U.S. Surgeon General Dr. Vivek Murthy: Efforts & Challenges in Promoting Public Health

Dr. Vivek Murthy (00:00:00)

• Dr. Vivek Murthy is a medical doctor and acting Surgeon General of the United States.
• Dr. Murthy oversees more than 6,000 dedicated Public Health officers responsible for promoting and advancing the nation's public health.
• The discussion covers important health issues globally including obesity and nutrition, mental health, loneliness, and corporate influences on public health.

Surgeon General Roles (00:04:35)

• Dr. Murthy explains the two primary roles of the Surgeon General: disseminating information about critical public health issues and overseeing the United States Public Health Service.
• The United States Public Health Service is one of the eight Uniformed Services in the U.S. government, consisting of 6,000 officers from health-related fields who are dispatched in times of public health emergencies domestically and internationally.

Illness Framework, Enhancing Wellbeing (00:07:44)

• Health discussion must revolve around both prevention and management of illness and optimizing overall mental and physical health.
• The goal of public health is not just addressing diagnosable mental illness, but also promoting overall wellbeing and functionality in individuals' personal and professional lives.
• Public Health initiatives must also focus on providing information to people about enhancing their physical and mental health, apart from preventing and managing diseases.

Priorities as Surgeon General (00:12:42)

• Dr. Vivek Murthy became Surgeon General unexpectedly after a career in medicine and health technology.
• He was increasingly concerned about the issues in the healthcare system, such as accessibility, affordability, and lack of focus on prevention.
• The role of Surgeon General is independent and allows Murthy to focus on initiatives rooted in science and public interest.
• President Biden doesn't dictate Murthy's pursuits. Decision-making about where to deploy resources comes from collaboration and feedback from colleagues, states, agencies, and the public.
• Examples of initiatives include mental health support in Maui, addressing the opioid crisis, and tackling e-cigarette use among youths.
• Priorities for the office are determined firstly by data on population impact and health trends. Second, they rely heavily on feedback from people, through town halls, community visits, and listening sessions.
• The issue of loneliness and isolation became a focus point due to the repeated concerns voiced during these interactions with the public.

Public Health Message Distribution (00:19:50)

• There is a challenge in the efficient spread of public health messages, particularly during crises such as a pandemic.
• Traditional media and online channels are commonly utilized for public health communication, but they may not reach the entirety of the population.
• Attention in traditional media can quickly shift from one issue to another, leading to messages perhaps being overlooked or forgotten.
• The ability to reach all citizens quickly and comprehensibly with health messages is still lacking in the US.
• Public health communication also struggles with a lack of infrastructure, resources and funding.

Diagnosis vs. Optimizing Health (00:28:24)

• The focus of health communication has historically been on treatment and diagnosis, with less attention given to prevention and wellness.
• Mental health challenges are increasing, due in part to lifestyle factors like disrupted sleep, poor nutrition, and social isolation.
• The lack of communication channels where citizens can directly seek advice and information on health matters from trusted authorities is a problem.
• It's essential for individuals to have accurate, easily accessible information about preventive health measures and lifestyle choices.
• The education system could play a stronger role in teaching core pillars of a healthy life, such as sleep, nutrition, physical activity, and social relationships.

Food Additives, Highly Processed Foods, Food Availability (00:34:01)

• U.S. Surgeon General, Dr. Vivek Murthy, indicated that decisions regarding food safety and allowed additives in U.S. food products are made by the Food and Drug Administration (FDA), not his office.
• Dr. Murthy expressed concern about the high consumption of highly processed foods in America, often containing high levels of sodium and sugar.
• He pointed out the lack of data on the health impacts of many food additives.
• Dr. Murthy discussed the overconsumption of refined sugars, which aren't just in desserts, but also in foods perceived as savory, like pasta sauces and salad dressings.
• The Surgeon General acknowledged that food choice isn't completely in the hands of individuals, with socioeconomic factors and food availability playing a huge role. The cheapest foods are usually the most processed, and fresh produce often isn't readily available in low-income neighborhoods.
• Dr. Murthy talked about how convenience store offerings primarily include alcohol, caffeine, energy drinks, nicotine products, and high sugar, highly processed foods, disguising these places as a sort of "pharmacy". There is lack of fresh fruits and vegetables available at such outlets.

Difficulties Addressing Health Issues & Highly Processed Foods (00:39:11)

• High-quality studies showed that consuming sweet and savory foods (often found in highly processed foods) makes the brain rewire itself, increasing appetite and altering responses to healthier food options.
• While these studies did not conclusively link such unhealthy diet with development of diseases like cancer, there are concerns on how long intervention should be delayed.
• There's a view that a precautionary approach would be better, with awareness campaigns informing the public about the risks of high consumption of such processed foods.
• The current situation shows a divide where wealthier individuals are more informed and conscious about their food sources, while many others lack resources and access to healthy food.
• One of the challenges is simplifying and making nutritional information more available and accessible to the public, especially as many people struggle to understand what they should be eating.
• There is a concern about additives and other products in food for which there is not enough long-term data on health risks. Therefore, promoting less processed foods and more fruits and vegetables is seen as important.
• However, these healthy foods must also be cost-accessible. For instance, the lack of grocery stores in a community or high prices of fruits and vegetables are current barriers.
• Additionally, the incentive for food companies to sell more creates a focus on creating products that are addictive rather than healthy, similarly to time-intensive business models of social media platforms and nicotine industry.
• The potential effects of additives in highly processed food include greater ingestion, addictive behaviors, and related health issues like obesity that can lead to various medical conditions.
• Hence, authoritative reports about diet and its impact on health are seen as crucial for the public.
• Some argue that the health risks stemming from constantly consuming unhealthy foods, such as rewiring the brain, are well-known and no further clinical trials are necessary. It's important to intervene now, avoid certain things and choose healthier options.
• The mere knowledge of certain foods being nutritious can lead to more satiety after eating them, a phenomenon confirmed by physiological changes, not just psychological effects. Eating healthier, nutrient-rich foods can lead to feeling better and affect overall health positively.

Retribution, Integrity & Public Health Trust (00:49:53)

• The preparation before submitting any public health report involves thorough vetting, data and source verification, consultation with experts, and a strategic communication plan to ensure trust from the public.
• Public health reports and initiatives influence philanthropists, foundations, schools, workplaces, and policy makers, hence the need for solid preparations.
• Public health and medical personnel need to be protected from retribution when disseminating information that may affect certain industries or investments.
• Personal experiences of opposition from industries and supporters while issuing the First Federal report on e-cigarettes and the alcohol and drug report illustrate the challenges faced during public health missions.
• Part of the mission in public health is to maintain integrity, be transparent with information while being mindful that opposition is expected on certain issues.
• Public trust needs to be rebuilt in the field of medicine and public health due to the decrease in trust over the years.

Company Opposition (00:54:41)

• Issuing warnings on certain health issues is often met with resistance from vested interests.
• Pushback from the public is usually constructive, as it can help shape initiatives, whereas opposition from companies with financial interests in a particular product can pose challenges.
• Decision-making should be driven by scientific data and public interest regardless of any political or job-related implications.
• The current dietary setup in the industry is not serving the public well - unhealthy foods are cheap, healthy foods are expensive, and the necessary information for making health-conscious choices is often inaccessible.
• Providing the public with easily understandable and accessible information about healthy food choices is imperative.

Public Health Communication, Masks & COVID-19, Public Trust (00:59:50)

• In the initial stages of the pandemic, the change in messaging about wearing masks caused confusion and distrust among the public.
• Acceptance of mistakes and transparency in communication are essential for maintaining public trust.
• One should explain the basis of health recommendations, whether they are backed by significant data or are based on expert consensus in the face of insufficient data.
• It’s challenging to translate nuanced information in an era of sound bites and headlines, and many important details often get lost.
• The approach to patients should be of humility, taking into account the patient's unique experience and input.
• Many local and state public health officials faced personal attacks during the pandemic, which led to the loss of many valuable personnel.
• The necessity to maintain an environment of humility, civility, and respect for diverse views is emphasized.

Masks, Humility; Building Public Trust (01:07:01)

• The decision to have students wear masks in schools was made locally, and many parents were resistant for several reasons.
• It's necessary to consider and respect different points of view, particularly when making decisions that impact children's experiences and social development.
• Failure to have open, respectful discourse about preventative measures exacerbated divisions among parents and community members.
• The division and polarization seen during the COVID-19 pandemic could pose significant national security risks in future crises.
• The key challenges for future pandemic responses lie in building trust, effective communication with the public, and maintaining unity in the face of adversity.

Rebuilding Relationship to Public, Vaccines (01:10:45)

• The U.S. Surgeon General, Dr. Vivek Murthy, emphasized the importance of implementing empathy in public health, especially regarding vaccine hesitancy and possible vaccine injuries. Effective communication and understanding are fundamental to mitigating health crises like a pandemic.
• Dr. Murthy pointed out that medical professionals should acknowledge adverse effects a patient might experience with a medication, even if it benefits the majority. Similarly, he noted that this approach should be applied when considering adverse events reported from vaccines.
• The Center for Disease Control (CDC) and Food and Drug Administration (FDA) regularly track and analyze adverse effects reports from the public and clinicians, determining whether there's a correlation or causation with the vaccine. That analysis is then crucial to be clearly communicated to the public.
• Dr. Murthy recommends acknowledging the experiences of individuals who believe they've experienced adverse effects from vaccines, and educating the public on the process utilized for determining if these experiences were related to the vaccine or not.
• Comparisons to other medications such as Tylenol were made to illustrate that all medications, while generally safe, can have rare side effects. Dr. Murthy expressed concern about anecdotes of adverse effects being generalized, potentially creating unfounded fear.
• A call for a combination of clear communication, empathic listening, and provision of context-rich data was made to restore trust and relationship between the medical and public health establishment and the general public.

Community Core & Diversity; Federal Funding (01:17:41)

• The idea of having diverse committees instead of individuals issuing public health guidelines resonated with U.S. Surgeon General Dr. Vivek Murthy.
• His office built the community core which is comprised of diverse groups of people, many of whom have public health backgrounds, who became leaders in spreading information to their communities.
• He stressed the need for these diverse groups to be represented in the media for maximum impact.
• Dr. Murthy also addressed the challenges in disseminating funding, noting that less sophisticated organizations often lacked the means to apply for grants.
• He spoke in favour of organizations that channel funds to groups that have built trust within the communities they serve and discussed how the hierarchical distribution of federal funds often misses out groups that are not connected to local or state Health Departments.

Big Pharma, “Pill for Every Problem” Society (01:24:55)

• Dr. Murthy acknowledged public suspicion towards the pharmaceutical industry's potential influence on public health initiatives and medical advice.
• He believes that medical advice and public health initiatives should be independent of pharma's influence, emphasizing that accepting money from pharmaceutical companies is problematic for physicians.
• He supports prescribing medications when necessary and if it's proven they work, however, highlights how modern society has a problematic propensity for seeking a quick fix.
• Dr. Murthy suggested that disregard for lifestyle choices such as diet, physical activity and sleep is a greater concern, pointing out they heavily influence health.

Interdisciplinary Medical Teams, Individualized & Value-Based Medical Models (01:31:48)

• Small, interdisciplinary medical committees are proposed as a more holistic approach to treat patients, particularly those experiencing chronic pain.
• Challenges to implementing this model include identifying the experts needed in the committee, creating efficient systems, and reimbursement process.
• There's an increasing trend toward creating group experiences for patients dealing with similar conditions, which has been notably underutilized so far.
• The current healthcare model is often individual-centered, causing patients to struggle in piecing together information from different specialists. It's also inefficient and burdensome on healthcare professionals.
• A shift toward a value-based model where health systems focus on efficient, integrated, multidisciplinary care is seen as a solution. These models have been encouraged by acts such as the Affordable Care Act.

Insurance Barriers, Mental Health Care, Drug Prices (01:38:44)

• Delay in addressing healthcare system problems can benefit interest groups profiting from the current system.
• Private insurance industry has been creating barriers to care through practices such as prior authorizations and inadequate reimbursements.
• Mental healthcare is notably difficult to access due to historical insufficient reimbursement from insurance companies, and the imposed limit on therapy sessions.
• The Biden administration recently proposed a rule to strengthen mental health parity law.
• Negotiating drug prices through the Medicare program has commenced, a move aimed at ensuring taxpayers' money is being used wisely.
• More steps in the right direction need to be taken to improve the healthcare system.

Isolation Crisis, Social Disconnection, Health Risks (01:44:40)

• Surgeon General Dr. Vivek Murthy discusses the issue of loneliness and social isolation.
• Reports indicate one in two adults in America suffer from significant levels of loneliness, with higher rates among young adults and adolescents.
• Loneliness is associated with increased risk of depression, anxiety, suicide, cardiovascular disease, dementia and more.
• It's suggested that the risks associated with social isolation, such as premature death, can be bigger than that of obesity, highlighting the severity of the issue.
• Loneliness and social isolation are seen as significant public health challenges hidden behind a wall of stigma and shame.

Community Organizations & Modern Life, Social Media (01:49:15)

• The decline in participation in community organizations, and changes in modern life, including increased mobility and convenience, contribute to social isolation.
• Many necessary interactions that once required face-to-face contact can now be carried out remotely or using technology, reducing social contact.
• The use of social media has changed the nature of social connections, often replacing in-person relationships with online ones.
• This shift to online interactions has led to a form of communication lacking in empathy and can harm self-esteem due to the ease of comparison to others.
• Even though we are talking more via social platforms, we are understood less, leading to a crisis of loneliness and social disconnection.

Youth & Social Media, Parents, Policy Change (01:56:36)

• The discussion starts with the acknowledgment of how social media and technology can deprive our nervous system of normal development and cause negative impacts. This is due to the lack of real, physical interaction replaced by online engagement.
• The possibility of a youth rebellion against over-reliance on technology is considered, similar to how youth rebelled against smoking due to advertisements that manipulated them.
• Evidence of some kids and parents choosing to delay social media usage, create boundaries, or even replace smartphones with simpler phones is shared.
• It was recognized that social media platforms' profit-making model, based on time spent on platforms, does not align with the well-being of users, especially young people. The platforms are often designed to be addictive.
• Data highlight issues like sleep deprivation, worsened body image, anxiety, and depression among adolescents due to excessive social media usage. Even though there are benefits like self-expression and connection for some kids, the negatives seem to outweigh the positives.
• Social media use also erodes self-esteem, as children feel the need to present a curated version of themselves online, leading to inauthenticity.
• The burden on parents to manage their children's engagement with these rapidly evolving technologies is seen as unfair. There's a need for safety standards and policies to protect kids from exposure to harmful content, bullying, and overuse of social media.
• The need for policies requiring data transparency from social media companies is emphasized. Independent researchers are currently having difficulty accessing comprehensive data on the impact of these platforms on children's mental health.
• The discussion concludes that assistance to parents and policy intervention in the realm of children's social media use are needed for the better mental health of kids. It's not about restricting parents but offering support so they can make safe and informed decisions about technology usage for their children.

Real Life vs. Social Media, Kids & Playtime (02:06:45)

• There are issues arising from the over-reliance of both children and adults on screens and technology in modern society.
• The model behavior projected by parents, who often use screens even during outdoor activities or events, has led to increasingly 'screened in' families with a lack of social connection.
• Overuse of screens can lead to an inability to fully appreciate experiences in real life.
• Distorted representations of life are often presented on social media, which can impact individual's perception of their own, and others', lives.
• The importance of the 'real world' and actual, offline experiences should not be overlooked.
• Over-structuring of children's lives and the decrease in unstructured playtime have negative impacts on children's mental health and development.
• Unstructured playtime helps kids learn important life skills such as conflict resolution, negotiation, collaboration, interpretation of emotional cues and much more.
• By allowing children to engage more in the real world, their ability to learn, retain information, perform well in school, live self-sustained lives, build families etc. could be enhanced.

Social Media Advice for Parents (02:11:56)

• Parents are advised to delay their children's use of social media at least until after middle school, to avoid the possible impact on mental health and social development. This may require partnering with other parents, to ensure children are not feeling left out or isolated.
• For children already active on social media platforms, it is important to establish “sacred spaces” free of technology, such as an hour before bedtime, throughout the night, and during meal times. Protecting these times allows for proper sleeping habits and quality family interaction.
• Parents are encouraged to start a dialogue with their children about their use of social media to understand their experiences and concerns. It is essential that children are aware they should report any incidents of online harassment, bullying, or disturbing content to their parents.
• Parents should lead by example, endeavouring to follow the same social media guidelines they set for their children. This involves keeping devices away during family times, and avoiding unhealthy comparisons and negative content online.
• Ultimately, these changes are easier to implement when not attempted alone, and the support of other parents or friends can be beneficial to maintain accountability. Understanding that technology use counteracts multitasking can encourage healthier behaviour.
• While whether social media is addictive or not is debatable, it is generally seen as a compulsive behaviour that happens reflexively. It is crucial to become more conscious of how and when we use social media, recognising the value in setting it aside, especially during sleep hours when brain rewiring occurs. This is essential for everyone but especially important for children.

Society & Disconnection, Human Connection & Service (02:20:43)

• There is a prevalent issue of disconnection in society, largely due to disagreements and online altercations. Disinvestment and isolation are increasing.
• The disconnection is a manifestation of societal changes over time, disconnecting and disincentivizing investment in one another.
• This separation is contrary to our evolution and could hinder our future growth and development.
• Deeper societal issues underlie much of the anger and hostility seen in society.
• Small steps can make a significant difference when it comes to human connection.
• The U.S. is experiencing an identity crisis that necessitates a crucial decision about individual and national identities.
• Much negativity and pessimism persist, but the presenter believes America's true nature to be hopeful, kind, generous, and interdependent.
• There are concerns for the future, especially for the next generation growing up in this divided and disconnected society.
• Reinforcing connection, especially giving people our full attention and looking for ways to serve one another, are steps towards rebuilding societal bonds.
• Core values such as kindness, generosity, courage, and service should guide our personal decisions, advocacies, policies, and leadership choices.
• The importance of these values extends to leaders' decisions made behind the scenes, reflecting the values we hope to instill in our children and desire broadly in society.
• Addressing epidemic levels of loneliness, anger, resentment, and mistrust that exist not only in America but globally requires the embrace of a more human identity centered around kindness, service, friendship, and generosity.
• The presenter emphasizes the power of love as our greatest source of healing and strength. He encourages a mental shift away from being bystanders to being healers, capable of restoring hope and creating a better life.
• An appeal is made for more love, unity, and support for public health, as well as continued open-mindedness in addressing challenging questions.