, but then I also got sidelined for a while. Similar a little bit in that respect. I’m interested in the fact that you’re a Surgeon General with a podcast.
Murthy: (laughs)
Friedman: Which is really good, the House Calls podcast. That’s unusual for somebody in sitting office of any kind. And the podcast is about wellness, not about medicine per se. I’m curious, how did that come about for you? How did you choose that platform?
Murthy: I spend much of my job talking, but what I really like doing is listening. It’s something I did a lot as a doctor, spending time with patients and listening to their stories. Not only was it helpful for me in figuring out how to diagnose and treat them, but I also felt as though I learned a lot just by listening to people’s life experiences. The podcast was an opportunity for me to do some listening and to try to bring out some of the wisdom in lessons that other people had gathered through their life experience and to share that with folks across the country. That was why we started the podcast.
A lot of our podcast sessions focus on the broader topic of well-being and how we can create that, whether it’s through our relationship with technology, renegotiating that, or whether it’s how we refocus our lives on relationships, how we deal with conflict, how we manage anxiety in our lives. The conversations go in many different directions, but they’re all centered around how to create a life that is filled with good health, happiness and fulfillment in a world where sometimes that can be really difficult, where we’re pulled in so many different directions, where the pace of life is so incredibly fast, and where there’s so much pressure also to focus on a particular definition of success: how much fame do you have, how much money do you have, how much power do you have, how fancy is your job. These are the things we tend to associate with success.
Over the years when I’ve sat with patients toward the end of their lives and talked to them in those final days about what truly made their lives meaningful, they would talk about their relationships, the people they loved, the people they wished they had shared more time with, the people who loved them. They didn’t talk about how much money they had, how big their office was, how fancy their job was, how long their curriculum vitae was. It struck me that we don’t have to wait until the end of our lives to understand what truly makes us happy. We can recognize and start living a life that’s consistent with that right now. That’s what the conversations are often about, trying to understand what can really drive health, happiness and fulfillment in our lives and how we can work together to make a better reality.
Because this work is hard to do on our own. But if we know that there are others out there who are trying to walk down a similar path, who are trying to define success through their relationships and their contribution to the world, as opposed to through how many followers they have on social media or how much money they have in their bank account, that makes it a little easier to walk that path.
Friedman: How did you start focusing on loneliness. I just want to highlight the significance of a Surgeon General putting out an advisory about loneliness as a public health epidemic. We think of the word epidemic as meaning really widespread, something we want everybody to be aware of. How did you hit upon that?
Murthy: It certainly wasn’t in the original plan, I’ll tell you that. When I first started as Surgeon General, I had a bunch of other public health issues I wanted to work on, and I did work on many of them: the opioid epidemic, the e-cigarette crisis we had among youth, and many other issues that came up along the way, like Zika and Ebola and then of course COVID-19. But one of the things I realized in having conversations with people around our country is that people were actually struggling with loneliness. It kept coming up in conversation after conversation, often in subtle ways, with people telling me how invisible they felt or how they felt that they were carrying so many burdens in their lives and had to carry them alone.
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I was talking to college students on campuses who were saying, “Yeah, I’m surrounded by thousands of other students, but there’s no one with whom I can really be myself, who gets me. I feel really alone.” Hearing that again and again made me realize that there was something happening here. It reminded me of the many conversations I’d had with patients over the years where I’d realized that they may have come in for pneumonia or a blood clot, but they were actually struggling with loneliness in the background. It reminded me of my own experiences struggling with loneliness as a kid and being too ashamed to talk about it. That shame is really important to recognize, because it’s what keeps loneliness in the shadows. It’s why one in two adults in America report measurable levels of loneliness. But we wouldn’t know it because to all the outside world it looks like people are getting together all the time, that they’re surrounded by lots of people, that they’re laughing and having a wonderful time, because that’s what people post on social media. That’s the exterior face we put on for the rest of the world. Yet inside, there are a lot of people who are struggling.
So I decided to put that advisory forward, a Surgeon General’s advisory for the first time on loneliness and isolation, because I wanted to pull this issue out from the shadows. I wanted people to know they weren’t alone if they were struggling, and I also wanted them to know that this really is a public health issue. Because when people struggle with being socially disconnected, it raises their risk of depression, anxiety, and suicide and also increases the risk of heart disease and stroke and dementia and premature death. When you have a risk factor that’s impacting so many people, it’s time for us to address it as a public health issue.
Friedman: That was one of the things I was struck by in reading your advisory — the stakes of addressing it. I’m a psychiatrist by training, so certainly I’m aware of how clinical depression can affect health. But you talked about something broader than that. It might raise the risk of depression, for instance, but it can affect people even if they are not meeting criteria for a diagnoseable mental health condition.
Murthy: That’s exactly right. It’s a risk factor that impacts so much of our lives, not even just our health. It turns out that when we are struggling with being socially disconnected, it impacts how we perform our work. We’re less creative, less engaged, less tied to our work, and that impacts our productivity in profound ways. It also impacts how our kids perform in school, and our level of civic engagement. It creates what I believe is a sense of division and polarization that’s been growing over the years. Whether you care about health, or creating a community that is more unified, or having better productivity and better results in workplaces and schools, it turns out that building a more connected life helps in all those areas.
That’s why I see our connection with one another as part of what fuels us as human beings. It’s foundational to our lives, and building a more connected life in a more connected world strengthens that foundation. Everything we build on top of that, whether individual pursuits or the organizations that society depends on, becomes healthier and stronger.
Friedman: I was additionally struck that the statistic that you referred to – that one in two people are affected by loneliness – is a pre-pandemic figure. Also, the word epidemic – beyond meaning widespread – implies a condition different from previous eras, from a different cultural situation. Do you have any thoughts about how we got to this epidemic of loneliness?
Murthy: I’m really glad you raised that. The pandemic poured fuel on the fire of loneliness, but the fire was burning long before. In fact, we’ve seen for probably a half century or more declining participation in so many of the organizations that used to bring us together, like religious organizations, recreational leagues, other service-based and community organizations. But we’ve also had other changes in the last couple of decades.
The introduction of all kinds of technology into our lives has been a boon in many ways. It’s made us more efficient in some ways. It’s given us opportunities to get groceries and packages and goods delivered to our houses, to come to us without our even having to leave our homes. But therein comes also the potential downside, which is that our opportunities to interact with one another have also declined.
Sometimes we don’t think about that incidental interaction we have with somebody at the post office or the grocery store or waiting in line for coffee at the coffee shop. We don’t always think of those as important or consequential. But it turns out they really are. One of the experiences highlighting this was COVID – that first year of COVID, in particular, where people really pulled back from their interactions with one another. I remember talking to so many people on the phone who would say, “You know, I just miss sitting in a coffee shop and being around other people. I miss walking in the mall and seeing other people out there. I miss just seeing other people, whether I know them or not.”
As human beings, our need for connection is profound. We need the intimate connections, connections with spouses and best friends with whom we can get support. We need friends in our lives, people we can have birthday parties with, go on vacation with, take in a movie or a game with. But we also need a broader sense of community where we feel we belong. It could be people we work with, people we volunteer with in our community, our neighbors. These different levels of connection are important. I think of them as intimate connections, relational connections, and collective connections. And the reason that’s important to know is that if you are, let’s say, in a really fulfilling marriage but you don’t have friendships and you don’t have those collective community connections, you may feel lonely. And if you don’t know that there are these different types of connections that we need in our lives and you’re that person’s spouse, you might think, “Gosh, this is my fault. If they’re lonely, it’s probably because our relationship isn’t fulfilling.”
However, that may not be the case at all. In fact, I say this as somebody who experienced loneliness at a time when I was in a very fulfilling relationship – and continue to be – with my wife, Alice. But the problem, which she herself in fact diagnosed, was that I wasn’t spending time with my friends. I had lost touch with so many friends. And once I rebuilt that, gosh, I felt so much better, so much less lonely. But it wasn’t about my relationship with my wife.
Friedman: I want to make sure I turn back to Chet and let him ask some questions. Thank you.
Murthy: That was great.
Cooper: Thank you, Gillian. I think the most important question is, how do you say to people, “I’m a General and a Vice Admiral”?
Murthy: (laughs) I keep it easy and simple. I just tell people, “Call me Vivek,” that makes it really easy. That’s what my friends call me. Otherwise people do get confused on what to call me. And technically I’m referred to as a Vice Admiral by rank, even though my title is that of Surgeon General. Sometimes that can get confusing.
Cooper: How do you choose who to be on your podcasts?
Murthy: That’s a good question. It comes in different ways. Sometimes I’ll read an article or a book that somebody wrote and it’ll inspire me. Sometimes my team will have ideas about who we should talk to. I have an endless list of people with whom I want to have conversations. I’m just hungry to learn more about different pathways for creating well-being. The truth is, I’m a student of this as well. Like all of us, I’ve picked up a lot of lessons along the way, but I’ve got a lot more to learn. To me, one of the most important things we can do is to have conversations about these topics, recognizing that we all have different lives, but every now and then, something you hear about how somebody navigated a particular hardship in their life or a tool that they have or a life hack, if you will, that helps them manage some sort of challenge, sometimes that can help you. Not just help you in giving you a tool, but sometimes hearing these conversations can remind us that these issues are priorities, that as much as our lives in society are centered around work and traditional achievement. There are other things that may contribute as much if not more to our happiness and well-being.
So, being a part of these conversations can sometimes draw me in, and I hope our listeners that it’s okay to prioritize your relationships, to prioritize physical activity because that impacts your physical and your mental well-being. It’s okay to think about how to carve out time for yourself because we all need some time to ourselves to be able to let ourselves settle and ground ourselves, to let that noise settle around us that sometimes distracts us and prevents us from figuring out what really matters to us in our lives. I want people to feel that they have permission to make those things priorities. I think that’s what creates the foundation for health and well-being – when we’ve got healthy time with ourselves, we’re building healthy relationships with others, and we have the permission to focus on things like exercise, diet, and other types of activities and practices that sustain us.
Cooper: Gillian has done so much in the mental health space, not just because of her career as a psychiatrist, but as a volunteer. Her efforts dealing with issues around suicide in the military, her nonprofit support, for example with ABILITY Corps and Habitat for Humanity. We build houses for families of low income with disabilities, and we access volunteers with disabilities to build the homes.
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Murthy: Oh!
Cooper: There are so many great stories of people who had life-changing experiences volunteering and building someone a home.
Murthy: Just hearing a little bit about what you’re doing, especially for the disability community, I so appreciate that. It’s actually very relevant to what we were just talking about. One of the areas that we call out in our advisory on loneliness and isolation is that some populations are affected more than others. We want people to be cognizant of that. For example, many people are surprised to know that young people struggle with the highest rates of loneliness. They may be surprised to know that when you are dealing with severe illness, or if you’re differently abled, or if you struggle with other challenges – such as past trauma, for example. That can all impact your ability to see other people, whether it’s to physically get out and interact with other people or whether it’s your psychological comfort and willingness to do so.
If we recognize just how important and consequential loneliness is, my hope is that as a society we can also recognize who is at greatest risk and take extra steps and efforts to make sure that people feel included. We can do this partly through simple things like checking on one another. When you know that it might be hard for somebody to go out and see others, when you know that they’re struggling at home, whether with their own illness or taking care of a relative who may be struggling with an illness, it’s important to check on them and to recognize that what we see on the outside, the brave face that everyone always tries to put on, doesn’t always reflect the reality of what they’re experiencing inside.
Sometimes it’s just a simple call to someone who might be struggling or having a tough time. It can be a lifeline for them and can help them during incredibly difficult moments. The bottom line is, however you look at it, we all need each other. We’re better off when we’re connected in healthy relationships. My hope is that if we understand that, we can create the kind of society where everyone is included and no one is left out. Right now, there are too many people who are feeling left out, whether it’s on the basis of their health and abilities, their race and ethnicity, their beliefs, whatever it might be. People for one reason or another are feeling that they don’t belong and don’t have a chance to be a part of a real community, and that hurts all of us. That’s one of the key messages from our advisory: we should all be vested in how connected we are as a community, and when we talk about community, inclusion is a key component – that everyone is a part of that community.
And it starts locally. This feels like a big problem – one in two adults struggling perhaps with loneliness, that can seem overwhelming – but it starts locally. My hope is that people will think about the folks around them in their neighborhood, at work, their family and friends, and recognize that when we want to address loneliness, sometimes it’s just reaching out to someone for 15 minutes a day to check on them and see how they’re doing. That can make a difference. It’s also making sure that when we are reaching out to people, we’re giving them our full attention, that we’re not distracted by technology when we’re having dinner with a friend or when we’re talking to a loved one or we’re saying hello to a work colleague.
And just finding ways to serve others. Gosh, that’s one of the most powerful antidotes to loneliness. Counterintuitive, perhaps, but it turns out that when we help other people, we forge a connection with them, and we also remind ourselves that we have value to bring to the world. That’s something we can forget easily when we struggle with loneliness. We can start to feel we’re not worthy of connection, that we’re not likable or lovable in some way. And service reminds us that’s not the case.
Friedman: Do you see that in the reverse also, that when you invite others to help, it has that benefit for them?
Murthy: That’s absolutely right, and I’m so glad you said that. It can be really hard to ask for help. But asking for help is not just about you getting help – the person helping benefits, too. I’ll tell you one small story that illustrates this, although I’m not recommending people do this. When I was working on a big writing project some time ago, I would spend time at a grocery store, in the cafeteria area. I would just be working and writing all the time. I was on my computer. I was there alone. But sometimes I wanted to go and get something to eat, go to the rest room, take a two-minute walk, just to get some fresh air. But what was I going to do with my computer? It was sitting there, with all my wires, bags, everything.
I got to know over time some of the people who were sitting around me because there were some regulars, and I would just ask them, “Can you just watch my stuff for a couple minutes?” I was asking them for help. And while it seemed like that was really small, I’ll tell you, it felt really good to be able to ask someone for help and to have someone step up and say, “Yeah, sure, I’ll do that for you.” They didn’t know me and I didn’t know them, but we were having this really human reassuring moment where we both stepped up to be there for one another. And that always felt good to me, to ask for help.
I know it can be hard sometimes to ask for help. We live in a culture where we’re told, “Hey, you should be independent,” and that means you shouldn’t need anyone. But that’s not consistent with being human, because as human beings we all need each other. We’ll have moments where we need help and when we have a chance to help other people. So just remember, when you’re asking for help, you’re not just helping you. You’re giving someone else an opportunity to do something that will help them, too.
Cooper: I had mentioned earlier that Gillian had a connection with you that she didn’t know about.
Friedman: Oh! Doctors for America. I had no idea you founded Doctors for America.
Murthy: Oh, my gosh!
Friedman: I’ve been active with them.
Murthy: Wow! What a wonderful throwback! I love it. (laughs)
Friedman: I wasn’t founding nonprofits in my undergraduate years and early medical school – I was just trying to get through my schooling. (laughs)
Murthy: (laughs)
Friedman: But thank you for doing that!
Murthy: I’m so glad that we did this. It was really good to talk to both of you. I so appreciate the work you’re doing in the world.
Cooper: I’ll start listening to your podcast.
Friedman: Thank you. It’s so nice to meet you.
Murthy: It was for me, too. Take care. I’m glad we did this.
The U.S. Surgeon General is the Nation’s Doctor, providing Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury.
