When people think of the public health issues that have been pet priorities for surgeon-generals, physical health concerns usually come to mind. Smoking. Immunisations. Obesity. Preventing the spread of the Aids virus.
But Dr Vivek Murthy, who became the United States surgeon-general in late 2014 after a lengthy confirmation battle over his remarks about guns being a healthcare issue, added emotional well-being and loneliness to his list of big public health worries.
Now out of office, he's writing about the impact of the workplace on those issues, taking his concerns to employers and speaking out about how the "loneliness epidemic" plays out on the job.
In a new cover story in the Harvard Business Review (HBR), Dr Murthy treats loneliness like a public health crisis, and the workplace as one of the primary places where it can get better - or worse. "Our social connections are in fact largely influenced by the institutions and settings where we spend the majority of our time," he said in an interview with The Washington Post. "That includes the workplace."
In the article, Dr Murthy writes that "we live in the most technologically connected age in the history of civilisation, yet rates of loneliness have doubled since the 1980s".
The Post spoke with Dr Murthy about what leaders can do, why he calls it an "epidemic", and why he didn't focus more on employees being overworked in his essay. The conversation has been edited for length and clarity.
Q What inspired you to take this on as an issue?
A When I began my tenure as surgeon-general I did not think I would be talking about loneliness and emotional well-being. But when I was travelling to communities across the country I found that loneliness was a profound issue that was affecting people of all ages and socio-economic backgrounds. This is true in urban areas, in rural areas, in the heartland and on the coast.
As somebody who trained as a doctor, I also found that in medicine we get very little guidance on how to approach emotional well-being. We don't often screen patients for loneliness. And many clinicians aren't clear about the strong connection between loneliness and the very health problems we are trying to address, often with medications and procedures.
When you look at the data, what's really interesting is that loneliness has been found to be linked to a reduction of lifespan. The reduction in life span (for loneliness) is similar to that caused by smoking 15 cigarettes a day, and it's greater than the impact on lifespan of obesity.
So if you think about how much we put into curbing tobacco use and obesity, compared to how much effort and resources we put into addressing loneliness, there's no comparison. Look even deeper, and you'll find loneliness is associated with a greater risk of heart disease, depression, anxiety and dementia. And if you look at the workplace, you'll also find it's associated with reductions in task performance. It limits creativity. It impairs other aspects of executive function, such as decision-making.
Q Why focus on work? Loneliness is obviously something that affects other parts of people's lives, too.
A What's striking about the workplace is that people spend a significant amount of their time there - eight hours a day, and in many cases more. For people who may not have a lot of social ties outside of work, your place of employment can sometimes be your primary social circle. This is why the workplace is so important.
Most people go to work wanting to enjoy their relationships with the people they're working with, wanting to feel like they are contributing to something meaningful in the world. But that is not the experience many people have. Many people feel that the folk they're working with are work colleagues, but they wouldn't call them friends. They wouldn't describe them as people they can trust.
If you think about how much we put into curbing tobacco use and obesity, compared to how much effort and resources we put into addressing loneliness, there's no comparison. Look even deeper, and you'll find loneliness is associated with a greater risk of heart disease, depression, anxiety and dementia. And if you look at the workplace, you'll also find it's associated with reductions in task performance. It limits creativity. It impairs other aspects of executive function, such as decision-making.
DR VIVEK MURTHY, former US surgeon-general, on the impact of loneliness.
And there's a real lost opportunity there, because when people have strong connections with the people they're working with, that can not only improve productivity and the overall state of the company but it can also improve their own health.
Traditionally, we thought an employer caring about health was primarily about them ensuring an employee has health insurance coverage. That's important, but it's not the only aspect of health.
When most people think of public health crises, they think of the flu or other physical diseases. We have enough trouble in America just recognising mental health disorders; "loneliness" has the potential to be even more amorphous and hard for people to take seriously, don't you think?
Traditionally, anything related to our mental or psychological state has been looked at as a choice. And this is a real challenge. We know that mental illness isn't always something people choose. We know that substance use isn't always a path people choose. And we know loneliness isn't always a state people choose.
When people have diabetes we don't say: "Why do you need medication? Why do you need to see a doctor? You should be able to suck it up and deal with it on your own."
I think of these as collective problems that we have to solve with collective solutions.
Q You suggest in the article that things like office happy hours are not enough to build the community at work that you're talking about. What kinds of tangible, specific things do organisational leaders need to do?
A I don't want to convey the idea that there's no role for happy hours. That can be a starting point. But in addition to that, what we need to do is create opportunities for colleagues to learn about each other at a deeper personal level. People want to be understood and appreciated as individuals who are more than a job. They are mothers and fathers. They are people with passions outside of work. They are community members.
In the surgeon-general's office, we had a five-minute practice during our weekly staff meetings: We would give an individual the floor for five minutes and they would tell their own story. Some people focused on their family, other people focused on experiences they had before they came to the office, some people focused on what their dreams are for the future.
But in that brief five minutes, people were able to give a window into their lives we didn't see. Of everything we discussed in those weekly staff meeting, those five minutes were the most interesting.
I encourage leaders to evaluate the current set of conditions in their workplace. It can be done through surveys, it can be done through small group discussions, but it's important to understand the current state of your workplace.
This is not about creating a new programme or initiative. It is about changing culture, and that requires leaders to lead by example. You have to model what those relationships look like, and that includes demonstrating vulnerability.
I was at a well-known university about nine months ago, when I was in office, and I asked an audience of 400 faculty and students the following question: "How many of you look at emotions as a source of weakness versus a source of power?" And nearly every hand went up. This is the paradigm we have to flip in this country.
Q A lot of the article focuses on creating better connections between people at work. But we live in a world where people are constantly tethered to a digital device and expected to be working 24/7. That wasn't addressed much in the article. Why not?
A You bring up a good point and there's a lot more we could have added to this article. This practice of working in excess has become the norm in America. Over the last 10 to 20 years, when I think about my time in the workforce, I knew very few people who actually worked 40 hours a week. They see that as not working enough.
If you look at companies that get this, you find they're often encouraging employees to cut off access to e-mail on weekends and during vacation. You find bosses who are thoughtful about this, who are limiting how much outreach they do to employees on the weekends.
Q It just seems that if the article is about work and "how to fix loneliness", one of the biggest things is to stop making people work so hard or to hire more people, so people can get out and build those relationships that really matter in their personal lives.
A Those are important contributors. The topic of emotional well-being is one that's near and dear to me and one I'm planning to focus on during my time out of office. To the extent (employers) can help support people in their lives outside of work and protect time outside of work, they can help people enhance their emotional well-being.
Q It's powerful to hear a former surgeon-general talk about this as an epidemic. Why is it important to use that word?
A For better or worse, people understand the language of epidemics.
I think of loneliness as an epidemic because it affects a great number of people in our country but also because one person's loneliness can have an impact on another person. This is not a condition that is developing in isolation.
I talk about this as an epidemic because it's far more widespread than people believe and, like many illnesses that are related to our mental and psychological state, it gets swept under the rug and exists in the shadows. That's why I speak about this with the urgency that I do.
A version of this article appeared in the print edition of The Sunday Times on October 15, 2017, with the headline 'The loneliness epidemic'. Print Edition | Subscribe
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