>> if anyone was going to write a tell-all it is more likely to be you but any juicy secrets you share anyway, that wasn't 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 wasn't 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 didn't realize it was so common and i

didn't 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 millennial's 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 can't 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 don't 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 one's 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. haven't 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 mom's 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 couldn't 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 didn't, 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 self-esteem 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, didn't 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 don't 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 well-known. 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 de-prioritize 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 can't go in

travel and see them often in a regular basis, that could be a social experience, to connect with people off-line. 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 don't 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 self-esteem 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 there's 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, pre-pandemic, 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 doesn't 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 don't need to quit our jobs and spend all our time out with

friends. we don't 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 haven't 5 minutes a high-quality 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 don't 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 covid-19, this disturbing virus. it has become more important to build on these principles into our life. we made be physically distant but we can't 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 to people and relationships, prioritizing those relationships and act on it by reaching out to people we love with more focus and care, whether it is a neighbor who might be struggling colleague at work having a hard time homeschooling their kid and teleworking at the same time. through these opportunities of shifting our perspective cannot only deepen the position we feel but set ourselves up to be more connected, more fulfilled. >> a beautiful sentiment. i you love the term you use,

urging to counter that, urge people to get takeout from a small business, asking people to think about that socially too, making those investments in your relationships and friendships, the social economy doesn't go into recession like the economic economy. >> i would say this, we think of this as an opportunity for social revival and social revival doesn't mean we have more parties. that might be one way people are getting together. whether you are an introvert or extrovert, we need social connection and social revival is one where we prioritize people. if i had one simple credo. i realize in my own life that is what i need to do.

at the heart of building a people centered life and people centered world. what i worried about when we first found out my wife and i were pregnant with our first child and i worried about the kind of world, the growing polarization of the struggles from climate change to healthcare and on and on and we are most concerned how separated people are, how mean people are to each other and we wonder what kind of world we are bringing our child into and we thought is so many parents do, we recognize what we needed to do.

to tip the scales in the world away from fear, a deep struggle between these forces. this generosity of compassion and kindness. so happy to see so much of that during a time of great trauma with covid-19 but we also see fear manifest as anxiety, anger, frustration and insecurity. that can have a toxic effect on our relationships and organizations in politics. i come to believe much of our decisions in life, much of our motivation comes from one of these sources from love or fear. the whole reason we worked on this book over the last two years, we saw it as part of our effort in a small way, tipping

the world to create a kind of world that would heal by kindness, compassion, the forces that we know our children need to sustain them, give themselves the vote. we start in our own minds and ask how we can start living more out of love than fear, we are all involved to them. >> amen. i will turn to audience questions. a wider variety of friends, young, black, white, liberal, conservative.

>> and we have a lot of anecdotal evidence. in terms of life experience. that will make you more open to people who think differently from you in other respects and in the current, in traditional society 100 years ago it was easy to live in a setting where you only associate with people who could do that, traveling between countries that you really are now when we have here. in 2020 it is much harder to avoid people who think differently from us with racial, ethnic and religious background so what we have to recognize, the setting of this type of diversity, we can go in

one of two directions, embrace it with inside to understand and reflect that or we can get close to people who think like us. the problem with the latter is because we will always be interacting with people who are different from us because of the way the world works and not cultivated the ability to understand them by interacting with them and befriending them we run the risk of feeling more deeply alienated from those around us, that is what we are seeing in society which has pulled themselves away from folks who are not like them and feel resentful at times and angry that their way of life has changed or others are diluting, we develop all kinds of narratives when we feel

threatened by others, we have to recognize while that approach pushing ourselves often looking at it as the other can lead to discord. the way to overcome that is not to put people in a room together and say let's talk about our views on controversial issues, it is a common solution, what if we got everybody together on different sides of the aisle, we can come to agreement that is not how humans work. it is not by talking about issues first but building relationships first, when we get to know whether people to understand their experiences but also find common ground.

when we have a relationship we can deal with challenging controversial issues because we can listen to other people. the uncle you have over for thanksgiving dinner, vastly different views. you may not agree on those topics, a stranger on the internet on that point of view, that gives us the capacity to listen and the ability to listen is at the heart of the ability to work through big problems and solve problems like climate change and healthcare together. >> two questions about the role of physicians and i combine them. do you believe physicians should be screening for

loneliness or lack of mitigating these risks with the stories you have heard, reminded you of times in hospitals and a patient's final days understand the consequences that loneliness can have, what would you do to recommend to help with this. how do you deal with loneliness? >> >> the position i found myself in, it is exceedingly important that doctors and nurses. and with the care we are giving somebody to engage in the care we are seeking to provide.

is that the responsibility of a doctor to treat and solve loneliness? i don't think that is a responsibility for nurses and doctors alone. and recognizing it doesn't always look like a person sitting in the corner alone, it can look like anger, frustration and irritability, anxiety, loneliness is a great masquerade or bus what we can do is we can connect people in the community to build connections. and increasing in other

countries, doctors and hospitals are identifying people to connect them to the community resources. there is tremendous value to surface the conversation about loneliness, and i didn't know how to talk about, i didn't think through it enough and i feel bad about that. i wish i had done more to help the people traveling in front of me. to understand loneliness and talk about it, it can be extraordinarily powerful and transformative. >> there's a question here, loneliness as a writer, many are skeptical from learning about, quote, us after side of

health, mental health. it can be difficult to talk about things like loneliness or beneficial things like gratitude as a science writer i'm curious what techniques you use to get past that skepticism in the mental health stigma. >> it is an abort question it if you can't get people to take it seriously, this is part of the reason i wrote this book, this is an important issue we have to take seriously and i wanted to apply the public health and medical vantage point we had looking at this not just as an initiative that makes you feel bad, but has profound consequences for society. part of the way we get people to take this seriously is to root it in our lived experience. many people who downplay loneliness, not that they never experienced it but society around them tells them this is

not something that is an important situation. we talked about shared experiences, how important it is. and it is consequential, it will be information to recognize this is, sharing our own experiences and extraordinarily powerful. empowering to other people for substance abuse for the larger movement and what powered that movement, sharing their story, making the case that addiction

is not a character flaw with serious, urgency, compassion. when i think about those patients i saw in the final moments of their life, think about the conversations, one that is privileged and participate in. they didn't think about how many powers and media profiles were written about, people talked in their final moments of life about relationships with people they love, people they wish they spent more time with, the ones that broke their heart. those final moments of life are deeply clarified.

it gives us a clue as to what is truly important to us but one of my great realizations when writing this book, we don't need to wait until the end of life to realize what matters. it is right there in front of us asking to be embraced, relationships we often have that have been forgotten. that have been prioritized. people who need us as much as we need them. if we can focus on the human part of connection with the human need we all feel not only can be kind, to build a community that values, prioritizes, we can create a social revival not just in the united states but all over the world. >> amen to that my friend. two questions, the first, i'm going to combine two questions

about children and early life. i am a middle school, what words do you use when talking with children about loneliness and i am struck by the connection to asa screening for our adverse childhood experiences. you see connection between loneliness and early life trauma, how people connect to others, both childhood and childhood experiences. >> that is where the revenue took me. it is important to have conversations with our kids about loneliness. one of the people who inspired me on this subject is mark brackett from yale who has devoted himself to building

social and emotional learning curricula, a particular program that he developed at yale, designed to build emotional literacy and be comfortable, not just talking about emotions but recognizing what you are dealing with and it starts very powerfully, seeing how teachers and parents talk about emotion, we all feel sad sometimes. this is what it feels like to me. to talk about that and experience sadness at the same is true for loneliness. when we talk about experiences that can encourage a child to feel that way to give them permission to talk about it as well. it is important to make it clear that being lonely is not a sign that you are broken are deficient in some way but to

normalize it. we all experience loneliness. we show it in different ways but it is invisible a lot of the time. can't always see it in other people. doesn't mean it is not there. it is important for kids. when it comes to trauma especially, one of the things i was struck by, when i write about in the book, a study that looks at children who experienced trauma and in this study, a study that followed kids for several decades, found the children who experienced trauma who were able to find strong social connections in their life had far fewer of the negative after effects of trauma than children who did not have those relationships. people who worked on it for years and years and years, one of the common themes that comes

up in conversation is as powerful as these adverse childhood experiences with trauma are, as deep as the wounds may go and as harsh as they be an increasing risk from addiction to lung disease to early mortality, one of the most powerful medicines we have is social connection. a lot of it comes to our relationships, i say the word very intentionally and purposefully. it is important we talk about love, we don't talk enough about it. and anything that is more powerful. and if we look at loneliness,

what ails around you, to feel more connected. to, to give and receive. that is how we address loneliness to build a more connected world. >> the final question, in light of what the uk has done. is there a public policy solution, do you need a social stimulus plan? talking about various state community school levels, a coordinated approach to

loneliness? >> that is what i would say is there is a very important role for government to play. it's not the responsibility of any one entity. it is a shared problem that requires all of us to step up, individual organizations, professions and public sector of the government. it can invest real resources and research, helping us understand the drivers, the second thing governments can do is help prioritize issues. when the government states a certain issue when i was surgeon general at the opioid epidemic, that is important to do because you can help convene and break through to fashion solutions, this is a public health priority. a third thing the government can do is examine more deeply the impact of its policy on social connection.

we were not able to appreciate this as much 30 or 40 years ago, the policies having an impact on health are not just healthcare policies but transportation and housing policy have impacts, education policy has an impact on health. what happens at schools impact the health of our children. education, housing, transportation policies, policies and the department of defense having spoken to many of our wonderful military servants. these policies have an impact on social connection when we cut cities up with highways and design neighborhoods it makes it harder for people to connect with each other. when we build a culture powered by cars, so people don't walk into each other and run into each other that is our social connection.

to focus on testing, they pay little attention to prioritizing social emotional learning, in all these ways government can have a really profound impact, how we impact the impact of policy and drive solutions by bringing various aspects. our time has come to a close, this is a very special experience for me being here because i'm doing this, this is one of the first evens, i want to pay tribute to my family, to

my mother, father, sister, grandmother, extraordinarily powerful supports but also teachers, the final pages of the conclusion the story i wrote was about my parents and minister, about a patient my mother and father cared for, a patient who passed away, studying cancer. it is 2:00 in the morning. and, they were doing that not because it was in the job

description as doctors, or the manager at the office, we are getting reimbursed by it by an insurance company. that is their responsibility as a member of the community, somebody who had a relationship with this wonderful family. to this day i will never forget in her traditional indian side. and embracing her, thinking how different they were. my mother having grown up in india, vastly different life experiences but in that moment, every life they are so deeply connected. the kind you choose for yourself. i ended with that story because

i realized the writing of this book, not just told but lived for me about human connection is demonstrated for example, those stories are going to be my guide. they reminded me our connection to each other is at the heart of where we are as human beings, how we experience joy, find support, get meaning, and so i want to end with a tribute to them. nobody has given me more than the family i just named. i feel so deeply grateful to share this book and all the lessons we learned that wouldn't have been possible at all without their example. >> the apple did not fall far from the tree. they had a huge impact and i

have seen it, thank you for the beautiful evening. this is what we all needed at this time. >> i absolutely agree, so proud to have been watching along with you. thank you for that really really beautiful, profound, timely discussion. thank you guys, thank you everybody for being with us. thank you for your attendance and your book sales are what enables us to bring you the programming. you we love hosting these events. we appreciate you all coming

out. we encourage you to keep supporting your independent bookstores. you can follow politics and prose, and be notified of future crowd cast on the same platform. we have a great program of events set up for the rest of the month. going into may as well. as a wrap-up, i am wondering, what are you guys reading during this time? >> you go first. >> i am not going to lie. twitter, the new yorker, i finished racial cadiz's book, i am going to do it.

>> similarly, i'm not reading adult books. i'm reading a lot of dr. seuss and other kids books as i try to entertain my 3, and 2-year-old when they are on the potty, at mealtime, that is the literature. >> we love that. we really hope everybody in our audience and everybody here stays well, stays safe and stays well read. see you next time. >> here are some of the current best-selling nonfiction books according to the washington post. topping the list is untamed. after that the split in the file, eric larson's study of winston churchill at leadership during the london blitz.

david allen sibley describes the life of birds followed by darley mc cassie. wrapping up our look at the best-selling nonfiction books according to the washington post is robert coker's hidden valley road. a profile of the gallon family which consisted of 12 children half of whom were diagnosed with schizophrenia. some of these authors have appeared on booktv and you can watch them online, booktv.org. >> the presidents from public affairs available now in paperback and e-book, presents biographies of every president organized by their ranking by noted historians, from best to worst and features perspectives into the lives a nation's chief executive and leadership style. visit our website, c-span.org/thepresidents to learn more abo e