On August 24, 1992, in the early hours of the morning, my family and I stepped out of our temporary shelter to find our city — and our lives — forever changed. We had spent the past several hours huddled together as Hurricane Andrew battered our South Florida neighborhood with torrential rain and winds near 170 miles per hour. We saw pieces of homes strewn across the landscape, power lines flung about like pieces of string, and sea creatures stranded in trees, having been blown far inland by the storm.
Like thousands of others, we survived the storm and the many dark days that followed because of the kindness of strangers who brought food, water, and comfort. Hurricane Andrew forged a deep sense of connection and community in South Florida as the nation rallied around us and as we supported each other. But slowly, as normal life resumed, the distance between people returned. We went back to our homes, our work, our schools, and our lives, and once again we grew apart.
Looking today at so many other places around the world ravaged by disasters of all kinds, I think about how often tragedy brings us together — and how fleeting that connection often is.
There is good reason to be concerned about social connection in our current world. Loneliness is a growing health epidemic. We live in the most technologically connected age in the history of civilization, yet rates of loneliness have doubled since the 1980s. Today, over 40% of adults in America report feeling lonely, and research suggests that the real number may well be higher. Additionally, the number of people who report having a close confidante in their lives has been declining over the past few decades. In the workplace, many employees — and half of CEOs — report feeling lonely in their roles.
During my tenure as U.S. surgeon general, I saw firsthand how loneliness affected people of all ages and socioeconomic backgrounds across the country. I met middle and high school students in urban and rural areas who turned to violence, drugs, and gangs to ease the pain of their loneliness. I sat with mothers and fathers who had lost sons and daughters to drug overdoses and were struggling to cope alone because of the unfortunate stigma surrounding addiction. And I met factory workers, doctors, small business owners, and teachers who described feeling alone in their work and on the verge of burnout.
During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness. The elderly man who came to our hospital every few weeks seeking relief from chronic pain was also looking for human connection: He was lonely. The middle-aged woman battling advanced HIV who had no one to call to inform that she was sick: She was lonely too. I found that loneliness was often in the background of clinical illness, contributing to disease and making it harder for patients to cope and heal.
This may not surprise you. Chances are, you or someone you know has been struggling with loneliness. And that can be a serious problem. Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day and even greater than that associated with obesity. But we haven’t focused nearly as much effort on strengthening connections between people as we have on curbing tobacco use or obesity. Loneliness is also associated with a greater risk of cardiovascular disease, dementia, depression, and anxiety. At work, loneliness reduces task performance, limits creativity, and impairs other aspects of executive function such as reasoning and decision making. For our health and our work, it is imperative that we address the loneliness epidemic quickly.
Once we understand the profound human and economic costs of loneliness, we must determine whose responsibility it is to address the problem. The government and health care system have important roles to play in helping us understand the impact of loneliness, identifying who is affected, and determining which interventions work. But to truly solve loneliness requires the engagement of institutions where people spend the bulk of their time: families, schools, social organizations, and the workplace. Companies in particular have the power to drive change at a societal level not only by strengthening connections among employees, partners, and clients but also by serving as an innovation hub that can inspire other organizations to address loneliness.
THE ROOTS OF LONELINESS
Loneliness is the subjective feeling of having inadequate social connections. Why has this feeling increased over past decades? Partly because people are more geographically mobile and are thus more likely to be living apart from friends and family. Indeed, more people report living alone today than at any time since the census began collecting this data. In the workplace, new models of working — such as telecommuting and some on-demand “gig economy” contracting arrangements — have created flexibility but often reduce the opportunities for in-person interaction and relationships. And even working at an office doesn’t guarantee meaningful connections: People sit in an office full of coworkers, even in open-plan workspaces, but everyone is staring at a computer or attending task-oriented meetings where opportunities to connect on a human level are scarce.
Happy hours, coffee breaks, and team-building exercises are designed to build connections between colleagues, but do they really help people develop deep relationships? On average, we spend more waking hours with our coworkers than we do with our families. But do they know what we really care about? Do they understand our values? Do they share in our triumphs and pains?
These aren’t just rhetorical questions; from a biological perspective, we evolved to be social creatures. Long ago, our ability to build relationships of trust and cooperation helped increase our chances of having a stable food supply and more consistent protection from predators. Over thousands of years, the value of social connection has become baked into our nervous system such that the absence of such a protective force creates a stress state in the body. Loneliness causes stress, and long-term or chronic stress leads to more frequent elevations of a key stress hormone, cortisol. It is also linked to higher levels of inflammation in the body. This in turn damages blood vessels and other tissues, increasing the risk of heart disease, diabetes, joint disease, depression, obesity, and premature death. Chronic stress can also hijack your brain’s prefrontal cortex, which governs decision making, planning, emotional regulation, analysis, and abstract thinking.
This isn’t just bad for our health; it’s also bad for business. Researchers for Gallup found that having strong social connections at work makes employees more likely to be engaged with their jobs and produce higher-quality work, and less likely to fall sick or be injured. Without strong social connections, these gains become losses. Connection can also help indirectly by enhancing self-esteem and self-efficacy while also shifting our experience toward positive emotions — all of which can buffer an individual during stressful situations and have positive effects on health. Indeed, studies have found that companies whose workers feel they have high-stress jobs have markedly higher health care expenditures than their counterparts with low-stress employees.
Our understanding of biology, psychology, and the workplace calls for companies to make fostering social connections a strategic priority. A more connected workforce is more likely to enjoy greater fulfillment, productivity, and engagement while being more protected against illness, disability, and burnout.
FORGING CONNECTIONS AT WORK
My experience has been that people bring the most to their work when they feel connected to the mission and the people around them. While I was at the Surgeon General’s Office, our staff grew quickly as we sought to build a team that could address an array of pressing public health issues. Although team members got along well, it soon became clear that we didn’t fully recognize the rich life experience that each person brought to the team. We had a decorated Army nurse, a woman who had spent years providing medical care to prison inmates, an accomplished pianist and preacher, an Olympic-level runner, and several team members who had struggled with addiction in their family. Even though we were operating with the formality and hierarchy of a uniformed service, my team was hungry to know more about each other.
To bring us closer, we developed “Inside Scoop,” an exercise in which team members were asked to share something about themselves through pictures for five minutes during weekly staff meetings. Presenting was an opportunity for each of us to share more of who we were; listening was an opportunity to recognize our colleagues in the way they wished to be seen.
The impact was immediate. These sessions quickly became many people’s favorite time of the week, and they were more enthusiastic about participating at staff meetings. People felt more valued by the team after seeing their colleagues’ genuine reactions to their stories. Team members who had traditionally been quiet during discussions began speaking up. Many began taking on tasks outside their traditional roles. They appeared less stressed at work. And most of them told me how much more connected they felt to their colleagues and the mission they served.
I remember one Inside Scoop from a team member who had proudly served in the U.S. Marine Corps. I expected him to talk about his experiences in the military. Instead, he spoke about the complex relationship he had had with his father and how he could see his father’s spirit living on in the musical talent of his grandchildren. He described his mother as his hero and shared how remembering her in the face of a challenge would transform his doubts into strength. As he spoke, his eyes glistened. I felt a deep connection to him in that moment and was inspired by his honesty and compelled to reflect on my own relationships. Even though we were close before, my relationship with him became even stronger after that day.
I share what my office did not as the antidote to loneliness but as proof that small steps can make a difference. And because small actions like this one are vital to improving our health and the health of our economy.
We know that if we are to prioritize our health and the health of our companies, the workplace is one of the most important places to cultivate social connections. And while it may seem easy enough to organize a team-building event, grab a cup of coffee with a colleague, or chat with people around the water cooler about Game of Thrones, real connection requires creating an environment that embraces the unique identities and experiences of employees inside and outside the workplace. Here are five deliberate steps that can help build healthy and productive relationships:
Evaluate the current state of connections in your workplace. Strong social connections are not simply about the number of friends and family members one has; it’s the quality of those connections that matters more. You can be surrounded by many people and have thousands of connections on LinkedIn or Facebook and still be lonely. Conversely, you can have just a handful of people with whom you interact and feel very connected. To assess the quality of the relationships at your organization, here are some questions to consider: Do employees feel that their colleagues genuinely value and care for them? Do they believe their institution has a culture that supports giving and receiving kindness? Would they characterize their relationships with colleagues as being driven more by love or by fear?
Build understanding of high-quality relationships. Strong social connections are characterized by meaningful shared experiences and mutually beneficial two-way relationships, where both individuals give and receive. High-quality relationships must be grounded in love and informed by kindness, compassion, and generosity. There is a tendency to look at such positive emotions as “soft” and even as a liability that distorts judgment and impairs tough decision making. But research increasingly shows that positive emotions enhance performance and resilience. Be clear with employees and colleagues about the types of relationships you want to see at work and what types of actions, like generosity, foster those relationships.
Make strengthening social connections a strategic priority in your organization. Designing and modeling a culture that supports connection is more important than any single program. It will require buy-in and engagement from all levels of the organization, particularly leadership. Having senior members of an organization invest in building strong connections with other team members can set a powerful example, especially when leaders are willing to demonstrate that vulnerability can be a source of strength, not weakness. Ask yourself if the current culture and policies in your institution support the development of trusted relationships.
Encourage coworkers to reach out and help others — and accept help when it is offered. Although it may seem counterintuitive to assist others when you are feeling lonely, extending help to others and allowing yourself to receive help builds a connection that is mutually affirming. Late one night during my residency training, I was managing a busy intensive care unit when one of my colleagues stopped and offered to help with a sudden influx of critically ill patients. Because of his generosity, we were able to rapidly place specialized catheters in patients with bloodstream infections and get them life-saving antibiotics quickly. We worked together for only an hour that night, but the connection we built lasted years. Giving and receiving help freely is one of the most tangible ways we experience our connections with each other.
Create opportunities to learn about your colleagues’ personal lives. The likelihood that authentic social connections will develop is greater when people feel understood and appreciated as individuals with full lives — as mothers and fathers, sons and daughters, individuals with passions outside of work, concerned citizens and community members. Everyone in an organization has the power to create spaces for sharing, whether it is in a formal gathering or an informal conversation over lunch.
HEALING ONE ANOTHER
When I think of loneliness, I think about the first day of my internal medicine residency program. A faculty member advised us to call the people we love and tell them that they wouldn’t be hearing from us much over the next year. As medical students, we’d heard about the trials of residency training: the unforgiving hours, the grueling intensity, and the crushing isolation. That morning, the idea of stepping away from our most trusted social relationships felt unnerving.
Despite my initial fears about loneliness, those three years ended up being the best of my life. The hours and intensity were just as billed, if not even more so. As predicted, it was very difficult to stay in touch with friends. But in time I developed rich and fulfilling relationships with my colleagues in the hospital.
Coming to work came to feel like spending time with friends. There were plenty of difficult moments when our emotional, intellectual, and physical reserves were tested — navigating a difficult end-of-life conversation, trying to find an elusive source of infection in a critically ill patient, or simply fighting back our own exhaustion — but my bonds with my colleagues softened the blows and saved me from plenty of others. Those bonds enabled me to do more, give more, appreciate more, and be a better doctor to thousands of patients. Today, years later, I wonder if these relationships provided deeper healing: if they made me not just a better doctor but a better colleague and leader, too.
The world is suffering from an epidemic of loneliness. If we cannot rebuild strong, authentic social connections, we will continue to splinter apart — in the workplace and in society. Instead of coming together to take on the great challenges before us, we will retreat to our corners, angry, sick, and alone. We must take action now to build the connections that are the foundation of strong companies and strong communities — and that ensure greater health and well-being for all of us.