There is an epidemic of loneliness in the United States and lacking connection can increase the risk for premature death to levels comparable to smoking 15 cigarettes a day, according to a new advisory from the U.S. Surgeon General.

The report released on Tuesday, titled "Our Epidemic of Loneliness and Isolation," finds that even before the COVID-19 pandemic, about half of U.S. adults reported experiencing measurable levels of loneliness.

And it warns that the physical consequences of poor connection can be devastating, including a 29% increased risk of heart disease; a 32% increased risk of stroke; and a 50% increased risk of developing dementia for older adults.

"It's hard to put a price tag, if you will, on the amount of human suffering that people are experiencing right now," Surgeon General Dr. Vivek Murthy told All Things Considered.

"In the last few decades, we've just lived through a dramatic pace of change. We move more, we change jobs more often, we are living with technology that has profoundly changed how we interact with each other and how we talk to each other."

"And you can feel lonely even if you have a lot of people around you, because loneliness is about the quality of your connections."

Across age groups, people are spending less time with each other in person than two decades ago. The advisory reported that this was most pronounced in young people aged 15-24 who had 70% less social interaction with their friends.

Murthy said that many young people now use social media as a replacement for in-person relationships, and this often meant lower-quality connections.

"We also know that for some kids, being online has been a way to find community at a time when many of them have not been able to," he said. "What we need to protect against, though, are the elements of technology, and social media in particular, that seek to maximize the amount of time that our children are spending online at the expense of their in-person interactions."

Advisories are reserved for issues deemed significant public health challenges that "need the American people's immediate attention," according to a statement from Murthy, who has spoken openly of his own experiences with loneliness in the past.

In response, the advisory outlines the framework for a new national strategy. It is based on six foundational pillars, which are:

1. Strengthening social infrastructure, which includes things like parks and libraries as well as public programs.
2. Enacting pro-connection public policies at every level of government, including things like accessible public transportation or paid family leave.
3. Mobilizing the health sector to address the medical needs that stem from loneliness.
4. Reforming digital environments to "critically evaluate our relationship with technology."
5. Deepening our knowledge through more robust research into the issue.
6. Cultivating a culture of connection.

Murthy said loneliness isn't a uniquely American problem, but instead a feature of modern life around the globe. Yet he noted that in the U.S. participation in community organizations — from faith groups to recreational leagues — has declined in recent decades.

"So we're seeing more forces that take us away from one another and fewer of the forces that used to bring us together," he said.

The advisory comes on the back of numerous studies in recent years that warn of the mental and physical dangers of loneliness.

A 2022 paper from Johns Hopkins University also found socially isolated older adults had a higher chance of developing dementia than their peers.

"Social connections matter for our cognitive health, and the risk of social isolation is potentially modifiable for older adults," Thomas Cudjoe, an assistant professor of medicine at Johns Hopkins and a senior author of the study, said in a statement.

'A cultural problem'

Eric Liu, the CEO of Citizen University — a Seattle-based nonprofit that aims to build community and civic awareness nationwide — isn't surprised by the effect of loneliness on "the body and the body politic."

A broken heart is both a physical and a social diagnosis, he told Morning Edition on Wednesday.

"When you are alone and disconnected there's more stress, there's more inflammation, there's more anxiety," he said. "And that has effects not only on the body but the ways in which we see each other in community and feel connected to one another."

Liu said that the longer a person is disconnected, the easier it is for them to stop believing that others have their interests in mind or that it's possible to find common cause.

"So much of the challenge that we have right now is far upstream of electoral politics and policy, it is a culture problem," he added. "That's why I think one of the things that's so important about the surgeon general's report is creating a culture of connection."

Murthy said loneliness can impact people in a variety of ways, so understanding the signs is the first step to addressing it.

"Some people react to loneliness by withdrawing and getting quiet. Others react to loneliness by becoming irritable and angry, and they may lash out more," he said. "That's why sometimes it takes a little time to really reflect on what's happening in our life. And sometimes we need somebody else to tell us, 'Hey, you've been withdrawing more' to help us understand that we might actually be dealing with loneliness."

Rachel Treisman contributed to this report.