Former US Surgeon General Vivek Murthy: Is Technology Fuelling a Loneliness Epidemic?

0:00Vivek Murthy:And that was the badge that one of his grandfathers used to badge into the factory when he would work at the Iron Mill. And it was a sign of respect and absolutely was a challenge. In other words, don't let me down. There's a lot of writing on this. Today on the podcast, we're joined by Dr. Vivek Murthy, who served as the 19th and 21st U.S. Surgeon General. Dr. Murthy's work has transformed our understanding of the forces that shape our health. As Surgeon General, his initiative shaped national and international conversations. He has drawn attention to critical and underappreciated health issues, particularly the epidemic of loneliness, but also the impact of social media on youth mental health and health worker burnout.

0:45Speaking to patients and from his own experiences, Vivek Murthy noticed the growth in global loneliness, declaring it a public health concern. He wrote an instant New York Times bestseller about it, Together, Loneliness, Health, and What Happens When We Find Connection. In the book, he studies loneliness and shows its role in some of the greatest modern ills. Not just anxiety, depression, addiction, and violence, but also real physical impacts, like the increased risk of coronary heart disease and stroke. He also reveals that it's fixable and simple to implement. In this episode, we talk about loneliness.

1:21Why are so many people so lonely? What does it do to our health and what can we do to improve our connection with others? Welcome Vivek. Thank you so much. It's good to be with you. Let's start by defining loneliness. What does loneliness mean to you? Well, loneliness is a subjective feeling. It's the feeling that the connections we need in our life are greater than the ones we actually have. And in that gap, we experience loneliness. And it's in contrast to a objective measure of isolation, which is more a measure of the number of people we have around us. This distinction is important though, because you can be in a situation where you're surrounded by lots of people, so you're not isolated.

1:59But if you don't necessarily feel connected to them, if you don't feel like they're people who understand you, who you can be yourself with, then you may feel profoundly lonely. And unfortunately, that's how many people in the world feel today. Give us a sense of the scale of it. That's the thing that really jumped out reading your book. And I don't think many people grasp how serious, but also just how widespread loneliness is. Yeah, it is shocking just how common a challenge this is. And I think one of the reasons it's shocking is because we don't talk about it very often. So often we'll see people on the outside and think, oh, they seem like they're perfectly happy.

2:34They're posting pictures of parties and family vacations and their family just doing all kinds of day-to-day stuff together, like having dinner together. They must not be lonely at all. But that can often obscure and hide the fact that many people are very quietly struggling with loneliness. Here's a scale of what we're dealing with. Across the world, according to a recent World Health Organization report that a commission that I chair helped put out last June, there are about one in six people in the world who struggle with loneliness. That's a lot, one in six. But in certain countries, it can be even higher.

3:10If you look at the United States, for example, where I live, about one in three adults are struggling with loneliness. But if you look at young people, the number goes even higher. It's closer to one in two. So this is a real challenge, especially in countries that have modernizing cultures, which have a lot of benefits, but unfortunately have also come at the expense of our connection to one another. That's fascinating. You mentioned modern culture being kind of a strong correlation with loneliness. What do you think it is about modern culture in the modern world that is making us lonely? You know, I thought about this a lot because I, you know, I grew up, you know, in one of these modern cultures.

3:46I grew up in the United States. And I think it's actually a few things. I wish there was just one thing, a factor that we could address. But here's what's been happening. I think as time has progressed in recent decades, we found ourselves, one, moving around more, often changing jobs more. And that comes with certain benefits. But it also means that we tend to leave communities behind. We also, in the last half century or so in the United States, And I believe in many other countries, too, we've seen a decline in participation in the institutions that used to bring us together. So think about recreational leagues, service organizations, faith organizations.

4:24We see participation having declined in many of these organizations over time, which means that those forces that bring us together aren't nearly as strong. And then more recently, in the last few decades, we've seen the impact of technology on our lives. Again, a lot of benefits there, a lot of conveniences, efficiencies we've gained from technology. But what we've also seen is tech also means increasingly we can use services that require us not to see people. I can have my groceries delivered to my house. I can get virtually any product that I want delivered to my home as well by shopping online without having to go to a store or see people in transit to the store.

5:01But when it comes to social media in particular, that form of technology, we have found increasingly that there's more and more data pointing to the fact that it's had more harmful effects on us than we recognized, especially in early years. And especially for young people, I worry that those effects have often led them to feel like their self-esteem is taking a hit as they're immersed in this culture of comparison online. They end up spending more time online than offline. And that makes in-person interactions, as they often tell me, feel more awkward and harder. And ironically, even though you're virtually connected to other people, again, if you're in a performative environment, one where you don't feel like you can be yourself, where a lot of it is about comparison, if you're getting bullied and harassed online, as too many young people are, then you can often feel actually less connected to people than you did even before.

5:49So all these forces together have led to us being more lonely and isolated. And again, the answer isn't to go back, you know, 75, 80 years into the past and discard all of the technology that we use now or the conveniences we've gained. But it's to ask ourselves, what's actually helping versus hurting us, especially in the technology that we're using? And how can we mitigate for some of the effects of disconnection by proactively building the social infrastructure that we need to create and support healthy relationships? We're going to talk quite a bit about technology and social media. We're going to do a proper deep dive there.

6:24But so is it fair to say that we've gained freedom as individuals to move around the world, to kind of pursue our choices, pursue our careers? But in that process, we've become somewhat unmoored from the communities that root us and the responsibilities we have to them. And so we've gained something, but we've certainly lost something in that journey as well. I think that is true. And in fact, if you look at many traditional cultures, many of them were based in this notion of a collective, right? Like they weren't, again, traditional cultures, I'm not saying that they were perfect, but one thing that they had, and my father and mother came from one of these cultures in India.

6:58And in fact, my father grew up in a very small village that had this very deep sense of connection. People looked out for each other. They supported each other. They didn't have a whole lot. In fact, my father grew up in pretty dire poverty. But what people did is they shared what they had with each other. They looked out for each other's kids. And for example, when my father's mother died when he was 10 years old from tuberculosis, the village stepped in and became surrogate parents for him and his five siblings. So that was just what life was like in many of these societies. It wasn't always easy.

7:29There were some downsides, but folks felt a part of something and people looked out for each other. My father told me a very interesting thing. He said that he never, as hard as his life was, he never really knew what it meant to be lonely until he left the village. And, you know, he eventually made his way to England where my parents lived for seven years. They lived in Canada for a couple of years. They eventually moved to the United States. And he found beautiful, wonderful things. about the community in all three countries but he felt lonely in a way that he never had in his village and i found that to be quite striking because what the folks there lacked in material possessions they more than made up for in some ways in terms of their relationships let's talk about men and male relationships so i think i'm right in saying that 27 of men only have six or more close friends so a pretty small proportion of men in the u.s have have six or more close friends and often you know the perception is that it's older people who struggle but actually young men in particular are really suffering from loneliness why do you think that is well i think culturally we've told men that there's a certain way to be a man and that it involves number one being completely independent which means you don't rely on anyone that it also means uh being relatively stoic which means you don't express your emotions especially your pain And the one circumstance where maybe it's okay to express some of that pain is in a romantic relationship, which not only narrows who you can talk to, but also puts a lot of pressure, by the way, on that relationship.

9:02I think those are some factors. But I think the other thing that's happened to young men, especially over the years, is that I think in our education system, I think we find that there are a lot of young boys who are increasingly falling behind and who are tagged as having emotional or behavioral challenges, which often can lead them to even be further isolated in the system. and now what you have in terms of technology, not just social media, but you think about gaming, you think about other platforms that young boys are increasingly spending their time on, you have technology that's further isolating young men from each other.

9:38It's very interesting. I'll tell you about that. I'll give you an example of a story that I encounter all the time. I'll run into a couple in the airport or at an event and they'll tell me, I'll ask them, how are your kids doing? And they'll say something like, you know, my daughter's doing okay. Hey, she's, you know, things have been tough, but she's working hard and she made her way and she graduated from college and she has a job. We're very excited about it. Where, you know, she's met somebody who we really like as well. So, you know, she's doing well overall. Oh, how's your son doing? Well, you know, our son, you know, he's finding his own way.

10:11He's struggling a bit. You know, he doesn't really have a job right now. He's staying with us until he finds his way. honestly, he's spending a lot of time, you know, just in the basement gaming, and we don't quite know what to do about it. But we're hoping that, you know, eventually that he'll find his way forward. That is a incredibly common story that I hear from people of all walks of life. And I do think that right before our eyes, young men and boys are slipping into this profound, profound set of challenges that's leading to not only more loneliness and isolation, but to mental health challenges as well, including depression and anxiety.

10:53And by the way, this issue of loneliness and isolation, this is not just a health issue, although it is a profound health issue. And on that note, we have found in some of the research that I put together in a Surgeon General's report I issued in 2023, that people who struggle with this sense of social disconnection, they have a higher rate of depression and anxiety and suicide, but also higher rates of heart disease and higher rates of dementia and premature death. So much so that the life-shortening impact of social disconnection is comparable to smoking and to obesity. But again, it's not just limited to health and as profound as those health effects are, but people who are socially disconnected, who are lonely, they also struggle with productivity in the workplace relative to folks who are not, it negatively impacts your educational outcomes.

11:39And it contributes to the kind of division and polarization that we're seeing in the world today. It seems like all roads lead to technology in many ways for this loneliness epidemic. Do you think that technology has accentuated the problem? Or do you think technology is the cause of the problem? Hearing you speak, it sounds, you know, I feel sorry for young men and their teens growing up today. There's such macro forces weighing on them. It seems almost impossible that they would be able to overcome that and not be lonely. So curious what you think about that. I know Tommy has strong views on social media.

12:10I'm off Instagram, I'm off X, and I'm very glad it only emerged at the end of my teens. But yeah, what do you think about that? Well, Cameron and Tommy, I mean, I'll tell you, I feel the same way. If I grew up today, I think I would be in a much worse place than growing up in the times that I did, you know, in the 1980s and 90s. And I think it's because the digital environment is profoundly different. I don't think technology is the sole cause of loneliness and isolation, but I think it is an important contributor. And I will also say somebody who's a believer in technology. You know, I spent seven years building a technology company before I served in government.

12:46I'm a believer technology has the power to make our lives better. But whether it helps or hurts us is determined by how we design it. And that ultimately drives how we use it. And what I would love to see are a generation of technology entrepreneurs who are committed to using technology to strengthen and better humanity. And that means to strengthen our connection to one another, to help us build the skills we need to succeed in the world that helps us actually be more productive in the workplace. and to derive joy from the things that we know reliably have given us joy over the years, a sense of engagement in each other's lives, like meaningful relationships, a sense of purpose.

13:28I think too often, though, what we see is technology that is doing the opposite of that. That's pulling us more and more into a world where our real-life connections are being substituted for by online connections, which are often of lower quality, where the time that we would normally spend with other people or sleeping or being physically active or learning are instead consumed by time that's spent scrolling online. And the saddest part about this for me is when I talk to young people in particular about this, they are not oblivious to these negative effects. In fact, they are the ones who often would talk to me about this when I would go on the road.

14:06They're the ones who put this on my map in a way as a top priority. Because what they said is we want to get off of these devices and platforms, but it's really hard to. We feel like we're addicted to them. And they're not the only ones, by the way. And this is not by accident. You know, the platforms are often designed, social media platforms specifically, to maximize how much time we spend on them. That's what the business model is based on. But again, if that comes at the expense of the health and well-being of users, that's too high a price to pay. And that's why I think that if we don't change the direction that we're going in right now, and we can talk about how to do that, I worry that we are going to take this natural experiment that we embarked on 20 years ago of unleashing social media on the population, and we're going to continue to see negative effects, which I think will be compounded in the age of artificial intelligence, where we're now seeing AI chatbots and others, which are accelerating this drive to replace human relationships with artificial ones.

15:06Yes, we want to talk to you about that, about AI. But before we do that, Vivek, our most watched episode on YouTube, until you, I'm sure I'm confident you'll outdo this, but the most watched one so far was Alain de Botton, the philosopher talking about success and the meaning of life. And one of the quotes that really stuck with me from Alain was that the greatest challenge of a modern marriage is to be more interesting than your partner's smartphone. And I think it speaks to this point you're making, which is it's not just that technology is separating us from making new connections, but it's actually separating us from existing connections.

15:38I remember this very, very poignant meme that was circulating online a few years ago of a couple lying in bed with their backs turned to each other, holding their phones, but the phones had been superimposed out. And it just kind of made the point of how absurd it is the way that we don't talk to the people around us because we're stuck on a phone the whole time. How do we solve this? What is actually the route to dealing with what everyone knows? You're talking about the kids who say to you they wish they could get off their phones. Australia has banned social media for under-16s. Is that the really simple route we all need to go down?

16:10Well, here's what I find hopeful. I actually think this is a problem that we can solve. I don't think we're consigned to the fate that we find ourselves in today. But here are a few things that we're going to have to do, and it's not going to be simple. Number one, we have to start by talking more openly about how social media and technology more broadly are impacting our lives. We actually don't talk about that nearly as often enough as we should, and that leads to a sense of further isolation and shame. I see this particularly among parents who are struggling to manage social media in their kids' lives, but they feel like they're a failure because they don't know how to do it.

16:42But they often don't talk to other parents about it. So that's number one conversation. The second thing that we have to do is we have to create technology-free zones in our life. It doesn't mean we have to give up all technology 100 % of the time. What I am saying, though, is that we need to have some space in our life where we are focused on what is present in front of us, each other, whether it's strangers, if we're in a coffee shop, ourselves, just being able to listen to ourselves, think and process, which we don't do really much anymore. And so what are those tech-free zones? Well, they could be, for example, mealtimes, when we decide that we're just going to focus on the people at the table and we're all going to put our devices away.

17:21This is a great thing for families to do. Another way of creating tech-free zones is could be around bedtime, saying, okay, an hour before bed, we're all going to charge our devices in the kitchen. We're going to go to bed in the morning. We're going to get them. And as crazy and countercultural as it seems, this is actually how we used to sleep. We used to sleep without the kind of constant distraction and disruption that we had, which is better both for quantity and quality of sleep. And the lack of both of those is actually impacting mental health as well as physical health. The third thing I think we've got to do at a societal level is ask how we can both create more social infrastructure, and those are programs and opportunities for people to actually connect and get together in real life, as well as put in place more safety precautions and standards that will help protect people from some of the harmful effects of technology.

18:11And this is one of the places where I think government has a role. You know, when cars rolled onto the scene, you know, many decades ago, and when we started seeing high levels of auto accidents and related deaths, we could have just said, well, that's just the way life is. That's the price of modern technology. Or we could have said, you know what, we're going back to horses and buggies. And we actually found a third path. We said, we want to keep modern technology, in this case, cars, but we want to make it safer. And in the United States and other countries around the world, we put in place safety standards that got us seat belts and airbags and crash testing and a host of other interventions that ultimately made cars safer.

18:51But we actually have not done that at all with social media in the United States. And other countries are trying to take steps forward. What Australia has done, as you mentioned, with banning social media for kids under 16. That I think is actually a very understandable and reasonable response in an environment where the platforms have no safety standards around them. And the more data we get shows more evidence of harm. So I hope we get to a place where we can actually have laws that require data transparency, require companies to demonstrate the safety of their products and subject themselves to public audits.

19:26Until we get to a place where we can demonstrate safety though, In my opinion, these platforms are not safe for kids to use. And I do worry for many adults as well that the net effects are ultimately often harmful. Do you wish that when you were Surgeon General, either under Obama or Biden, do you regret not pushing for a ban? Well, actually, when I was Surgeon General under President Biden, I did issue a report on social media's impact on youth mental health. I did say that social media was, in fact, not safe for adolescents and was supportive of efforts to restrict the use among adolescents.

20:02I said those publicly. I said those in my reports. And the challenge, though, is that even though we had actually at that time, subsequently, members of Congress who stepped forward to put forward bills, they ultimately never passed those into law. And so the lives of young people did not change. And that is one of the things that I find most troubling is that, you know, there are a lot of things that legislators do each and every day. You know, most of them are important. But what could be more important than protecting the well-being of our children? And each day, you know, I either get messages or encounter young people and their parents who have been harmed by social media.

20:42And in the face of that, I think the failure to put in place safety standards and meaningful restrictions on use for adolescents, I think it's a black mark on many of our legislatures. And I think that unless we change that, I think we're sadly going to see more people hurt because of these technologies, which have no proven safety record. So to summarize, I guess, four major things you think we need to do. we have to have the conversation as a society as individuals about what social media is doing in particular two we need to take individual responsibility to have some tech-free zones as a family and as individuals three you think we do need to regulate in some ways and then four you talk about kind of social infrastructure and these solutions and i'd love to double click a bit more on what that infrastructure could look like and what you think should be provided by the state versus you know obviously we're very interested in entrepreneurs solving solutions at giant that's what we do here day to day, particularly technology entrepreneurs.

21:40So, you know, we kind of, I guess, have a dual view. I'm very curious as to what kind of solutions you think both the state and entrepreneurs can provide to this problem of loneliness. Well, one thing, look, I think there's actually a lot we can do without government here when it comes to building social infrastructure. I think workplaces, for example, can think about how they can strengthen social connection in the workplace. There are very simple, low cost ways of doing that. In our office, for example, when I was in government, we used to once a week have what we called our humans of OSG exercise that was suited for Office of the Surgeon General.

22:12But we would bring our team together for our usual all-hands meeting. And we would take 10 minutes during that time where we would ask one person on the team to interview the other about their life, about anything they wanted, as long as it wasn't about their current job. And what was very interesting is how much we learned at a human level about the folks that we were working with. and we learned things about them, whether it was about hardships they had growing up or who their heroes were when they were kids or what they actually thought they were actually doing in terms of a career and the things that changed their life around.

22:41We learned things that we often had not understood even despite being with these folks for a year or more. And so we came to feel a lot closer to them. It's a simple intervention we can make in the workplace and the school level as well. We can make decisions to actually help build the social emotional learning tools that kids need into the curriculum, as a number of schools are increasingly starting to do. But that recognizes that you don't just come into the world knowing how to build friendships and maintain relationships, whether it's in the workplace or in your neighborhood. We often need coaching and training on that.

23:14And a lot of kids aren't getting that at home. And then finally, if you just think on a social infrastructure basis about the kind of programs that we have that can bring us together, recreational programs, think about faith organizations and what they often do to bring congregants together to get to know each other, support each other. If you think about other organizations like YMCAs and others, which used to bring people together, you know, just for service activities or just to come to get to know each other. Why isn't that happening now, though? Well, I think there are a couple of things.

23:44I think, one, a lot of these organizations have lost a lot of their funding and support. But the demand has also gone down. We're seeing participation in faith organizations has gone down, and there are complicated reasons for that. I think a lot of people have become distrustful of organized religion. But what's interesting is among young people, what's called spiritual hunger, desire for spiritual meaning in their life, is actually quite high, as reported on surveys. But they're not finding necessarily an institution through which to meet that need. But lastly, I just want to say about entrepreneurs, because this is very, very important to me.

24:18You know, I spent a number of years building organizations, initially nonprofit organizations, then a technology company, coming out of government. You know, I felt one of the most important things that I could do in addition to continuing to tell the story of why this issue is so important and bring policymakers together to address it is I also wanted to support entrepreneurs in their efforts to use technology and other forms of innovation to create opportunities for us to connect more deeply. It's one of the reasons I joined a venture fund as a partner and why now have ways to invest in entrepreneurs who are doing just that.

24:51And I think it's going to be really important because there are important roles for government to play here in helping to invest in research, elevating the importance of these issues, passing laws to make tech safer. But ultimately, I don't think this is a problem we can solve without the innovation and the ideas and the hard work of people on the ground. And those include entrepreneurs, particularly in technology. One more thing on technology that I'd love to ask you about before we come on to more solutions. And this is more on the negative side of it, but we haven't touched much on AI yet. And you mentioned briefly the influence of chatbots.

25:24That strikes me as we're about to make this whole thing much worse and highly intelligent chatbots who are going to play back to people exactly what they want to hear and do it in a way that is perhaps much easier to deal with than real human beings. It strikes me that we're setting ourselves up to go way deeper down the rabbit hole of people just confiding in their phone rather than their friends and their family and other potential people they can speak to. And I guess the analogy is like, you know, potentially a very bad therapist who just tells you what you want to hear and makes you become, you know, more of a narcissist, more lonely, all the bad stuff.