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Surgeоn Generаl: We Hаve Becоme а Lоnely Nation. It's Time to Fix ThatBy Vivek H. Murthy (2023) The surgeon general of the United States is the leading spokesperson on matters of public health in the federal government. In this opinion essay, Dr. Vivek Murthy — surgeon general under Presidents Obama, Trump, and Biden — writes about loneliness. A patient of mine once shared with me a most unusual story. He had worked for years in the food industry with a modest salary and humble lifestyle. Then he won the lottery. Overnight, his life changed. He quit his job and moved into a large house in a gated community. Yet as he sat across from me, he sadly declared, “Winning the lottery was one of the worst things that ever happened to me.” Wealthy but alone, this once vivacious, social man no longer knew his neighbors and had lost touch with his former co-workers. He soon developed high blood pressure and diabetes. I thought about his story in 2017 when I found myself struggling with loneliness. My first stint as surgeon general had just ended. I was suddenly disconnected from the colleagues with whom I had spent most of my waking hours. It might not have been so bad had I not made a critical mistake: I had largely neglected my friendships during my tenure, convincing myself that I had to focus on work and couldn’t do both. Even when I was physically with the people I loved, I wasn’t present — I was often checking the news and responding to messages in my inbox. After my job ended, I felt ashamed to reach out to friends I had ignored. I found myself increasingly lonely and isolated, and it felt as if I was the only one who felt that way. Loneliness — like depression, with which it can be associated — can chip away at your self-esteem and erode your sense of who you are. At any moment, about one out of every two Americans is experiencing measurable levels of loneliness. This includes introverts and extroverts, rich and poor, and younger and older alike. Sometimes loneliness is set off by the loss of a loved one or a job, a move to a new city, or health or financial difficulties — or a once-in-a-century pandemic. Other times, it’s hard to know how it arose but it’s simply there. One thing is clear: nearly everyone experiences it at some point. But its invisibility is part of what makes it so dangerous. We need to acknowledge the loneliness and isolation that millions are experiencing and the grave consequences for our mental health, physical health, and collective well-being. This week I am proposing a national framework to rebuild social connection and community in America. Loneliness is more than just a bad feeling. When people are socially disconnected, their risk of anxiety and depression increases. So does their risk of heart disease (29 percent), dementia (50 percent), and stroke (32 percent). The increased risk of premature death associated with social disconnection is comparable to smoking daily — and may be even greater than the risk associated with obesity. Loneliness and isolation hurt whole communities. Social disconnection is associated with reduced productivity in the workplace, worse performance in school, and diminished civic engagement. When we are less invested in one another, we are more susceptible to polarization and less able to pull together to face the challenges that we cannot solve alone — from climate change and gun violence to economic inequality and future pandemics. As it has built for decades, the epidemic of loneliness and isolation has fueled other problems that are killing us and threaten to rip our country apart. Given these extraordinary costs, rebuilding social connection must be a top public health priority. It will require reorienting ourselves, our communities, and our institutions to prioritize human connection and healthy relationships. The good news is we know how to do this. First, we must strengthen social infrastructure — the programs, policies, and structures that support healthy relationships. That means school-based programs that teach children how to build relationships, workplace design that fosters connection, and community programs that bring people together. Second, we have to renegotiate our relationship with technology, creating space in our lives without devices so we can be more present with one another. That also means avoiding online dialogues that amplify judgment and hate instead of understanding. Finally, we must take steps in our personal lives to rebuild connection. Small actions can make a big difference. Research shows that connection is linked to better heart health, brain health, and immunity. It could be spending 15 minutes a day reaching out to people we care about, introducing ourselves to neighbors, checking on co-workers, sitting down with people who hold different views, or seeking opportunities to serve others. Helping people is one of the most powerful antidotes to loneliness. If loneliness and isolation have left you struggling, reach out to someone supportive or to health care providers. If it is a crisis, call 988. When you go through major social changes, be open with your providers, since this may help them understand and manage health effects. For me, it took more than a year of struggling with the pain and shame of loneliness, but I eventually found my footing. I didn’t do it on my own. My mother, father, and sister called me every day to remind me that they loved me for who I was. My wife reminded me that the light she had seen in me when we first met was still there, even if I couldn’t see it. And my friends committed to regular video calls, texts, and conversations about the issues that weighed on our hearts and minds. During one of my lowest lows, the people in my life patched me up with their acts of love and connection. It is still a work in progress, but years later, in my second tenure in public service, I am making a much bigger effort to build and maintain my relationships. I am a better father, husband, friend, and surgeon general as a result. Every generation is called to take on challenges that threaten the foundation of society. Addressing the crisis of loneliness and isolation is one of our generation’s greatest challenges. By building more connected lives and more connected communities, we can strengthen both individual and collective well-being and be better prepared to face the threats confronting our nation. This work will take all of us — schools, workplaces, community organizations, government, health workers, public health professionals, individuals, and families — working together. And it will be worth it, because our need for human connection is as essential as food and water. The joy I felt being reconnected with my friends and family is possible for our nation.