Surgeon General Vivek Murthy’s Landmark Initiative On Loneliness And Social Isolation

Just a few days ago we learned that cigarette smoking in the United States dropped to a historic low. That’s news to celebrate. It’s also worth acknowledging that one of the reasons we reached this milestone is that for more than half a century, U.S. surgeons generals have led a protracted fight against big tobacco. Continuing this line of work, this week, Surgeon General Dr. Vivek Murthy today unveiled his plans to take on an even more daunting opponent: loneliness.

His effort is bold and timely, and will likely be viewed by future generations the way we look at past efforts to curb smoking.

Moreover, just as health practitioners took to the frontlines of the anti-smoking war, they must again take up arms in the fight against loneliness, and acknowledge from the start that it is a multi-front war that, as I’ve discovered, it will be equally hard-fought.

Bowling Alone

The movement to address loneliness and social isolation has been simmering for decades. Harvard’s Robert Putnam first identified the impending crisis 25 years ago in a landmark essay titled “Bowling Alone.” In the essay, which later yielded a popular book of the same name, he pointed a spotlight on institutional, technological and societal changes that diminished Americans’ social connectedness in the late ‘60s and after.

Putnam also surfaced a few prescriptions for addressing the problem, including things like service-learning programs, more interactive cultural and artistic endeavors, and technologies that reinforce face-to-face interaction. (The latter idea actually served as the inspiration for Meetup.com.)

Notably, Putnam also prescribed more tight-knit connections at work. I’ll return to that one in a moment, in the context of healthcare

Loneliness as a Health Problem

I was lucky enough to study under Putnam in college in his very first seminar on the topic, and I very much took his teachings to heart. Later, when I became a physician, I discovered that in addition to what I’d learned from Professor Putnam, I also began to understand that loneliness often forms a pernicious ecosystem within which chronic illnesses can flourish.

Socially-isolated patients miss appointments more frequently. They skip medications more often. They rely heavily on unhealthy coping mechanisms like smoking, alcohol or drug abuse. Many of them report that without loving connections to family or friends, they simply grow less interested in living life, so why would they invest themselves in everything that’s needed to stay healthy?

Despite all the above, medical systems were slow to do anything meaningful to address the growing epidemic of loneliness. So when I was appointed the leader of CareMore Health (a division of Elevance), which delivers care to seniors with chronic illnesses, I created the industry’s first Chief Togetherness Officer to lead the company’s response. Our Chief Togetherness Officer reported straight to me, and she had a significant budget and staff that rivaled other clinical divisions in the company.

Among that team’s duties: work with clinical staff to identify socially-isolated seniors. The program’s staff or – even better – volunteers within the company called socially isolated members each week just to talk and sometimes visit them inside their home. The results were legendary inside the company, with some seniors (and employees) reporting that their interaction with the program wasn’t just the highlight of the week – it led to more socializing with others and, as they often put it, gave them more reason to live.

Notably, the callers and visitors often spoke about their health to the clinical team, alerting them to situations like mental or physical decline, that led to life-saving visits from our doctors. This video with one of our earliest members, Virta—tells the story better than I ever could.

I helped establish a similar program at the company I now lead, SCAN Group, which serves seniors across several western states. We, too, have a Chief Togetherness Officer and our program is staffed largely by our Peer Advocates, who themselves are older adults as well as SCAN employees. Data shows that talking to peers with whom they can relate and share common experiences has benefited SCAN members. The program also includes virtual “learning communities,” where people with shared interests gather and connect, be it for help writing their autobiography or to discuss challenging topics like grief and loss.

A New Social Compact

As proud as I am of such measures, they’re ultimately Band-Aids on a badly fractured culture. We need nothing short of a new social compact in this nation. This became clearer than ever during the height of the COVID19 pandemic—when we were literally forced into isolation.

How many of us know our neighbors, let alone have brought them a gift or a meal, or simply checked in with them? How many of us do the same with parents or other family members? How many of us take the chance to peek into the next cubicle (remember those?) and ask a new colleague how their work is going, and maybe even discuss it over lunch.

Putnam pointed out that such gestures are anything but empty; rather, they can generate social capital and thereby lead us to a feeling of greater responsibility to one another and to our surrounding communities.

I can hear skeptics seizing on that word – responsibility – as if anyone needs another thing to feel responsible for these days.

I’d argue that social connectedness is far from a burden, though. It’s actually a liberating force. Ask any volunteer how they feel after they’ve given their time and sweat to an effort that by design makes other people happier: almost always they feel like they’ve gained much more than the experience cost them.

Health Workers

Importantly, when it comes to all the above prescriptions, they’re especially critical for healthcare workers and their leaders.

The reason is simple. In the effort to help Americans quit smoking in the 1960s, our doctors played a key role in leading by example. They quit cigarettes at a much faster rate than the general public, and they did it publicly, with their patients, families and friends quickly getting the message that the health hazards were real.

Our nation’s health practitioners must be supported well enough by industry leaders to do the same when it comes to loneliness. Especially as we emerge from the pandemic, physicians, nurses and other frontline medical professionals have been overworked, underappreciated and often insufficiently compensated, to the point where many of them simply feel undervalued or unseen.

If there’s fertile ground for loneliness, it’s a situation where people feel unseen.

Healthcare leaders must commit to not just preach about loneliness among patients, but to take concrete steps to alleviate the problem in our own workforce. It can take the form of employee affinity groups, or budget for out-of-office celebrations and activities, or simply having managers visibly and sincerely checking in on their staff members. We must reverse the “line worker” mentality that has invaded the management model and parlance of many healthcare institutions—and stopped seeing healthcare workers as people who do sacred, emotionally taxing and complicated work.

Whatever it is, leaders must hold themselves accountable for measuring and reducing their staff’s feelings of social isolation. We can talk about the problem until we’re blue in the face, but until we show our patients and colleagues that it’s a problem worth solving, they’ll pay little attention.

The Surgeon General has certainly thought of many of these elements as he’s designed his ground-breaking new anti-loneliness initiative. But this initiative will no doubt evolve, and every one of us needs to be all in for the entire battle.

The more we can lean into his solutions and add our own, the faster we can get to a healthier society.