The Surgeon General Warns About An Epidemic Of Loneliness

IRA FLATOW: This is Science Friday. I’m Ira Flatow. About two years ago, I sat down with US Surgeon General Dr. Vivek Murthy. It was at a stage of the COVID pandemic where cities were just starting to open up but a rise in cases was forcing many places to reinstate masking mandates.

They were concerned about whether a large enough part of the population would receive vaccines. And boosters were still in development. But in the middle of that public health crisis, I asked Dr. Murthy what he would focus on post pandemic. And without hesitation, he said there was another crisis he saw looming, and that was depression, social disconnection, and the overall mental health of America.

He’s made these issues the key part of his health agenda now and has recently added loneliness. So I wanted to bring him back to get an update. Dr. Vivek Murthy is the US Surgeon General. He heads the US Public Health Service. Welcome back to Science Friday.

VIVEK MURTHY: Well, thank you so much, Ira. I’m glad to be back. Thanks for having me.

IRA FLATOW: You’ve been pretty busy, haven’t you been?

VIVEK MURTHY: I have. [LAUGHS] It’s been a busy time.

IRA FLATOW: Let’s start with a statement I read that you issued in May. And you said, “We are in the middle of a national youth mental health crisis, and I’m concerned that social media is an important driver of that crisis, one that we must urgently address.” Tell us how we address that.

VIVEK MURTHY: Well, I’ll tell you, Ira. First, the reason I issued it is because, not only as surgeon general but as a doctor, as a father myself, I’m watching what is happening to our children around the country with regard to social media use. And I’m deeply concerned about the impact it’s having on their mental health and well being.

We are in the middle of a youth mental health crisis. And I believe that social media has become a major contributor to that. The data that we laid out in the Surgeon General’s Advisory issued in May of this year on social media and youth mental health speaks to some of the reasons why we should be concerned. What we’re seeing, for example, that adolescents who spend more than three hours a day on social media face double the risk of poor mental health outcomes, such as symptoms of depression and anxiety.

Now, this is concerning because, in part, the average amount of use is 3.5 hours per day among adolescents. Body image issues we’re seeing significantly impacted in a negative way by social media use. We’re seeing it detract from kids’ sleep. Many kids are saying they feel addicted to it.

And as many described to me when I do roundtables around the country, kids will most often tell me they, number one, feel like social media makes them feel worse about themselves. Two, it makes them feel worse about their friendships. But three, they can’t get off it.

And so I’m very concerned about this. And I think, to address this, what we’ve got to do is first recognize that, up until now, we’ve placed the entire burden of managing the risks of social media entirely on the shoulders of parents and kids. And that is just not right. These are rapidly developing technologies that most parents didn’t have to grow up with. And they are designed by some of the best developers and program designers in the world.

And so you pit those developers up against kids and parents, that’s just not a fair fight, which is why what I call for in the advisory, in addition to individual action, community action, is policymaker action. And specifically, we need policies that, number one, establish safety standards, like we have for motor vehicles and for other products that kids use, that will help to reduce their risk of exposure to harm and also reduce the likelihood that companies will develop the kind of technology that would manipulate kids into spending more and more time on them.

And finally, we also need to ensure that companies are required to disclose data to the public and to parents in particular. Our researchers tell us constantly that they are unable to get access to the full data they need from social media companies to understand the extent of impact on the mental health of kids. We should not be hiding this data. That’s another area where policymakers have a role to play.

IRA FLATOW: Is there any way to stop companies from targeting kids?

VIVEK MURTHY: Well, there certainly are ways to stop companies from exposing kids to harm. And I know that because we’ve done that in other industries. As surgeon general, I do a lot of work related to tobacco and our office has a long history of working on this issue. And this is a place where we’ve had public health successes by working through policy and through culture change and practice and getting industry to reduce their targeting of youth. There’s more to do on that front, by the way, and we’re actively engaged in it.

So the bottom line is we can do it. But we have not up until this point. There, we have moved very slowly on the policy front. I would say it’s been about 20 years that social media has been on the horizon as being used by adolescents and by people of all ages. Yet we’re still in infancy when it comes to actually designing the kind of policy response that’s required to keep our kids safe.

IRA FLATOW: What kind exactly? What would the policy say that you would like to have designed?

VIVEK MURTHY: Number one, it would require data transparency. Companies would need to disclose the data that they have on the mental health and overall health impacts of their platforms on kids. That would need to be disclosed to the public. Number two, we would need to establish actual safety standards, like we have done for automobiles, for other products, that would limit the following– number one, the exposure of children to harmful content, like extreme violence, pornography, and other harmful content, that would limit the bullying and harassment that too many kids experience, now including from strangers, that would also limit the use of manipulative features that would essentially get kids to use more and more and more of their social media platform in a given day such that it displaces sleep, time with friends in person, time for physical activity.

These are design choices that companies make. And what policy can do is to help reduce the likelihood that those features are in place. It can also require evidence. If a company says to me, you know what? Our platforms are safe because we’ve taken certain measures to ensure that they’re safe.

Well, I don’t want to just take their word for that. I want to see their proof. Where is the evidence that shows me that using these platforms is not harmful for my kids? I have not seen that evidence yet. And the independent scientists I talked to on the outside have not seen that either.

IRA FLATOW: You brought up tobacco, which we know is a potent addictive drug. It’s like you’re comparing social media to being addicted to a drug.

VIVEK MURTHY: Well, I think if you talk to young people, that’s exactly how many of them, in fact, describe it. In fact, a third of adolescents say that they feel addicted to social media. Half of them say, if they had to stop using social media, they would have a very hard time doing so.

You don’t have to just look at kids. Talk to adults. Think about your own life experience. I suspect many people listening to this may also feel like they are addicted to social media.

And this is not happening by accident. The business models of many of these platforms are built on how much time you use the platform. The more you use it, the more revenue it generates. So their incentive is to create more and more ways to keep you on, whether that’s good for your health or not.

We need a different model, a model that actually prioritizes the health and well being of the users, particularly our kids. That’s what I care about most as surgeon general.

IRA FLATOW: You’ve also made room, though, to talk about the benefits of social media, specifically in usefulness to under-represent groups. Can you talk about that a bit?

VIVEK MURTHY: What we do know is that community is very important for all of us but particularly for individuals who find themselves going through life experiences or having an identity, a background, that is not necessarily shared by a lot of folks around them. So we look at members of the LGBTQ community. We look at people who may be struggling with certain illnesses that are rare or unusual.

A lot of times, it’s hard to find community, to find people around you who are going through what you’re going through, who you can talk to openly. And social media for some people has had the benefit of helping them find community. That’s a good thing.

But because there are some benefits of social media does not mean that we should swallow all of the harms that are associated with it as well. And again, to use as an example a parallel, automobiles, there was a time when I was growing up when the number of automobile-related fatalities was extraordinarily high.

And we didn’t say, you know what? That’s just a price of modernity. Automobiles are helping people get more efficiently from point A to point B. So we just have to accept all of this harm that’s taking place. We didn’t do that.

What we said instead is we need to make this a much safer experience. And that’s why we put standards in place and ensure that cars had seatbelts. They had airbags. They had to undergo crash testing to ensure the frames were safe.

What we also did not do, Ira, at that time is we didn’t put the entire burden on parents. We didn’t say, hey, when your child turns 16 and when you’re getting them into a car, why don’t you go ahead, as a parent, test out the frame yourself, test out the brakes, make sure that all elements of the car are actually working? That would have seemed ridiculous. Parents don’t have the expertise to do that.

But we’re finding that true here as well. Parents need help. They need support. And this is why legislation and regulation is actually critical when it comes to protecting kids from social media.

IRA FLATOW: Your advisory calls for more research. Give me an idea of what kinds of research has already been done that you think should serve as a bellwether to future research.

VIVEK MURTHY: Well, some of the questions we want to understand more deeply are, which kids are most deeply affected by the potential harms of social media? We also want to know, what kind of use seems to generate the most harm? What times of the day does using social media seem to be most concerning?

We know, for example, right now already, that a third of adolescents stay up until midnight or later on weeknights using their devices. And a lot of that is social media use. So there’s more that we need to understand in terms of the granularity of harm. This will help us to better tailor interventions and to tailor policy.

But I do want to stress, Ira, that we know enough now to take action. And the call for more research must be pursued alongside in parallel with policy-related efforts to ensure that we’re putting these kind of safeguards and safety measures in place.

IRA FLATOW: One of the biggest parts of your agenda now is, as I mentioned before, is dealing with the crisis in loneliness. How did you arrive at that as part of your agenda?

VIVEK MURTHY: Well, the truth is, Ira, I experienced loneliness long before thought of it as a public health problem. Like many people in America, I struggled with loneliness when I was younger, when I was in school, in grade school. I never told anyone about it because I was ashamed. I thought it meant that I was not likable or somehow something was wrong with me.

And over time, though, and I became a doctor, I came to see that many of my patients were also struggling with loneliness. And I never learned about it in medical school, yet there it was, staring at me in the face. And I realized I didn’t quite know what to do in those circumstances for my patients.

It was when I became surgeon general, though, Ira, that I realized that this was an experience that went way beyond my own life and my patients’ lives. But this was something people all across our country were struggling with. And as I dug into it, I realized two things, Ira.

One is that loneliness is extraordinarily common with one in two adults in America with measurable levels of loneliness. The numbers, by the way, are much higher among young people. But the second thing I realized is how consequential loneliness is for our health. And the people who struggle with being socially disconnected, with feeling lonely or isolated, they actually are at much higher risk for depression, anxiety, suicide but also– and this is surprising– for physical illness.

They’re at increased risk of heart disease, of dementia, of premature death. And so however you look at it, loneliness is an important public health concern, one that has flown under the radar for a long time but one that I think is exceedingly important for us to address right now. And the pandemic made it worse for many people, even though, as the pandemic recedes, we’ve got to recognize that there was a very high level of loneliness long before COVID-19 arrived.

IRA FLATOW: How do you report loneliness? How do you track it? How do you measure it? It seems to me that it would have to be self reported or physicians. Or how do you know about it?

VIVEK MURTHY: That’s a good question. Well, loneliness is a subjective term, and it is based on whether the connections you feel you have in your life are sufficient. And in fact, if you need more connections than you actually have, you feel lonely. But it is a subjective term.

Isolation, on the other hand, is an objective term. It’s a descriptor of how many people you may interact with or have physically around you. And there are now validated survey instruments that we can use to actually measure the level of loneliness or isolation, like in a population. And thankfully, this data has been collected now over the years. We need much more of it.

But the data we have tells us that, number one, loneliness is exceedingly common in the overall population, around 50% of people with measurable levels of loneliness. That’s adults. But the real concern for me, Ira, is looking at young people, who, despite how connected they are by technology and, in some cases, because of it, seem to have the highest rates of loneliness of people across the age spectrum.

IRA FLATOW: This is Science Friday from WNYC Studios.

Compared to other countries, how lonely are we?

VIVEK MURTHY: Well, it turns out this is a global challenge. The United Kingdom, Australia, other countries in Europe, Japan– many of these countries are struggling with loneliness as well. In many cases, they are still very early stages of gathering the kind of granular data that you would want to fully and in an in-depth way understand the extent of the crisis. But it has become clear that we’re not alone in this struggle.

The United Kingdom, in fact, and Japan both appointed cabinet-level individuals in government to actually look at the issue of loneliness and to help develop a strategy for their countries. So while we are not the only ones who are struggling as a country, I do think it’s important that we move quickly in building the kind of national strategy and response that we need, because the bottom line is loneliness is much more than a bad feeling.

It is a public health crisis that has consequences for our mental and physical health as well as for our communities. It turns out, Ira, if you look at communities that are more connected, they tend to be more economically prosperous. They tend to have lower rates of violence. And they also tend to be more resilient in the face of adversity, like hurricanes and tornadoes.

IRA FLATOW: What’s ironic about this is when I had this interview, like I’m having with you now, with psychologists when social media started, let’s say, 20 years ago or so and one of the things that the psychologist told me is, once we get kids hooked up to social media, they’re going to be less lonely. And it doesn’t seem to be turning out that way, is it?

VIVEK MURTHY: Ira, you know what that reminds me of? It reminds me of what I heard when the internet was first coming into common use. When I heard someone say on the news, once everyone starts using the internet, people won’t be able to lie anymore because they’ll just be able to look up the truth.

IRA FLATOW: [LAUGHS]

VIVEK MURTHY: And it’ll be there. Well, I think both of those predictions turned out about the same, which is that, when it comes to social media in particular, while there are some kids who have been able to find connection and community through social media, there are many more, I think, who have struggled and who’ve struggled in a few ways. One, I think many of them have come to experience a shift from what used to be in-person connections to online connections, which are different.

They also experienced a shift from a smaller number of high-quality connections to a larger number of lower-quality connections. It’s fine to say I’ve got 1,000 or 2,000 connections on a given social media platform. But how many of those people truly know you, would show up for you in a crisis? How many of those people could you be truly vulnerable and open with? That’s what truly matters in terms of feeling lonely.

And finally, I think one thing we sometimes underestimate is the extraordinarily harmful effect of the culture of comparison that exists on social media. People have been comparing themselves to each other, Ira, for millennia. We do that all the time. But what is different with social media is that the sheer volume of comparison that’s happening is like nothing we have experienced before.

Maybe when I was growing up in a given school day, I compared myself to the 20, 30, 40 kids I interacted with in school on that day. But now, as many young people tell me, they may see thousands of images of people in their social networks. And they’re constantly comparing themselves to their lives, to their bodies, to their academic achievements, to everything else, which is why nearly half of adolescents say that social media makes them feel worse about their body image. So we have to take all this into consideration and recognizing that what may have started off as a well-intended platform that sought to connect people and build community has, unfortunately, for many young people, become a force that has eroded their self-esteem, weakened their social connections, and contributed to real mental health harms and suffering.

IRA FLATOW: We’re going to have to take a break. And when we come back, more talk with Dr. Vivek Murthy, US Surgeon General.

This is Science Friday. I’m Ira Flatow. If you’re just joining us, I’m continuing my conversation with Dr. Vivek Murthy, US Surgeon General. We’re talking about youth mental health and loneliness. It’s part of the answer, then, just getting people or kids out and into the public domain, again, meeting other people in real time?

VIVEK MURTHY: I do think that is part of it because, when we look at how the harms of social media actually play out, we find that, in addition to being exposed to harmful content, in addition to being exposed to bullying and harassment and to this culture of comparison, there’s a displacement effect that’s taking place, where the more social media kids are using– and again, it’s about 3.5 hours a day on average for adolescents now– but that takes away often from sleep, from in-person interactions, and from physical activity, all of which we are essential for the mental health and well being of young people. So one of the things I often advise parents is that, if their child is already on social media, one of the things that they can do is to carve out tech-free spaces in their child’s lives, where their children will be off of their phones and their devices and will be out in the world, interacting with people, playing with friends, being present at dinner, and interacting with family members. That’s a big part of what we need to do now.

It’s not easy, which is also one of the other things I recommend to parents is to partner with one another, to support one another. When parents are doing this together, they’re forming partnerships, that can make it easier. And it also helps kids understand that they’re not the only kids who are being asked to create these kind of tech-free zones. Other kids are doing it as well.

IRA FLATOW: Can you teach parents to recognize loneliness in their kids and possible side effects?

VIVEK MURTHY: Loneliness I think of as the great masquerader. It can look different in different people. Sometimes it can look like someone who’s withdrawn or quiet. Other times it can look like someone who’s irritable, and angry, and lashing out.

And so it’s not always easy to recognize, which is why I think it’s so important for us, as parents but also just as friends and family members, to check in on one another, to ask people how they’re doing, how they’re feeling, and sometimes to ask them how they feel about the friendships in their life, whether they have enough time with friends, whether they feel like there are people in their life they can talk to if they’re having a hard time. And sometimes it might seem awkward or hard to have that kind of conversation.

But I will tell you this– having spoken to many people who have struggled with loneliness, I know that just even having someone in their life who would open up that conversation would be something they would be so grateful for. Many people feel like, gosh, nobody even cares enough about me to ask about these things. And when you’re lonely, sometimes you can go into a downward spiral, where the lonelier you are, the more it erodes your self esteem, makes you feel like you’re lonely because you’re not likable, which makes it harder to reach out to people, which makes it even lonelier.

And sometimes breaking out of that cycle of loneliness, you need somebody else in your life who can pause, who can say, hey, you know what? I see you. I care about you. I want to know how you’re doing.

IRA FLATOW: What you’re saying are anecdotal things that happen in your life and my life. But I’m wondering, are there any real examples of an intervention that has generated measurable outcomes, that some sort of thing actually works to combat loneliness?

VIVEK MURTHY: Yeah. So there’s a lot that works. And the interesting thing about this is some of the examples I’ll share with you are going to sound deceptively simple. And the reason they sound so simple is because, as human beings, we actually are hardwired to connect. It doesn’t take a lot for us to actually come back to one another and build healthy relationships.

But it’s getting started that is often the hard part. So here are some of the interventions I’ve seen around the country that have really made a powerful difference. I’ve seen on a school level, for example– I’ve seen programs like the Beyond Differences program, which started in California and now spread throughout the country. This is a simple program, where high school students mentor middle school students and help teach them how to look out for other kids who may be struggling with loneliness in their school.

They might find someone who’s sitting alone, eating by themselves at lunchtime, day after day. They help teach them simple and kind ways to bring them in to a circle without embarrassing them and making them feel like they’re part of a community. That’s had a powerful effect on reducing rates of loneliness.

I think also of the Becoming a Man program. This is a different kind of program. But it’s a program now with a counterpart called the Working on Womanhood program, the BAM and the WOW programs. But these involve bringing a small group of about 10 young people together with the facilitator who meet once a week.

And they talk about what’s going on in their lives. They build trust. They build a relationship with one another. And over time, they help each other resolve conflict and deal with challenges. I witnessed one of those groups in action when I was in Chicago a few years ago. And it was really powerful to see the bonds that are formed there.

I’ll lastly share one other example with you, which is outside of a school. This is something called the Neighbor’s Table that a woman named Sarah Harmeyer started in her community in Dallas, Texas. She moved there some time ago, didn’t really know anyone, wanted to feel more connected to people, wasn’t quite sure how. So she did something bold and that was a little scary to her at the time, which is she sent an invitation out to all of her neighbors and asked them to come over for a meal.

She didn’t know who would show up. Her father helped her build this big long wooden table, which she put outside. And you waited, and it turned out a lot of people wanted to come. So they showed up.

And day after day, she started having these types of meals for her neighbors. And she found that a lot of them had lived there for a long time but didn’t know one another. And over drinks and meals, they came to just chat, to get to know one another, and to feel like they had a community.

So these small initiatives, checking on each other, inviting people over for a meal, making sure that your kids have actual time in person with friends and with family, these can go a long way toward helping us build connection because, again, Ira, this isn’t about transforming ourselves into something different, and foreign, and unnatural. This is about returning to who we are, who we’ve evolved to be, which is beings who are deeply connected to one another.

IRA FLATOW: And letting people know they have outlets to be reconnected.

VIVEK MURTHY: Yes, absolutely. And one of the things I call for in our advisory that I think we need to do in our country is to rebuild social infrastructure. We’re used to thinking about the physical infrastructure, like bridges and highways. But there’s also something called social infrastructure, which are the programs, and policies, and structures that support the development of healthy relationships.

These could be programs in schools like the ones I described earlier. They could be workplace programs that actually create opportunities for colleagues to get to know one another. But they can also be programs in the communities run by faith organizations, and YMCAs, and others that create spaces for people to come to know one another, especially across different backgrounds.

We used to have a lot of this before, Ira. But over the last half century, there has been a decline in people’s participation in those organizations and community efforts that used to bring people together, whether they were faith gatherings, service efforts, recreational leagues. And we’re seeing the consequence of that combined with how we’re using social media technology, combined with the fact that technology is just evolved in a way that’s made it unnecessary for us to run into each other at the grocery store or the post office.

Put on all this together, we’ve seen a real toll on our relationships. And this is the time for us to consciously rebuild that social infrastructure and rebuild the connection in our lives.

IRA FLATOW: I’ve only got a couple of more minutes. I want to touch on the fact that we’ve seen evidence that cases of COVID are on the rise again. People are talking about masking up in certain crowds again. Coming to a winter where people are going to be isolated more, are we going to be seeing– put it as an outbreak of loneliness or being alone again and actually increasing those problems?

VIVEK MURTHY: Well, that’s an important question. And I think one of the things we learned in the first year in particular of the pandemic was that what really suffered were our connections with one another. And a lot of people were separated physically and otherwise from each other. And it did increase loneliness.

If we think about the winter that’s approaching, we have a lot more knowledge and tools with which to approach this winter in a way that I think can result in us not necessarily having to struggle with loneliness the way that we did in 2020. I think we can and should be much more proactive about reaching out to people, even if they’re not able to come to a gathering. Maybe they’re worried about their health. Maybe they’re unwell with flu, or COVID, or another winter-related illness.

Reaching out to people to make sure that they don’t feel isolated, that they don’t feel alone is important. And proactively reaching out to our friends if we’re not able to join gatherings is also important. I think we’ve also just realized that the more we use the tools that we’ve developed over the last few years, the better off we will be as a society.

In 2020, when we were struggling, we didn’t have vaccines. We didn’t know what treatments would work to help people with COVID. And in some cases, those treatments hadn’t been developed.

We have treatments now. We have vaccines that are effective in reducing the risk of bad outcomes with COVID. This is a time for us to utilize those tools. And if we do, my hope is that we can manage COVID the way we do other respiratory illnesses, like flu and others, where, yes, they still do circulate every year but we know how to manage them, how to live our lives, and how to stay connected with one another.

IRA FLATOW: One last question. We saw how health misinformation and disinformation can be a huge public health problem. We saw that during the height of the pandemic. And it continues to be a concern for a lot of us and for your office. Can you tell us about how you go about combating this?

VIVEK MURTHY: Well, this is one of the great public health challenges we’re going to face over the years ahead. We’re in the throes of it right now. We saw, during the early years of COVID in particular, such an overflow, if you will, of misinformation around COVID. And now that’s just spreading to other health conditions as well, to other vaccines.

We put out an advisory on health misinformation in the summer of 2021, laying out strategies for how we can address this as a country. It involves actions that we can take as individuals, for example, like making sure that we don’t forward information, even with the best of intentions, to other people unless we know it’s from a credible scientific source. But it also involves steps that information platforms, including the media, including social media, need to take as well to ensure that their sources are accurate, that they’re scientifically based, that they give context.

Make no mistake– especially with the increasing presence of artificial intelligence in our information environment, that it is becoming easier and easier to mask and disseminate misinformation. So this is a threat that we’re going to have to be mindful of, vigilant about for years to come.

IRA FLATOW: Dr. Murthy, we have run out of time. I want to thank you for taking time to be with us and being one of public health’s most thoughtful speakers. Thank you very much for your service.

VIVEK MURTHY: Well, thank you so much, Ira. It’s an honor to be with you.

IRA FLATOW: We’ll have you back. Maybe not wait two years from now.

[LAUGHTER]

VIVEK MURTHY: Would love that.

IRA FLATOW: Dr. Vivek Murthy is the US Surgeon General. He heads the US Public Health Service.

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