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The Epidemic of Loneliness · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Social isolation and loneliness are in the news Surgeon General Vivek Murphy just issued an advisory, calling it an epidemic and extolling the healing effects of social connection and community.
• 0:11
  David: Things were bad enough before the pandemic, but they got a lot worse and more than half of people report loneliness in some surveys.
• 0:19
  David: I actually used to think this was mainly a problem for the elderly, but it actually affects young people more.
• 0:24
  David: And those with lower incomes and people who are unmarried, there's a bunch of solutions out there, but sort of a mixed bag.
• 0:30
  David: Uh, for example, you might think social media could help with connections, but often it has the opposite effect.
• 0:35
  David: And of course, we're just getting started with ai.
• 0:38
  David: Welcome to CareTalk America's home for incisive debate about healthcare, business, and policy.
• 0:43
  David: I'm David Williams, president of Health Business Group.
• 0:47
  John: And I'm John Driscoll, the profession of Walgreens health.
• 0:50
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• 0:59
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• 1:01
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• 1:07
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• 1:12
  John: Hey David, this is in many ways, people, an is.
• 1:15
  John: Loneliness is an issue that people thought of as a soft issue, but it's actually having some dire consequences.
• 1:22
  John: I mean, loneliness can kill.
• 1:24
  John: I mean, the Surgeon General's report, which builds on work that he did before he became Surgeon General, uh, 29% increase in heart disease.
• 1:35
  John: Uh, 30% increase in risk of stroke, a significant increase in risk in dementia.
• 1:43
  John: And according to the surgeon, general loneliness can kill as effectively as a, as, as as smoking.
• 1:52
  David: John, when you think about the, what we make
• 1:54
  John: of, what are we to make of all of this new data down on, on, on the issue.
• 2:01
  David: John, when, you know, when you mentioned the Surgeon General and the Surgeon General's report, the first thing that comes to mind, uh, for me is, you know, the report in the 1960s or I think around 1964, about smoking and, you know, the Surgeon General's warnings on, on packs of cigarettes.
• 2:14
  David: So when the Surgeon General makes a report, it is usually something pretty serious.
• 2:19
  David: And, you know, not only does it seem as though smoking, uh, and, and loneliness are about in the same, uh, in the same neighborhood in terms of their impact, but it's also some of the same things like a heart attack.
• 2:30
  David: You know, doesn't, the windows doesn't directly cause lung cancer, but it, it, it, it's pretty, uh, it's pretty dangerous.
• 2:36
  David: So.
• 2:37
  David: I mean, I think we need to, we need to face it head on.
• 2:39
  David: John.
• 2:39
  David: The first thing, like with any of these is, is to get some solid data.
• 2:42
  David: Now, I mentioned that there's some surveys out there and you see that loneliness affects something like 50% of the people, and that's true in the us it's true in the UK as well.
• 2:52
  David: So this isn't just a, a phenomena,
• 2:54
  John: there's more disconnected people in the UK and fewer in Japan.
• 2:59
  John: But it's, but it's a growing problem in the us.
• 3:02
  John: David.
• 3:03
  John: And what, and, and what I think is fascinating is that it doesn't, to your point, it doesn't just affect the older demographic.
• 3:11
  John: It really is affecting every demographic.
• 3:13
  John: We've got a, an epidemic of disconnection in some ways.
• 3:17
  John: And, and just to be clear, loneliness is different than solitude.
• 3:21
  John: Being alone is fine.
• 3:22
  John: This is not a judgment on whether people are, you know, are, would rather spend time in, in, in groups.
• 3:29
  John: Than, um, than, than than working quietly alone.
• 3:33
  John: It's really Do you feel disconnected from the people around you?
• 3:37
  John: We're social animals?
• 3:39
  John: Uh, and, and, and, and society's failing us, or we're failing society?
• 3:42
  John: I don't know quite which.
• 3:44
  John: And it's getting worse by the day in every demographic.
• 3:48
  David: John, it does make sense to, to talk about the segments, and you're right, it doesn't, it doesn't, uh, focus just on one area, but I was surprised, and, and maybe it's just counter to, uh, what we normally expect is that it's not older people in general, uh, who are affected by loneliness.
• 4:04
  David: It's, it's younger people, older people, to a certain extent actually.
• 4:09
  David: Maybe get together more in person, maybe are less on social media in some way.
• 4:13
  David: And even if they may be slowed by mobility, maybe people, you know, they've lost people and their families and, and friends and so on.
• 4:19
  David: They have more resilience in some ways and are better able to, to cope.
• 4:24
  David: And I think the younger crowd, uh, that has embraced things like so-called social media, uh, find they actually are more lonely and have sort of fewer friends and and fewer connections.
• 4:33
  David: So this is tied in.
• 4:35
  David: Very much I think to the kind of technology that we have encumbered ourselves, uh, with the unmarried part doesn't surprise me too much.
• 4:43
  David: Uh, you know, if you're married, presumably have a, have a companion and, uh, that person is your, you know, somebody you're connected with and also may, may get you out and about meeting others lower income.
• 4:54
  David: Not sure exactly how to parse that one, but there are certain segments and I think understanding the data helps us figure out what to do with it.
• 5:01
  John: Well, I think, I think that the, the family formation may have something to do with, and the erosion of that for lower income or folks who go through a period of, of low income could, could have some something there.
• 5:11
  John: But this is a bigger, longer term trend than I think even, uh, uh, uh, uh, the surgeon general.
• 5:19
  John: It's always sort of weird to think of a doctor as a, a general Yeah.
• 5:23
  John: Um, uh, uh, holds forth.
• 5:25
  John: I mean, the, the, the Harvard, uh, political scientist.
• 5:30
  John: Bob Putnam many years ago wrote a book I think almost 20 years ago, called Bowling Alone about the erosion of social connection in society.
• 5:38
  John: And he made an interesting distinction.
• 5:41
  John: Um, I think it's between bridging, which where people connect to one another in social and civic activities and bonding, where they become more exclusive.
• 5:51
  John: And if you think about those pressures, uh, the things that brought us together as a nation, Um, the, the, the, the two world Wars in, in some ways, the depression, um, and all of the, the, the social and civic organizations that the, that the beginning of this country, de Tocqueville called out as being one of the unique aspects of the US as you had all these civic groups that would pull people from different, um, Beth ethnic backgrounds and immigrant backgrounds together, uh, that that all starts to erode.
• 6:26
  John: With the first wave of technology tv.
• 6:29
  John: Um, and although there was a, there were, there were challenges in the past.
• 6:33
  John: Uh, if you think about what social media's doing, it's doing a lot less bridging and a lot more bonding, which breaks chunks of society into more and more tribal groups.
• 6:43
  John: So I think we've got a, a growth in the loneliness challenge accelerated, I'm sure by the pandemic with social media, that not just fakes connection.
• 6:53
  John: But actually creates or, or sort of supports exclusion.
• 6:57
  John: I mean, we, that's a pretty toxic cocktail if you think that as we've now shown in the data, loneliness can kill, it's like
• 7:05
  David: a cocktail, John.
• 7:06
  David: Um, I'll make sure to order one up next time we go out together.
• 7:09
  David: And it was fun to see you last week, by the way.
• 7:11
  David: Speaking of, uh, of isolation.
• 7:12
  David: It was a, it was a good time.
• 7:14
  John: Well, you know, we, we as, as, uh, with, with a, with an Irish Catholic.
• 7:18
  John: Big Irish film.
• 7:19
  John: We're always trying to connect with one another, but it is, it is one of the luxuries of, uh, post pandemic life that we get to see our friends.
• 7:27
  John: But David, what are we to do about this?
• 7:29
  John: I mean, this is a, this is, this is coming fast and furiously at us and, you know, you've consulted on loneliness for companies.
• 7:36
  John: Yeah.
• 7:37
  John: Uh, to try to help them think through what they're gonna do.
• 7:39
  John: In fact, the Surgeon General actually challenged companies to help solve the problem.
• 7:44
  John: He doesn't see this as just a healthcare challenge.
• 7:47
  John: Uh, I get to ask the question on this one.
• 7:49
  John: What are we
• 7:49
  David: gonna do about it?
• 7:50
  David: Yeah, so the surgeon General does have a number of recommendations, uh, in his report, and I think it's interesting what's included and, and also what's excluded.
• 7:57
  David: So, uh, some of the things are kind of motherhood and apple pie.
• 8:00
  David: Talk about strengthening the social infrastructure, like having more parks and playgrounds where people can, can hang out, and having public policies that that help connect people.
• 8:09
  David: Getting the healthcare sector involved.
• 8:11
  David: Um, reforming digital environments, which sort of means signing off of Facebook.
• 8:15
  David: But it's interesting, John, on the social media side, because you, you know, you mentioned the television, or as my mother used to call it the idiot box or the boob tube, I think for the same reason, right?
• 8:24
  David: You, you sort of like, get up, get up and go out and play with your friends.
• 8:27
  David: Which, which actually we could do cuz they weren't all on their, on their phones cuz they didn't have any.
• 8:31
  David: But one of the other, other suggestions is actually creating a culture of connection.
• 8:36
  David: So informal practices, like when the phone rings, pick it up and talk to somebody, you know, for, for a few minutes is, it's interesting that you know the phone.
• 8:45
  David: Which is something that we have communication at a distance and was originally seen as kind of an intrusion into people's home is actually a good way to connect, whereas maybe social media isn't.
• 8:55
  David: So I think that's interesting.
• 8:57
  David: And when we talk about companies doing something, uh, there may be technologies that may be technologies that can actually help us, but they don't automatically help us.
• 9:05
  David: So I think that's an interesting area.
• 9:07
  David: I, I mentioned before, there are a couple things that were left out of the report.
• 9:10
  David: Um, one of which was just about going to religious services.
• 9:14
  David: You know, that's a place where people meet, uh, in person generally with a phone, uh, off.
• 9:19
  David: And it's a chance to, you know, talk about something a little deeper than the, than the moment to moment.
• 9:24
  David: And then also another thing that people recommend sometimes is serving other people.
• 9:28
  David: If you're feeling lonely, you're feeling down, you're feeling not connected, going and, you know, volunteering and helping somebody else, uh, is a good way to do things.
• 9:37
  John: Well, I think that any form of connection, you know, uh, that, that there's a, there's, there's a, um, the first, uh, I think step.
• 9:48
  John: In turning around this social problem, it's a little bit like the first step towards beating addiction is to recognize that we've got a problem and I think there's a, there's a a million little things that we can do, but it's not just, well, it's got a dire healthcare consequence.
• 10:03
  John: It's not just a healthcare problem.
• 10:04
  John: It's your point about picking up the phone, religious observations, meeting and connecting.
• 10:09
  John: You know, the last time that American society.
• 10:12
  John: Um, went through this kind of a, uh, of a disk of, of a discombobulating time was really in the 1870s when, uh, the rise of the cities, the rise of industrialization, and it really blew up all of the, the, the small communities.
• 10:27
  John: The small rural communities, the, the, the communities that existed.
• 10:31
  John: At the time, and you know, one of the points of the progressive movement was a lot of the new civic associations that grew, uh, that were really founded at the turn of the, at the beginning, at the end of the, the 19th, the beginning of the 20th century.
• 10:43
  John: Things like the NAACP and Boy Scouts.
• 10:46
  John: It really, I question, is there a way to go back to the notion of local civic organizations?
• 10:52
  John: Um, one of the things that, uh, deve Murphy suggests is consciously engineering, um, local government.
• 11:00
  John: To, to support social connection, which would be, you know, expanding walkways so you can walk around the suburbs, um, creating parks that people want to go to, maybe thinking about libraries differently.
• 11:12
  John: And it also challenges businesses to make room.
• 11:16
  John: For people to connect because people spend so much time at work.
• 11:21
  John: That to, uh, which was, is, is sort of an indirect way of saying, let's, let's, let's not just rely on this work from home nonsense as a replacement for office work.
• 11:32
  John: Not just because it, you get people together from apprenticeship, but you get people together for connection because a lonely employee is not, is not gonna be a, a particularly highly motivated employee and it's gonna lead to more absenteeism.
• 11:45
  John: So there's an economic argument, John.
• 11:47
  John: I worry we're going, it's a challenge for
• 11:49
  David: everyone, John.
• 11:51
  David: I worry we're going in the wrong direction on some of these things.
• 11:53
  David: So, you know, we mentioned, uh, before that, uh, you know, one of the Surgeon General's recommendations is more libraries and so on, but we've seen what's actually happened in libraries, which turned out to be.
• 12:02
  David: A safe place for people who might be socially isolated, let's say for, uh, a lot of kids that, that are, that are gay, grow up and go to the library and it's actually a place where they could connect.
• 12:11
  David: And we, we see a lot of political pressures and things that, you know, previously weren't, weren't an issue coming down into the library and really being very threatening to people.
• 12:19
  David: I think when you talk about, uh, civic engagement, uh, let's say local government, one of the things people go around and, you know, knock on doors and say hello and try to persuade their neighbors.
• 12:27
  David: And there have been some very violent incidents.
• 12:30
  David: Uh, recently, uh, that would make you think twice before that I even saw someone talking about, you know, being in the quiet car on Amtrak and he sometimes used to go and nudge somebody, Hey, like, you know, could you, could you quiet down and say, you know, they're not gonna touch that anymore due to just the, uh, the fear of physical violence.
• 12:44
  David: So I think while we need to make progress, uh, we even need you to preserve sort of the civil society that we have now.
• 12:49
  David: And to go back to harping on the television as you did sometimes as people that are sitting around watching certain television channels, uh, learning to be fearful.
• 12:58
  David: Uh, and may be hateful of, of, of others that are around them, and we gotta find a way to, to reduce that.
• 13:03
  David: So, I know I'm being the negative one here, John.
• 13:05
  David: There are some, you know, there are some technology solutions potentially.
• 13:10
  David: Do you have a view of whether technology can help us here as well as hurt us?
• 13:13
  David: I, I, I
• 13:14
  John: think, I think you're, you, you're very comfortably being the negative in the skeptic, but in this case it's, it's, it's hard to see a lot of positives.
• 13:22
  John: I think if, if you think of this bonding versus bridging, we don't have enough bonding and we've got a lot of.
• 13:27
  John: Where you don't have enough bridging, rather, we have got a little too much bonding into tribes.
• 13:32
  John: I, I think that, I don't think, I mean, technology's funny, David.
• 13:37
  John: It, it's a, it, um, the ability just to use the phone, which is the, the technology you started with is, can be an incredible device to connect folks to tell someone you love them or, or let them respond in same.
• 13:52
  John: Um, but this is ultimately a human problem and it's gonna require a human solution.
• 13:58
  John: Um, And, uh, and an understanding that the society wanna, we wanna live in is one with less lonely people.
• 14:05
  John: And if that's true, it's, it's, um, it's a, um, it's a, it's, it's millions of people making small acts of connection.
• 14:16
  John: It's, it's not gonna be solved in healthcare, and I don't think it's gonna be solved completely with government.
• 14:21
  John: This is one of those things that, um, it's gonna require an all aspects of society.
• 14:28
  John: To pull together because the, the, the institutions that used to pull us together, um, you know, are, are, are, are, are eroding.
• 14:35
  John: And the ones that will pull us together, we need to create on our own.
• 14:40
  David: So let me, let me offer a little bit of positive from the company side before I go into my dystopian, uh, reality, which is that there are some of human focused companies and some we've in fact had on this podcast, including thinking about kind of companion care.
• 14:53
  David: We, we interviewed.
• 14:54
  David: The CEO of Papa, uh, you know, which, which provides companions, uh, to people.
• 14:58
  David: Online communities can potentially be a way, uh, to connect.
• 15:03
  David: And maybe it's the bonding and not the, the bridging.
• 15:05
  David: Nonetheless, I think there's, there's some of that.
• 15:07
  David: And then this whole concept of, of social isolation and loneliness actually does fit into the social determinants of health framework.
• 15:15
  David: And there are organizations like Unite Us would be an example that are trying to pull together some of these.
• 15:20
  David: Uh, community organizations that are sometimes hard to hear about or it's hard to navigate to, and, and put them together in more of a network and an easier way to access it.
• 15:29
  David: And although it's not only a healthcare solution, you do see some, um, some health plans like United Kaiser, Humana, Cigna, have all been working, uh, recognizing this issue because they see the healthcare cost and have been working on it from a social determinants, uh, standpoint.
• 15:44
  John: So, well, and, and you've got the ability of businesses to lean in and bring people together.
• 15:49
  John: And you know, the businesses that are most reliant on remote work have often found that the hardest thing is to engineer business meetings that don't have agendas so that people can just connect with one another.
• 15:59
  John: I think that business has a major role to play here.
• 16:03
  John: I I also think we have to create room for clinicians to actually diagnose this as a problem and suggest non-traditional solutions.
• 16:14
  John: Because this is, this is, this is not, you know, we have a, you know, the, the whole germ theory of medicine has led us down a, a hard science route where sometimes we don't actually prioritize, uh, the softer, the softer aspects of, uh, of humanity that create can, can create some of the hardest problems.
• 16:33
  David: Do I have your permission to end on a dystopian note?
• 16:37
  David: Sure.
• 16:39
  David: Thank you.
• 16:39
  David: I, I know that was, that was willingly, it wasn't compelled there.
• 16:42
  David: So, you know, if you look at things that are going on now, like.
• 16:45
  David: Consider like deep fakes, right?
• 16:46
  David: Where you can make a video of, of whatever.
• 16:49
  David: So some people have have suggested, yeah, some people have suggested that, you know, go and create, like some people are lonely, right?
• 16:56
  David: Because maybe somebody passed away.
• 16:58
  David: Now if you've got some video of them, maybe they were on the web, maybe they had a podcast, you know, you can easily reconstruct them.
• 17:04
  David: And bring them back, uh, as an AI companion that, uh, looks and talks just like they did before.
• 17:09
  David: Now some people are prescribing that and, and it's, John, you are laughing, but, you know, that is, uh, that is something people might be interested in.
• 17:16
  David: David, David
• 17:16
  John: did, did, did, did, did you invest in a zombie caregiving
• 17:20
  David: company, John?
• 17:22
  David: I, I mean, if you mean that I, did I borrow money and put it in?
• 17:25
  David: Is that the same as investing?
• 17:27
  David: Uh, we'll, we'll, we don't offer, let's, let's, let's,
• 17:29
  John: let's, let's, let's, let's say suggest something a little bit more positive that everyone, uh, try to understand that the call to action of our surgeon general is, it's one of the few things where, where someone in the healthcare system is complaining about something and every one of us can contribute to solving, oh, John, telling people you love them, or going and meeting someone or just.
• 17:55
  John: Making room for to connect at a human level.
• 17:58
  John: Um, perhaps not with your zombie caregiver,
• 18:01
  David: David.
• 18:01
  David: All right, well, I'm not gonna top that beautiful little point there, John.
• 18:05
  David: So I'm gonna say that's it for yet another episode of CareTalk.
• 18:08
  David: We've been talking about social isolation and loneliness.
• 18:11
  David: I'm David Williams, president of Health Business Group,
• 18:15
  John: and I'm John Driscoll, the president of Walgreens Health.
• 18:18
  John: If you liked what you heard or you didn't, we'd really appreciate it if you subscribe on your favorite service.