In mid-May, U.S. Surgeon General Vivek Murthy issued an advisory titled, “Our Epidemic of Loneliness and Isolation.” The advisory notes that several indicators of isolation are higher in the U.S. than in the past; points out statistical associations between self-reported isolation and poor physical health outcomes, such as heart attack and stroke; and sets forth six “pillars”: areas in which Dr. Murthy believes federally funded action will improve Americans’ social interconnectedness.

Murthy’s first pillar is “Strengthen social infrastructure in local communities,” which he defines as increasing funding for government-run programs like public transportation and local libraries, as well as increasing the number of parks and public recreational facilities. Murthy also notes that volunteering and attending church can increase people’s sense of connection.

The second large action area is “Enact pro-connection public policies.” Murthy’s explanation of this pillar centers on federal agencies monitoring their own actions and ensuring that they don’t increase social isolation or worsen disparities across demographic groups. “[G]overnment has a responsibility,” Murthy writes, “to use its authority to monitor and mitigate the public health harm caused by policies, products, and services that drive social disconnection.”

“Mobilize the health sector,” the third area of focus, involves tasking medical professionals and para-professionals with monitoring social isolation. A major challenge to this step is the sheer lack of healthcare workers to be mobilized. The average length of a primary care visit is 18 minutes, and has been declining for years, according to the American Public Health Association and the Annals of Family Medicine. Thirty-seven percent of the U.S. population lives in an area deemed a Mental Health Professional Shortage Area by the Health Resources and Services Administration. One-quarter of primary care practitioners surveyed in 2022 reported plans to exit the workforce; more details of the ongoing “great resignation” in medicine are available from JAMA here: doi:10.1001/jama.2022.5074

The fourth pillar, “Reform digital environments,” focuses on setting up “safety standards” for the internet, including “age-related protections for young people.” The federal government successfully limited some individuals’ ability to be heard on large online platforms when agencies, including the FBI and the Dept. of Defense, asked companies like Twitter to ban some users, including journalists Matt Taibbi and Alex Berenson, in 2020 and 2021. Although effective in marshaling online vendors’ “trust and safety” functions to reduce the public’s exposure to dissenting views, the legality of the practice is currently being explored in the courts. Taibbi testified in March 2023 in Congress about the joint federal-Twitter censorship apparatus; Twitter settled with Berenson in 2022; hearings for Berenson v. Biden have not yet been scheduled.

Murthy has labeled young people’s use of social media apps particularly deleterious to their mental health; critics like UCSF epidemiology professor Vinay Prasad have noted that Murthy’s own policies led to increased use of social media by kids and teens. “School closures and preventing teens from interacting,” Dr. Prasad commented in a May 24 op-ed, “increased online social media use, particularly in lieu of in-person interactions.” The problems Murthy highlights, Prasad argues, are a “consequence of (or at least worsened by) the policies he supported when he advised candidate Biden, and the policies his administration enacted.” Prasad further notes that research has not demonstrated the benignity of heavy online use that excludes social media; spending hours alone online on a smartphone may be damagingly isolating.

“Deepen our knowledge” – pillar five – is Murthy’s plea for additional funding for research into “social connection and disconnection,” as well as campaigns to educate the public that loneliness and social isolation can be harmful. “Cultivate a culture of connection,” the final pillar, is a request that individuals, particularly “influencers,” promote values of kindness and respect, including through media and entertainment.