Isn’t it time we touched base? Angry, sick and alone: A public health crisis in the making

COVID-19 merely exacerbated an existing trend by cutting off people from friends and family

"I could have chosen to write about the Health Workforce Plan 2023/24 or the ongoing primary care nurse pay saga – the latter being a drama on three fronts and worthy of a Netflix series – or perhaps about the frustration of years of dithering on doctor training.

I got waylaid. Somewhere in my social media feeds, I saw mention of an “advisory” released by US surgeon general Vivek H Murthy. For Dr Murthy’s purposes, an advisory is a public statement calling attention to an urgent public health issue and recommending how it should be addressed.

Health officials in Florida and Texas recently reported the first locally acquired malaria cases in 20 years, but the surgeon general’s advisory was not about malaria.

The Centers for Disease Prevention and Control has this year released advisories regarding wildfire smoke exposure, an increase in measles cases, an outbreak of fungal meningitis in US patients having surgery under epidural in Mexico, and a potential risk for new Mpox cases. Also, there have been CDC advisories of an increase in extensively drug-resistant shigellosis in the US, of Marburg virus outbreaks in Equatorial Guinea and Tanzania, of increased Chikungunya virus activity in Paraguay and an outbreak of extensively drug-resistant Pseudomonas aeruginosa associated with artificial tears.

Serious and curious as these all are, the surgeon general’s advisory in this case was on none of them.

Rather, the advisory from Dr Murthy was about a risk to health associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety and premature death.

The mortality impact of this public health threat is similar to that caused by smoking up to 15 cigarettes a day and is even greater than the health impact associated with obesity and physical inactivity.

The threat in question is loneliness or, for the more academically minded, social disconnection.

Our Epidemic of Loneliness and Isolation is an 82-page report. Among its 11 pages of recommendations is one for investment in social connectedness equivalent to that spent addressing tobacco use, obesity and the addiction crisis in the US.

This public health crisis is older than the COVID-19 pandemic, which merely exacerbated an existing trend by cutting off people from friends and family and other support systems. Before COVID, one in two adults in the US had reported experiencing loneliness.

The rate of loneliness among young adults has increased every year between 1976 and 2019. For young people aged 15 to 24, the decline in spending time with friends is stark. Their time spent in-person with friends has reduced by nearly 70 per cent over almost two decades, from roughly 150 minutes per day in 2003 to 40 minutes per day in 2020.

That is a sad statistic for a social animal.

On a recent Friday, I found myself alone in the office, my colleagues on leave, sick or recently off to new pastures.

I thought back to the loneliness of COVID and the people in so many jobs around the country who now opt to work from home, or who have essentially been given no choice as companies have closed down branch offices or downsized their space, making the office less inviting.

I have wondered how this affects creation and maintenance of organisational culture, for instance, in the case of our new national health agencies. I’m sure it’s an issue they’re aware of, but maybe not so much as part of a wider public health issue.

I am not one for spending too much time alone. I have always loved the buzz of physically working with others. Being social is what we are about and the drive to working from home, while convenient, seems to me to be another social experiment along the lines of easy access by children to social media – we really don’t know the long-term outcomes.

In his advisory, Dr Murthy is pretty clear on the price to the US of failing to address the damage to individual and collective wellbeing wrought by social disconnection; or failing to “mend the social fabric of our country”.

“If we fail to do so, we will pay an ever-increasing price in the form of our individual and collective health and well-being. And we will continue to splinter and divide until we can no longer stand as a community or a country. Instead of coming together to take on the great challenges before us, we will further retreat to our corners – angry, sick, and alone.”

I thought that was strong stuff in a report on loneliness and coming from the US surgeon-general.

But as Dr Murthy puts it: “the keys to human connection are simple, but extraordinarily powerful” and start with the simple things like phone calls and shared meals, and at a national level, policies which support people being able to connect with each other.

While the report is about the state of affairs in the US, it raises a flag for our own health and wellbeing as a country. Even more so in an election year, when politics targets the issues that push us apart.