If anyone was going to write a tellall it is more likely to be you but any juicy secrets you share anyway, that wasnt really an option for me but this is not a book i am trying to write. I did have some ideas coming out of office. I thought maybe something on a new view of Public Health to rebuild the Public Health infrastructure. I would write about my time in office and what i learned about government. What happened is sometimes you can have the best laid plans and then change direction and that happened to me. In 2017 i wrote an article for Harvard Business review because the editor asked me to. I wasnt entirely sure how interested Business Leaders would be but what i found following publication of the article is i was getting so many messages from around the world other than media folks who said this is a real problem. These messages would come from india, japan, south korea, countries across europe and latin america but a whole bunch of other types of messages. I have been struggling with this for a long time or my spouse has been a didnt realize it was so common and i didnt need to be ashamed of it and that was striking to me and long story short after that what happened is it became clear through that experience and the suggestion of a good friend and confident that this is the issue, the more i realized it is important to me and it is resonating with mild lived experiences as a child and that helps me focus on this topic. When i traveled around the country and met people in big cities i heard stories that were not surprising, stories about people struggles with Substance Abuse and addiction and parents who lost their children to overdoses from opioids, and experience no one should have. I heard about parents who were worried about depression and anxiety that seems to be rising, kids and other children in their generation but what i started to see behind these stories was a deeper threat of loneliness and here is how it was presented, not somebody coming up and saying my name is jack and i am struggling with loneliness. They would say i feel like we have to deal with all these problems and i have to do it all on my own and i feel if i disappear tomorrow nobody would even notice. I feel absolutely invisible and time after time airing that it started to register that there is something bigger going on the reminded me of my experiences in the hospital where from my earliest days of doctoring i had so many patients come in, sometimes when we had an important diagnosis we had made or had to make a decision about treatment i would ask who could i call so that we could have a family conversation, tough issues to deal with by themselves so the answer is there was nobody to call. Even at the last stages of those final days and hours where i was privileged to sit with people and be with them to their final moments a lot of times it was just me and my colleagues in the hospital who were those witnesses and there was nobody else who was there so i was reminded of those experiences when i was traveling the country and the more i looked into it i realized loneliness is more common and more consequential in terms of its impact on our health. It sounds like you are seeing loneliness in many populations. We think of the elderly being lonely but i heard you say it was affecting people of all ages and backgrounds. Is that the case . Absolutely. When i travel abroad and talked to people in england and other countries i found most people have a notion, this assumption that it was the elderly that struggle with loneliness and the reason, as we get older sometimes we are limited in our ability to go out by disability or we have the experience of losing the entire family and friends as we get older and others get ill and we are unable to connect to people as well and all of that is true but i found out that loneliness was affecting people across the spectrum and you had a spike impact among young people, folks who cast themselves as millennials in the millennial generation. What i found is it seemed to be the great equalizer. Whether you were rich or poor people lived in urban areas or rural areas but i traveled to the fishing village in alaska and heard stories, members of congress in washington dc who would tell me behind closed doors they were struggling with loneliness and wondered if their peers were too. People who were rich or poor, everybody seems to have an experience to share or they need somebody in their life who was struggling with it and made me realize Something Different is going on. You cant find so many issues to come together on. What i found, interestingly enough as polarized an environment as we are living in, in talking about loneliness and social connection it resonated with everybody and i would say there was no topic including the Opioid Epidemic i touched on during my tenure that seemed to strike accord within people as much as the substantive moment. Seems there are Mental Health effects was i was struck by how loneliness has physical Health Effect we just one point you mentioned it is the equivalent of smoking a number of cigarettes a day. It was really shocking. This was surprising to me as well. I learned through conversations with people i had and other research i did afterward that loneliness is more than a vaccine. It has deep consequences for our mental and physical health. It has major consequences outside our health as well involving how we perform in the workplace, and how kids perform in school and as we will talk about later in this conversation has serious contributions to the polarization we are experiencing in our politics and difficulty having dialogue in society. What the study seems to show is a Strong Association between loneliness and the risk of Heart Disease and dementia and anxiety. People who struggle with loneliness may sweep the same number of hours. Given everything we are learning about the importance of our Overall Health with increased risks of obesity from people who dont sleep enough, we realize sleep is important and the impact of loneliness on sleep is quite profound. The most striking that you referenced was the study at Brigham Young university, the announcement would show the association between loneliness and longevity is interesting. The mortality impact or the degree to which ones life is short and when you struggle with loneliness seem to be similar to mortality impact of smoking 16 cigarettes a day. It seems to be greater than the mortality impact of obesity in the sedentary living. I see this as someone who served as Surgeon General in an office that spent decades working on smoking and physical activity. Havent really focused on issues of loneliness and social connection because we never appreciated how powerful and impact. Host that is extraordinary and sobering. When we say loneliness, you distinguish between loneliness and solitude. Something more to it than that . Guest loneliness is a subjective term determined by how we feel about the quality of our connection. If you had to define it further loneliness is a gap between social connection, what we need and what we have in our life. A couple things that are important, it is an unfortunate stigma around it. It makes for lonely, to admit you are not likable or social decisions are appropriate. I say that not as a theoretical in practical experience or personal experience, my own struggles loneliness have a child, that is how i felt. I am blessed to have my mother and father and sister, i knew that from my youngest memories. I felt secure at home. That belonging even actuated when i walked into school. When my moms car pulled up. I was scared of moments on the playground, i worried about the last one when i had good athletic ability. I worried most of all about lunch time walking into the cafeteria, not knowing if there would be somebody to sit next to and i couldnt wait until 3 00 pm in elementary school, where i felt secure. I know from personal experience to shame the comes with loneliness is profound, what is happening, everyone else around us has their loneliness. There is an important reason to understand loneliness is shameful but it is physical a bodies have that. Hunger or thirst, when we lack social connection, we have that evolution, we actually feel a similar signal and that signal is loneliness it if we respond to that signal by seeking out meaningful connection, going to visit whose company we enjoy. And going into the Health Consequences that you are talking about ancillary interesting things happen, we start to develop these patterns that are deeper. We are wired like we are in a state of threat coming in danger when we are lonely for thousands of years. When we are hunter gatherers, did depend on numbers, in trusted relationships, we could watch out for predators and ensure we didnt, our chances for survival automatically dropped. We perceived separation and loneliness as stress and experience it with elevated threat levels with increased focus on our self, worried about safety. It makes sense to transport that to the modern world to think about what happened in the modern world, where the company by elevated threat level where you are more suspicious of people in development around you or more centered on self, you can see how you make it harder to connect, when you combine that, it is chips away at our selfesteem to convince what is harder for people to venture out. In a paradoxical sense you find we are chronically lowly you miss trust further and further into your shell when you need to be reaching out. That is why loneliness is so insidious and persistent unless we understand how to approach it. Heartbreaking to think of this, deeper loneliness leads to deeper loneliness, a very painful place to be. What are the historical and societal trends that led to the rise in loneliness. With social media, not just causing loneliness but alleviating loneliness, which is it . Is it responsible for loneliness . People feel less lonely, what is the role of that with the trend we are seeing . When you hear loneliness, i will tell you that my experience talking to people about the subject over the last few years, i feel deeply inspired, it is the extraordinary power of the connection. Not only body and minds, those stories, made me realize we have at our fingertips the ability to build a world that cannot only sustain us in a more fulfilling way but support our children in the ways that make them live. It is important to recognize the challenge of loneliness they discovered under deeper resources and deeply 6 synced. It turns out loneliness, didnt just happen when the internet started, people have been lonely to generation to generation. It seems shakespeare, in literature. What is driving us from several factors, and creates opportunity, and and it is one of the most insidious and difficult to address. If i go to a Street Corner and asked ten people what is your number one priority in life i guarantee you they would say a person or group of people but even though they say that if you look at how we live our lives as judged by where we put our time and attention and energy, what it indicates for me over the last many years, focuses on those people and other priorities. They dont value human relationships. It is defined in a particular way, not by their ability to build positive relationships over time. It is defined by your ability wealth, power, or reputation. To make a lot of money, called successful in the media. Lots of followers on social media, people who are popular and wellknown. You hear that term all the time. If i become president of the United States, manager of my own organization, principal at my school. With a position of power. When you talk to people and what they have achieved in these areas with a will almost uniformly think is the pursuit of that goal after they achieved it. Not the lasting fulfillment they wish to have. They lead us to prioritize success in a way that is different and almost separate from human relationships, ultimately leads us to focus on things that separate us and lead us to deprioritize human relationships. Technology is the single question to ask, parents in particular see their kids offloading their rooms and weekends is this hurting my child, making my child more lonely, these are important questions to ask. My belief about technology and what i have seen and read and understood, the question is how do we use it and we can use technology in ways that strengthen the connection. You live far away from a relative that we cant go in travel and see them often in a regular basis, that could be a social experience, to connect with people offline. If i am coming to miami florida, and there are not many people like you around, race or ethnicity but happen to be in your community or find that you are gay and others around you, to helping people, that is with others who shared experiences. What i worry about with technology, it is in a different way because what is happening with the use of technology, the time we spend on social media, email and devices taking away from the time we normally spend with a person, a detraction of 24 hours a day. The technology dilutes the interaction quite often. How many of us had lunch or dinner catching up to friends and a restaurant and each of us are checking phones in between are getting distracted when alerts pop up on our phones. Even worse than that the we are feeling guilty about, many experiences taught me, mindlessly scrolling through my social media feed. I dont need to do that. And it was very clearly, and they are switching. It is so important to ask the question, perhaps more importantly the quality of time and search by the intention. All this to Say Technology is a mixed bag to weaken our connection. I worry how we are using technology is in serving us well. When i think about young people about my kids as they grow up and what they will encounter on social media i worry about accelerated culture of preparedness you see propagated on social media where people are posting about their best days and we are comparing it to average days and we come up short. It is chipping away further at selfesteem which makes it harder for them. It one last question before we open up to audience question. This is about solutions. I was particularly moved and uplifted that you detail beautiful vivid pros the story so many people engaging in pollution around the world, individual schools, communities, cities, states but i would love to hear about the solutions, particularly ones that could be relevant at the pandemic, those responsible are engaging in serious physical distancing and theres a line in your book that struck me where it said for biologically primed not just to feel Better Together but to feel normal together. A lot of us, prepandemic, or helpful at all. This is one of the most inspiring principles. I had this incredible privilege, often virtually and sometimes in person, these extraordinary individuals around the country and around the world that struggled with loneliness but had extraordinary ways to connect to people. It took courage and risk and initiative and creativity. They were showing me in that example that we are not consigned to be lonely. That doesnt have to be our destiny but we can find ways to build connections in life which is how others are struggling by connection as well. I found in the course of reflecting on these stories and i want to share those with you. Principles that i think of as the bedrock for a living. One has to do, a quantity of time. Spending some time each day, 15 minutes a day, that can be an extraordinary foundation in videoconference, we say i am thinking about you. I want to know how you are doing. That may not seem like a long time but one of the things i have learned is a little bit goes a long way. We dont need to quit our jobs and spend all our time out with friends. We dont need to turn our life upside down but we can start small and we will feel more deeply connected. The second thing i learned is the quality of time really matters in the way to improve the quality of time with other people starts is eliminate distractions when we are with others. One of the greatest gifts, in a world we are so primed to act to solve problems. Can have a profound healing effect on other people. If you think back to an experience you had where somebody has been fully present with you and listen actively to what you are saying, you have this amazing feeling of being seen in that setting. It is an intimate experience. It can all happen. By eliminating distractions, the gift of our fool attention, by being open and sharing, we can deepen the quality of interaction we havent 5 minutes a highquality interaction can be much more powerful than 30 minutes of distracted conversation. The third thing was service is a power plant and now that you understand the evolution of loneliness, understated has this paradoxical effect of chipping away at the scene, you understand it should shift the attention away from us to someone else in the context of positive interaction but also reaffirms we have value to bring to the world in a tangible way and the sense of self that we affirm who we really are and there is an Important Note here about the importance of solitude which is we dont think of solitude as important, the difference between solitude and lonely, you leave me alone in a state of solitude but it is pleasant, a welcome state where we let the noise around this fall and connect more deeply with ourselves and center ourselves and that might be 5 minutes you spend on your stupid feeling the wind against your face for a few minutes you spend, it might be time that you spend at the beginning or end of the day in simple meditation or prayer or a walk you take in nature but those moments of solitude are precious and powerful, when we anchor ourselves and when we approach other people from that state of centeredness and peace we can often have better conversations and enjoy somber connections. These four i would put together as some of the Core Principles i learned from people i met everywhere, especially the busy life we lead especially given the state of the world now, how we were struggling with covid19, this disturbing virus. It has become more important to build on these principles into our life. We made be physically distant but we cant allow that to mean we become socially distant and we have an opportunity to choose between a path of deepening loneliness, a path that will ultimately lead to a social recession if you will or have a choice in the opposite direction, to step back and reaffirm the importance of connections in our life, to recommit