The Rich Roll Podcast - U.S. Surgeon General Dr. Vivek Murthy On America’s Epidemic Of Loneliness

Episode Date: September 25, 2023

I think it’s safe to say that many people are suffering, not just from major public health concerns and economic hardship, but also from loneliness—the prevalence of which has skyrocketed in recent years. Studies indicate that about half of U.S. adults have reported experiencing loneliness. The impact of this extends beyond a decline in mental health, increasing the risk of heart disease, dementia, stroke, and even premature death. It’s a problem today’s guest has officially labeled an epidemic—and has made his mission to ameliorate. Meet the 21st Surgeon General of the United States, Vice Admiral Dr. Vivek Murthy. Today Dr. Murthy explains how we arrived at this juncture of disconnection and why it is so vitally important to redress. We also discuss the compound effects of loneliness on our health as individuals and as a society, and what we can do to engender our lives with more connection, companionship, and community. It was an honor to host an important conversation with such an esteemed individual. I was deeply impacted by what he shared and suspect you may feel the same. Show notes + MORE Watch on YouTube Newsletter Sign-Up Today’s Sponsors: Seed: seed.com/RICHROLL Momentous: LiveMomentous.com/richroll  On Running: on.com/RICHROLL Modern Elder Academy: www.MEAwisdom.com Whoop: whoop.com/RICHROLL Inside Tracker: fitnessfuelslongevity.com  Plant Power Meal Planner: https://meals.richroll.com Peace + Plants, Rich

The Rich Roll Podcast. If we can't solve this loneliness problem and redress the mental health issues, what is the future of this country? What we need is nothing less than a major culture shift. If we don't consciously make rebuilding connection a priority in our individual lives and in society more broadly, then we will continue to see an erosion. What you're asking for is a revolution of consciousness. The ask is not small because the need is great.

I think it's pretty safe to say that there are a lot of people out there suffering right now. One out of every two Americans is experiencing measurable levels of loneliness, one in two people. That's more people than suffer from diabetes. Like, this is a huge problem. The rates of loneliness are even higher among young people. The impact of this, of course, is on our mental health,

but it goes beyond that. It's related to an increase in risk for heart disease, for dementia, for stroke, and even for premature death. Chronic loneliness can lead to a cascade of inflammatory factors in our body and that can increase our risk of illness. The 21st Surgeon General of the United States, Vice Admiral Dr. Vivek Murthy is someone I think it's fair to say has restored a certain gravitas to his office that has made him one of the most trusted voices in America on matters of public health. In this conversation I'm proud to host, Dr. Murthy explains how he arrived at this juncture and what we can all do to engender our lives with more connection, more companionship, and more community. It was an honor to host what I think is a vitally important conversation with such an esteemed individual. So without further ado, this is me and the Surgeon General of the United States, Dr. Vivek Murthy.

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Well, I'm delighted to meet you. I'm honored to be able to host you here today. Thank you for coming. Well, thank you for having me on, Rich. Excited to talk to you. We had a poll here in the studio as to whether you would show up in your full regalia, which you did. I'm very pleased to see you in your appointed dress.

And I guess that makes me curious around the nature of your charge, your mandate as Surgeon General. Like what is the mandate and what is the kind of legacy of this being a Naval position? Like you're a vice Admiral, right? So what does that mean exactly? Like that seems strange to the casual observer that it would be a military position.

Yeah, so it's interesting. The origin of our service is, it is an interesting story behind it. And it's the US Public Health Service that I lead. And it's one of the eight uniformed services in the US government. So it's not Naval. It's not Naval,

but the uniforms are very similar to the Navy. And the origins of the service actually do have a maritime sort of connection, which is that when the public health service was in its original earliest stages, it was set up as a service that would actually help protect the United States from disease that ships would bring in from the outside.

And so they would often stop the ships and it would be essentially a public health service officer who would go out, who would investigate the ships, see if things were okay or if the ship had to be quarantined and then in that way help protect folks in the mainland from the spread of disease. So sort of a public health, but also a national security charge from the get-go.

That's right, yeah. And over time, the service evolved in different ways, but that mission of protecting the public health of the country has always remained at the center. So today, we have 6,000 officers who are nurses, doctors, physical therapists, pharmacists, healthcare professionals across the board. physical therapists, pharmacists, their healthcare professionals across the board. And in their day jobs, they help serve in public health roles in various regions all across the country, rural and urban areas, every state.

But more broadly during emergencies, we deploy them to respond. So for example, when there are hurricanes or tornadoes, we send public health service officers to help shore up the healthcare system there to provide emergency care, to help support the public health apparatus. We deployed thousands of officers during COVID, during the Ebola outbreak in West Africa. Back in 2014, we also sent hundreds of officers to Liberia to help set up a medical unit called the Monrovia Medical Unit to help care for those who are sick. So our officers do an extraordinary job and I'm incredibly proud of them,

proud to be a part of the service. But it's for that reason that the Surgeon General wears a uniform and we follow the rank system that the Navy has. So that's why instead of, you know, I'm an Admiral instead of a General for those reasons. Right, I got it. It's interesting.

And in terms of the scope of your personal mandate, what is your charge? How do you describe what it is that you do? Yeah, so the Surgeon General has two primary responsibilities. One is to make sure that the public knows about critical public health threats and understands what steps they can take

to protect themselves and their families. And that traditionally has been around issues like tobacco, for example, but has also included infectious disease outbreaks, HIV, and it's included chronic illnesses like obesity. The other job of the Surgeon General is to oversee the US Public Health Service Commission Corps. And that involves managing this uniformed service of 6,000 plus

officers. For me, I would say, I actually never thought I would work in government. It was never an aspiration of mine. But what happened to me is back in 2013, when I was approached by President Obama's team about serving in this role. Number one, I was surprised that they had asked me because again, I was not necessarily looking to serve. But what did draw me to the role was the fact that this is one of the few roles in government that is a truly independent position where your job is not to execute the agenda

of a president or a party or any other group. It is to build an agenda based on what you believe are the public health needs of the country. And so your fidelity is to science and the public interest first and foremost. And I really like that about the role. And so it's been an incredible honor certainly to serve in the role now on two separate occasions. But the best part has been really being able to a sense of what I wanted to work on, that agenda was significantly shifted based on these conversations I had

with people I encountered all across America who really helped me understand what the problems, the deeper problems or the deeper root causes of what's hailing us. Yeah, and that's what I wanna get into. It is interesting that you have that level of independence. You basically get to wake up and decide what you think is important

based upon what you're seeing, hearing, studying, reading, et cetera. And then you get to deploy resources towards solving whatever that problem is. And I have seen that evolution and change. And you've arrived at a very interesting place where there's a lot of clarity around what it is that you're trying to accomplish

and the problems you're trying to address. And part of your mandate is, or the mandate of the office is to occasionally in your discretion issue these advisories, right? And I think probably the most sort of historically resonant one would be like Surgeon General Koop with his secondhand smoke. What was that, 1986 or something like that? Yeah. We all remember,

how smoking was his big thing, right? And it's not often that the Surgeon General issues these advisories, correct? That's right, yeah. These advisories are, the Surgeon General's office has historically produced a lot number of reports on tobacco and HIV, other subjects.

But these advisories are targeted documents that are issued on a shorter turnaround basis when there's an issue of urgent importance to call the country's attention to and to call the country to action to address. And there are a few of those that I have issued during my time because we've been dealing

with some urgent crises that couldn't wait. And so during our time, we've issued advisories on the youth mental health crisis, on the loneliness crisis, on social media and its impact on youth mental health based on common questions I was getting from parents. So yeah, these have been areas that we've chosen to focus on in addition to some more niche areas like health worker burnout, which also is presenting now an imminent threat to our emergency

and primary care in the country. And when you issue these advisories, what is the sort of mandate of those in terms of like, what are they capable of achieving? You're not writing legislation, right? They're policy initiatives, they are recommendations. So where's the, you know, what are the teeth in this and what are the kind of, you know, weaknesses in these advisories in terms of what they're capable of achieving? It's a really good question.

And you're right to point out these are not legislative or regulatory documents. They don't compel or require action. What they do is a few things. One is they will call the country's attention to a particular issue and help lay out why that needs to be a public health priority. The second thing they'll do is they'll lay out concrete actions that individual stakeholders can take. These might be schools, workplaces, government itself, individuals, families. So we'll lay that out often with a national strategy for how we can address that particular issue and then we take that advisory to various

audiences we'll actually work with legislators you know on the issue whether that's in helping them craft legislation advising them on legislation they're trying to put together or working directly with community organizations to do this as well to implement their part of the strategy. One reason that these are important, Rich, which goes beyond sort of traditional levers of power that we think about like funding, legislation, regulation, is that some of the important changes we have to make are actually cultural shifts. Some of the important changes we have to make are actually cultural shifts. And you can't mandate those, you can't legislate those, but these are issues that only happen if you call people's attention to an issue and layout

what kind of shift has to take place. And that, for example, in particular, is what we did on the issue of loneliness and isolation, was lay out not just the problem, not just the policy programmatic solutions, but laid out what kind of cultural shift we need to create together as individuals and communities to truly create a more connected country.

So that's the power of the advisories. I will say, if you look historically back, let's say at 1964, when Surgeon General Luther Terry first issued the very first product on tobacco from the Surgeon General's office. That similarly did not have, it wasn't a piece of legislation or regulation. But what it did do is call the country's attention to this problem, lay out some solutions and mobilize the country such that back then we had a 42% smoking rate in the country. And now we're looking at a level that's closer to 11 or 12%.

And that's because the community really responded, but it took a lot of longitudinal effort. And that's what we're gonna need on these topics as well. To identify a problem, draw awareness to it, to announce that this is indeed something that we should be expending our resources and attention on dealing with it is the first step and the acknowledgement aspect of it.

It is, yeah. And one of the things I came to appreciate during my time in government also is that if you put policies in place without building adequate public understanding and support for them, those policies are very tenuous. They can get turned around a few years later. They can lose funding support when people choose to switch their attention to a different topic.

It's only when an issue has a deep understanding and I would say buy-in from the public that we're able to actually create the sustainable programs and investment that we need to truly address an issue. And that's one of the places where our office can make a and investment that we need to truly address an issue. And that's one of the places where our office can make a difference, where we try to focus on making a difference is in creating that broader support awareness, but also in mobilizing communities to really take action,

recognizing some of these problems can't be solved by government alone. In fact, I would argue that nearly all of them require effort and leadership from communities as well. Well, certainly loneliness and isolation is not gonna be solved by government alone, right? That's right. So let's talk about that advisory first.

This is an advisory that came out in May of this past year. I wanna talk a little bit about the origin story behind that. In your book together and in your New York Times op-ed piece about this, you demonstrate a pretty rare level of vulnerability in recounting your own experience with loneliness and isolation as context for why this is an important issue. So talk a little bit about that and the decision to share that aspect of your personal life into all of this, which is something we don't typically see with people of your sort of stature and position. I have worked not just in public health, but in medicine more directly.

The more I've cared for patients over the years, the more I've just come to realize that these issues are just deeply personal for so many of us. We can intellectualize them in the form of reports, you know, and write cerebral news stories about them. But at the end of the day, like issues like loneliness, I think are very personal. We all have our own experiences with loneliness. We all know people likely in our lives who are struggling with loneliness and isolation. And I wanted to start there with the personal because that's truly how I come to this issue. I think about my own personal experiences. I think about the people I know and

care about who've been affected by loneliness. And that's a big motivator for me in addressing this. I think about the people I know and care about who've been affected by loneliness. And that's a big motivator for me in addressing this. But I also think that it's important for us to be able to be honest with each other about what we've been through. If we want to pull down this terrible curtain of shame that I think still surrounds the issue of loneliness

and that more broadly still surrounds mental health. And so I felt like the only way I could ask other people to do that, to be open and to share their own stories is if I was willing to do the same. And in my case, when it came to loneliness, I had many deep experiences with loneliness starting when I was a child, from thinking about those early days in elementary school when I was incredibly shy, introverted, had a hard time making friends, and I didn't really wanna go to school many days. I would make up the fact that I had a stomach ache on some days just to stay home.

I really hope my mother doesn't listen to this podcast because she was the one I had to convince him. So I've been told that some of those were fake. But the reason I didn't wanna go to school is because I just didn't wanna feel like alone again. I didn't wanna walk into the cafeteria yet another time and be scared that there would be nobody who would wanna sit next to me.

I didn't wanna be the person who was last picked, to be on a team at recess, not because I wasn't athletic. In fact, I was very athletic, but because I didn't really know the other kids well or have connections with them. And so like from a child, that period of my life, I experienced loneliness. I never talked about it because I felt a sense of shame about it. But then I kept seeing it in my own life, in the life of the patients I took care of eventually

when I became a doctor. When I was in med school, nobody talked about loneliness in the curricula. There wasn't a class on it. But I would say it was one of the most common things I saw in the hospital. And as a young doctor, I didn't know what to do when I was encountering patients who said, I'm all alone here and I'm really scared about my illness, but I have nobody to talk to. I have no family I can call. There are no friends who are coming by. Or yeah, it's time for me to go home. I'm having a hard time walking. I want to go home, but there's no one who can help me there. These stories of being isolated, being lonely, we just abounded in the hospital. And I felt ill-equipped to deal with it other than by lending an empathetic ear at the time. But it was really when I became Surgeon General and started traveling the country and talking to people, When I asked them, how can I be helpful?

That's when I started hearing these stories that went beyond my personal experiences that really spoke to this deep well of loneliness. And I'll tell you that people didn't use that word very often. They never came up to me and said, hi, I'm rich, I'm the vague, I'm lonely. But they described a life where they felt invisible, where they felt like they didn't matter anymore.

They didn't feel seen. And I was hearing that from a lot of young people as well, which really concerned me. Like kids who were on college campuses surrounded by thousands of other kids, but yet still felt profoundly alone. So all of these personal stories really went into informing how and why I decided to focus on this.

And lastly, the story I shared in the op-ed that I had written when our advisory came out, that was a particularly fresh one for me because it happened after my term as Surgeon General. My first term as Surgeon General ended abruptly and I found myself without a team that I had come to consider as family. And I had also neglected many of my preexisting friendships and that had left me also feeling quite alone. And so I had to contend with that loneliness. I had to contend with the sense of shame and failure that came with recognizing that I just didn't do a good job at staying in touch

with the people I loved and the people who loved me. And I had to deal with the scary question that often arises, which is, do they still wanna hear from me? If I reached out, would they still answer my call? Do they still love me anymore? So those are the things I always found myself grappling with. Hey, big shot, now that you're not in office anymore, now you call me?

Right, and at a time when they were in need perhaps, and I wasn't- You were unavailable. I was not available. Like, I still think back on that and I feel terrible, and these weren't conscious decisions where I was like, you don't matter to me, I'm crossing off our friendship. It was never that.

No, it's a common, I think it's a very common thing. I mean, it's very common what you experienced as a child. I think that's highly relatable to anybody who's listening or watching. But also somebody who is ambitious and has a demanding career, it's very common for that person, myself included, to lose touch with friends

when your time is very limited and it's your job and then it's your family. And there isn't a lot of room for anything else until you get a couple of decades down the line and you realize like you miss your friends, you haven't talked to them in a long time. But I found that those friends are often doing the same thing

and they're always welcoming when you make that effort to reach out. I'm sure you experienced that as well. Yeah, no, that's well put. And you're right. Because what I was reminded of by somebody who, an old friend I reconnected with during that time, who I confided in and told her,

hey, I'm really struggling here. And she said, Vivek, you know, your problem is not that you don't have friends. Your problem is you're not experiencing friendship. She said, the friends are there. They may be latent. You may not have talked to them, but pick up the phone and call them. And you'll be surprised that they still want to be there for you.

And it was one of those times that made me realize one of the great myths that we tell ourselves, which is that we will catch up with people later when we have more time, because that later never comes. And sometimes when we're less busy, they may be more busy. And it just sort of made me realize two things. One is that like later is really, it has to be now, like in terms of us making people a priority in our lives. But the second is that seeing in touch with people

doesn't have to involve massive amounts of time either. Sometimes it's the brief outreach that we make to a friend on the way to work, the five minutes we may call someone to say, hey, I'm thinking about you. Or it's sometimes simply picking up the phone when someone calls, even if it's to say, hey, I'm about to start this podcast with Rich and can I call you back later?

That 10 seconds of just hearing someone's voice can make such a difference. And it feels quite different from just texting them back to say, hey, I'll call you later. So, because I think we're hardwired to connect as human beings, even a little bit of authentic connection can go a really long way to helping us feel like we belong and that we are deeply connected to other people.

Loneliness isn't something that's new, but what is new is this epidemic of loneliness that currently defines our culture. The statistics as you lay them out are quite shocking. Like you say, one out of every two Americans is experiencing measurable levels of loneliness, one in two people. That's more people than suffer from diabetes.

Like this is a huge problem, right? So I guess the question I have is how did we get here? What are the tectonic plates that have led us to this state that we're in? Yeah, the numbers are quite shocking. And you're right that this is extraordinarily common. And as surprising as the one in two number is, the rates of loneliness are even higher among young people,

which surprises people who think, hey, aren't they connected by technology? Yet they are saying, whether it's in spite of that or in some cases because of the use of social media, that the sense of connection people feel has actually diminished. So how did we get here? Well, several things happened and we didn't get here overnight either. But I think that our sense of disconnection has been building for some time. So here are a few things that started to happen.

Over the last 20, 30 years, we have become more mobile, right? So we move more often for work, for school, and we often move multiple times, sometimes in a short timeframe. Whereas before that, people would often stay in the areas that they grew up in. They would stay connected to the people they were friends with in high school. They still lived around them. But as you move more, communities become more fragmented. So that's sort of one piece. The second thing that has happened is historically, going back generations, people tended to live in extended family environments. And so, you know, not that that was all simple or that it was all good, you know, but those environments, you know, more often than

not ensure that people were connected with others. The shift away from, you know, but those environments, you know, more often than not ensure that people were connected with others. The shift away from, you know, from extended families has been one more factor. I mean, it's led people to live in smaller and smaller circles. But the other factors I think that are important here is that we've also seen over the last half century a significant decline in participation

in the community organizations that used to bring people together, particularly faith organizations, but also service organizations, recreational leagues, youth leagues. These used to bring folks together from different walks of life to get to know one another, to break bread together, to engage in activities together. But that opportunity has also been lost. Two other factors worth mentioning. One is the rise of what I think of as convenience technology, right? So today, if I can sit in my home

and get groceries delivered to me, I don't really need to go to a post office. I can get most things I need from Amazon. I don't need to go to a store. My need to go out and have interaction with other people is dramatically lower just from a practical standpoint. So we have lost actually a lot of those informal loose ties, if you will.

But finally, I think we have to look at the phenomenon of social media itself, which has dramatically transformed how we interact with each other and also has transformed how many people see themselves and their friendships. And this is particularly true for young people. But while there are some benefits of social media, it can be helpful to get messages out, to share useful information, to share honest reflections with a

large group of people. More often than not, what we're finding is that for many people, well, I'll just tell you what young people tell me most commonly. They tell me three things. They say their use of social media often makes them feel worse about themselves as they're constantly comparing themselves to others. It makes them feel worse about their friendships as they're constantly seeing what other people are doing without them and feeling left out. But third, they say that they can't get off it either because these platforms are often designed to maximize how much time we spend on them.

Not necessarily the quality of time, but the quantity of time. And what is happening, especially to many young people, but frankly to many older people as well, is that that is taking time away from other critical activities like sleep, like in-person interaction, and other activities that are essential

for our health and wellbeing. So you put all these factors together, Rich, and what you see is that we have become lonelier, we've become more isolated. And I think we've realized, and this is not just an American phenomenon, by the way, this is a broader feature of modernity that the UK, Australia, Japan,

and many other countries are experiencing as well. So we've got to recognize that. And it doesn't mean that we should go back to 1920 or 1930 or 1950. But what it does mean is that we have to recognize that if we don't consciously make rebuilding connection a priority in our individual lives and in society more broadly,

if we don't do that through individual actions and the building of social infrastructure in our communities, then we will continue to see an erosion of our relationships. And we'll see not only the health consequences of loneliness, which are profound, mental and physical, but also the economic and the national security implications of loneliness, which make us more prone to division and to polarization. That gets into the underappreciated nature of this epidemic, because it's one thing to say, okay, a lot of people are lonely, but what does that actually mean, right? We could talk about the mental health implications of a lonely person, but there are also a plethora of physical implications as a result of loneliness that

are not insignificant. I mean, you say that lacking social connection can increase the risk for premature death as much as smoking up to 15 cigarettes a day. And that insufficient social connection is associated with a 29% increased risk of heart disease, a 32% increased risk of stroke, increased rates of dementia. Like there's a whole litany of downstream health complications that result from this that I found quite surprising for the significance of that impact. It is quite surprising for the significance of that impact. It is quite surprising.

I was shocked honestly, when I first came across this data and the more you look into it though, it starts to make sense because one, we evolved to be connected to one another for our safety and security. When we were hunter gatherers, it was people who were connected to one another, our safety and security. When we were hunter-gatherers, it was people who were connected to one another, who shared their food supply,

who take turns watching around the fire at night. Those are the folks who survived, who did well, versus the person who went off on their own, who said, I'm independent, I don't need anyone else. They often did not survive. But the other thing that's interesting is because of that evolution and because our healthy relationships

came to be viewed as key to our survival, when we were disconnected from our group, that actually put us in a physiologic stress state because we were worried about our survival. And it made sense. We had good reason to worry then. Interestingly though, even though our circumstances are different now,

our nervous systems are very similar to how they were thousands of years ago. So when we feel separated from other people, when we feel lonely, we find ourselves in a physiologic stress state as well. Now, short-term stress is not necessarily always a bad thing, right? So if I, for example, feel stressed

before giving, I don't know, a big speech or before turning in an assignment, if used well, that stress might motivate me to focus more and to perform better. It's when stress is extreme in amount or prolonged in duration that it can become particularly harmful. And that's where chronic loneliness,

which puts us in a chronic stress state, can lead to a cascade of inflammatory factors in our body and that can increase our risk of illness. And that's frankly what we're seeing in the data with increased risk of cardiovascular disease and other medical conditions. One of the insipid things about loneliness is when you are lonely, you are less inclined to seek help.

Like when I feel lonely, I just double down on isolation. Like I don't want to connect with anyone, right? So you're basically by kind of leaning into that feeling, you're digging the hole even deeper and deeper and deeper. So what is going on neurologically? What is the neurochemistry of loneliness? Yeah, that's interesting. And I, it's a question about that I wanna ask you actually, but I'll say that this is a common experience that people have, which is that

even though they're lonely, like they don't want to reach out, they actually withdraw more. And that's, I think that's for a couple of reasons. One is when you're in a chronic stress state, that can be exhausting over time as well. It takes some degree of energy to reach out to people. So sometimes when you're struggling with that for a while, it just saps you of your energy, you don't reach out. But there's something else behaviorally that's happening, which is that loneliness takes a toll on your self-esteem over time as well.

And you come to believe, as I did when I was a child struggling with loneliness, that the reason you're lonely is that you're not likable or you're not lovable, that something is wrong with you. And that actually makes you less confident about reaching out to other people, makes you not wanna be rejected.

There's a third element here as well, which is that loneliness puts us in a state of hypervigilance, right? So back to go back to the example of hunter gatherer days, when we were alone, separated from our group, we entered a state of hypervigilance where we were particularly on the lookout for any threat that might be around us.

Now you can imagine that was for good reason. Like if there was a twig that snapped behind us in those days, even if there's a 1% chance that it was a predator, you wanted to interpret it as a threat because your life would have depended on it. But think about that in the context of loneliness now when I'm feeling lonely. Yes, my energy has been sapped.

My self-esteem has been hit. But also in this state of hypervigilance where now you, Rich, come over to me and say, hey, do you wanna get lunch tomorrow? Now the normal expectation would be, I would say yes, because I'm feeling lonely, right? In a hypervigilant state though, I might look at you with suspicion and be like,

is Rich just trying to like take pity on me? Is he, does he think that I'm a loser and somehow I can't find friends on my own? Like, heck, I'm not gonna like do that. I'm just gonna say no, right? So, and that seems this very nonsensical, but your things are fundamentally shifted when you're struggling with loneliness

for a long period of time. It changes your perception. That's where the hypervigilance is like, you would think of it almost like a different set of glasses with a different shade on it. That's changing how you're looking at the world around you. And I guarantee you all of us have encountered people in this circumstance.

It may have happened to us as well. And sometimes you encounter somebody like that at work or in another social setting, and you think, ah, they're aloof. People are approaching them, but they don't seem to be responding. They're pushing people off. But loneliness is the great masquerader.

It can look like aloofness. It can look like withdrawal. It can look like anger and irritability, which is often how it presents in older men. And so we have to be thoughtful about that and recognize that it may not seem like it from the outside, but a lot of people around us based on the numbers we know are in fact struggling with loneliness.

Yeah, there's a whole cascade of emotional experiences as a result of that, the lowering of self-esteem, the sense of worthlessness. So if somebody asks me, do you wanna go to lunch? I may not look at them with suspicion, but my sense of self is so disempowered and feeling so worthless that I can't imagine that I could go out in public.

I can't be seen by anybody else, or this person doesn't really wanna have lunch with me. Right, they feel sorry for me. And so, no, I'm gonna say no to that. Yeah, that's right. Can I ask you Richard a question? Yeah. You mentioned that the sometimes when you felt lonely, you felt that sort of pull to withdraw more

rather than reach out. What have you done in those circumstances that's allowed you to actually end up reaching out to folks or what's worked for you? Well, I'm also long time in recovery. So I'm a 12 step person. So I have a toolbox of tools. And so I've developed that reflex to pick up the phone

and call somebody when I feel like that, even though that's the last thing that I want to do. And that's not to say that I'm always great at that, but I know that I have these tools available to me and I have communities of people that I rely upon who give me feedback, keep me in check, know how I'm doing, know when I don't show up and the like. And I realized that that's not everybody's circumstance.

Like that is a peer group that's super important to me in addition to my family. And I have another men's group that I go to and I have friends and the like, but I also can get very caught up in this and this can be all consuming, meaning like what I do for a living. And I can make my life very small as a result of that.

And it's not until many weeks of that before I come out of a fog and realize like, I haven't called a friend or I haven't gone to a meeting or I haven't done these other things that I know that I need to do to maintain my mental health and my physical health as well. So it's imperfect, I would say, but those are the general kind of tools

that I have available. Gotcha. And I have available. Gotcha. And I have therapists too. I mean, I do it all. You do it all, that's good. You know what I mean? I do it all. I'm curious about the men's group.

You mentioned that you're part of a men's group. How did that come to be? Friends in the area. I have one friend, he said, "'Hey, I'm getting some guys together "'and we're gonna have a therapist who's gonna moderate. "'We're gonna do this once a week. "'Do you wanna do it?

I said, yes. He said, okay. And we had our first meeting. And the rule is if you're in town, you come. There can be exceptions here and there, but this has to be a priority. And it's something I've been doing, I think maybe five years at this point.

That's great. Once a week, which has been great. And supplementary to 12-step because that's a different thing. That's very specific about a very specific problem. Whereas the men's group is more like, how's your relationships? Like, do you wanna run a business idea?

You know, it's just like other like-minded guys who are going through life in various stages where we can kind of share our experiences, solicit feedback, receive the feedback, which I think is really important, and hold ourselves accountable. I think everybody should try to create that in their community and their friends,

but also I need to have friendships outside of, anything structured also. Yeah. Did you find when you first joined the men's group, was it, did it come naturally to you to be a very open in the group or did that build over time? It was natural because I had years and years and years

of 12 step in therapy under my belt. So I don't have a problem being open and vulnerable in that context, but I had a lot of practice. So I realized that's a leap for a lot of people. Vulnerability is frightening. And I think, again, the way that we opened this conversation, me crediting you for being open and vulnerable about your own experiences, you can't expect other people to follow your lead and to engage in that unless you're willing to do it yourself.

And so I'm always trying to model that on this podcast because there's a great strength in that. I think, we think that it's weak or we're afraid to show people who we really are, but weakness is keeping it to yourself. I think it takes courage to share those things. And every time that I have, and I've seen other people do it,

not only does that set them on a trajectory towards a greater self-actualization and healing, it's empowering and it's received welcomingly by those who are on the receiving end of it. That's so powerful. And I'm so glad you had that experience in the 12 step program of sharing openly and being vulnerable.

It sounds like that may have been a process through which you had to work through to come to that point where you felt so open. But I mean, something I've long admired in the recovery movement is the recognition that in addition to potential medical therapy and counseling, the community is really essential. Oh, 100%.

Like, you know, I think about all the thousands of people I've met over the years in this job and as a doctor directly with patients, like how many people I've met who are in recovery and I'm having a hard time thinking of any of them who have made it into recovery without somebody or a community at their side or somebody who helped them through that difficult process.

So I think it's absolutely essential. And I think your experience also in this conversation I think highlights the fact that we need those kinds of communities everywhere in our life, right? Not only for recovery, but for dealing with a lot of the other challenges that we encounter, whether they're relationship challenges, whether they're health challenges.

One of the broader movements that I really love in medicine has been the move toward doing group visits with patients and trying to build communities of patients that can support one another through difficult health challenges. So yeah, I think this should, it feels like this should be a key pillar of how we live our lives, having these kind of communities.

Yeah, and modernization has driven us in opposite directions from that in every regard. I was in Europe the other week and had the good fortune of visiting a few different cities and realizing that the infrastructure of a lot of cities overseas are orchestrated to cultivate and create collision and community in ways that our cities and suburbs are certainly not.

And that's a big part of the problem as well. It really is, yeah. And I even think about in workplaces, for example, and think about how we design workplaces, how we design schools, as well as how we design cities. We want to make connection easier, both with the people you know and care about and wanna see, but also with other community members and strangers

who you may not know. And one of the things that was interesting to me during the pandemic was how, which was a time I think when among many other things, people were so separated from one another, is I had many people came to me and said, you know, I expected to miss my family and my friends. What I did not expect

was to miss seeing strangers in the coffee shop or other people in the grocery store. But all of those touches, all of those connections, they really do matter. And I had some experience in traveling through Europe some time ago, also recognizing that, wow, these places feel like they're built to make collisions and connection happen.

But that is part of what I mean when I talk about social infrastructure. Social infrastructure, really the programs and policies and structures in a community that support the development of healthy relationships, the people coming together. And I do worry, as you said, that we are moved away from that.

We've cut our cities up with highways. We've made it harder for people to run into one another. And again, with the benefits of technology, we've gained tremendous efficiencies with having things come to us where we are at home, into one another. And again, with the benefits of technology, we've gained tremendous efficiencies with having things come to us where we are at home, groceries, you know, retail items, but we have lost something as well,

which are these collisions with other people who are part of our community. So in terms of the solution, you have this six pillar plan. Part of it is top down. What is government's responsibility? What is the private sector's responsibility? What is the legislative regulatory landscape look like

to try to address and solve this problem? And then you have bottom up solutions like protocols that every individual can practice to improve their sort of connection hygiene, community hygiene. So maybe talk a little bit, I mean, you've already kind of canvassed it, but specifically what are some of the top-down solutions that you would like to see moving forward?

So, with a caveat is you both of us have said that, this is not a problem for government alone to solve, but government does have a role here in building greater connections. So some of the top-down things that government and private sector can do is, number one, the government has the ability to identify an issue as a national priority

and to bring the community together to address it, critical stakeholders. That's a role government can and should play. Government can also invest in research so we can better understand not just who's most deeply affected but what strategies work to address loneliness and disconnection that's a critical role and then government can also look at its own policies uh we're used to looking at policies with a financial lens to see how much does this cost and how much revenue might

it bring in i think we should also be looking at policy with a connection lens to understand how is this actually going to help or hurt the ability of people to come together and build healthy relationships. If we had thought about that with housing and transportation policy over the last century, I think that some of our decisions perhaps would have been different. So government can do that. In terms of the private sector, workplaces actually can be intentional about how they design, not just a physical workplace, but workplace culture to create opportunities for people to come together and get to know one another. There are things we do in our office, for example, not that we are perfect, we're still a work in progress, but the things we do to try to

enable people to come to know one another. For example, when I was Surgeon General, the first time we had this practice, we called our inside scoop exercise, where we would have one person during our all hands meetings once a week, we'd give them five minutes at the top of the meeting to share pictures with us. And we had pictures of anything they wanted,

but just as it wasn't about their current job. And people would bring in of anything they wanted, but just as it wasn't about their current job. And people would bring in all kinds of things, pictures about their family, pictures of activities and sports they participated when they were younger, when they had those dreams of being a figure skater or a professional athlete. And they would bring in pictures of other things

that were revelatory about their lives that helped us understand who they were. That five minutes often helped us understand somebody more deeply than the year that we often had beforehand just bumping into them. So there's workplace design issues and in schools as well. I think that we cannot take for granted anymore that people just automatically have the skills,

confidence and wherewithal to just build healthy relationships from the get go. What we're seeing and hearing directly from young people today, what I've heard from university chaplains, including earlier today, you know, chaplains who are looking out for the mental health and spiritual health and wellbeing of students

on campuses is that they, more and more young people are telling them that they don't feel comfortable actually going out and starting a conversation with a stranger or asking someone out on a date or dealing with conflict in a relationship or disagreement. So they'd rather remain silent. Their whole life is on text.

Yeah, and there's- Not even by talking to people on the phone, it's all texting on the phone. Yeah, and we lose so much nuance, right? The nuance that we evolved over thousands of years to be able to interpret everything from body language, to tone of voice, to everything that's unsaid. That's all part of how we communicate,

but we lose a lot of that when we're at a distance just through text. So these kinds of skills though, I think of these as social emotional skills or relationship building skills are what educational institutions can also play a renewed role in helping to bring people together across differences to learn about one another, to form stronger connections. So those are a lot of the top-down solutions as you might think of them.

And these have to be combined with the bottom-up solutions, the individual actions that we take in our lives. Because one thing I don't want is for people to look at the profound challenge of social connection, of social isolation and loneliness and to say, gosh, this is just too big to solve. Like somebody with a lot of power and a lot of money has got to solve this,

but us everyday people, we can't do anything about it. And that's actually not true because I think a big part of this is changing culture and changing individual practice. And culture shifted when our beliefs shift, when we choose to act differently.

And here, if we decide that we're gonna make a shift from the lives that we live now, which are often work-centered lives to truly living people-centered lives, then we can start doing that just by keeping five minutes every day when we're reaching out to someone that we care about, just to say, hey, I'm thinking about you,

wanna know how you are. We can do that by making sure when we're reaching out to someone that we care about, just to say, hey, I'm thinking about you, I want to know how you are. We can do that by making sure when we're interacting with our friends and with our family that we're giving them the benefit of our full attention and putting our devices away, which is easy to say, so much harder to do. And I say that as somebody who has been distracted often during conversation is working on that too. We can also do that by looking for small ways to serve other people, to help one another. Service is not just going to a soup kitchen and volunteering. It's helping someone when you see them in need,

whether that's a helpful word, whether that's literally helping them with papers that they dropped or with a cup of coffee that they spilled. These small acts of service, they tell someone else, hey, you matter, I see you, you're not invisible. And that's a message that people need to hear. So there's a lot we can do in the face of the loneliness crisis.

And the other piece of good news is that these small actions, they can feel good, even if we haven't solved the entire big problem yet. Right, and when we start to take those steps, we just realize the truth, I think, that biology and research have told us again and again, which is that we are hardwired to connect with one another when we give ourselves the opportunity to do so

in an honest, open, authentic way. Even a little bit of interaction like that can make us feel really good for a long time. Yeah, that's beautifully put. When I think about avenues for connection that exists, particularly for young people, you think about youth leagues, park leagues, after school sports, after school programs,

places for people to go, YMCAs, and even the faith-based organizations, they're all in decline or have evaporated. So I'm interested in what's causing this. Certainly there seems to be a bit of a, maybe at the very root, a spiritual malaise, but also a funding malaise or a lack of political will, or I don't know what it is,

but those avenues don't seem to be as robust as they once were. And that seems to be, you know, a huge kind of contributing factor to all of this. Yeah, no, you're spot on. And I think different reasons why these different institutions have declined in participation.

I think when it comes to faith organizations, I think that there has been, especially among younger generations, a disinclination to participate or affiliate with faith organizations. Now, the reasons are varied. Some young people say it's because they've lost faith. Well, no pun intended,

but they've lost trust in faith institutions. And when they look at transgressions, they look at scandals, they look at all these things and they ask themselves, who can we really trust? I worry that that means they also lose a lot of the community and benefit that comes with faith communities. But I think that's a factor. When I was talking to some university chaplains earlier today, in fact, an interesting statistic they told me is that at their universities, they said that greater than 50% of the students say that they have no religious affiliation,

but 75% of the students say that they are spiritual and that's important,ity is important to them. And what they say, and this is echoed by so many other chaplains that I've spoken to as well, is that the spiritual hunger is still there among younger generations. They just have not felt that- There's no avenue for them to explore that

in a community context. That's right, that's right. And the traditional institutions have not, they're not feeling connected to. I think also when you look at other types of organizations, service organizations or recreational leagues, I think part of what may be happening there that I worry about is,

I think we have put so much pressure on young people to lead the perfect life, to achieve success, with quotes around it here, but where we define success is a fairly narrow set of things, achieving a fancy job, a certain level of income, a certain level of public recognition, perhaps fame. And in the context of that, you might look at things like,

hey, just volunteering at an organization in your community as inefficient or a distraction, because how is it contributing to your success in that traditional definition? And similarly, like, look, this is, I think what interesting thing that kids need is in addition to every child needing loving relationships in their life, and I think that of all things, that's perhaps one of the most important things. Recipes for success for a child is to have loving relationships in their life.

But kids also need unstructured playtime. They need the opportunity to explore and be creative. They need the opportunity to work out things on the playground and in other settings with other kids. That's where they learn social skills, how to negotiate, how to communicate, how to deal with conflict. And when we don't give kids that, when we hyper-structure things for them, when we make sure that they're not only going to school, but they're doing six afterschool activities here and there that are all hyper-structured. I worry that we are depriving them of that open space and creativity that they need in their lives.

So look for, I think a bunch of reasons, participation has gone down, but I think one of the biggest things is in plain sight, which is that I just don't think we thought that these were, or recognize how important these were. You know, I think similarly with, I think the decline in relationships and increase in loneliness over the last several decades

has not been because we made an affirmative decision that relationships don't matter. It was more a consequence of neglect, right? Where we said, hey, all this other stuff has become really important. We got to chase this. And when you realize that relationships don't just happen, community doesn't just get built.

It's an investment that has to be made a priority that has to be safeguarded. Further confusing that is social media, which was built on the promise of increasing connection, right, which in fact, it's working at cross purposes with in many ways. And that's the subject of your other advisory. You mentioned national security

and that's super interesting. I think, you know, when I think about the impact of loneliness on national security, I can't help but think about the, it's sort of a third rail issue, the extremely online disenfranchised young male who doesn't have adequate access

to an upwardly mobile trajectory for himself, finds himself in the proverbial basement of his mother's house, engaging with people online who are activating their sense of disenfranchisement by provoking their anger and their frustration and channeling it in a certain direction. And we've all seen the violence that can erupt from this.

So when you're talking about national security, I would have to imagine that it includes trying to figure out how to help this cohort of young people that I think are suffering right now and creating kind of real world havoc. And this is an important point. And I think most people don't recognize that loneliness is so much more than a health issue.

Like when we are divided and isolated, it is easier for a foreign adversary, for example, to come in and to spike the information environment with misinformation or disinformation in that case, right? To create confusion, to turn us against one another. Versus when we're more connected with one another, we tend to give each other the benefit of the doubt, right? We tend to, even if we disagree on an issue,

still be there to have each other's backs. Think about that relative who you might get together with at Thanksgiving or over other holidays who may have different political views from or views on other issues. But at the end of the day, you know if he or she ended up in the hospital,

you'd show up and vice versa, because you have a deeper well of trust relationship. You give them the benefit of the doubt. When you don't have that, you can be exploited as a society. And I think to your point about young people who are feeling alienated and disenfranchised, I do worry about that a great deal

because for some people they'll react to alienation and to loneliness by just withdrawing further and further. But others may express that as anger. And when people are led to believe that they should blame specific groups or certain people for their loneliness and alienation, then it can lead to harm to those groups and to violence, which is not productive for anyone

and is destructive for society. So I think part of this has to involve, on the one hand, recognizing how deeply people are affected by this, how painful, in fact, loneliness and alienation are. But it also has to involve giving people healthy pathways to build community, to address that. Look at the heart of this, Rich.

We all as human beings have three core needs. We all want to know that we are seen and understood. We all want to know that we matter and we all want to be loved. And if we don't have those, then we don't do well. We can't survive in the long term. And so the question is, how do we help people feel seen and understood? How do we help young people know that they matter?

Well, I'll tell you one way we don't do that is by telling them that the only way they matter is if they're successful in the traditional way, if they earn a certain amount of money, if they have a certain amount of fame, have a certain amount of power. And the people who remind me of this every day that our fundamental worth is not extrinsic,

but that it's intrinsic are my kids. And I think about my kids were five and seven. When they were babies, I remember how they didn't need to be taught to be in the moment. They didn't need to be taught to be loving the moment. They didn't need to be taught to be loving and expressive. That's just who they were. So I remember talking to the son of Daniel Barden,

who is a six year old child who was killed in Newtown during the horrible school shooting that took place in 2012. And Mark, Daniel's father, told me that even as a six-year-old, Daniel had this instinct to go up to other kids who were alone on the playground or alone in the cafeteria and just to go and sit next to them. Sometimes he'd ask them how they were doing. Sometimes he would just be present and sit with them,

knowing that no one should have to be alone. That instinct is, I think, what so many children are born with. And we just lose that over time because we get told that that's being naive, that if you're too nice to people, they'll hurt you. We have difficult traumatic experiences in our lives that may lead us to shut off from other people.

But part of what we have to recognize is that what we need is nothing less than a major culture shift to recognize that we have to move from living in a world where we are stoking fear and shift back to a world where love is powering what we do in the form of kindness and generosity and service to one another.

We have to decide that one of our core values is going to be that we have each other's backs, that we don't leave each other alone and leave each other behind. And that shift starts with each of us, with the decisions we make in our own life, about how we treat other people, how we interact with our community. It's built, with the decisions we make in our own life, about how we treat other people, how we interact with our community. It's built on by the decision we make about

who we advocate for. I have kids, but my neighbor may not have kids, but they may go to a school board meeting and advocate for better funding for our schools because they know I have children and I matter to them, right? Like advocating for people who may have interests that are different from ours, but because we know them, we believe they matter. That's gotta be a part of how we build a society that's more centered on love as well.

And this is also about the decisions we make in our schools and our workplaces. Think about the leaders that we choose. One thing I've learned about leadership over the years is that 90% plus of the decisions that leaders make, they make behind closed doors when the cameras aren't there. And what's guiding them in those moments are their values.

At some point, we came to think that the values of our leaders don't matter, that it's just their policy positions that matter. But that couldn't be further from the truth. I think this moment in particular is one where values matter. centered around kindness and generosity and service and friendship, centered fundamentally around love. And we can do that by the choices we make in our homes, in our communities, at the ballot box, because that's how we change society. Sure, very ambitious, but beautiful in its heart centeredness.

And as you were sharing that, I'm thinking about the actual implementation of that. And it's really what you're saying on some level, maybe you disagree, but what you're asking for is a revolution of consciousness, because we're in a culture that where the incentives are misaligned, right? Like we're rewarded for being snarky and ironic and cynical

and owning the other side. And we're looking up to the wrong role models. And we're being told that happiness is found in luxury and convenience and wealth, et cetera. When in truth, everything that ails you and that which you most seek can be found in service, kindness, generosity, being a friend, seeking out friendship,

holding yourself accountable to somebody else and modeling a certain way of being in the world that you would like to see percolate out into the collective consciousness. And it does start with who our leaders are and how they're modeling their values in public. Irrespective of the decisions that they're making behind closed doors,

when they get up behind a podium and the cameras are on them, how are they acquitting themselves publicly? What are they saying? Not necessarily even in just their words, but in their demeanor and their behavior and what they choose to focus on and what they choose to focus on and

what they choose to respond to and how they respond to those things, that stuff matters. And it percolates down into our collective awareness of how we're meant to be in the world. So what you're asking is no small ask, but that is the question, right? And short of us being able to, for lack of a better phrase, grow up and mature, what is the future of this country, right? If we can't solve this loneliness problem and redress the mental health issues and the downstream kind of domino effect of that,

I don't see that we have much chance of cohering as a nation. Yeah. We can't communicate. We don't share the same set of facts. We're not interested in our fellow man because we've been told that our liberty and our freedom and our individualism is what's most important.

So in so many ways, we have it backwards and you're asking us to truly remember who we are to really understand what is important and to begin practicing it. That's right. And that was beautifully put. And you're right that the ask is not small because the need is great.

And in moments of great need, when we're faced with what I believe is an existential crisis and a crisis of identity, because this is an identity crisis. We're trying to figure out who are we? Like what is important to us? And I believe that our identity should be defined by these core set of values.

If you live life without a moral compass, it's hard to know where to go. And we have more and more choice now than perhaps we've ever had before. But what good is all that choice if you don't have a compass to guide you? And so what we need is nothing short of, as I think of it, a moral renewal in our country, where we recenter on those core values. We determine what our identity really is. And a core part of that has to be recommitting to one another.

It has to be a commitment to these values that we're talking about around kindness and generosity, around service and friendship. And we've got to do that, not just for now, but because our kid's future depends on it. You know, I think any parent out there knows that while your kids sometimes listen to what you say, they more often listen to what you do.

And our kids watch what we do. They watch, we might say, hey, be kind to someone else. But then if we are vitriolic and abusive to other people, whether it's in person or online, that inconsistency does not serve our children well. So, I believe that fundamentally, we have to get this right. The other pieces, getting the right policies in place,

building the right programs, making the right financial investments as a country, these stem from that deeper culture, that moral identity that we have as a people. We have to get that right. Because if we don't, it's like we're revving up our car, but we're going in the wrong direction. Right, but you also can't make it a sense of obligation

or make people feel like martyrs in doing this, right? You have to create a culture that's conducive to these choices being the preferable one and people doing it because they're realizing that it makes them happier, not because it's necessarily the right thing to do out of obligation, but because this is the better path that makes us happier, is better for our kids,

is better for society, you know, all the way down the line. I'm really glad you said that actually, because I think what's interesting about this is if we start building on this movement for a moral reawakening in America, I actually think it will make people feel better in the doing of it. And I think that will make it easier for them to do

and to continue to build that movement. And here's why, like think about the example of an experience you may have had in the past where let's say you were engaged in a service project in your community and maybe one person joined and that made it a little easier for other people to join. Like, ah, so-and-so's doing it, my friend. I guess maybe I'll volunteer and do that. Or think about somebody in the office, let's say who maybe had a time of need, maybe a relative passed away or they got really sick and they needed somebody and somebody stepped up to say, hey, you know what? I'm going to go over and visit them. And then other people joined and said, you know what? I'm going to do the same too.

One person stepping up made it easier for others to do the same. And it actually feels good to do these things. It actually feels good to serve other people. Not only do we help them, but we feel useful ourselves. It feels good to be kind to someone else, to see the benefit that accrues to another human being from our own actions. And it feels good to be courageous and bold, which is, I think, a core skill and trait that we want to cultivate in young people as well. These things feel good when we do them, but there's an activation energy to doing them. It's infectious. It's infectious, right, in a really good way, which is why I think about this advice

that an old mentor of mine gave to me at a time where I had an idea that I wanted to build, but I wasn't sure if anyone, I thought it was gonna be too hard to do, and I was scared nobody would care about it and wouldn't support it. And what she said to me is she said, Vivek, when you stand in strength,

you allow others to find you. And I think about that often because every time somebody stands up and lives out one of these core values we're talking about, every time they're kind to someone in distress, every time they help somebody who's in need, every time they give someone the benefit of the doubt instead of judging them or blaming them, they're standing in strength. And people watch us, our kids watch us, our neighbors and family members watch us. And it reminds them of a better way to be.

It's not that we are saying we are better than them. We all have the good and the bad inside of us. We have the ability to be incredibly loving and we have the ability to hurt other people as well. It's what part of ourselves we choose that can not only make us feel better, but can serve as an inspiration for people around us. Yeah, that's beautiful.

I call that the lighthouse effect. You stand in your power. You're not necessarily trying to change anyone's mind or to even advocate your position. You are just in your strength, solid, sturdy, and that becomes a tractor beam for other people when you model it that way. Yeah.

How has this exploration into loneliness and into social media, I guess as well, impacted your parenting style? I mean, your kids are still young, so the devices I'm sure are not in their hands yet, but soon that will be a thing. Yeah, what's going on? Yeah, so it has actually impacted us a lot.

So I'd say one on the loneliness front, we've made it a real priority of the last few years to make sure we are investing, not necessarily in objects that we can buy them, but in experiences with people that we can create for them. And for us, that involves making sure we're using, you know, whatever vacation time we have or other breaks create for them. And for us, that involves making sure we're using, whatever vacation time we have or other breaks

to get them to see their grandparents, to see their aunts, to be with family and friends. It means even though sometimes we're tired on a given day, trying to make some simple, create some simple opportunities for their friends to come over so they have some time with them or to have some unstructured playtime with other kids in the community.

So we're trying to create those experiences for our kids because one, we know the connection is important, but also I'll just say on a personal level, having struggled with being really shy and introverted and lonely when I was a kid, I look at my son who's seven right now and I see some similar tendencies in him. I look at my daughter who has a lot more fire

than I had when I was a child and in a really, really good way. But I see how shy she is and I do find myself worrying about them. So kids evolve at different paces, but I wanna make sure that we're doing everything we can to create the environment and opportunities for them to really connect with others. Lastly, on the technology front,

I'll tell you honestly, this is hard. Like they are, these devices are so intuitive for kids, right, that even I remember when they were two years old, if they saw us using their phone, their eyes just immediately went to the phone and they grabbed it and they wanted to use it. And we would take the phone back, but we can tell that they're magnetically drawn

to these devices and they can figure them out very quickly. And so one of the things, they're too young to use social media, but that doesn't mean they're not aware of it. My daughter, when she was in preschool, came home one day and asked my wife and I if we could post a picture

on a social media platform for her. And we were like, what? How do you even know about this platform? How do you like know that pictures should go there? We were flabbergasted, but her preschool classmates were talking about posting pictures on social media. So we know we have to be vigilant there. And part of this for us is about protecting time without devices.

So we have a curated list, a sort of set of videos that we will allow them to watch in small doses from time to time when we're on an airplane, for example, or here and there. Things that have some sort of educational or cultural value to them, things that don't have harmful content in them. So we try to limit how much time they spend there. But we also know that as they get older, that we have made the decision that we want to delay their use of social media until they're well past middle school and potentially beyond that.

That's not easy to do. It's incredibly hard. But one thing we know is that it'll be easier if we can do it with other parents. And this is something that I've now heard more and more from parents of kids who have older kids is that this is really tough to do on their own. But when they find one parent, two parents

who are willing to make the same decision for their child, whether that's delaying the use of social media or whether that's creating tech-free zones in their child's life, like not using social media or technology in the half hour before they go to bed and throughout the night or around mealtimes. It becomes a lot easier when you're doing this with other parents. It's still not simple because over the years, I think largely this technology has spread like wildfire without any real guardrails to limit children's use and to healthy use. And so what you're seeing is that it's become this expectation that every child is on it. In some cases, schools are even assigning homework that requires the use of devices and in some cases of some social media platforms.

social media platforms. So we have to pull back a bit and get to a place where we can have tech-free zones where parents can work together and support one another in delaying use. And I think when we're planning to do that until, one, we feel that our child is actually developmentally ready to use social media, and two, until real safeguards have been put in place, and I mean specifically safety standards like what we did for automobiles that we are now calling for in our advisories to be applied to social media. And until there's data that actually tells us that these platforms are in fact

sufficiently safe for our kids. Like we don't let our kids take medicines that aren't studied to be safe and effective. We don't put them in car seats that haven't been certified to be safe. Yet we're having them use these platforms, which are profoundly changing how they see themselves and others,

with scan data to reassure us at all about safety. Yeah, it's a huge problem. I'll be interested to see how that progresses for you as they age. It's almost like an asymptotic curve, like with every year, the pressure to get the device to be online in that way increases exponentially.

And it's a hard problem because on some level, fluency on those platforms is a gateway or kind of a key to having a social life, right? If you can't be a Luddite, you would be a social pariah amongst your peers and your classmates as a young person who's on the outside. It's sort of like the kid who doesn't get picked

for the kickball team is the kid who's not part of the Snapchat group chat or whatever it is, right? So that complicates it from a parenting point of view. Rich, can I just say on that though? just say two interesting things that I've learned recently? One is that as I've talked to more and more students, like middle school and high school students who are actually building movements to actually get off social media and get offline, they often have, in the beginning, when their parents told them, hey, you can't use this until later, they fought it and they were angry. But over time, they actually came to feel a lot better

because they saw themselves less subject to a lot of the anxieties and struggles that their peers were going through as they engage with bullying or harassment online or constant comparison with other people. But the other thing is as that community grows and builds, those kids aren't alone, right? And there are more parents I also encounter

who are looking for what we use to term dumb phones, right? Phones that don't have the capability of having social media, but have the ability to text, to look up, to make phone calls, to use maps. So good for safety, good for communication with friends, but don't necessarily subject you to all of the other potential adverse effects of social media. So I think there are additional pathways that we have

to build here, but you're absolutely right that it's not simple. And there's a transition challenge here, which is why I think it's so important that we do this together with the support of other parents. I know my wife and I can't do this alone. If we were left up to us alone, we'd probably fail at some point, maybe cave in at some point, not be able to deal with the pressure, and worrying about our kids being left out. But if we can find two, three, four other parents who might be similarly inclined, and not only is it good for us,

but we know our kids won't be alone either. Yeah, yeah, yeah, that's interesting. I mean, I have found that there's a certain level of sophisticated astuteness in young people, like 20 somethings. they're on an accelerated sort of learning curve with all of this that I missed or whatever. And they're way more analog than I am.

And they do have those dumb phones and they have learned, and I think the pandemic probably accelerated this to appreciate in-person connection early, right? And I think that's reframing that generation's relationship with technology in a really interesting way. And it'll be interesting to see what the generation coming up, your kid's age,

how they're going to experience this, because everything is happening so quickly. 10 years from now, it's gonna look completely different. And hopefully it will look more like the world that you're trying to craft. I hope so. And what you're saying actually, it reminded me of a conference

where we started this conversation with 12 step groups. Right, because, and there's an interesting connection here, which is one third of adolescents who are using social media right now, say they feel addicted to social media. Half of them say if they had to get off of it, it would be incredibly hard for them to do so. And when I talk with educators-

I would think it would be even higher. Yeah, well, this is what people are willing to say on surveys. So I think chances are it is higher. When I talk to educators, interesting what they say is that when they have made decisions to, for example, not allow phones during lunch breaks,

or in some cases during their class, for example, they find that kids grumble, but a lot of times they thank them afterwards. And they say, you know, we felt a lot better, you know, just being able to not constantly be on our phones. But the question is, if you felt better, why didn't you do it by yourself? Because it's not easy to do by yourself, right?

Because separating yourself from that device is hard when they've been designed specifically to maximize the amount of time you spend on them to suck you in. And you're being asked to separate yourself from the pack. Exactly, you're asked to do something that's different. So it has to apply to everyone. Yeah, and we also, I think for adolescents in particular,

just have to recognize that they're not just younger adults. You're asked to do something that's different. So it has to apply to everyone. Yeah, and we also, I think for adolescents in particular, just have to recognize that they're not just younger adults. They're fundamentally at a different stage of brain development and social development where they are more prone than adults to social comparison and to social influence. And so you put all of this together and you recognize that what a lot of students are telling educators is true, which is that they may see the challenge,

but in some cases they need a little help and support in creating the environment where they get an opportunity for them to actually separate. And when they do and experience that, a lot of times they wanna build on it, just like the 20 year olds that you're talking about. And that's the thing that's part of the reason why we're seeing more communities of kids coming together

to say, hold on, we're tired of this. We want a different path. That's not to say we're eschewing technology and putting it at the side. We want to use technology responsibly, but we don't want it to rule our lives. We want to be the people who decide how it's used. And we want to have a life that's lived

outside of technology. Because the truth is, everything that's happening in social media is not necessarily real life, right? There's real life happening offline. And sometimes to truly connect with others, we have to disconnect from technology. And I think that's what many of these kids are doing. And the life that's happening online

is not an accurate reflection of what's happening in the analog world. All you have to do is scroll Twitter for a while. You'll get a very thwarted view of what's happening in the analog world. All you have to do is scroll Twitter for a while. You'll get a very thwarted view of what's actually happening versus what it's actually like to live your life. You quoted this study, this longitudinal cohort study of US adolescents

that said kids between the age of 12 and 15 that adjusted for baseline mental health status found that adolescents who spent more than three hours per day on social media face double the risk of experiencing poor mental health outcomes, including symptoms of depression and anxiety. But we know that there's a lot of kids who are even younger than that.

And basically every kid is on social media more than three hours a day. Yeah, so the average is three and a half hours a day right now, which is obviously higher than that number of three hours. And even though technically 13 is the age at which many platforms say people can start using them, about 40% of kids eight through 12 are using social media.

So those rules are not being enforced adequately either. So you're right. I think the concern is great here. And this is one of the reasons I issued this advisory is it was in response to a question that parents kept asking me, which is, is social media safe for my kids? And putting all all this together,

my two most important takeaways were, number one, we don't have enough evidence to say it's in fact safe. And two, there's in fact growing evidence that it's harming many of our children. And that statistic is one of those data points. And I think this is just for me a cautionary tale also of how we have to be thoughtful about how we embrace and integrate new technology into our lives. It's not that we should push away technology. Look, I'm a believer in technology. I use technology. I spent seven years building a technology company. I'm a believer in technology. But it's ultimately in how it's designed and how we use it that ultimately impacts how it affects our lives. And I think particularly when it comes to our kids, I think you can judge a society by how well it cares for and supports and protects its children.

And I think in many ways, we've done a great job in society on many other fronts, making sure our kids have vaccines available to them, making sure that public school is something, that it's a reality in our country for children. But I think here we dropped the ball and I think we've got to catch up and do better because it's not okay to just say, well, the horse is already out of the barn, so whatever's gonna happen is gonna happen.

We can't control it. That's an unacceptable response to the current situation. It would be like if we went back to a time when you and I were younger, when motor vehicle accidents were really high and just said, well, you know, cars, new technology, they're improving our lives. This is just the cost of new technology.

People are gonna die. Instead, what we said is, we're not gonna go back to horses and buggies, but we've gotta make these safer. And we worked hard to put safety standards in place that got us crash testing, airbags, seat belts, and a number of other safety measures that over time reduced motor vehicle fatalities.

And we've gotta take that same determination and rigor when it comes to making social media safer for our kids. Like with loneliness, it's a top-down set of solutions and a bottom-up set of solutions. In the advisory, there's recommendations for government involvement. What is the responsibility of big tech? What is the responsibility of the parent? What is the responsibility of the user, right? There is no one culprit here. Everybody's going to have to buy in on some level and participate in this. And I would say that even the behemoth big tech companies understand that this is a problem. And if they're interested in continuing and perpetuating and innovating, that they've got to find a way to cooperate on this. I think they

get that, right? Like I just had the episode that went up on the show today is with Francis Haugen who blew the whistle on everything. And maybe that prompted Facebook to be a little more receptive to what needs to happen here. But what is your sense of receptivity with the technology companies and what is the political will in terms of legislative and regulatory change? Well, these are the right questions. And I think that, look, I, giving the, you know, the benefit of the doubt here, you know, I suspect that most of these platforms began with people who thought they could create more connection and community, you know, by building social media platforms. But at the end of the day, I think you have to judge your technology by the effects it has on people.

And you have to measure those effects. And you have to be transparent about what that data shows. And we haven't necessarily seen that. I think Frances's testimony, her bringing voice to some of that data that was internal, I think confirmed for many parents what they had suspected, which is that there are negative effects on our children that we're not being told about. And many researchers in fact, have told me, a researcher who spent years working in this area

of social media's impact on mental health, have said that they have not been able to get all the data they need from the technology platforms to be able to do a full assessment and understand the full impact of social media and the mental health of kids. Look, as a parent, Rich, I don't wanna ever feel like information

is being hidden from me about the things my kids are using. Like if you told me that, can you imagine the uproar if it was determined that a car seat manufacturer was hiding safety data from parents? They would understandably be just incredible anger and frustration. And so we got to apply a similar principle here. So I think while companies, I think, recognize increasingly that there is a problem here

in terms of the mental health impact of their platforms, what I don't think is going to happen is that we are going to get to a place where these platforms are safe solely by relying on the companies to fix the problem. We didn't rely on motor vehicle manufacturers to fix all the safety issues entirely on their own. We didn't say, you know, good luck. We'll hope and pray that you do a good job here.

In the 20 years since social media emerged on the scene, we've not seen the kind of change or data transparency that we need to make these platforms safe for our kids. So what we need to make these platforms safe for our kids. So what we need is external accountability, and that's where having federal safety standards is essential, and why parents have to be at the table when those standards are developed and why it actually has to be enforced. So look, I think technology companies ideally should be willing partners in this. It's one of the reasons we lay out recommendations

for technology companies as well. But I just worry that we have right now a business model that is based on time spent instead of time well spent. And how companies resolve that is certainly a challenge that they've got to figure out. But as Surgeon General, as a doctor, as a dad, most importantly, my biggest concern is making sure that whatever my kids are exposed to and are used

has been sufficiently evaluated for its safety. And until that happens with social media, I wouldn't blame any parent out there for being skeptical about allowing their child to use it. Sure, I mean, because of the misalignment of incentives, the big tech companies are not gonna willingly implement these sorts of safeguards because the business model is orthogonal to that.

So it is gonna require intervention, governmental, legislative, regulatory intervention. My sense is that there is bipartisan support for this. There is, and that's a good news here, Rich, is I've spoken with members of Congress and for both parties and spoken to the president about this. I've spoken to many folks in government

and across the board, there's strong interest in doing something real. And in fact, just recently, the Kids Online Safety Act was finally pushed forward by the Senate. And this had been a bill that had been worked on for quite a long period of time. And it's one step forward. It's not the only step we need.

There's more that has to happen. But the point is, this is a moment in time where parents are feeling the pain of this and they're calling for action when increasingly young people are saying to us directly and in surveys that they recognize that social media is harming them, where there is bipartisan support. And we have to use this opportunity to move forward and finally take the action that needs to be taken. These kind of windows of opportunity to do the right thing, they don't remain open forever. There's always stuff happening,

people can get distracted by one issue or another. But one of the reasons I issued this advisory and I've continued to focus on this issue is I think this is too important for us to get distracted from. Because every year for a child is an extraordinarily important time of development for them. Our kid's childhood is happening right now.

We can't say, come back in five years and we'll fix this. We've got to do that because every day, I'm getting stories from parents who are telling me about how their child was harmed, how their child was exposed to content that urged them to take their own life or to harm themselves, how they were harassed, exposed to racist remarks, to misogyny online. You hear this again and again and again from parents who are saying, why is this happening? Why isn't someone

doing something about it? Why doesn't someone have my back? We've put the entire burden of managing this new rapidly evolving technology on the shoulders of parents who never grew up with it. That's not fair, right? Or on young people who don't have the brain power skills to rebut its addictive lures. That's right. And what that basically is, is it's pitting

the best developers and program designers in the world against parents and kids. Yeah, you're bringing a knife to a gunfight on that one. And that's not a fair fight. And that's why we've got to have the backs of kids and parents on this issue. And again, I can't think of something that's more important for us to address.

Look, when it comes to mental health more broadly, we've with kids, I've at length spoken about the importance of us improving access to treatment. We gotta do that. We're investing more in the last two years in that. That's a good step forward. There's more to do there. But if all we did was focus on treatment

and didn't address these deeper root causes, like loneliness and isolation, like social media, which are impacting the mental health of youth, then we just can't keep up with the demand. You know, like universities are compared to 10 years ago, many of them have hired double, triple, in some cases quadruple the number of mental health counselors,

and they still can't keep up with demand. So we've got to get at the root causes of some of this. And this is why addressing technology and loneliness are so critical. I do have one last question for you. It's a question, it's a tweak on a question. Historically, over the decade of doing this podcast, every time I have a medical doctor on the show,

I kind of end the episode by asking them if they found themselves transported to a parallel universe and woke up and realized that they were the surgeon general, what is it that they would, what would be their mandate? What would be the thing that they would try to make happen? And I've had a lot of very interesting responses to that. Most of them fairly idealistic, not that yours isn't.

Yours might be the most idealistic mandate of all of them. But here I am in a very surreal moment where I actually have the surgeon general sitting before me. So I can't ask him that question, but I know that there's a sense of urgency. Your term may be coming to an end, we're not sure. Maybe you're gonna be around for five more years, who knows? But what is it that on a very practical level,

you wanna make sure it gets accomplished before your tenure is over? Beyond what we've talked about, like what is the real legacy that you wanna leave behind? You know, I always think that the question of legacy is tricky, cause that's for others in history to determine, but the issues we've talked about today are certainly close to my heart.

The thing that I want most for our country, for our children in particular, the issue that I'm increasingly talking about and want to build an initiative around is this broader question of what is our vision for our country what is our identity as a nation and to me this is inextricably linked with the core values that i believe should define how we live our lives and how we build our communities. We have a choice right now between a world that is mired in fear, where people are angry at each other,

where people are feeling left out, like they don't belong, like they're on their own, where they feel invisible, and a world where people feel like they belong, where they have each other's backs, where they feel that the future is something that we can shape together, regardless of what may come,

because we don't have to face it alone. We can face it together. That is a choice that we have to make about which world we want to live in. And it's a question of identity. And I think we have to decide where we want to come from, like as individuals, as families, as a community. Do we want to come from a place of fear? Do we want to come from a place of love? And if anything I can do as Surgeon General,

most importantly, as a concerned citizen, to ensure that we choose the path of love, importantly, as a concerned citizen, to ensure that we choose the path of love, that we recognize that love is our greatest source of strength, that it's our greatest source of healing. And they will reflect that in tangible ways in how we behave and how we treat each other and the choices we make in our life and what we demand from our leaders

and how we design our institutions. To me, that is what will transform society for the better. It's what will allow us to put in place policies that extend healthcare to everyone who needs it, that make sure that we're supporting our schools and ensure that we are working towards lifting up everyone from an economic perspective. These all flow from the core values that we commit to. And so that to me is the most

important thing I want to do over the next year is to help build that broader moral reawakening that we need in our country to support it in whatever way I can. And to gather the people who are out there who I know believe strongly in this, who have faith that we can be better than what we've been over the last few years, that it's actually fundamentally who we are, that who we've been the last few years, that that's not our true nature. And I've seen this in our unguarded moments

when no one is looking in the heights of the pandemic. I saw neighbors who went over to help others who were struggling. I've seen after tornadoes and hurricanes, people coming together, disregarding their own safety to help people who are struggling and having a hard time. I've seen nurses and doctors

who put themselves in harm's way during COVID to take care of people that they had sworn an oath to care for. Selfish people don't do that. Mean-spirited people don't do that. But that's not who we are. So we've got to make that choice. And right now it feels like the choice is being made for us, that we're steeped in this information environment that's extraordinarily negative, that's telling us everything is broken about the world, that nobody can be trusted, and that everyone is only out for themselves. We've got to turn that off and tune in

to what's actually happening in our communities and choose again, love. I always say that every decision that we make, we can ask ourselves a question, am I making this decision out of love or out of fear? And if we choose love as often as we can, then we'll build a kind of life that feels good for us, that's good for our communities,

that our kids can be proud of, and that will help create the world that ultimately future generations need. I would say that's a pretty good answer to the question. Thank you for that. Beautifully put. People are good. If we raise our consciousness,

we can solve all of our problems and it stems from operating from that higher place. So I really appreciate that was really lovely. We need more leaders like you. I appreciate the level of service and integrity that you're bringing to your office. It's very commendable, this life that you're pursuing. And I have so much respect for what you're doing. I was listening to a podcast that you did with Scott Galloway

and he had mentioned that you bring a certain, or you've returned a certain gravitas to this office. And I think it's very true. Thank you. I'm at your service. It was really beautiful to spend this time with you. So thank you for that. So many things I wanted to talk to you about, like tons of other issues.

I hope you'll come back, cause I'd love to talk to you about healthcare versus sick care, addiction, so many other things. So yeah, I really would love to do that. We'd love to continue the conversation and happy to come back whenever. And thank you for this conversation. I just, I must say, I was incredibly impressed

when I read your bio and learned about your story. And, but I feel even more just appreciative of who you are meeting you in person and just feeling the reflectiveness that you have and the thoughtfulness with which you pursue conversation. But your kindness also just comes across very clearly. And so I'm grateful for this conversation we had together and thank you for all the good that you're bringing into the world through your podcast. I appreciate that. That means a lot. Also check out your podcast, House Calls.

We didn't talk about that either. We have lots of guests overlap. Amazing that you're doing a podcast given the office that you hold. I think that's really cool. And also I will put all the links to, I'll put links up to the PDFs of the advisories in the show notes so people can find that

as well as links to all of your information. But if you wanted to direct people who are listening or watching to one particular place, where do you want them to turn? Well, our central location, a repository for all our products is searchandgeneral.gov. And so there you can find our priorities page, which has all of our core advisories on it.

So feel free to go there. And we try to write these advisories so that they're easily digestible for the public. You don't need a PhD or a medical degree to be able to read them and they're actionable as well. So please check them out. All right, thanks so much, Matt. Thanks so much.

Cheers. Appreciate it, Rich. Peace. That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. related to everything discussed today, visit the episode page at richroll.com where you can find the entire podcast archive as well as podcast merch, my books, Finding Ultra,

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subjects, please subscribe to our newsletter, which you can find on the footer of any page at richroll.com. Today's show was produced and engineered by Jason Camiolo with additional audio engineering by Cale Curtis. The video edition of the podcast was created by Blake Curtis, with assistance by our creative director, Dan Drake. Portraits by Davy Greenberg, graphic and social media assets courtesy of Daniel Solis, as well as Dan Drake. Thank you, Georgia Whaley, for copywriting and website management. And of course, our theme music was created by Tyler Pyatt, Trapper Pyatt, and Harry Mathis. Appreciate the love.

Love the support. See you back here soon. Peace. Plants. Namaste. Thank you.