We're More Isolated Than Ever. It's Killing Us.
In 2014, when Dr. Vivek Murthy took office as Surgeon General, he didn't consider loneliness a public health issue. Then he started listening.
During a cross-country tour, Americans told him they felt isolated, invisible, insignificant. They couldn't always articulate the word "lonely," but the sentiment was unmistakable. People from every background and income level confessed to shouldering life's burdens alone. Some wondered if anyone would notice if they disappeared.
"It was a lightbulth moment for me," Murthy wrote in his 2023 advisory on social connection. "Social disconnection was far more common than I had realized."
The scientific literature confirmed his observations. About half of American adults reported experiencing loneliness in recent years, a figure that predated the pandemic. The implications are stark: lacking social connection increases the risk of premature death as much as smoking up to 15 cigarettes daily.
The Scope of the Crisis
The data paint a troubling picture. Social isolation increases mortality risk by 29 percent. Loneliness increases it by 26 percent. Poor social relationships are associated with a 29 percent increased risk of heart disease and a 32 percent increased risk of stroke, according to a synthesis of 16 longitudinal studies.
The cognitive impacts are equally concerning. Chronic loneliness and social isolation increase dementia risk by approximately 50 percent in older adults. Among all age groups, those experiencing loneliness face more than double the odds of developing depression compared to those who rarely feel lonely.
"Loneliness is far more than just a bad feeling," Murthy noted. The mortality impact rivals that of obesity and physical inactivity, conditions that have received far more public health attention and resources.
The economic costs are substantial. Social isolation among older adults alone accounts for an estimated $6.7 billion in excess Medicare spending annually, driven largely by increased hospital and nursing facility use. Loneliness-related absenteeism costs employers roughly $154 billion each year.
Yet fewer than 20 percent of people who often feel lonely recognize it as a major problem.
How We Got Here
Americans are spending significantly more time alone. Between 2003 and 2020, the average daily time spent isolated increased from 285 minutes to 333 minutes, an increase of 24 hours per month, according to research tracking social exposure patterns.
In-person socializing has declined precipitously. Time spent with friends dropped from 60 minutes daily in 2003 to just 20 minutes in 2020, a loss of 20 hours of social engagement per month. Young people ages 15 to 24 experienced the steepest decline, with in-person friend time falling nearly 70 percent over two decades.
The pandemic accelerated existing trends. One study found a 16 percent decrease in social network size between June 2019 and June 2020.
Demographics tell part of the story. Single-person households have more than doubled since 1960, rising from 13 percent to 29 percent of all American households by 2022. Nearly half of Americans in 2021 reported having three or fewer close friends, compared to just 27 percent in 1990.
Traditional sources of community connection have eroded. In 2020, only 47 percent of Americans said they belonged to a church, synagogue or mosque, down from 70 percent in 1999. This marked the first time membership dipped below 50 percent since pollsters began tracking the question. By 2018, only 16 percent of Americans reported feeling very attached to their local community.
Trust has declined alongside these shifts. Polls from 1972 showed roughly 45 percent of Americans believed they could reliably trust other Americans. By 2016, that figure had shrunk to approximately 30 percent.
The Digital Dilemma
Technology's relationship with social connection is complicated. Digital tools can reduce barriers for people with disabilities, help maintain long-distance relationships and create community for marginalized groups. Nearly all teens and adults under 65 use the internet, and 80 percent of adults use social media.
But the costs are mounting. Americans spend an average of six hours daily on digital media. One-third of adults report being online "almost constantly," a proportion that has doubled among teenagers since 2015.
Research reveals concerning patterns. A study found that participants using social media for more than two hours daily had roughly double the odds of perceived social isolation compared to those using it less than 30 minutes per day. Phone use during face-to-face interactions reduces conversation quality and diminishes enjoyment of time spent together, whether between parents and children or among friends.
"Technology can also distract us and occupy our mental bandwidth, make us feel worse about ourselves or our relationships, and diminish our ability to connect deeply with others," the advisory states.
The modality matters. While video calls and messaging can supplement in-person interaction, they cannot fully replace it. Our biology evolved expecting physical proximity to others. Despite modern conveniences that allow us to live without direct human contact, our fundamental need for connection remains unchanged.
Beyond Individual Health
The consequences extend beyond personal wellbeing to community outcomes. Research across political science, economics, sociology and public health demonstrates that communities with higher social connection experience better results across multiple measures.
A meta-analysis found that on average, a one-unit increase in social capital increases the likelihood of survival by 17 percent and of reporting good health by 29 percent. During the COVID-19 pandemic, counties with strong social ties experienced fewer deaths. An international study of 177 countries found that greater interpersonal and government trust correlated with lower infection rates.
Connected communities show increased resilience to natural disasters. Neighbors who know each other are more likely to share resources, comply with emergency procedures and coordinate recovery efforts. Studies show that high social connection reduces population exodus after disasters and enables faster rebuilding.
Public safety improves as well. One recent study found that a one standard deviation increase in social connectedness was associated with a 21 percent reduction in murders and a 20 percent reduction in motor vehicle thefts.
Economic prosperity follows similar patterns. A three-year study of 26 American cities found that those with the highest levels of resident attachment experienced the greatest GDP growth. Communities with higher social capital weathered the 2006-2010 recession more successfully, showing greater resilience against unemployment.
What Connection Actually Means
Social connection involves three vital components, according to researchers. Structure refers to the number and variety of relationships and frequency of interaction. Function describes the degree to which relationships meet various needs, from emotional support to practical help. Quality captures whether relationships are positive and satisfying versus negative and draining.
Each component matters independently for health. Someone might have many acquaintances but lack meaningful support. Another person might live with family but experience poor relationship quality. The absence of loneliness doesn't necessarily indicate high social connection, just as the absence of disease doesn't equal good health.
Social connection exists on a continuum. It's dynamic, changing throughout life due to moves, job transitions, illness and countless other factors. Everyone falls somewhere along this spectrum, with low connection generally associated with poorer outcomes and higher connection with better results.
Importantly, social connection isn't purely an individual issue. Community infrastructure, public policies, workplace practices, technology design and cultural norms all shape opportunities for connection. Many barriers and facilitators lie beyond personal control.
A Path Forward
The Surgeon General's advisory proposes a national strategy built on six pillars.
Strengthening social infrastructure means investing in the physical spaces, programs and policies that facilitate connection. This includes parks, libraries, public transportation, community organizations and local institutions that bring people together. Design matters: walkable neighborhoods, accessible gathering spaces and inclusive programs create more opportunities for interaction.
Pro-connection public policies should adopt a "connection in all policies" approach, examining how decisions across sectors affect social wellbeing. Paid family leave enables relationship-building during critical life stages. Transportation policy determines how easily people can connect. Housing and zoning laws can either isolate or integrate communities.
Mobilizing the healthcare sector requires training providers to recognize social connection as a health factor comparable to diet or exercise. Doctors should assess patients for social isolation and loneliness, educate about risks and connect at-risk individuals with community resources. Insurance should cover these assessments and interventions.
Reforming digital environments demands transparency from technology companies about their products' effects on social health. Safety standards should protect users, especially minors, from features that drive disconnection and division. Companies should prioritize social wellbeing in design from conception through evaluation.
Deepening knowledge means funding research commensurate with the problem's severity. Studies should examine root causes, evaluate interventions and track trends over time. Public education campaigns should raise awareness that social connection is as essential to survival as food, water and shelter.
Cultivating a culture of connection requires embracing core values of kindness, respect, service and commitment. Leaders should model healthy social behavior. Media and entertainment can portray positive relationships. Schools and workplaces should prioritize connection alongside other goals.
What Individuals Can Do
While systemic change is essential, personal action matters. The advisory recommends investing time in relationships through consistent, quality engagement. Minimize distractions during conversations. Reach out regularly to friends and family. Share meals without checking phones.
Seek opportunities to serve others through volunteering or helping neighbors. Practice gratitude and responsiveness in relationships. Engage with people from different backgrounds. Join community groups aligned with your interests.
Reduce harmful patterns including excessive social media use and disproportionate screen time. If struggling with loneliness or isolation, reach out to healthcare providers, counselors or support services. These conversations are neither trivial nor shameful.
Be open with doctors about significant social changes, as these may affect health. Participate in civic life through constructive political engagement and community involvement.
A Collective Imperative
"Given the profound consequences of loneliness and isolation, we have an opportunity, and an obligation, to make the same investments in addressing social connection that we have made in addressing tobacco use, obesity, and the addiction crisis," Murthy wrote.
The evidence spans decades and multiple scientific disciplines. It demonstrates consistent, robust associations between social connection and health outcomes. While some research questions remain, the existing data provide compelling justification for treating social disconnection as a public health priority.
The benefits of action extend beyond preventing harm. Stronger social connections enable people to live healthier, more productive, more fulfilled lives. Connected communities are safer, more prosperous and better equipped to handle challenges from economic downturns to natural disasters to pandemics.
"Our relationships and interactions with family, friends, colleagues, and neighbors are just some of what create social connection," the advisory states. Connection is also shaped by neighborhoods, digital environments, schools and workplaces. It's "a critical and underappreciated contributor to individual and population health, community safety, resilience, and prosperity."
The crisis of connection isn't inevitable. It results from choices about how we structure society, design technology, organize communities and spend our time. Different choices can produce different outcomes.
"We can choose, in short, to take the core values that make us strong," Murthy concluded, "and reflect them in the world we build for ourselves and our children."
