On its face, Surgeon General Vivek Murthy’s recently published advisory about “our epidemic of loneliness and isolation” is a work of hard-nosed, evidence-based public-health advocacy. Yet it is best read as the charter of a kind of cargo cult, a devout effort to recreate a lost and fundamentally misunderstood world by the application of sympathetic magic.
Just as postwar Melanesians sought to lure back the recently departed US Navy and its coveted “cargo” by fashioning and manning wooden airplanes and air-control towers, the surgeon general would have us recreate the outward trappings of richly connected communities and loudly invoke their appearance, apparently without much of a clue about what actually fosters them.
The report begins by emphasizing that contemporary America is suffering an unprecedented crisis of loneliness and social isolation. The data are disconcerting: From 2003 to 2020, the average American’s self-reported time spent with friends and in “social engagement with others” decreased by two-thirds and one-third, respectively, while her time spent in social isolation rose by 17 percent. In 2020, 29 percent of Americans lived alone, up from just 13 percent in 1960. Marriage and birth rates are at all-time lows, religious affiliation has fallen to 47 percent, from 70 percent in 1999. Volunteering and other forms of civic participation are in long-term decline, as well.
These trends are concentrated among the very old, who are especially isolated, and the screen-addled young, who have become our loneliest demographic. Murthy stresses that social disconnection predicts increases in unhappiness, depression, and anxiety, but that it also compromises cardiovascular health as severely as regular smoking. It is a key driver of suicide, which is rising at alarming rates, along with other “deaths of despair,” caused by alcohol poisoning and drug overdose.
The report is reasonably comprehensive in diagnosing the scope of the loneliness epidemic, but the same can’t be said of its diagnosis of causes and potential cures. Social connection, the report stresses, isn’t merely a matter of individual preferences, but is also influenced by “social infrastructure,” meaning the “physical assets,” “programs,” and “transportation networks” that facilitate the formation of social connection in a community. Social infrastructure is in turn influenced by “broader social policies, cultural norms, the technology environment, the political environment, and macroeconomic factors.” This sentence is one of just a handful of entirely general invocations of “economic factors” as potential causes of loneliness and isolation, compared to the detailed discussions of social connection’s economic outcomes.
The report reflects a startling lack of interest in the actual drivers of contemporary social disaffiliation. Even as he notes the significant effects of declining family formation and religious participation on loneliness and social isolation, for instance, Murthy blandly observes that “the reasons people choose to remain single or unmarried, have smaller families, and live alone over time are complex and encompass many factors.” Truer—and less informative—words were never written. And what might we do about these trends? Murthy suggests that we “cultivate ways to foster sufficient social connection outside of chosen traditional means and structures.” Translation: “No spouse, kids, or church? No problem: How about a cooking class organized by the Rec Department instead?”
The chief exception to this fundamental lack of interest in deeper causes is Murthy’s thoughtful treatment of the role of digital technology, especially social media, in crowding out flesh-and-blood relationships and replacing them with increasingly pathological forms of interaction. He is right to demand greater “data transparency from technology companies,” to allow us “to understand their current and long-term effects on social connection, and [to] implement and enforce safety standards (such as age-related protections for young people).” Better still would be to call directly for legislation imposing age restrictions on these platforms, or banning addictive infinite-scroll feeds. Nonetheless, it’s encouraging that a high public-health official is sounding the alarm about the dangers these technologies pose for young people in particular.
The bulk of the sixfold approach Murthy advocates is less cogent. One of his six “pillars” for reducing loneliness and isolation is to create more “social infrastructure,” such as “libraries, parks, green spaces, and playgrounds,” on the apparent theory that if we build them, the children will come—from where?— to enjoy them.
Another proposal is to get doctors involved in actively diagnosing and treating social disconnection, as though a major reason that people are lonely and isolated today is that no medical professional has reminded them to get married, have kids, or join the local Elks Club. The fifth and sixth pillars, by contrast, are to “improve public knowledge” of the importance of social connection, and to create a “culture of connectivity”: We must, that is, gather the tribe and invoke the blessings of the longed-for cargo, looking imploringly to the skies in the hope that it will arrive—but from where?
This vague and superficial approach would perhaps be less frustrating if we didn’t already know a great deal about the origins of the crisis of loneliness and isolation. Social disconnection doesn’t erupt at random. Its critical drivers are economic and technological. Aspects of this story have been told many times and in many ways in the last several decades.
For a highly partial survey, you might start with William Julius Wilson’s book The Truly Disadvantaged (1987). In it, the author analyzed the way in which the declining economic prospects of urban black Americans unraveled their social fabric, in the first instance by decreasing the “marriageability” of men.
There are also Robert Putnam’s Our Kids (2015), Nicholas Eberstadt’s Men without Work (2016), and Anne Case and Angus Deaton’s Deaths of Despair and the Future of Capitalism (2020), which argues that “the loss of good jobs for less educated Americans” has triggered a cascade of social pathologies, amounting to “the slowly unfolding loss of a way of life,” which in turn explains the rising epidemic of deaths of despair.
Most recent and succinct is Michael Lind’s Hell to Pay: How the Suppression of Wages Is Destroying America, published this month a day before the surgeon general’s report on loneliness. Lind copiously documents how, over the past 50 years, a combination of corporate labor arbitrage, union-busting, and credential-inflation has depressed the average American’s real earnings. These diminished economic prospects, in turn, depressed marriage and birth rates and hollowed out the mass-membership civic institutions that once pervaded American life, leaving us profoundly vulnerable to loneliness, isolation, and anomie.
Lind’s economic story can be summarized in a single snapshot: While “in 1985, a typical male American worker could pay for the housing, health care, education, and transportation of a family of four on 30 weeks of salary,” by 2018, “it took 53 weeks to do so.”
This change was wrought in part by declining worker bargaining power, driven by the erosion of unionization and the accretion of measures—some of them of dubious legality, such as “salary bands” or “no-poach agreements”—to suppress wages. It also owed much to corporate labor arbitrage, both through the outsourcing of production to low-wage settings following free-trade deals and the importation of low-wage workers through legal and illegal immigration. And finally, these trends produced and were exacerbated by a race to the bottom in the form of credential inflation, as workers sought to bolster their declining economic prospects by investing ever-more time and money in licenses and degrees meant to confirm their market value.
The combined effect of these three interacting trends is that Americans enter the workforce later, and earn less (in real terms) once they get there, than they did in previous generations. Declining real wages have driven steep declines in marriage rates among less-educated segments of society, where men increasingly struggle to attract and keep spouses. Declining wages have had similar effects among the growing cohort of the highly educated, whose professional lives boost the opportunity cost of children.
The downstream costs of these economic changes aren’t limited to marriage and children. Fewer well-paying, unionized jobs mean less socializing in union halls and less time to spend at the local Eagles Lodge. Low-wage jobs subject to “just-in-time” scheduling make it harder to arrange and keep a social calendar. Fewer marriages and children mean less religious participation—the strongest predictor of resumed religious service attendance in adulthood is having a child enter kindergarten—which in turn means less volunteering. And our current practice of vacuuming up highly educated Americans toward a handful of cities on the coasts means that fewer older Americans live near their children and grandchildren. Remove the cornerstone of widespread jobs paying decent wages, and the complex social ecology they sustained begins to collapse.
Americans aren’t, for the most part, lonely and isolated because there are too few playgrounds and public buses in their towns, or because too few doctors are lecturing them about how they need to get out more. They are lonely and isolated above all because their economic prospects have eroded over the past half-century. There’s more to the story even than Lind tells, to be sure, not least the role of birth control in disjoining sex from marriage and children in our collective imagination, and the chaos that has sown in our social lives.
Any serious framework for addressing the crisis of social disaffiliation would have the economic challenges Lind canvases at its heart. It would call for increasing worker earnings and bargaining power through the revival of private-economy unions and wage boards and the end of corporate labor arbitrage. A serious framework would treat marriage and religious community as the load-bearing and irreplaceable institutions they still are, not as boutique lifestyles that can be compensated for by “social connection outside of traditional means and structures.”
The Nation’s Doctor should be applauded for drawing attention to the rising tide of loneliness and isolation in America, and the myriad ways it is making us sick in mind, heart, and body. Nonetheless, his reports sheds little light on the economic disease that underlies these wracking symptoms, and so has little to teach us about how to cure it.