Graduates of UPenn’s MAPP program know well that social connection is a powerful and necessary ingredient for well-being. At the MAPP Summit last October, students were treated to a visit from the 19th Surgeon General of the United States, Dr. Vivek Murthy, who has made it his mission to spread the message that lack of human connection poses a significant public health risk to our nation. In fact, lack of connection, experienced as loneliness, can affect our health in profoundly negative ways.

In a fireside chat-style conversation with co-founders of UPenn’s MAPP program Dr. Martin Seligman and Dr. James Pawelski, Dr. Murthy talked about his many trips around the country as acting Surgeon General, speaking to hundreds of people about their health. Throughout these many conversations, he noticed the common thread of loneliness. Regardless of geography or socioeconomic status, underlying the stories of opioid use, depression, anxiety and chronic illness, Dr. Murthy saw that loneliness was as prevalent as any of the other health struggles he was used to treating. During these interactions, he heard quotes like “I feel like if I disappeared tomorrow no one would notice” and “I feel like I am invisible.”

As a physician, Dr. Murthy was used to dealing with cardiovascular disease, obesity and diabetes, but as he delved deeper into the topic of loneliness, he began to see it was “more common and more consequential” than he had previously thought. He shared with the MAPP audience the results of a Brigham Young University study that showed a strong correlation between loneliness and mortality. Shockingly, in the research, chronic loneliness had a negative health impact on par with smoking 15 cigarettes a day. Loneliness was also found to increase inflammation in the body, heightening the risk of dementia and cardiovascular disease, as well as anxiety and depression.

Loneliness may stem from our evolutionary interdependence. Dr. Murthy explained that during the evolutionary period when humans were hunters and gatherers, group cooperation and togetherness helped people share food and resources and watch for predators. Our survival was dependent on other people, and this strategy became wired into our DNA. He explained that when we experience loneliness, our body perceives it as a state of threat and creates an elevated stress response. Paradoxically, this threat perception leads to an enhanced focus on self and perpetuates loneliness by making us more suspicious of others and of our surroundings, leading us to further withdraw and exacerbate the situation we need to reverse.

Dr. Murthy described loneliness as “the perceived gap between the social connections we have and the ones we feel we need.” He likened loneliness to hunger or thirst, a natural signal indicating we have a deficiency in something we need for survival. If we don’t respond to that signal by seeking out social connection, we run the risk of the experience of loneliness becoming chronic, with negative health consequences.

Dr. Murthy shared his personal experience of being lonely as a child. Although he felt loved and secure in his home life, he noticed that the feeling dissipated when he arrived at school and faced the possibility of being excluded in the cafeteria or not picked for a sports team. Exacerbating this feeling of loneliness was the feeling of shame he associated with it; that by admitting loneliness, he was admitting to being unlikable or socially deficient. Unfortunately, the fear of acknowledging loneliness is not uncommon and is not relegated to childhood experiences. The shame associated with feeling loneliness causes people to further withdraw, creating a downward spiral, Dr. Murthy explained.

What has led to this prevalence of loneliness? Dr. Murthy highlighted societal trends that may be contributors. We are more mobile as a society than we were in decades past; it is easier to move away from our families and communities of origin. As a result, we often live our lives far away from those to whom we would normally turn for support.

Loneliness can also arise when our desire for connection and value of relationships are overshadowed by other priorities. Our time and attention may be devoted to achieving goals related to cultural definitions of success, usually wealth, status, and influence. Paraphrasing Dr. Murthy, focusing on these things shifts us away from focusing on relationships.

Along with these two trends, our access to technology and our use of social media have changed the way we relate to one another. Dr. Murthy observed that of all the questions he is asked when he speaks about loneliness, the most common one is about the role of technology. As to whether it helps or hinders connection, it depends, he noted. Technologies like FaceTime and Zoom can be useful tools to connect with those who we can’t easily see, whether because of geography or because of our current health crisis. Likewise, social media can help foster connection by helping people to connect offline, for example, by organizing plans for a reunion with faraway friends.

Dr. Murthy cautioned that many of us are also using technology as a replacement for in-person connection, or in ways that dilute moments of one-on-one time with people we value. For example, checking phones during a meal with a friend or using social media to catch up with loved ones instead of picking up the phone to call them are both examples of how technology can undermine our relationships. The use of social media can also erode relationships by creating social comparison—as he says, “comparing our average days to someone’s best days,” lowering self-esteem and making it harder to genuinely connect.

Despite these social trends, Dr. Murthy is optimistic that we can build connection in our own lives and help others do the same. He suggested behavior changes that enhance both the quality and quantity of the time we spend with others. Although it may sound like a small thing, picking up the phone to connect with a loved one instead of texting that person can have a big payoff. Furthermore, a short interaction between two people who are fully present is more important than hours of time with someone in a distracted state. As he says, “one of the greatest gifts we can give someone is our full attention.”

Loneliness can also be mitigated in other ways. Acts of service help us shift our attention to others, building self-efficacy and emphasizing our ability to positively impact others, Dr. Murthy explained. And conversely, solitude can also alleviate loneliness. Solitude, unlike loneliness, is a desirable state that is sought after, a time where we can connect with and center ourselves. By helping us re-anchor, solitude can facilitate better connection with others, as we show up in a more authentic way.

Dr. Murthy assured MAPP students and graduates that in the end, he doesn’t find the prevalence of loneliness discouraging. In fact, he feels inspired and hopeful that as humans, we are so powerfully moved by social connection. In April, he released his new book Together, with a message that will deeply resonate with the MAPP community: we can use the power of connection to create a world that tilts away from division and fear and tilts toward connection and love.