and marketing firm in addition to being a public prosecutor and attorney in private practice. he has also served in the virginia house of delegates since 2002. democrat will represent virginia's seventh district. the former postal inspector in cia officer. she later worked for a company enrollmenteab services, which ups colleges and universities develop more diverse student bodies. and jennifer wexton was elected to virginia's 10th congressional district. the publicved as prosecutor and attorney in private practice. she was elected to the virginia senate in 2013. new congress, new leaders. watch it all on c-span. >> now a discussion on loneliness and social isolation among older americans. we will hear from a former surgeon general, the president

of the aarp foundation, and others composed of by the atlantic, it is an hour and 15 minutes. >> please welcome to the stage. >> good evening. thank you so much. as you heard, i am president of atlantic live and we bring the atlantic journalism to life on stages across the country. tonight we are so glad to welcome you to our home here at the watergate. 'tis the season to be jolly, right? merry everything, happy all. december is portrayed as a joyful time of the year, but it as everybody who has gathered here knows, for many this is a hard time of year. people feel profoundly alone and socially isolated, and that is what we are here to talk about this afternoon, the loneliness epidemic. we live in an era where in an

instant you can connect with someone, by email, text, twitter, and yet rates of loneliness in the country have doubled in the last 50 years. nearly half of all americans report feeling alone, left out or isolated on a regular basis. loneliness affects those who are married and living with other people, too, and a surprisingly large number of people feel like nobody in the world knows them really well. it is not something people talk about easily, and studies show loneliness contributes to poor health, like stress, high blood pressure, depression. over the next hour or so, we will dive into how and why loneliness is a public health crisis and explore what can be done to alleviate the situation. i want to take a moment to thank our underwriter for making this gathering possible. thank you so much. [applause] we are unanimously -- enormously

grateful for their support. with that, i am delighted to introduce dr. sachin jain, president and ceo of caremore health. the floor is yours. dr. jain: good evening. as we are here to talk about loneliness, i want to acknowledge my friends here. it is great to be surrounded by familiar faces and i want to thank you all for joining us. we are here to talk about loneliness. obviously for all the reasons you just heard, a very timely discussion. but i want to remind you all, loneliness is not a new topic. it is really as old as humanity. but i think there's been an undeniable acceleration in how much loneliness we have had in our society. robert putnam as early as 2001 told us about the coming wave and epidemic of loneliness. he called it a decline in social capital, but nonetheless warned us this was going to happen.

his colleague at harvard warned us about what he called an epidemic in plain sight, noting that people are lonely, we know they are lonely, we know it is a problem. but as a society, we are doing very little about it. you might wonder why a health system like caremore is underwriting an event like this. the answer is simple. we know there is a very strong connection between one's sense of togetherness and connection to other people and their own health and well-being. people who feel connected to one another tend to take care of themselves more, have other people in their lives who care about them. and as a result their health , outcomes are better when they feel more connected to society, and more connected to their community. so we made this an area of great focus for us at caremore. we appointed a chief

togetherness officer, robin caruso, seated right here. we built what i believe is the first clinical program in the world focused on identifying lonely seniors and connecting them to resources and the community, as well as individuals who outreach them regularly to express care and concern for them. over 1000 patients have now benefited from participation in our togetherness initiatives. we are seeing improvement in their health outcomes, in levels of engagement, participation in their community. but what i always find remarkable about this problem is that it doesn't require us to pioneer a new medical treatment or invent a new drug in a lab. this is a problem every one of us can help solve, if we just decided to, if we created social awareness of it, and then frankly created momentum around actually connecting people.

so this is something that each one of you has the ability to actually walk out of here today and make a difference to someone who needs connection, who needs a treatment for their loneliness. so what i am asking you to do is to call your moms and dads, call your grandparents, call your kids if you feel like they might be lonely. because this is an epidemic that knows no age, race, social economic bounds. this is prevalent around all classes and groups of american society, and something we all have a collective obligation to begin to make a dent in solving. my hope for this discussion today is that it's not another conversation about defining a problem, because i will tell you that there are academics with tenure many times over for having defined the problem, journalists who have written about it. it has been documented. we all know this is a problem. we have experienced it, or know people who have. my hope is tonight will be a conversation about solutions,

and the reason is that there are people who literally need the solutions today. robin caruso, our chief togetherness officer, frequently tells a story of calling a patient at home who says, hello, robin. the answer -- she said, how did you know it was me calling? the answer, you are the only person who calls me. so my push to every single one of you is to think about how you can be part of the solution, and i'm really excited about the dialogue this evening, especially excited about our keynote speaker, dr. vivek murthy. we spent the last hour catching up and feeling less lonely together. appreciate it. thank you. [applause] >> thank you. that was an inspired start. what i'm about to do is much more practical. please silence your cell phones, but don't put them away because we are on twitter. we would love you to join the

conversation in the room. #atlanticloneliness, which is quite a hashtag, but it will work. especially given the topic at hand. we want you to be part of the discussion. and now we begin with dr. vivek murthy, was surgeon general during the obama administration. welcome, dr. murthy. [applause] and here to lead the conversation, my colleague steve , clemons. steve: greetings to everyone. what a crowd. we not only have a standing room only audience tonight, but also c-span taping and recording, so this will go to a large audience and hopefully we make an impact this evening. i'm honored you are all here on such an important topic. the last time i was with you, i think we were in aspen.

you are talking about vaccinations. it occurs to me, you have been very bold, whether it is on vaccinations, guns, redefining what social health, emotional health, our society's health is, and you have written is very provocative piece about loneliness and health. i would like to have you share with us for a moment how you see dashboard of loneliness in this country right now. dr. murthy: great question. steve, great to be with you again. i want to thank caremore and the atlantic for hosting. we did have a chance to catch up and it did make me feel less lonely, so thank you sachin. , i will tell you, this is one of the subjects i find most important to talk about. when i was in office, when i had the privilege of serving, i had to engage on many different topics. i worked on zika, ebola, the opioid epidemic, a host of other public health issues. but i found when i would go out into communities and talk about issues, and more importantly

to listen to what people cared about, very often behind their stories were stories of loneliness and stories of isolation. and that's what first clued me in to the fact there was something going on we needed to address. now, i found this to be true in communities all across america. it was not just urban community's, but also rural communities. not just people who defined themselves as liberal or conservative. it was people across the age and political spectrum who seemed to be affected by loneliness. if you want to get a sense of how broadly this impacts the country, look at the research studies. i will have a caveat, there are a lot of them and they are often all over the map. they sometimes use different scales to measure loneliness, they sometimes look at different study populations, so it is hard sometimes to do apples to apples comparison. but what you can see, even if you look at the good studies and the range of loneliness, it is in the double-digit percentages of adults who in america say they are struggling with loneliness. and if that many say they are

struggling with loneliness, i guarantee the real number is higher. by virtue of comparison, consider that we have just under 10% of people in the united states with diabetes. and you start to realize, loneliness affects far more people than people with diabetes, people who smoke, people who are impacted by many other conditions that we put a lot of money into. you might say that that is because those are really consequential. when people smoke, they get cancer, they get other illnesses. with diabetes, there are serious complications that can lead to heart attacks, so that is why we have to put money into that. but more and more, research tells us there are real health consequences of loneliness, and some of the studies, including meta-analyses, have shown that people who struggle with loneliness have a significantly higher risk of premature death. in fact, their risk of premature death seems to be, or i should say that the risk of premature mortality is about similar to people who smoke about 15

cigarettes per day, and is greater than people struggling with obesity. and think of how much money we put into addressing obesity and cigarette smoking. there are reasons why this might be the case, and i am happy to share some of those theories with you. but the bottom line is that loneliness affects our health, and social connection can keep us healthy. not just prevent illness. this is an important it is not point. just about preventing diabetes and heart disease, but enabling us to be more and to perform or -- perform more at every stage of our life. there's nobody i know who just wants to be disease-free, right, or who just wants to be on the opposite edge of having a diagnosable illness. we want to be functioning at the top of our game. we want to be fully present when we are with our family. we want to be fully contributing members of society and as highly functioning as we can be. and it turns out that you do that, to optimize function in

life, we have to have not only physical health, but good emotional health, and a key component of our emotional health is social connections. steve: so what's coming undone? i went through the data, and i have to tell folks, i commend the harvard business review work on the loneliness epidemic. half of it was so depressing, half of it was uplifting. when i hear data like rural suicides have increased 53% in the last 20 years, what in our social gravity is making things worse than they used to be? part of it, if it was always this way, that would be one story. if you went back to the depression era, 1930's, a certain portion of people felt disconnected and we haven't budged that. but it seems that the pot is getting worse. robert putnam when he wrote "bowling alone," said other things are happening detaching people. i am interested in what is macro forces are, as you see them. dr. murthy: every era has faced challenges that have contributed

to loneliness. and loneliness has been a problem for quite a long time. we haven't measured it for hundreds of years, but it has been around for a while. there are modern-day forces making it harder to stay socially connected in a meaningful way. and one of those i think has to -- things has to do with the fact we are more mobile than we ever used to be. we move from community to community, often for work reasons, and we leave communities behind, including friends and family. the second issue has to do with technology. i don't think technology is all bad. i say this as someone who spent years building a technology company, who uses technology, who believes in technology, but i think what matters is how we use technology. we can use technology to connect with others. for example, if you traveled here from new york city and you posted on facebook or twitter to your followers, i am coming to d.c., would anyone like to get together for dinner after this event? and you have dinner with an old friend, that's a great way of using technology to bridge

to off-line connection. the challenge is when we start using technology in ways that substitute lower quality connections for higher-quality connections. because having 5000 friends on facebook or 10,000 followers on twitter is not the same as having people who know you authentically, who you can be yourself with. and unfortunately that substitution often happens. technology has a role to play here. and work culture is important. partly aided by technology, work now seeps into every part of our lives. evenings, weekends, vacation time, and that can come at the cost of quality time with the people we love. some of the most insidious factors, hardest to deal with, are cultural factors. what we unfortunately have, a culture that has skewed so far towards the individual that it has led people to think that the key to success and being worthy in life is to be self-sufficient.

you need to be able to do everything on your own, not rely on anyone for anything, whether that is support at work, emotional support, to be able to be self-sufficient. this is a narrative we give to both men and women, but it turns out it gets conveyed to young boys at a particularly young age. to truly be a man, you have to be self-reliant, you cannot need anyone else. also in our culture, we tell people what they need to do to be valuable. and it turns out, to be valued, you have to have, look a certain way, have certain assets, income, have a certain type of lifestyle. i think about my own kids. i have a two-year-old son, a 10-month-old daughter, and when they grow up, i want them to live in a society where they believe that what they are worth

is about who they are. whether they are compassionate, kind, generous. not about what kind of car they have, how much they have in their bank account, whether they have the latest fashion trend hanging in the closet. but we tell people over and over again, through advertising and other means, that they are not enough, that they are insufficient on their own. i think this grates at people. a little later i want to get to solutions, talk about how to address the challenges of loneliness, because they trace back to the key elements, not just how we reconnect to others, but how we build stronger connections with ourselves, value ourselves more, because that is the foundation on which our connections with others are built. steve: the second paragraph of your article, a story of how your family was a victim like so many others of hurricane andrew in south florida in 1992. like thousands of others, we survived the storm and the many dark days that followed because of the kindness of strangers who brought food, water and comfort. hurricane andrew forged a deep sense of connection in south florida as the nation rallied around us and we supported each

other. but slowly,1 as normal like resumed, we went back to our work, schools and lives and once again grew apart. that was a very stark image. that where our clutch is is not in connecting, in moments of crisis, or tension, or despair or something. i am interested in whether human nature has taken us there, whether you think that is reversible. that elements of empathy, social concern, that is something that can be seriously sustained on a more consistent basis. dr. murthy: that experience of living through hurricane andrew, it certainly was a profound one for me. what it exposed me to, and i think this is true of many natural disasters, it exposed me to what people are really like at their core. at their core, people are empathetic, kind, generous, but

things happen to us in our life that lead us to believe we cannot be that way. we are told, if we are too kind, we will be taken advantage of. we are told a whole bunch of things that lead us to believe ultimately that our focus should be on the individual, and should be on work, as opposed to on others and on building community. and what has happened as a result, as we built our lives around work and external values, as opposed to around people. i think about that a lot right now, because my wife and i are trying to figure out where we should live, what we would like to do in this next phase of our life. and it has become very clear to us, in part because we have kids, but even just on our own, we want to and need to live someplace where we prioritize people, whether that his family

and being close to them, or being close to close friends, or being in a place where we can make new connections. but we want to build this next phase of our life around people, and we realize we have been guilty of spending the last several decades building our lives around work, often to the detriment of our social connections. but i do think it is our natural state to be empathic. when we are in places of extremis, in crisis situations, that tears off all the other layers and exposes who we really are. you see communities come together in these extraordinarily beautiful ways. i would love to flip the ratio in our lives, and have that be more of our day-to-day experience, so that we can live in the way i believe we truly evolved to be. steve: i want to get to solutions. i know you deployed some of these as surgeon general, but i want to ask a different question that might sound unsympathetic, and i'm trying to figure out how to craft this. dr. murthy: don't be gentle.

steve: i can tell by the interest in the room. i can tell by what i have read, how serious this is. is there a way to make it less fuzzy? i mean, is there a way to talk about action plans or frames or processes people can do to remedy this, or to frame it in a way that is less fuzzy and imprecise? because i am interested as a doctor, when you are out there trying to talk about emotional well-being, why can't we find a way that is just, i don't know, more direct? does that make sense? dr. murthy: yes, and it's an important question to ask. we tend to gravitate toward concrete things we can get our arms around. this is true in medicine as well. there is this old sort of tale about a man walking down the street one day, and he sees another man looking for something under the lamp post,

and he pauses and says, sir, did you lose something? he says, i lost my keys, i am looking for them. this guy says, let me help you maybe we can find them better together. they don't find anything. after five minutes he says, sir, are you sure you lost them over here? he says, i lost them in the bushes. why are you looking over here? this is where the light is. the reason i share that story, sometimes we go where it is easy to go, where it seems more rational, even though the solution is elsewhere. in medicine, this happens all the time. i know there are other clinicians probably watching this right now. we are taught a lot of algorithms. how to for example manage and titrate people's blood sugar with diabetes, how to manage blood pressure, how to manage numbers quite well. so we tend to pay attention to, focus on these things. but sometimes the things that

matter most to our patients don't fit neatly in a numerical box. every doctor or nurse who has cared for patients will tell you that a patient's will to live is extremely important in their ultimate outcome. they will tell you, if a patient is profoundly depressed, it is hard for them to really engage in their treatment, regardless of whether they fulfill the criteria for major depressive disorder or not. it is often in the emotional dimensions of our life that we have to deal with the most fuzziness, but where the greatest impact is often had on all the other parts of our life. but when it comes to loneliness, there are ways to make it even more concrete. number one, there are scales we can use to evaluate whether people are lonely or not. ucla developed a scale that is used in a large number of research studies. that certainly helps. but there are also concrete things we can do to address loneliness, and we can conceptualize them in three

major bina. -- bins. one, steps we can take to strengthen connections to people we know and love, family and close friends. the second, things we can do to strengthen connections to our outer circle. if the inner circle is close friends and family, outer circle are the people we interact with in the world. neighbors, coworkers, strangers we might meet on the subway, the street. the third bucket, things we can do to strengthen our connection with ourselves. and this matter so much, because -- matters so much, because our connection with herself, how much we value ourselves, how much we believe in our self-worth, is the foundation on which we build our connection to our inner and outer circles. for the simple reason, if i don't believe i am worthy and valuable as a human being, why would i think you would want to spend time in me or have an interest in may? this is particularly important because of the culture we live in right now, which is i think stripping away the self esteem

of so many people, including our young people, who are made from a very early age to feel they are not enough. so there are things we can do in these three buckets, and in the article i talked about one example of this, a tool that actually helped strengthen our connections to our outer circle. something we did in the office of the surgeon general when i was there. even though we had this great family -- steve: this is inside scoop. dr. murthy: even though we had this great family feel in the office, we realized people were not as connected to people as they could be, not necessarily feeling bonded to each other in a way that made coming to work feel like coming home. we felt that was something we needed to do something about. we tried having happy hours, weekend picnics where people could get together with their families. there's nothing wrong, those are wonderful things to do. steve: so we can keep those, margaret. [laughter]

we are using this for us. dr. murthy: one challenge with doing those, they take a lot of resources, a lot of time as well. and when you -- what you are often asking participants to do is sacrificed time with their family or time at work, and sometimes they have to come back and finish that work later. sometimes it's worth it,, but it is challenging. we decided to try something even more simple, to take five minutes once a week during our all staff meeting and ask the people, ask one person on the team to take that five minutes to show us pictures. it can be pictures of their choosing. of their life before they were in the office, of their childhood, their friends, their aspirations, anything they wanted. but just show us pictures, in five minutes. and that's what they do. it was an extraordinary thing. in a very short peiod of time, a couple weeks, this meeting quickly became people's favorite meeting of the work. if i tried to reschedule the meeting, there was holy hell to pay. nobody wanted to it miss the meeting.

steve: did you show your pictures? dr. murthy: i did not. the reason i did not, we didn't actually get around to me before my time in office ended. [laughter] they have time with me. that was fine. but the bonds they built with each other were our highest priority. we found not only people loved the exercise, but we were surprised to see they felt more comfortable. people started crossing outside of their lane, into other people's lanes to help them out when they were struggling. we realized people were raising their hands more at meetings to participate, because now they felt part of this community, more connected to everyone else. that is a simple exercise to do, but for us it was five minutes that was perhaps the most important high-yield five minutes of our entire week, and it helped our whole team work a lot better. steve: in a moment, i will go to a live view and we will make a

special phone call to someone who is trying to work in the austin community on this issue, which i will get to in a minute. but as you are thinking about other strategies, i just want to be candid, the notion of mental health or emotional well-being, i know you talked about emotional well-being often gets conflated as happiness, it is a hard thing to achieve in some communities. the atlantic helps produce the aspen ideas festival, and we did a thing on the happiest places in america, and interestingly bolder, colorado comes out -- boulder, colorado comes up number one. the mayor said it was because most people felt like they had a sense of purpose, something that calls them, and they ride bikes and walk everywhere, that mobility. not every place is boulder. if you were to get a second chance at surgeon general, returned, what would you prescribe at a level to go into some of the worst, most stressed

part of the community and figure out how they get back on track? what are proactive things? we have lots of folks here who are multipliers in their community and watching. what are some other things you would consider. dr. murthy: i think in communities, you need different parts of the community to play a role in building a really connected community. they community made up of -- the community is made up of entities, nonprofits, workplaces. there are things each of them can do. workplaces can start simply by measuring loneliness in their own workplace, with simple steps to get people opportunities to understand each other as authentic people. people want to be known as more than just joe who is great at excel, mary who is great at pricing strategy. that doesn't mean everyone needs to know you at work, but people need to see the human society of you beyond your skill set.

schools can start to look at how to build social, emotional learning into their curriculum, and nonprofit organizations, particularly focusing on youth. i look to some amazing programs already built around the country as ways to bring young people together. an example, in chicago there is a great program called the becoming a man program -- and the goal is reducing violent arrests among at-risk young men. it is a simple program bringing small groups of young men together with a facilitator, and once a week they talk. they talk about a range of issues, and the facilitator helps them get to deeper issues and start sharing about the stuff that really matters to them. whether its relationship with family, concerns with safety. it takes time to build up to that. but what they found, a study conducted at the university of chicago crime lab, in one year when compared to a control school, students who participate in this program once a week for 30 weeks had a 44% reduction in

violent arrests compared to the other group. when i spoke to the founder of the program and set, what is the real active ingredient? teaching skills for conflict resolution and de-escalation? he laughed, said no. the number one, two and three reason the program works is because we are addressing loneliness among these kids, giving them the opportunity to build trusted connections with each other. the truth is that it's not just these young, at risk men struggling with loneliness, but people across the age spectrum. i was doing a radio program with iowa and pr some months ago -- npr some months ago. people called in at the end. a man in his 40's called in and said my best friend died two or three years ago, and i have felt profoundly lonely since then, but as a guide, i feel like -- guy, i cannot say that. a woman called in whose daughter had just gone to college, and said, my daughter came back home for the holidays and said, i am

texting with people all the time, messaging all the time, but nobody really knows who i am, and i feel so alone. she was crying telling me this story. she says, i sent my daughter to school to be part of a community, and i never thought she would feel so profoundly alone. so there are these steps that institutions can take. but local government, one of the most powerful things it can do is to simply acknowledge that social connection matters and addressing loneliness is a priority, and set the stage for bringing together these other sectors. employers and health care systems, schools, social institutions like the ymca, to develop and be part of a strategy to create a more connected community. there are mayors who have done

this. anaheim is one city. louisville, kentucky. the mayor of anaheim actually ran on a platform of making anaheim a more compassionate, connected community. he thought he would be laughed off the stage, but won by a fair margin. the sooner we put loneliness on the agenda as an urgent priority, the happier and healthier we will be. steve: we will take a quick moment for a phone call to my friend, tom gimble. he runs austin city limits, and he and his wife courtney have created something called the hi, how are you project. it came out of his relationship with a musician, daniel johnston, who had some struggles and triumphs, and they wanted to deal with the stigma of mental health, getting poor community stakeholders to reach out to people who might be alone. by complete coincidence, i was emailing him today and set, weight -- said, wait, we will give you a call, because he will try to put together the live aid version of a big music festival, if you will, on january 22 year

focusing on this question of how to reach out to people. have we reached our friend? tom: i'm here! steve: we are on with vivek, a roomful of people, and broader on the country on c-span listening. i shared a little bit about what you and courtney did with the hi how are you project in austin and broadly. and i wanted to give you an opportunity to ask -- to make a very quick comment and ask vivek a question. >> i appreciate -- yeah. i appreciate the opportunity. it's an honor. yeah. as you mentioned, you know, what we're trying to do is encourage people to say, hi, how are you, on january 22. and i really appreciate what dr. jane said in his opening remarks about reaching out and calling a loved one. that's what my, how are you is really about. it came about from courtney's personal struggles with mental health and depression and of course my experience with

danielle johnson over the last 30 years. reach out to someone who is a co-worker or family or loved one and there is catharsis and there's power and there's healing in that. so that is the purpose of hi, how are you day on january 22. it's going to be a live streaming concert event and as you mentioned we want it to be a live aid moment for mental health. you know, so many of my questions have been answered as i've been listening here on the phone. but one for dr. murthy is it appears to me that in western medicine, that often the first

course of treatment is a prescription drug. and as it pertains to loneliness and to mental health, do you feel that there are other treatments and therapies that should be recommended first? >> that's such a good question. tom, let me thank you for the amazing work that you and your partner are doing in building this initiative. i think we underestimate the power of simple things like looking people in the eye and saying hello. interesting study done on eye contact that showed when people experience eye contact from someone else who's walking down the street, a stranger, it actually improves and measurably changes their feelings around loneliness and decreases their loneliness. that's how powerful simply making eye contact can be. so i love what you are doing. in terms of -- >> thank you. >> what you do, it's so interesting. i think back to our training and how -- what we learned about the history of medicine. and we often used to say that 50, 60 years ago before we had medicines like beta blockers and

other heart medicines to give to patients, when they had -- somebody came -- when somebody had a heart attack and came in they would often sit in the hospital for weeks while people observed them. and we used to say gosh, things are much better now and our outcomes are better. now, the medicines are important. and they work. and if i had a patient or a family member who was ill, i would want them to get medicines that are proven to work. but what i worry has been left -- that piece of medicine and reclaim that part of the doctor-patient relationship because i think it's essential if we want people to be healthy. >> thank you very much.

thank you, tom. to all of you, questions, comments here, thoughts. don't be shy. right here in the front. yes, ma'am. >> my name is paula gordon. and i have a website called gordondrugabuseprevention.com. one of my major areas of concern right now is marijuana and how it is being used so widely and leading many of the users to chronic depression and suicidal depression and increasing numbers of suicides. and in fact, there's a code red series of videos that can be found on youtube, dr. simmerville from one of the -- said that the suicides that they have seen that -- around 90% of them have t.h.c. in their systems. and i think this is something that we really have to pay a lot of attention to. >> thoughts on -- what clearly is -- you know, even the greater legal use of marijuana. but thoughts on that and the question of isolation and also health.

>> yes. so -- marijuana, i've been concerned just about how rapidly states have been legalizing marijuana for recreational use. and here's the reason why. and even for medical use. and the reason is that i actually don't think that we have nearly as good data as people think we do on how to use marijuana for medical purposes. if you have back pain, for example, and you go for a prescription for medical marijuana, how somebody -- how the practitioner is supposed to know how much to give you for what duration of time and what interaction to look out for there are a lot of unknowns here and i think that we have overestimated how much we actually know. and have not been cautious enough. but more broadly with drugs, i actually think that this is very much connected to issues around loneliness and social connection. because social connection is essential for our emotional well-being.

when our emotional well-being is depleted, we experience that as a void in our lives. and as human beings, we will seek to fill that void to avoid the pain. the question is what do we fill the void with when we're in deep pain? we may fill it with friends if we're fortunate enough to have friends. but what we don't is have people around us we may reach for something around us. it could be alcohol, it could be drugs, it could be violence, it could be self-harm. it could be a number of things that are ultimately destructive to ourselves and to others. so i think as we think about the opioid epidemic, for example, and other issues around substance use and substance use disorders, we have to recognize that if we do not address the emotional well-being of people in our country, we will not get a handle on the issues that we are facing with drugs. we will not be able to address the opioid epidemic if we are not addressing emotional well-being. and i think that's essential for us to know that's why investing in social connection is i think

one of the important strategies for ultimately addressing our drug epidemic. >> yes, right back here. hi. >> thank you. i'm katie dana from the national league of cities and i appreciate your comment, dr. murthy, on local leadership and local mayors and governance and the comments about measurement, right? is this too soft? >> right. >> and fuzzy? and so i'm wondering there seems to be two parts. i would love to hear -- your thoughts about, one is a very often on the fuzzy things we need stories. and stories to inspire more leadership. and then in terms of what's measurable there are things that are probably measurable that we're not all as aware of. so i would love to hear -- >> before you take the mic away, does the national league of cities have any resources itself? are you folks thinking about this topic among your own member cities? >> we are not focusing on this topic specifically. but one of the things that crossed my mind is that true community engagement is such a vital part of good plans, for cities, and it's a vital part of equity, narrowing disparities and to the extent there's real

connectedness and civic connectedness in the communities it also -- it helps us the cities as a whole and also i think in many ways address some of the issues that this forum is about. >> so this is going to be your wrapup here. so make it good. >> well, i think -- you know, we do have tools for measuring. the question is, we have to prioritize measuring and include measures of loneliness in the surveys and studies that we're already doing. but i think if it we look closely, we'll see that there are stories in growing number of stories of how this is actually happening. we heard from dr. jane about some of caremore's efforts, that robin is heading up. to me that's a bold example of an organization that even in the

face of a lack of data and research in the field, it's saying a lack of data is not a reason to be inactive and just to sit on our heels and wait. but we need to move forward and we need to try things and we need to study them and see whether they're working or not. so i think there are a growing number of stories like that. but i think local leaders are essential because they can help set the table that other people come and join. they can make this a priority issue. and there is something very powerful about naming the issue of loneliness that helps people feel that you see them in a way that's deeper than how they're often being felt before. one of my great concerns when i was surgeon general is i realized very quickly that we have so many amazing citizens in our country who are walking around feeling invisible, not seeing, not known, not heard but that people -- by the people around them. and they lead lonely lives as a result of that. and that takes a toll. it affects how they show up at

work and in school and in their communities. and i just wanted to say that when it comes to addressing loneliness it can get complicated. there's 10,000 things that you might think that you could do. but i try to think about three very simple things that i can do in my own life and that i suggest to others as well to address these three boxes of connection to our inner circle, our outer circle and ourselves. but i find when it comes to connecting with our inner circle that being present is what matters, spending just five minutes, being fully present with someone you love, whether that's putting your phone and your computer away at dinner time, whether that's taking five minutes on your transit home to just call someone you love and say i was thinking about you and want to see how you are. five minutes can do a lot. so being present is important. the second in terms of building our connection to our outer circle is actually helping others. this might seem ironic and if i'm lonely don't i need help from other people? but when we help others we actually reaffirm our own value and that we have something to give others. we foster a connection with them that benefits them and us. and then the third piece which i think is -- arguably the most important, building our

connection to ourselves, that requires us to love ourselves. what do i mean by this? well, loving yourself sounds selfish, and like we should focus on everyone else rather than ourselves. but the truth is when we don't love and accept ourselves, that's when we start falling into that, well, that tells us that we are not enough, that we're not valuable. and it becomes hard for us to believe that others would see anything of value within us and want to connect with us as well. and the easiest way i find sometimes to love ourselves is to remember our gifts. is to remember that we spend a lot of time focusing on what we're doing wrong, right? i should be going to the gym more and i should be eating better and should be spending more time with my kids. i should be doing a better job at work. but what are you actually doing well? what are the gifts that you've been given? i very much believe that every person has been blessed with certain gifts. that might be the ability to make others laugh, the ability to see incisively into an issue, the ability to bring people together and -- at a moment of

clarity and the ability to get people excited about a cause. we all have our own gifts. and remembering those, taking a moment to remember those is what i think we need to do to love ourselves. love as i mentioned is at the heart of addressing loneliness. love, as i mentioned, is at the heart of addressing loneliness. to me, loneliness is a problem of not being known and not being loved. and if you think about it, and when i reflect on my time in office, one of the most important lessons and insights that came out of it for me was a clear recognition that the world that we're living in is locked in this battle between love on the one side and fear on the other side. and fear is manifesting as anger and rage and jealousy and love has its own manifestations, generosity and compassion and the real question is, which way is the balance going to tip in our world? for my kids, i want them to live

in a world powered by love, that is inspired where people are generous and look out for each other, where we all come together around the big threats and challenges we face, whether that's health care or climate change are whatever it might be. that's the world that i want for my kids, a world that's driven by love. but that is going to take each of us to think about how we live lives that are more connected, how we live lives where we both are open to the love of others but also give of that love in our own way. and if you ever forget the power of love, just remember that love is, in fact, the oldest medicine that we have. it's more powerful than anything else that we have. but we have often forgot about it as we are writing our prescriptions. so just do this for a moment. take your right hand and just hold it up. i want you to close your eyes for a moment and put your hand over your heart. and for the next 10 seconds, i want you to just think about the people who have loved you over your life. think about the people who have accepted you for who you are, who have cheered you on in your

dark moments, who have believed in you and remembered what you stand for even when you have forgotten, the people that you can look to who won't judge you, but who love you on your good days and your bad days. and feel the joy and the support and the energy and the love flowing through you as you remember those people. that is the power of love. that is how love heals. and if we commit to living lives that are grounded in love, if we build connections that are powered by love, then i believe that what we can do is create the society that we all dream of. we can create a society that we deserve and one that our kids deserve, as well. steve: ladies and gentlemen, vivek murthy. thank you. [applause]

[captions copyright national cable satellite corp. 2018] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] announcer: to discuss the age of social isolation, please welcome kate julian, senior editor at "the atlantic," kim parker, director of social trends research at pew research center, ryerson,marsh president of aarp foundation, and please welcome back "the atlantic's" steve clemons. steve: now that i got my voice back, that was so powerful. thank you all for joining us to dig deeper and broader into other corners on the area of social isolation. and i just want to pay tribute to my colleague kate julian on

the cover story, sex recession, which we will not be discussing, but it is a great piece and we have made available these magazines for you out there. so kate, thank you. but let me start with you, kate, for a moment. much of what you're talking about which i was trying to get into with dr. murthy what are the macro forces today that are changing the way we interact? you dealt with a lot with physical intimacy. but intimacy broadly, the connectivity between people and you wrote, printed out in small type a 23-page article that's probably, i don't know, 16,000 words. kate: 12,000. steve: what did your research show you? kate so i started with physical : intimacy in part because that's the most sort of surprising part of this picture. we all have this idea that other people are having a lot more sex than they actually are and the young people in particular are having a lot more sex than they actually are. and very attention getting when you tell people, in fact, people who are now in their 20's are less likely to be physically

intimate with another person and are having sex less frequently than people who were in their 20's from the gen-x generation or among the boomers. and what i found is leading likely causes of this change are both positive and negative, which is to say people seem to be sort of feeling more comfortable saying no to sex that they don't want to have. that's a good thing. other parts of this sort of increasing reliance on various forms of digital entertainment, porn is one of them, but by no means the only one, increasing reliance on dating apps, rising rates of depression and anxiety, and sort of a different approach to adolescence which we see more people coming into their 20's with less relationship experience than previous generations had are also part of this picture. and those together are more concerning because they sort of have profound implications for our ability to connect with people, not just sexually but

emotionally. steve: did you find cases -- i had a fantastic mom, but my fantastic mom was a case in point for someone who completely cut herself off from nearly everyone and became highly isolated. and when she passed, i heard from a friend of hers -- my mom apparently became one of the best elderly gamers in bartlesville, oklahoma. and young kids adored her in the sense that they knew when she had problems, so she had virtual relationships. and so a woman in georgia , literally whom she had never met, became her best friend. so i'm just asking, should we -- should we be cautious of the notion that digital relationships are fake relationships? because that's some of what the implication of what is being written about more and more, is that that virtual world of connectivity is a fake one that doesn't -- but i have to tell you, i found something different , at least in my mother's case

pure just wondering what you found. kate: well, i think in some cases absolutely digital connections are helping to compensate in really helpful and healthy ways for other types of connections that may be missing. if can you connect with somebody in another state and whom you may never contact in real life sure some connection -- real life and share some connection with them, that is absolutely a a salutary thing. the problem that i found in my sort of dozens and dozens of interviews with 20-somethings about their relationships and lack thereof is that most of the people who were not in relationships and who reported having difficulty making relationship contacts weren't happy about it. they were not saying i don't want to have a relationship because i'm -- you know, spending all my time gaming or because i'm spending all my time watching streaming tv. they were saying, i'm finding it very difficult to connect with other people and so i do these other things which make my life more pleasant in the short term but make it more complicated to find somebody in the medium term. you see this out

there. lisa: certainly. steve: i see you nodding so much. in the research that aarp has got, what aspect of that do you see as moving the needle in terms of how things have changed in terms of relationships? lisa: yeah, thank you, steve. certainly, we do, and the article was fascinating and i would agree with you, kate, that it is really about, in your mother's case, it is a case in point. it's about the quality of the connection. so we think about loneliness, right? which is subjective, how we view our own state or situation and social connection or social isolation which is objective. and it's not just about contacts and the frequency of contacts , but it is about the quality of those relationships and contacts. for example, in our recent survey, knowing your neighbors, which dr. murthy talked about so poignantly in the opening session, is powerful. 61% are lonelys, if they do not know their

neighbors. steve: let me ask you a question, kim, on the broad side of the data of what you have found at pew and i understand you've kind of looked not just at the loneliness question but the broader social context. again, i'm trying to get the context of -- if we were having this discussion in the 1930's when it was a time of social stress and you wouldn't have the same communication, how has the social pot changed from pew's perspective in the research you've done? kim: well, i think one of the biggest things that we've seen in our study of the changing american family -- and this sort of is the logical outcome of what kate is seeing among people in their 20's -- is that people are just not getting married like they did in the past. and i think, you know, we know that people are marrying later. but what we have found is that many people are foregoing marriage altogether, and that's obviously one of the most solid and profound connections upon which a family can be built and that can, you know, most likely prevent some loneliness in aging. among older adults, those who are married or have a partner are less likely to say that they're lonely. there's one other thing i wanted to mention which we haven't really talked about at all tonight, which is the changing

economy and the changing job market and the extent to which that might be alienating people. so labor force participation among women has gone up over the last recent decades. but among men it's been going steadily down and particularly among men without a college education. and i think there's a high correlation between those men who are struggling to have a place in this economy, their own sense of loneliness and alienation, and also some of the problems that we see with opioids and addictions and depths of despair. you, how dot to ask we fix this? part of me is -- this has been around. there's this columbia university study, and i apologize if i get part of this wrong, but it really impacted me. columbia university looked at some of the heat waves that hit europe. and they compared paris and the death rate among largely elder folks in paris to rome. and for whatever reason, the measurable social and family networks in rome with some of

these folks were higher and thus people were checking on them more, the provision of water was greater, and there were other things, so the death rate was significantly different between these two cities. if i break -- if i butchered that study, i am sorry. but that was the large outline. but this showed clearly, years and years ago, why have we been so poor at -- whether it's abroad or more nationally, at making a dent in this and what are you doing to make a dent? >> thank you, steve. first and foremost again, this is a thread that's going through this wonderful atlantic lives dialogue this afternoon is that we haven't talked about the issue. there has been such stigma about social isolation and loneliness. so part of it is as we keep in -- part of it is, as we keep repeating, is raising awareness about it. and there is the notion of people being less known. our study indicates also another

big topic for us to talk about and that is that for older adults, for those who are low income, so one in three already report that they are lonely. one in two for older adults who are low income, significantly higher risk for members of marginalized populations such as those who would identify as lgbtq plus. so we have to think about social structures, as well, and the fact that we haven't addressed changes that need to occur in order to be totally inclusive as well. we lost touch with each other. steve: kim, what do you think -- i know that you're not often necessarily prescribing changes , but you know the data well enough and the change. d have insights that if we were to make different sorts of social investments we have folks from cities here, and we're at the forefront of cities rewiring themselves and retrofitting themselves, we'll have sensors in just about everything -- do you see, i guess, any optimistic element of how we could rewire some of that to address some of these social isolation questions?

kim well, yeah, you're right. : we don't prescribe fixes. steve: i'm protecting pew here. >> you probably have some perspective. kim: well, one thing i would love to mention is that we did a big study on differences across community types last year looking at the urban and rural and suburban divides that exist. and we found, sort of to our surprise, that there aren't differences in terms of sense of connectedness to community and knowing your neighbors across these different community types. so you can build strong community and connections with neighbors in the city, in the suburbs, and in rural areas. and that was really interesting. so people in cities aren't necessarily rushing around in all the hustle and bustle and not making those connections with their neighbors. we found pretty standard levels of connectedness. but in the question where we asked about loneliness, we found that knowing neighbors and feeling connected were two of the biggest predictors of loneliness in the study. and there weren't big demographic differences. men and women, young and old, -- i would not say rich and poor because people who are more financially stressed were more likely to be lonely. but racial differences we didn't see in terms of predicting

loneliness. but we did find those community connections were extremely important. steve: kate, i want to ask you about your piece again. one of the things that comes blaring out of it, a lot of stuff i did not realize like the number of folks living with their parents right now. and while that may be bad for their sex lives -- but with the interior -- with the intergenerational connectivity, doesn't that yield other benefits that may help address some of this? because one of the things that we hear about, at least with greece, italy, and spain, this big family oriented social network. and i'm just wondering if by economic reality, generations are forced back together, does that help correct some of the alienation and mobility things, some of the things that you were laying out? you do not address that, but i'm wondering if you felt that was a net positive as opposed to a net negative?

kate: this is one of the big questions i was left with after the piece and i'm actually hoping to look into it for a future piece. but i think there is a lot of promise, right? and potential in the model that involves intergenerational living for people across the age spectrums. i think, certainly, one thing that needs to happen for that to work better is for us to sort of change our sense of what's normal and what is desirable. because many of the younger people who i spoke to who were living with parents felt that that was somehow a sort of mark of failure on their part. and that fed into some sort of low self-image problems that were, in turn, leading them to be more isolated. if we can kind of redefine this as a more functional way to live, i think that would be to everyone's benefit. in the course of reporting the piece, i spent quite a bit of time hanging out in co-living communities in d.c., and this didn't wind up in the piece but i thought this was a really interesting model, as well, sort of planned group living with some sort of support involved. and people sometimes refer to this as dorms for adults. but i actually wound up

thinking, you know, it's pretty attractive, actually, for people when they're not living in the context of a nuclear family unit to have some sort of living , setup where there's some sort of programmed social activity. and i was really struck by how diverse the places in d.c. are. ofe oslo, common, a bunch these different things. i thought that this has some promise to offer that sort of beyond what i would have expected. steve: lisa, aarp has a couple of things, and you have this initiative that you are doing. but i'm going to have you share just a couple of moments about that. but i'm also interested in the miami dolphins. lisa: they won the football game. steve: they won the football game but you have a collaboration with the miami dolphins. and i do not. i follow sumo, not football. [laughter] steve: they go out and they

deliver services and opportunities in the south florida community. and guess one of the questions i have, what it was alluding to, is cosmetic things that just touch something versus things that become deep and meaningful. so how do you make a miami dolphin's day of delivery and service into something that's not transitory and ultimately shallow and ineffective? and how does your other initiative -- : connecttoeffect.org. steve: share with us how to make that a deep thing that moves the needle, if you will. and then i'll going to all of you. lisa: i'll start with the miami dolphins. i didn't know much if anything about football before coming to aarp foundation. we began working with the miami

dolphins because, no prize to all of us here, there is a growing aging population in south florida. it's highly multicultural and really income diverse. steve: very politically powerful. lisa: yes. and the dolphins use their fan base as community volunteers. and they engage them multiple times throughout the year. so what we have been doing with them is to raise the issue of intergenerational connection and the importance of reaching out to vulnerable older adults with a variety of activities over time. as it relates to connecttoeffect.org, this is a platform and it's a manifestation of the commitment at aarp foundation to end senior poverty by increasing economic opportunity as well as social connection. we see both as equally important. and it's a platform for you to take an assessment of your risk, and it is to learn about what's happening in communities. there's a lot of mutuality stories that are shared as well. we share research with you. in fact, new research on the benefit of community choirs so the power of arts, for example, in our lives. we see connection as necessary for well-being, both physical and emotional, and harder to

attain for low income older adults. so i'm even looking out at colleagues, and things like hearing loss and low vision or vision loss which are real predictors and also causes. and we need technology to change. it is very expensive for low income people to get what they need in terms of those devices. that technology change will matter. steve: let's get back into popular's and see if we have lowered it by 10%. -- let's get back to this in two years and see if we have lowered it by 10%. we have questions here. yes? bill with national academy of social insurance. some years ago, audrey hepburn talked about how you often feel lonely, and do not confuse being alone with loneliness. is there some confusion? >> there is.

it is true that you can be socially connected and still be lonely. and you can be socially isolated and not feel lonely at all. again, loneliness is subjective and isolation is objective, but it is clear they are connected, very clear. >> absolutely. is clear that it has become more socially acceptable to be single and not to seek to be in a relationship. that is a good thing, and i welcome that. what concerns me more is many people who are not in relationships where a tribute in their unhappiness and loneliness to the fact they were not in relationships. for people who want it and cannot find it, elusive as it is, that is concerning. >> thomas from baltimore, maryland. is a book outhere

that talks about social infrastructure. i am curious to know what your thoughts are on the type of investment is getting done in social infrastructure a policy to improve loneliness. >> there are so any things i could mention that are sort of related. we have seen it in research in recent years, the role of religion and the rise of this in society. people have fewer and fewer connections to religious institutions and are not attending church or temple, and that is especially true among the young. in a survey, the young were most likely to say they were lonely and feeling disconnected. that is just another interesting thing to throw into the mix. steve: what kinds of investments should we be thinking about and

social infrastructure? >> it is critically important that we think about investments end that we are righting th balance of inclusion with social infrastructure across this nation. for me, that is everything about policies that address issues of access. you think about access to quality care, and that is really important to this conversation. i know there was a question earlier about what happens in cities, so it could be local policies, as well, that think about inclusion of all individuals, all neighborhoods, all people. policies that reflect that we all lose on people are lonely and are not able to share their gifts and talents with our communities. many more issues we could speak about later. >> hi, janine jacobs. as we think about the #metoo movement and dynamics, how does that play into loneliness? are people now more afraid to

attract with individuals of the opposite sex the cuss of some of the implications that are in -- of some of the applications now being discussed? the dataort answer is i relied upon in this piece does not yet reflect anything that happened in the wake of #metoo. did come up in interviews were men and women talked about a tentativeness and uncertainty about how or when to make the first move. part of the difficulty in figuring out how much of this is #metoo and how much is other things is looking at what has changed in the past 10 years. online dating has become really the acceptable way to meet people and by some measures the most common way. this does not work that well for all people. is it more awkward to strike up a conversation in role life because the blog spec you to do is more you tinder or

awkward because of #metoo or is it more difficult because of the settings in which we used to do that? we are now on our phones. the answer is probably all of those things. i talked about how i met my husband in 2002 in an elevator. this came up in conversations with a bunch of young women were they asked how i met my husband, and i would tell them, and it would prop surprise -- it would prompt surprise, like, oh, i would love to meet someone that way but it will never happen. beliefs we do not believe someone will talk to us in certain spaces. steve: i commend you. it was a wonderful treatment of that, and i love the section of ds topeace with regar the #metoo tensions. it was brilliant. awareness broadly,

raising is part of it and also taking action. i would be interested in what the three of you think of the things that one could most do to, again, make some progress on isolation. more broadly, mental health. in my own comment, i have been so impressed with the national council of behavioral health and trying to make mental health first aid and training a kind of new cpr. one million people out of 300 million people may not. select a lot, but it is a start. they have had a million people, and that is a sign of people making an effort. living with mental health is not easy for others. i would be interested in the insights the three of you have on what you would add that we could think about proactively doing. >> i would say it is very

important that we recognize that very few people talk about loneliness or social isolation with their health care clinicians at any level. so to educate those who are clinically trained to bring up the subject, understand people's needs, and to have interventions. really attack this with the same vigor we would other chronic diseases. and then i would say the conversation we're having about everyone being able to solve -- be the best possible neighbor you can be. you will feel better for reaching out, and your neighbors' lives will be improved as a result. studies see with many and public of any, raising awareness about an issue can really move the needle and change opinion. we have studied teens and their attitudes and there are concerns about anxiety. parents of teens are extremely

concerned about this. i think it is a positive sign because it is becoming more part of the dialogue. more people are adjusting the issue that are high-profile, neck can be important -- and that can be important. i think it is a process and we are moving in the right direction. >> i second that. i would like to see changes with adolescents. it has important ramifications providers,, for care educators, policymakers. oo long, without about adolescence is a holding pen and we have to just get through it. research is coming out showing it is a crucial develop mental period. if to just get through it, you're not having those expenses developing relationships, not just romantic that platonic, it is much harder in your 20's to do that in lasting and meaningful ways.

one thing i felt was fascinating as i was working on this was looking at how other countries are responding to some of the send of elements. in the netherlands where teenagers are having sex waiter and less at escalator and less, a good thing, they are holding hands less and learning less and kissing less. the dutch are really concerned about this. they sort of thing people are not getting the kind of experience connecting, so how will they do it as adults? i think we should take it just as seriously. steve: i want to say thank you so much. a big round of applause for kate julian, lisa marsh ryerson, and kim parker. thank you so much. margaret: thank you. thanks, steve, lisa, kate, and kim for raising our awareness is a beautifully. this was a rich conversation. we have had a lot of conversations saying we want

resolutions, but this is a rare moment where everybody talked about meaningful things, whether it was getting to know your neighbors. i left dr. murthy's recommendation to be present and help others, recognize your own gifts. i do not know if i got all the the insideght, and scoop, saying love is at the heart of addressing loneliness, beautiful words to live by. caremark so much to for enabling us to have this conversation. thanks for coming. we know how precious your time is an are really grateful you spent your time with us. have a wonderful evening. january, and will have the youngest was diverse freshman class in history. new congress, new leaders. watch a live on c-span starting

january 3. when the newly elected congress comes into session on january 3, republicans will have an expanded majority in the u.s. senate area mitch mcconnell will continue as leader. on the others of the aisle, chuck schumer remains the top democrat as minority leader with dig turbine as minority whip. january 3, watch the seas -- senate on c-span2. new congress, new leaders. watch the process unfold on c-span.

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