Chapter 1: What is the main topic discussed in this episode?
McKinsey on Healthcare, a podcast series about visionaries, leaders, and problem solvers shaping the future of healthcare.
I'm Pooja Kumar, a partner in McKinsey's Boston office. Today, I'm joined by Vivek Murthy, who served as the 19th Surgeon General of the United States. As America's doctor, he created initiatives to tackle our country's most urgent public health issues, including the Ebola and Zika viruses, obesity, mental illness, and tobacco-related disease.
He also worked on the Flint water crisis and the opioid crisis.
Chapter 2: What inspired Vivek Murthy to pursue a career in public health?
Vivek is also the author of a new book, Together, the Healing Power of Human Connection in a Sometimes Lonely World. It's great to have a chance to talk to you about the public health perspective on the COVID-19 pandemic.
Thanks, Pooja.
Vivek, let's start from the beginning. Tell us a little bit about how you got involved in public health and how you found your path leading the nation's efforts to address a broad range of public health concerns.
Well, thank you, Pooja. And it's really nice to be here with you and with the entire community online that's joining. My path to public health was accidental, as many other things have been in my life. I was never one who made five and ten year plans because when I did try, they would quickly fall apart. And when I was a freshman in college, I actually got a call from my father.
And he said, there's this philanthropist in Florida who wants to give money to a worthy cause, but he doesn't know what cause to give it to. Do you have any ideas? And what he meant was, do you want to do something? Do you want to build a project? And I had not thought of that at all. I was starting college. But that got me thinking. This was in the mid-90s when HIV was on the rise in India.
And so my sister and I together decided to build an effort to train young people, students, to go to India to empower really the students there. through community education programs. So we spent our first summer after a freshman year doing these education workshops. And we spent the next eight years building out this effort.
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Chapter 3: How did loneliness become a significant public health issue?
Along the way, we built a community health worker program in a series of small villages in South India. And this became our introduction to public health. And what I realized then is that I really enjoyed the experience of bringing people together around a vision for how to improve health at scale. And that's what began my journey in public health, which took me
to building more nonprofits ultimately led me to building a technology company focused on improving research and collaboration on clinical trials. But what tied all of those efforts together was really this common desire to bring people together around ideas that can improve health at scale.
Now, you've had a very accomplished career, including several of the experiences you just mentioned. But let's also not forget that you're only 42. What was it like being the first Surgeon General of Indian descent and the youngest active duty flag officer in the Federal Uniform Service?
Well, it was interesting. I didn't feel young because I felt that what I was bringing with me were a set of experiences and perspectives that I hoped would be helpful. But the other thing is I had to get used to working with people who were in different stations of life. So when I was 17 years old and my sister and I were building this nonprofit organization, I had to work with
principals of schools and superintendents and philanthropists who are 30, 40 years older than I was. And so the issue of being in different ages was less of an issue for me. But what I found and what I was really excited to encounter in government was that they were people of all ages and stages who were extraordinarily talented and who were doing amazing work.
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Chapter 4: What are the impacts of COVID-19 on mental health and loneliness?
We were there because of our ideas and our willingness to work hard and our creativity. And the last thing I'll say about that, which I found to be interesting during confirmation, is senators rightly asked, do I have enough experience to do this job? It's a question they should ask everybody for any major post in government. And I was able to make a case that I did.
But I found that one interesting thing is, When we get older, I think we tend to forget what it's like to be younger, right? And so we discount, for example, what younger people are able to do and how they're able to function. But I was blessed to have people, including a president who appointed me, who believed in my ideas and my experience and paid less attention to other issues like my age.
And I'm very grateful for that.
Real wisdom in your words there. You know, you started a conversation about loneliness even before this era of physical distancing that we are all caught in right now. In your new book, you discuss the importance of communities and human connection. I'd love to understand more about why you saw loneliness as a major issue in health care then even before all of what we're experiencing right now.
It wasn't the case that at the very beginning I thought I would work on loneliness. In fact, when I testified before the Senate for my confirmation hearing, I was asked what my priorities would be, and I gave them a list of issues, and they did not include loneliness.
I needed to be educated, frankly, by people around the country who, through their own stories, helped me to realize that there was something deeper happening beyond the stories of opioid addiction, beyond the stories of violence in communities and disparities in health.
that there was something deeper going on behind those stories, something that was unsaid, that I came to realize was connected to this sense of loneliness and isolation that so many people were experiencing.
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Chapter 5: How can individuals maintain connections during physical distancing?
And I found that in these stories, not just stories of one particular group, these were moms and dads across the country. They were people in remote fishing villages in Alaska. They were members of Congress that I was talking to. And in so many of their stories, I was finding that The people were speaking to this deeper emotional pain that they were experiencing.
The pain was often coming up as a sense of being alone. They would say, I feel that if I disappear tomorrow, it wouldn't matter, or I feel invisible. And hearing that again and again reminded me of two things, Pooja.
It reminded me of my own personal experiences as a child struggling with loneliness in school and feeling this sense of dread when my parents dropped me off at school because I was a really shy kid who had a hard time building friendships. The scariest time of the day for me was lunchtime when I'd walk into the cafeteria and be scared that there would be nobody to sit next to.
And I was reminded of those experiences when I was on the road as Surgeon General. I was also reminded of one other thing, which were my experiences in medicine, where I was surprised to find that so many patients came into the hospital alone. And even when we had to give them really difficult diagnoses, I'd say, is there somebody that we should call to come in?
Because this is a lot to deal with on your own. And a lot of times they would say, there is nobody. You know, I'll just have to handle this by myself. even Puja at the time of death. I remember so many cases where the only witness to someone's final hours were myself and my colleagues in the hospital. My experiences were not singular.
What I was being given a window into was a much deeper well of loneliness that affected people, not just across the U.S., but really around the world, and that had profound consequences as well for our health, given that we know now that loneliness is is associated with the increased risk of heart disease and depression, premature death, as well as anxiety.
It feels like a lot of the journey that you went through personally is now what a lot of us are experiencing through the eyes of COVID. How has COVID changed your thinking and what concerns you most about extended periods of physical distancing and isolation and its impact on society, if at all?
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Chapter 6: What challenges do frontline workers face during the pandemic?
COVID has changed my world and it's changed my perspective. Long before the pandemic hit, I was deeply concerned about loneliness. But in the age of COVID-19, I'm worried that loneliness could deepen further, that we could see the physical distancing that we're being asked to observe translate into social distancing as we feel more and more disconnected from the people that we need in our lives.
And the irony is that this is happening. during a time of extraordinary stress. And so I worry about what I think of as a social recession that we may incur with profound consequences for our health, for our productivity in the workplace, for how our kids do in schools.
But I also think that this could be an extraordinary opportunity for us to step back and to ask ourselves if we're leading the kind of lives that we really wanna lead, This is our chance to ask ourselves where people fit in our priority list and whether there's a gap between our stated priorities and our lived priorities. I will tell you that there's a gap in my life.
That if you ask me, what are your top priorities? I'd be very clear on that. My top priorities are the people I love. It's my mother, my father, my wife, my sister, my two children, my brother-in-law. But then the harder question is how am I actually living my life? Are Are the decisions I'm making about where I put my time, energy, and attention consistent with those priorities?
And if I'm honest with you, I'd tell you that a lot of times it's not.
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Chapter 7: How can the government better support frontline healthcare workers?
So there's a gap between my stated and lived priorities. And this moment is highlighting for me just how important it is to close that gap. Because I think for so many of us, we're realizing something we already knew in our hearts, which is that our relationships matter deeply to us, that they're not just nice to have, they're necessary to have.
And the science behind it tells us that they affect our health and they actually affect our workplace performance. Sehgal Barsade, a professor at Wharton, who along with others has found that loneliness is actually extremely common in the workplace. And it shows up as greater disengagement, which has downstream effects for their productivity, for their creativity, and even for their retention.
Same is true with kids. Children who are lonely struggle when it comes to learning. and their outcomes overall are threatened. So if we use this as a moment to recognize that, to build lives that are centered around people and to make the case
for creating a people-centered society, one where we do think about human connection as we design workplaces and schools, a world where we think about human connection and we're assessing the impact of policy as well, then I think we'll put ourselves on the path to creating a society that is healthier, stronger, but also more resilient than even before the pandemic began.
I love the way you spoke about being intentional and actually calling ourselves to account about what we want versus how we're acting. Are there other ways individuals can take steps to maintain their connections?
Well, yes, because we don't have the ability to be together. The question is, what can we do to strengthen connection regardless of that limitation? One of the great points of learning that I took from the extraordinary people that I met across the world in writing this book was a simple lesson that small steps toward connection can make an extraordinary difference.
That to build a connected life, it's not about necessarily transforming your life turning everything upside down, quitting your job and moving to be close to your friends. All of those things could be really helpful, but you don't have to necessarily transform your life entirely in order to see more connection. And so here's some simple things I think we can do during this pandemic.
One is we can make a commitment to spend at least 15 minutes a day reaching out to someone we love. That could be video conferencing with them. It could be calling them on the phone to just check in and see how they are. 15 minutes is not a long time. But when done consistently, it can lift our mood and can serve as a lifeline to the outside world.
The second thing we can do is we can focus on the quality of time we spend with one another, even if you don't increase the time you have with others by a single minute. If you are able to eliminate distraction when you talk to others, particularly from our devices, that can significantly boost how much you get out of the interaction and how much they get too. If you've ever had the experience
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Chapter 8: What role do private entities play in public health responses?
We've got parents who are We have these other needs that we've got to fill at home. But I'll tell you that it's really painful to see what is happening on the front lines because we have seen so many nurses and doctors who are going to work each day and who don't often have enough protection that they need.
And things are getting better, but there's so many pockets of the country where people don't have what they need. One of the things I learned in government about pandemic response is there are a few core principles that you absolutely have to adhere to. One of them is to communicate transparently and truthfully, even when it's hard, especially when you mess up.
The second is you have to lead with science and with scientists, letting science guide your decision-making, even when it's not popular. And the third is you have to get their resources to people on their front lines, the resources that they need.
And in this case, that's nurses and doctors, it's grocery store workers, it's postal delivery people, it's people who are having to put themselves in the line of fire, so to speak, because they're serving us and making our lives possible. And for healthcare workers, PPE is one piece of it. But the other thing to recognize is that many of them are going through a traumatic experience.
Like frankly, all of us are, but they are on the front lines of it. So the mental health impact on healthcare workers is already profound, but it's going to grow. Like what we know from the experience of studying hurricanes and tornadoes and other natural disasters,
is that mental health challenges arise in the form of depression, anxiety, post-traumatic stress disorder, but they don't disappear when the last house is rebuilt or the last piece of debris is cleared. In fact, they often persist for months and sometimes even years afterward.
And so that means as we think about our healthcare workers and other frontline workers, we've got to make sure that we have the mental health services for them. The last thing I'll say about frontline workers, it's not a specific policy that we need to take, but it's more about a trust or a compact that we have to build between government and frontline workers.
I believe that in moments like this, and frankly, in between moments like this, that the government's job is to support people and that people's job is to support each other. right? By that measure, I see people all around America upholding their end of the bargain. People are stepping up to take care of each other. They're dropping food off at the house of neighbors.
They're calling and checking in on friends. People are stepping up. From a government perspective, I think we've got a lot that's swinging in the positive direction. But I think we've fallen short in terms of implementation. And I think we're seeing that in terms of where the struggles that our frontline workers are having not just with PPE, but also with testing.
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