The Nation’s Doctor shines a light on health issues affecting all of us
For decades, the U.S. Surgeon General has shined a light on hazards to the health of Americans, both for individuals and society at large. The beacons have worked to persuade lots of people to improve health habits.
Dr. Vivek Murthy is an internist who served as both the 19th and 21st Surgeon General of the United States. As a federal government website explains: “The U.S. Surgeon General is the Nation’s Doctor, providing Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury.”
Dr. Murthy has highlighted some health hazards that are hidden in plain sight in many Americans’ lives: loneliness, parenting struggles, work-life balance, firearms, and social media hazards to children, to name a few.
It’s timely now to review some of the current surgeon general’s advice, since his four-year term is about to expire.
Overwhelmed parents need help
As the holiday frenzy sets in, a closer look shows that certain grownups seem especially anxious: the ones bringing up the next generation. Dr. Murthy has warned that today’s parents are overstressed and overwhelmed as never before. This poses big risks for them and society.
The surgeon general observed that recent surveys have shown that “41% of parents say that most days they are so stressed they cannot function and 48% say that most days their stress is completely overwhelming compared to [that of] other adults … Throughout their lifespan, parents and caregivers often face heightened stressors, including financial strain and economic instability, time demands, concerns over children’s health and safety, parental isolation and loneliness, difficulty managing technology and social media, and cultural pressures.
“Additionally, the significant mental labor involved with parenting — balancing complex schedules, anticipating a child’s evolving needs, making countless decisions each day on behalf of a child, and monitoring progress — can limit working memory capacity and negatively impact attentional resources, cognitive functioning, and psychological well-being.”
In his New York Times Op-Ed published around the time his formal warning was issued, Murthy noted: “The stress and mental health challenges faced by parents — just like loneliness, workplace well-being and the impact of social media on youth mental health — aren’t always visible, but they can take a steep toll. It’s time to recognize they constitute a serious public health concern for our country. Parents who feel pushed to the brink deserve more than platitudes. They need tangible support.”
Families, employers, and policymakers all must recognize, he wrote, that parents “are navigating traditional hardships of parenting — worrying about money and safety, struggling to get enough sleep — as well as new stressors, including omnipresent screens, a youth mental health crisis and widespread fear about the future … parents are stretched for time. Compared with just a few decades ago, mothers and fathers spend more time working and more time caring for their children, leaving them less time for rest, leisure, and relationships. Stress, loneliness, and exhaustion can easily affect people’s mental health and well-being. And we know that the mental health of parents has a direct impact on the mental health of children.
“All of this is compounded by an intensifying culture of comparison, often amplified online, that promotes unrealistic expectations of what parents must do. Chasing these expectations while trying to wade through an endless stream of parenting advice has left many families feeling exhausted, burned out, and perpetually behind.”
The doctor’s prescription: The surgeon general has urged those with the power to do so to significantly expand “access to early childhood education, maternal health programs, and a mental health crisis hotline for kids and adults. We have much more to do … [such as] bolstering financial support for families, including child tax credits. It also means ensuring all parents can get paid time off to be with a new baby or a sick child, secure affordable childcare when they need it, and have access to reliable mental health care for themselves and their children. And it requires addressing pervasive sources of anguish and worry that parents are often left to manage on their own, including the harms of social media and the scourge of gun violence.
“Having safe, affordable before- and after-school care programs, predictable work schedules that allow parents to plan childcare and workplace leadership that understands the complex demands on parents can help immensely. Safe playgrounds, libraries and community centers can give children places to play and learn and also serve as valuable settings for parents to gather and build social connection.”
Murthy also insists that each of us see the crucial ways we can bolster those involved in the vital role of parenting: “Too often, when someone is struggling, we wait for an invitation to help, or perhaps we worry we don’t have anything of value to offer. Simply showing up can make all the difference in the world to another person … Many parents and caregivers I’ve met say it’s not easy to ask for help when everyone is grappling with hectic schedules and when it feels as if other parents have it all figured out. As hard as it is, we must learn to view asking for help and accepting help as acts of strength, not weakness.”
A corollary warning on workplaces: Murthy has shown he is hyper-aware of the complexity of modern adults’ lives, including major challenges posed by the work-life balance conundrum. What steps could be taken to improve what many see as an impossible difficulty? As he has written in another advisory that companies, bosses, and workers should take in:
“The pandemic has presented us with an opportunity to rethink how we work. We have the power to make workplaces engines for mental health and well-being. Doing so will require organizations to rethink how they protect workers from harm, foster a sense of connection among workers, show them that they matter, make space for their lives outside work, and support their long-term professional growth. This may not be easy. But it will be worth it because the benefits will accrue to both workers and organizations.”
Firearms take an unacceptable toll
Firearm violence is causing unacceptable damage to the nation’s health, the surgeon general has warned. This advisory is among his starkest, cataloging a cascade of harms.
As he said in his 2024 warning:
“Since 2020, firearm-related injury has been the leading cause of death for U.S. children and adolescents (ages 1–19), surpassing motor vehicle crashes, cancer, and drug overdose and poisoning. In 2022, 48,204 total people died from firearm-related injuries, including suicides, homicides, and unintentional deaths. This is over 8,000 more lives lost than in 2019 and over 16,000 more lives lost than in 2010.”
The toll is far greater, though, the surgeon general has found, citing, for example, the evidence-based conclusion that “there are at least twice as many nonfatal firearm injuries as fatal firearm injuries … Physical and mental health impacts caused by nonfatal firearm injuries can be significant.”
Those traumatized by firearm wounds can suffer lifelong disability, chronic pain, sustained anxiety, depression, and other serious mental health problems. They are more likely to experience difficulties in employment, substance abuse, and post-traumatic stress disorder.
For the loved ones, colleagues, and communities affected by firearm violence — and Murthy noted the deeply troubling increase in mass shootings, especially in schools and situations involving the young — there also can be major psychological damage. The surgeon general finds a cascade of harm sweeping through big swaths of people due to firearm violence afflicting victims, their families, friends, colleagues and classmates, and communities.
Firearms and suicide
Firearms play a disproportionate role in suicide — an increasing and leading cause of preventable death, Murthy reported, noting that the “rate of firearm-related suicide in the United States increased by 20% across the population, with the highest increases among younger people.”
If you or someone you know is thinking about harming themselves or attempting suicide, tell someone who can help right away. Call 911 for emergency services. Go to the nearest hospital emergency room. Call or text 988 to connect with the 988 Suicide & Crisis Lifeline . The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress. Support is also available via live chat . Para ayuda en español, llame al 988.
The surgeon general’s warning on firearm violence also includes this tough-to-read information:
“Studies suggest that a fatal outcome is more likely when a firearm is used in a violent situation or in a suicide attempt rather than other methods. Nearly 90% of suicide attempts with a firearm end in death .. Acts of violence and suicide attempts often involve a rapid transition from thought to action, and access to a firearm during a time of acute stress can lead to deadly outcomes. Some suicide attempt survivors report that they acted within minutes or hours of deciding to end their lives. Suicide is one of the top leading causes of death in the United States for individuals ages 10-64. While mental health is an important risk factor for suicide, many people who die by suicide (all means) do not have a known mental health condition …
“Research shows that negative life events, such as family relationship problems, job-related stress, physical health issues, and financial or legal problems, are common circumstances of suicide, including among those without a mental health diagnosis. While the relationship between mental illness and suicide risk is complex, it is clear that access to a firearm can turn a moment of crisis into a fatal one. Attempting suicide by firearm is almost always an irreversible act that allows for little or no reconsideration by an individual.”
The doctor’s prescription: A key area that Murthy and others have zeroed in on to prevent firearm violence focuses on improved storage of weapons, including wider use of safes and separating guns and ammo. Individual gun owners can adopt steps like these with relatively low cost and effort, while increasing protection against accidental deaths and injuries among the young who find, play with, and accidentally fire weapons.
Murthy said the nation must significantly increase rigorous research on firearm violence and ways to prevent it. Congress, until relatively recently, had barred federal funding of such study. The surgeon general also has advocated for a range of laws to increase background checks and cooling-off periods in gun purchases, as well as bans on assault weapons and large-capacity ammunition magazines. He favors a deeper look at laws that take weapons out of the hands of those with histories of mental health problems and abusive and criminal behavior. He has urged the nation to recognize and treat firearms violence as a public health problem and to deal with it in ways proven to reduce other major harms.
Youngsters face big struggles
The surgeon general has received a lot of attention for his efforts to send what he considered a major message to the nation: Our kids are not all right. Their well-being has been put at high risk by multiple factors, including firearm violence (see above), the pandemic, technology — and especially social media — as well as other societal challenges, Murthy warned.
The convergence has created a crisis in the mental health of the young. As he wrote in an advisory on his concerns about the nation’s youth:
“[T]he challenges today’s generation of young people face are unprecedented and uniquely hard to navigate. And the effect these challenges have had on their mental health is devastating. Recent national surveys of young people have shown alarming increases in the prevalence of certain mental health challenges — in 2019, 1 in 3 high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% from 2009.
“We know that mental health is shaped by many factors, from our genes and brain chemistry to our relationships with family and friends, neighborhood conditions, and larger social forces and policies. We also know that, too often, young people are bombarded with messages through the media and popular culture that erode their sense of self-worth — telling them they are not good looking enough, popular enough, smart enough, or rich enough. That comes as progress on legitimate, and distressing, issues like climate change, income inequality, racial injustice, the opioid epidemic, and gun violence feels too slow.
“And while technology platforms have improved our lives in important ways, increasing our ability to build new communities, deliver resources, and access information, we know that, for many people, they can also have adverse effects. When not deployed responsibly and safely, these tools can pit us against each other, reinforce negative behaviors like bullying and exclusion, and undermine the safe and supportive environments young people need and deserve.”
Ills of social media
Murthy has gone further in raising alarms about ubiquitous social media, conceding that insufficient evidence exists about the exact balance between their apparent harms and benefits. But he has argued that a generation or more should not be lost, serving as a sort of lab rat in an unchecked, global technology experiment. As he wrote in a New York Times Op-Ed published after he issued a warning about social media:
“The mental health crisis among young people is an emergency — and social media has emerged as an important contributor. Adolescents who spend more than three hours a day on social media face double the risk of anxiety and depression symptoms, and the average daily use in this age group, as of the summer of 2023, was 4.8 hours. Additionally, nearly half of adolescents say social media makes them feel worse about their bodies.
“It is time to require a surgeon general’s warning label on social media platforms, stating that social media is associated with significant mental health harms for adolescents. A surgeon general’s warning label, which requires congressional action, would regularly remind parents and adolescents that social media has not been proved safe. Evidence from tobacco studies show that warning labels can increase awareness and change behavior. When asked if a warning from the surgeon general would prompt them to limit or monitor their children’s social media use, 76% of people in one recent survey of Latino parents said yes.”
The doctor’s prescription: Even as parents struggle with their own well-being, they must stay atop the mental health of their kids, Murthy advised. Parents must monitor young people’s lives, watching for signs of depression, feelings of worthlessness, and suicidal risk factors. They may need to be aggressive in seeking help from their pediatricians, other medical and mental health specialists, as well as school and community resources. The young, meantime, must be counseled that asking for help is a strength, not a weakness. They need to know that adults will be open and listen to them and help them with their concerns, including issues with self-image, bullying, loneliness, isolation, substance abuse, and more.
Murthy has made clear that he does not see quick or inexpensive answers. But he has argued that our nation will be judged in a big way as to how it cares for and sets up a healthy future for its young.
Bonus tips: Parents will find a magazine-depth dig into social media and the challenges it creates in a recent New Yorker article on the topic. And — with a forced sale and potential ban of popular video sharing app TikTok —those troubled by free speech arguments and attempts to rein in social media will find intriguing ideas offered by Israeli historian Yuval Noah Harari and his views on information, valuable information, and corporations’ reckless algorithms.
An epidemic of loneliness
So many people suffer with overpowering isolation and loneliness that it’s fair to label it an epidemic, the surgeon general has warned.
His advisory on this topic has won support from other experts, who have praised Murthy’s focus on this issue, about which he wrote this:
“In recent years, about 1 in 2 adults in America reported experiencing loneliness. And that was before the Covid-19 pandemic cut off so many of us from friends, loved ones, and support systems, exacerbating loneliness and isolation. Loneliness is far more than just a bad feeling — it harms both individual and societal health. It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death.
“The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity. And the harmful consequences of a society that lacks social connection can be felt in our schools, workplaces, and civic organizations, where performance, productivity, and engagement are diminished.”
Tech-altered lives
Murthy reported that even before the pandemic, the way people live, work, and play had begun to shift in ways that heightened their disconnection from others, pushing them toward isolation and even alienation. Technology has channeled more workers, for example, into solitary activity focused on screens and keyboards. While social media and tech advancements have made it faster, easier, and cheaper to be in contact with others, he said, online experiences — in online conferences, emails, texts, and the like — have not matched in-person contact, sharing, conversation, and bonding. At the same time, increasing numbers of us spend time, energy, and resources on online activities: We shop on computers instead of in malls. We play games and compete for fun online. We pursue romance and more with apps and on websites.
Murthy has warned that fraying human connections also can foster antipathy, alienation, and political polarization. We live so much on screens and in an interior world or in creations of a sharply fragmented media that we can convince ourselves of extremes and denigrate those with whom we disagree. We lose not only our social connections but also the social capital and support we build with others when we reach out and help them and they help us. Trust erodes. This is bad for individuals, institutions, communities, and the nation, the surgeon general has argued.
The health harms of diminished human interaction are becoming clear, Murthy reported:
“Evidence across scientific disciplines converges on the conclusion that socially connected people live longer. Large population studies have documented that, among initially healthy people tracked over time, those who are more socially connected live longer, while those who experience social deficits, including isolation, loneliness, and poor-quality relationships, are more likely to die earlier, regardless of the cause of death.”
The doctor’s prescription: Murthy, as always, has reported that all parties in U.S. society — government, health experts and researchers, schools, employers, philanthropic organizations, and more — must put a priority on taking steps to break down barriers and ease the loneliness crisis. His suggestions for families and individuals may harken to a different time that many regular folks would endorse. He wants us all to take time to meet many people we encounter throughout our day and to talk with them and listen deeply to what they say. He has urged us to be active in our churches, schools, and groups that interest us or that seek to improve the conditions of our lives. We need to have hobbies and interests and to share these experiences with others. We must remind ourselves to be grateful for the good in our lives, and to join with others in finding meaning, purpose, and belonging. We can turn off screens and keyboards.
“We must help our partners, children, and loved ones in building their connections — and support them so they can tell us when they need help and respond to those needs. If Murthy hasn’t already called on us to summon “our better angels,” he also underscores that key behaviors help build human connections, including compassion, respect, politeness, kindness, and a willingness to help others.
A top health communicator sees issues in his own field
The pandemic not only spread a deadly virus, it also unleashed another bug that has messed with many people’s health: medical misinformation and disinformation.
The surgeon general has kept up his sustained call for individuals and institutions to stomp out the viral spread of harmful bunk, writing:
“Health misinformation is not a recent phenomenon. In the late 1990s, a poorly designed study, later retracted, falsely claimed that the measles, mumps, rubella (MMR) vaccine causes autism. Even after the retraction, the claim gained some traction and contributed to lower immunization rates over the next 20 years.
“Just since 2017, we have seen measles outbreaks in Washington State, Minnesota, New York City, and other areas. Health misinformation is also a global problem. In South Africa, for example, ‘AIDS denialism’ — a false belief denying that HIV causes AIDS — was adopted at the highest levels of the national government, reducing access to effective treatment, and contributing to more than 330,000 deaths between 2000 and 2005.
“Health misinformation has also reduced the willingness of people to seek effective treatment for cancer, heart disease, and other conditions. In recent years, the rapidly changing information environment has made it easier for misinformation to spread at unprecedented speed and scale, especially on social media and online retail sites, as well as via search engines.”
Murthy points out that medical mis- and dis-information spreads so rapidly in public because it too often tugs at people’s emotions and base biases, with “emotionally charged” and false material more likely to be passed on. He and others underscore that social media rely on computer algorithms that, yes, they control and profit from — and these software programs drive targeted content that tries to maximize their engagement, too often their enragement and passion. Social media owners reasonably may claim First Amendment rights and say they neither generate nor alter materials others put up online (and gain so-called Section 230 protections, named after U.S. communications decency law that gives limited immunity to neutral “billboard style” posting of content).
But Murthy points out that, with medical falsity, “misinformation tends to flourish in environments of significant societal division, animosity, and distrust. For example, distrust of the health care system due to experiences with racism and other inequities may make it easier for misinformation to spread in some communities. Growing polarization, including in the political sphere, may also contribute to the spread of misinformation.”
The surgeon general has called for increased awareness and education, so members of the public are significantly savvier about health and medical topics as well as about the way modern media, social media, and information networks operate.
He has urged health and medical experts to communicate better with regular folks and to recognize their societal obligation to offer clear, concise information about illnesses, therapies, costs, and other crucial issues of public concern.
Medical-scientific researchers, he said, not only must also join with expert colleagues in improving their public communication — both in their published studies but also in talking about the works, their methods, and outcomes — but also in investigating mis- and dis-information.
Individuals, Murthy said, must step up, too. We all must be skeptical consumers of health and medical information, learning to spot bad and good material. We also must stop reflexively circulating stuff we see online unless we have checked it out and have high personal certainty that it is true — in other words, we’re responsible, too, for helping to clean up the online bull and not keep shoveling it all over cyberspace.
A bully pulpit with a record of positive change
Information campaigns by those who have held the post of surgeon general do matter.
As the New York Times recounted, these officeholders — over time — helped to prompt big changes in public views on pressing health concerns.
In 1964, the newspaper reported, then-Surgeon General Luther L. Terry … [issued] “a landmark report on the health hazards and consequences of smoking. Dr. Terry described the crisis as a ‘national concern.’ The fallout was swift. In 1965, Congress required all cigarette packages distributed in the United States to carry a health warning. In 1970, cigarette advertising on television and radio was banned.
“Tobacco has continued to be a target of surgeons general, who in later years highlighted concerns about secondhand smoke and tobacco promotions that targeted children. And in 2016, Dr. Murthy published a comprehensive report that called e-cigarettes and tobacco vaping ‘a major health concern.’ Cigarette smoking remains the leading cause of preventable disease and death in the United States today, according to the Centers for Disease Control and Prevention. But there has been progress: Smoking has declined from 21% of adults in 2005 to 11.5% in 2021.”
The newspaper reported that Dr. C. Everett Koop has been credited with “changing the public discourse around the HIV-AIDS epidemic during the 1980s. In 1986, he issued a generation-defining report on AIDS. In plain language, the report discussed risk factors and ways that people could protect themselves, including the use of condoms for safer sex.”
Dr. Jesse L. Steinfeld warned in his time as surgeon general about the harms of widespread media depictions involving violent behavior, the New York Times said, adding that he called for “appropriate and immediate remedial action” after a report to him found a “uniformly adverse effect” on children who watch televised violence.
The newspaper said that Dr. Koop also warned in powerful fashion, just before leaving his post, about the dangers posed by drinking and driving: “Dr. Koop called for tough new blood-alcohol level standards for drivers in 1989, as well as an increase in taxes on alcoholic beverages and a restriction of advertising of alcoholic beverages. He also called for the elimination of happy hours and the immediate suspension of any licensed driver found to be above the legal limit. These and other measures have greatly reduced drunken-driving deaths. In 2021, about 13,380 people were killed in motor vehicle crashes involving alcohol-impaired drivers, according to the National Highway Traffic Safety Administration.”
Surgeon generals have not been totally successful in their efforts, the New York Times reported, citing the term of Dr. Joycelyn Elders. She sought to expand access to health screenings and sex education but was forced from office “in 1994 after she proposed the distribution of contraceptives in schools and condoned teaching children about masturbation as a way to prevent the transmission of HIV, among other views that drew the ire of conservatives.”
For those unfamiliar with Murthy, the surgeon general’s website says he grew up in Miami, received his B.A. from Harvard, his M.D. from the Yale School of Medicine, and his M.B.A. from the Yale School of Management.
Before entering government service, he co-founded VISIONS, a global HIV/AIDS education organization; the Swasthya Project, a rural health partnership that trained women in South India to become community health workers and educators; TrialNetworks, a technology company dedicated to improving collaboration and efficiency in clinical trials; and Doctors for America, a nonprofit mobilizing physicians and medical students to improve access to affordable care.
His scientific research has focused on vaccine development and the participation of women and minorities in clinical trials. And as an internal medicine doctor at Brigham and Women’s Hospital and at Harvard Medical School, Dr. Murthy cared for thousands of patients and trained undergraduates, medical students, and medical residents.
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