U.S. Surgeon General urges Mainers to prioritize social connection

Gov. Janet Mills (left), U.S. Surgeon General Dr. Vivek Murthy and director of Maine’s Office of Behavioral Health Sarah Squirrell discuss the dangers of loneliness and isolation at University of Southern Maine on Sept. 27, 2024. (Photo by Emma Davis/ Maine Morning Star)

U.S. Surgeon General Dr. Vivek Murthy recalled asking his daughter what she thinks he should do after his time in the position concludes. One could view asking a six-year-old for career advice as desperate, Murthy joked, but his daughter’s response underscored a need he’s been working to address country-wide.

“She said, ‘I think you should spend more time playing with me.’ And that was really good advice,” Murthy said. 

Murthy sees investing in social connection as key to building a more secure, promising and healthy future, a vision he shared at the University of Southern Maine in Portland on Friday in conversation with Gov. Janet Mills, Director of the Maine Office of Behavioral Health Sarah Squirrell and former Commissioner of the Maine Health and Human Services Jeanne Lambrew.

When he started as U.S. Surgeon General, Murthy said he had a long list of issues he’d hoped to address — and social isolation was not one of them. However, as he toured the country speaking with people in rural and urban areas, in the Midwest and the coast, he found it to be the issue that resonated most. 

“You think, ‘Wow, smoking, obesity, these are classic public health issues,’” Murthy said. “But, it turns out loneliness and isolation are just as important.”

And research supports these qualitative findings. A lack of social connection can increase the risk for premature death as much as smoking up to 15 cigarettes a day. Poor or insufficient social connection is also associated with an increased risk for anxiety and depression, as well as disease, including a 29% increased risk of heart disease and a 32% increased risk of stroke. 

This realization led Murthy to issue a Surgeon General’s Advisory last year on the public health dangers posed by growing rates of loneliness and isolation. During Friday’s conversation, Murthy and Maine leaders highlighted Maine policy that aims to address this public health issue and what can be gleaned from tactics being used in other states.

While social connection is often considered an individual challenge, public policy is critical in creating the infrastructure needed for such support, Murthy explained. 

Schools and workplaces can help people build skills to understand their emotions and relationships, skills Murthy said cannot be assumed anymore in the age of technology. Physical infrastructure can also be social infrastructure, Murthy added, as roads and sidewalks provide pathways to bring people together.

A universal need

Mainers have a reputation that may appear at odds with social connection, Mills explained on Friday. 

“We’re a hardy bunch here in Maine,” the governor said. “We pride ourselves on our fierce independence.” 

That public veneer does not mean, however, that Mainers don’t value and need social connection, Mills said. And that quality is also not at odds with the notion of social connection, Murthy explained. 

Loneliness is a subjective state, Murthy said. It occurs when there is perceived isolation or unmet needs between a person’s preferred and actual experience. On the other hand, isolation is an objective term because it describes the number of people someone has in their lives, Murthy said. 

“But solitude,” Murthy said, “is actually a welcome state of aloneness, a welcome state of isolation.” 

Maine’s makeup does present some inherent challenges to addressing social isolation, however.

Geographically, the largely rural state can present physical proximity challenges for gatherings. Maine is also the oldest state in the nation, and research has found the highest rates of social isolation among older adults. In these instances, policy can lay the foundation for filling in support gaps. 

Addressing social isolation with public policy

When the Surgeon General’s Advisory came out last year, Melissa Hackett, coordinator of the Maine Child Welfare Action Network, said it affirmed what she’d been hearing from parents in Maine. 

“The parents we’ve talked to have said, ‘I feel judged. I feel isolated. I’m afraid to ask for help,’” Hackett said, explaining that the “Be There for ME” campaign was the group’s response to that, an effort coordinated with the Maine Department of Health and Human Services. 

This campaign is one of a handful that the speakers discussed as methods to build resiliency through social connection. They also highlighted the program StrengthenME, which offers free stress management and resiliency resources to people impacted by the mass shooting in Lewiston last year. 

Murthy also described the state government’s support of residents following the consecutive storms this winter through infrastructure recovery funding as a means of investing in sustained social connection. 

Also, Squirrell pointed to newly added supports for schools, such as increasing school-based health centers as well as a program called Sources of Strength, which is a student-led initiative aimed at improving mental health and preventing suicide, bullying and substance abuse.

Schools are an important inflection point on the issue of social isolation in Murthy’s view because they are where kids often learn the social skills that guide the rest of their lives. They are also a place where technology use can be addressed, as research has found technology can displace in-person engagement, reduce the quality of interactions and even diminish self-esteem.

Murthy pointed to success schools have had with technology-focused policies. For example, he visited a high school in Lincoln, Nebraska, that enacted a policy restricting the use of phones and heard from students who said they’d forged new friendships with long-time classmates they hadn’t thought to introduce themselves to previously. 

“Creating an environment in school where kids both have the skills and training to be able to build healthy interaction, this is just as important as reading, writing and math and science in terms of giving them a foundation for a healthy, successful life,” Murthy said. 

When asked after the event whether she would consider legislation on the issue of phones in schools, the governor said she wouldn’t mandate it statewide, though described it as a great practice that should be considered by school boards. 

“Technology at the end of the day is a tool,” Murthy said. “It’s how we use it, design it that determines whether it helps or hurts us.”

Murthy sought to address technology use by children, specifically when it comes to social media, in another Surgeon General Advisory from 2023, which cited research findings that adolescents who spend more than three hours per day on social media face double the risk of poor mental health. Surveys have found teenagers, on average, spend more time than that on such platforms. 

In that advisory, Murthy called for urgent action by policymakers, technology companies, and families to maximize the benefits and minimize the harms of social media platforms to create healthier online environments for children. 

The power of individual action

While the speakers talked about formal support to aid social connection, they also highlighted the power of individual action. 

“Sometimes we talk about, ‘Oh this will take an act of Congress to solve.’ Not this one,” Murthy said. “This is one where even as individuals we can start to make a difference in the people around us.”

Hackett with the Maine Child Welfare Action Network said parents also say informal support makes a difference. “We’ve also heard from parents about the importance of just having somebody who cares and supports them when they’re having a hard time,” Hackett explained.  

During an interview following the event, Murthy often thinks about a time when one of his friends stopped by to simply check in and hold one of his daughters when he was adjusting to life with a newborn. 

When he first assumed the role of Surgeon General, Murthy said he made the critical mistake of not keeping in touch with his family and friends. 

“A friend came to me one day and said, ‘Vivek, your problem is not that you don’t have friends. Your problem is that you’re not experiencing friendships,’” Murthy recalled, which prompted him to make social connection a priority in his own life. 

“The same way that we think about physical fitness as being important, we go to the gym or we eat healthy because we want to be able to remain physically fit,” Murthy said, “we also have to think about mental fitness and social fitness and being able to be fit in all of those dimensions of our health.”