The U.S. isn't Ready for Aging Boomers

In November, the Longevity Project, supported by the Stanford Center for Longevity, held The 2023 Century Summit, a 2-day event covering the global challenges of aging. Sessions featured leading professionals discussing such issues as healthcare, financial aspects of retirement, building community and more. You can view videos of all the sessions here.

While I learned many important things, I was particularly interested in one session: "Home, Place and Where We Will Live Our Longer Lives." It took on special relevance for me as an older Boomer since I had recently made the decision with my wife to downsize and relocate across the country to live near our daughter and new granddaughter.

It also struck a chord because in August, my mother-in-law reached her 100th year and then passed away in October. She had transitioned in her final years from independent living to assisted living to rehabilitation from a fall in a skilled nursing facility and briefly to hospice. I got to witness the full spectrum of end-of-life care.

This Century Summit session, in combination with my own recent experiences, prompted me to acknowledge a cold reality: The U.S. is simply not ready for aging Boomers. During the session I referenced, moderator Amy Yotopoulos, President and CEO of Avenitas, spoke with Dr. Terry Fulmer, President of The John A. Hartford Foundation and Seth Sternberg, CEO of Honor. (Rather than explain what these organizations do I have linked to them.) The discussion centered largely around in-home care.

As you may know, about 55 million Americans are over 65 years of age. You may also know that an overwhelming number of them (more than 90 percent) want to age in place.

The disconnect is caregiving.

Seth Sternberg made it clear: "The biggest barrier to in-home care is affordability." According to Sternberg, people who are well off can afford in-home care and people who are poor can apply for Medicaid to cover in-home care -- but that leaves "the middle," who typically have to rely on caregivers made up of family, friends and neighbors. One of the main problems with the caregiving industry itself, says Sternberg, is that it is "hyper fragmented," making it difficult to offer any kind of scale that results in affordability.

Terry Fulmer agreed, adding that very few of us who are over 65 "are getting the type of caregiving they want." Fulmer pointed out that a lot of this is based on payment structure. "We pay for things one disease at a time," says Fulmer.

How caregiving expenses are covered is also problematic. For example, if someone over 65 has hip surgery, Medicare will pay for hospital care and rehabilitation at a skilled nursing facility. But if that individual needs longer-term assistance, such as in-home care, assisted living or even a return to skilled nursing, health insurance coverage becomes far more complicated.

Fulmer cited some statistics that surprised me. She said only 800,000 people in the United States are in assisted living, and only 1.2 million are in skilled nursing facilities, with around 500,000 of them in skilled nursing for rehabilitation purposes. The PACE program, lauded for offering dining, recreational and daycare services to seniors who remain in their homes, serves only about 67,000 people.

It seems to me these numbers are stunningly low for a population in the tens of millions. With only 800,000 seniors in assisted living facilities, why should companies that operate them improve them, make them more affordable or even build more of them? The same goes for skilled nursing facilities if a little over half a million seniors are permanent residents there.

The North Carolina assisted living facility at which my mother-in-law resided cost close to $8,000 per month, while the skilled nursing facility she was about to enter as a permanent resident after rehabilitating there was closer to $10,000 per month. Without a combination of Social Security income, a few modest pensions and long-term care insurance (for which her children paid the premiums), she never would have been able to afford living at either facility long term. In fact, she remained living independently far longer than she should have, with my wife serving as her primary caregiver.

It may be possible for some seniors to remain in their homes, but for many it is an unrealistic scenario because their home is not conducive to aging in place. In addition, paid in-home healthcare is either too expensive or too inferior in quality. This is why millions of family members and friends act as unpaid in-home caregivers. This often leads to inadequate care and/or caregiver burnout.

The alternative -- assisted living -- is often unaffordable, as is the long term care insurance that helps offset the cost. If a skilled nursing facility is required, the cost is even higher. Only the wealthy can afford to pay privately for a decent skilled nursing facility. For anyone else, it is unaffordable, except those with assets less than $2000. These poverty-level individuals can apply for Medicaid, which will cover the cost of a skilled nursing facility that agrees to accept Medicaid residents.

What will millions of Boomers who are living longer do when they need care in their later years and our society isn't ready to provide it?

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How Many Boomers will be "SuperAgers"?

Have you heard about the SuperAgers Family Study? It aims to identify the inherited and natural factors that protect against human aging and related diseases.  The data from this study will be used to create a large biorepository for future researchers about healthy aging.

According to the American Federation for Aging Research (AFAR), SuperAgers, or individuals age 95 and older, are a promising, living source of scientific knowledge about health longevity. Their experience and biology offer unique insights into understanding the correlation between age-related diseases and living an exceptionally long, healthy life. By studying individuals age 95 and older, the SuperAgers Initiative builds on a foundation of research into the biology of aging and promising therapeutics to extend years of health.

The researchers behind the study include Dr. Sofiya Milman and Dr. Nir Barzilai. Dr. Milman, Principal Investigator, is the Professor of Human Longevity Studies at the Institute for Aging Research at Albert Einstein College of Medicine. Dr. Barzilai, Co-Investigator, is Scientific Director of AFAR and a chaired Professor of Medicine and Genetics.

The SuperAgers Family Study benefits participants by allowing them to learn more about their own biology as well as the ways in which their genetic traits have sustained their exceptional longevity. Research from this study will inform new treatments and approaches to healthy aging for generations to come. Participants will also have the opportunity to receive information on their ancestry. The study is currently enrolling:

• Individuals aged 95 years or older.
• Individuals whose parents are 95 years or older, who are currently alive and willing to participate in the study.
• Individuals whose parents-in-law are 95 years or older, who are currently alive and willing to participate in the study.

 Current probability forecasts indicate that nonsmoking women in excellent health have a 1 in 3 chance of living to age 95 or beyond, and men have a 1 in 5 chance of living to age 95 or beyond. The population of individuals 95 and older grew by 48.6 percent from 2010 to 2020.

Boomers already make up a substantial portion of the U.S. population. According to the U.S. Census, in 2020, the 65-74 age group: 

• Was the largest of the older age groups with 33.1 million people, representing over half of the 65-and-over population.
• Represented 1 in 10 Americans in 2020.
• Experienced the largest growth of any older age group the previous decade. Its numbers grew by 11.4 million or 52.5%, increasing from 21.7 mil­lion in 2010 to 33.1 million in 2020.

How many Boomers will be "SuperAgers"? It's an intriguing question to ponder.

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AARP Report: How Boomers Are Changing America

In the September 2023 issue of the AARP Bulletin, AARP reported on trends demonstrating the impact Boomers are having on a changing America. Here are some of the key trends covered in their analysis:

The Workplace

Not surprisingly, the number of workers age 65 and older increased by 117 percent in twenty years, as has employment of individuals 75 and older, according to the U.S. Bureau of Labor Statistics. Part-time work, phased retirement and "returnships" (short-term employment programs designed to help out-of-work individuals ease their way back into the workforce) are all trending up.

Healthcare

Healthcare is the only broad spending category that consistently increases with people's ages, reports the Bureau of Labor Statistics. Boomer households spent on average $6,600 per year on healthcare in 2021 while Millennials spent a third less. One of the major trends is aging in place. Today nearly 300 hospital-at-home programs exist in the U.S., and one in six hospitals will likely offer such programs by 2030. Consulting firm McKinsey estimates that $265 billion in home health care will be delivered to Medicare beneficiaries by 2025.

Financial services

Some $18 trillion sits in IRAs and 401(k) retirement accounts held by Americans. According to the Federal Reserve, the median holding in retirement accounts is $164,000 for households of people ages 65 to 74. Well aware of these retirement investments, the financial services industry is aggressively targeting older Americans. As people live longer, a common strategy of financial services providers is to help retirees understand how to make their funds last through retirement. This is especially crucial for Americans who are 60 to 69 years of age, because more than half of households headed by this group have less than $250,000 in financial assets. The Social Security Administration estimates that about 20 percent of Americans 65 and older rely on Social Security for more than three-quarters of their income.

Fitness

Older Americans are embracing fitness and exercise. Pickleball is the fastest-growing sport in the country, with 49 percent of frequent pickle ball players age 55 and older, according to the Sports & Fitness Industry Association. Everything from exercise machines to low-impact workout programs specifically target the senior set.

Travel

The top group in travel spending is Americans 60 to 60 years of age, according to AARP. Travelers in this age group will shell out an average of $7,300 this year, and those who are 50 and older will average four trips this year.

Entertainment

Older Americans are moviegoers, and we're seeing more older actors appearing in movies because of these older audiences. Music concerts are also popular with older Americans as performers in their seventies continue to appear on stage. Television viewing by older Americans is also strong, as evidenced by such breakthrough programs as ABC's The Golden Bachelor -- for the first time featuring a bachelor in his seventies.

Politics

You have only to look at the president, members of Congress, and Supreme Court justices to know that older Americans populate the government. What's more, older voters make a significant difference in deciding elections. According to AARP, 61 percent of ballots cast in the 63 closest races for the U.S. House of Representatives in 2022 were cast by voters 50 years of age or older. While change at federal, state and local governments comes slowly, legislation focused on an aging population is beginning to be proposed by lawmakers at all levels.

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Retirement is Really About "Restructuring" and "Bridging"

Researchers at Harvard Business School, Questrom School of Business, Bentley University and MIT Sloan School of Management recently interviewed 120 professionals to learn about the mental and emotional toll of retirement. They discovered that retirees go through two main processes: Life Restructuring and Identity Bridging. 

One of the researchers, Teresa Amabile of Harvard Business School, spoke with Curt Nickisch of Harvard Business Review about the study. In discussing "life restructuring," Amabile says,"You have to majorly restructure your life that day you walk out, whether you’ve been working full-time up to that retirement or part-time, you’re going to have to really approach your life differently."

Amabile suggests that the interactions with people in the workplace are significant. When individuals retire, "most of us don’t realize how anchoring and important those work relationships are.

"We also don’t realize how important the structure of work is. We have been living for several decades as kind of a tenant of a life structure that our organization has created for us. We know where we’re going to be at 9:00 AM Monday through Friday and we pretty much know what we’re going to be doing and who we’re going to be interacting with."

Amabile identifies four developmental tasks as part of life restructuring:

1. The retirement decision: Deciding when to retire and how to retire.
2. Detaching from work: "Some can let go completely... and for others, they have a hard time moving on at least mentally, even if they’re not engaging in work activities, they’re thinking about it a lot and they feel that they’re still in that world."
3. Managing the liminal phase: "Liminal means betwixt and between – kind of in the midst of change of some kind." Some people plan for this carefully while others don't.
4. The consolidation stage: That's when a new life structure is in place and it is working for the individual.

The second process is identity bridging. Amabile observes that people who can maintain or enhance aspects of themselves that existed in pre-retirement can enjoy satisfaction and enrichment in retirement. She says, "Often it’s bridging some aspect of that work identity. Often it’s enhancing, developing some non-work aspect of identity that you had. So, one of the most common things we’ve seen is that people will have had an avocation that they enjoyed a pre-retirement, that they get really engaged in much more strongly after retirement.

"And that’s very fulfilling for them, very enjoyable. Sometimes it’s the relationship they had that was important to them – an important part of their identity – and they’re now deepening that engagement, spending more time with that person."

One of the challenges related to identity bridging is how integrated identity is with working for many people. According to Amabile," So much of our identity is almost necessarily wrapped up in our work. So much of our mind space is occupied by our work, that we let other pieces of ourselves atrophy." 

Amabile notes that if people "can maintain some creative activity outside of work, even while they’re fully engaged in their career, that seems to stand them in good stead because that’s something they can grow afterward. That gives them a natural identity bridge."

If you are planning to retire -- or already retired -- maybe you are going through "life restructuring" and "identity bridging." If so, you are not alone.

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The Changing View of Retirement

A revealing new Harris Poll conducted by the firm Age Wave has confirmed substantial shifts in Americans’ perceptions of aging and longevity. The study surveyed over 2,000 U.S. adults, including over 900 adults age 50 plus.

Here are some key takeaways from the survey.
 
“OLD” ISN’T WHAT IT USED TO BE

The survey found that 79% of adults 50+ think today’s older adults are more active, and 58% say they are more open-minded and curious compared with the previous generation.
 
Correspondingly, the definition of what’s considered “old” today is changing. The survey found that while age 60 was considered “old” in their grandparents’ time, now age 80 is the median age considered “old” today.
 
Our vocabulary is starting to reflect this shift. When discussing growing older, 69% of U.S. adults 50+ find the term “longevity” more appealing than “aging.” The positivity felt by older adults is in stark contrast to the bias against them in the media, where they are still frequently portrayed as frail, grumpy, or incoherent. In fact, older adults are seven times more likely to be represented with negative stereotypes in the media.
 
OUR HEALTHSPANS DON’T MATCH OUR LIFESPANS

In recent decades, we have successfully extended our lifespans, but our healthspans (i.e., the years of dependable good health) have not kept up, remaining at an average of 66 years. Americans will spend a median of 12 years living with a disability or serious disease. Looking globally, the U.S. ranks #1 in healthcare expenditures per capita but only #68 in healthy life expectancy.
 
TRADING THE FOUNTAIN OF YOUTH FOR THE FOUNTAIN OF USEFULNESS

In this new age of aging, the importance of youthfulness has been replaced by usefulness. The survey found that 83% of U.S. adults 65+ say it’s more important for them to feel useful than youthful in their retirement years.Today’s elders increasingly want a continued sense of purpose and meaning in their lives.
 
ANXIETY PLUMMETS, HAPPINESS SOARS WITH AGE

Modern elders feel happier, more free, and less anxiety-ridden than younger generations. Today’s modern elders aren’t just looking back, reminiscing on the good old times. 71% of Americans 65+ say the best time of their lives is right now or in front of them.
 
THE DEFINITION OF “RETIREMENT” IS CHANGING

Today’s modern elders are dismantling long-held cultural beliefs and social norms about how older adults are supposed to look and act. They are eager to pursue new dreams, adventures, and goals, with 97% of adults 65+ agreeing that it’s important to stay curious and be willing to learn new things throughout life’s later years. Similarly, 66% of Americans age 50+ see retirement as a new chapter in life, while only 16% say it’s principally a time for rest and relaxation.
 
With these changing views of what retirement should look like, 59% of pre-retirees and retirees say they want to work in some form in retirement. Employee benefits like flex-work, remote-work, sabbaticals, and paid leave can help retain older workers and fuel economic growth.
 
LIFE LESSONS ARE THE MOST IMPORTANT LEGACY

As famous psychologist Erik Erickson wrote, “I am what survives of me.” The study shows that 65% of adults 50+ think that values and life lessons are the most important thing to pass on to their heirs and loved ones. Only 22% said financial assets and/or real estate were the most important.

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Rewiring Retirement as a Tech-Savvy Boomer

In general, Boomers are given far less credit than they deserve when it comes to embracing information technology. The fact is, Boomers are very plugged in to the use of online tools and streaming services. The AARP 2022 Tech Trends report indicated the following: "Three in four people age 50-plus say they rely on technology to stay connected, with those in their 50s (76%), 60s (79%), and 70s (72%) all exceeding 70%."

You may be part of the healthy segment of the Boomer demographic that is tech-savvy, which could translate into opportunities for personal gratification and supplemental income. An increasingly common way to take advantage of technology is to become part of the "gig economy." There are almost limitless opportunities for online gigs that don't discriminate on the basis of age. The tech-savvy Boomer can easily compete for projects of all types as long as you have the know-how in a specific discipline.

An obvious area you can leverage is social media. For example, while TikTok has been under fire lately, it remains one of the most lucrative online channels available for influencers. A recent article in The New York Times spotlighted older TikTok creators, suggesting:"No matter what their age or finances, some elder influencers are finding that being on the app can bring them extra cash, or even help them extend their careers."

According to the article, "These creators have been finding success by sharing life lessons and fashion tips, cooking, interacting with grandchildren or just being funny — while also promoting products. ...For the vast majority of influencers, the income from these gigs may not be enough to retire on, but it can help give their later-year finances a boost and even give them extra money to invest."

LinkedIn is another useful social media avenue for professional and business pursuits. Boomers can create a richly detailed personal profile, make connections, join groups and find opportunities by building a personal network. There are also many online job boards that offer tech-related gig opportunities.

With the dramatic increase in and acceptance of remote work, it is no longer necessary for Boomers who want part-time work to be limited to in-person jobs. Working from home offers the kind of convenience and flexibility that could be ideal for semi-retirement. The tech-savvy Boomer (or one who is willing to learn) can take full advantage of this new work environment and get the best combination of a part-work/part-leisure lifestyle.

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How Passion Translates Into Part-Time Income

The Boomer version of retirement is a new paradigm -- utterly different from past generations. One thing that has dramatically changed for Boomers is the reality that living longer means saving longer. In order to support themselves as they age, many Boomers are realizing they need more money than they originally thought to live comfortably.

A recent article appearing in PlanAdviser.com does a good job of characterizing the challenge. As retirement coach Nancy Collamer points out, “The fact of the matter is that a lot of people have gotten to this point [of retirement], and they haven’t saved enough. Working on a part-time basis becomes a real area of interest for these people.”

A main reason Boomers consider part-time work is to supplement other income, such as Social Security and retirement savings. For some Boomers, these sources simply don't provide enough of a financial security blanket. Research conducted by AARP suggests that the "gig economy" is alive and well for Boomers. According to PlanAdviser.com, "For those age 60 and older, [AARP] found the top ways of earning money without a full-time job include freelance or contract work (48%), teaching (16%), providing pet care (8%), doing home repair, such as handyman, lawn care, or snow removal (6%), shopping for others (6%), and making or growing things (6%)."

The PlanAdviser.com article cites this quote from an AARP executive:

“Among the 65-plus age group, entrepreneurial, gig, or nontraditional work has exploded,” says Carly Roszkowski, vice president of financial resilience programming for the DC-based AARP. “COVID has made us rethink how we want to live and the kind of flexibility we want; the gig or freelance work allows people to work when they want, be their own boss and have that work-life balance.”

Interestingly, the recent pandemic probably helped Boomers feel more comfortable using digital platforms and websites to engage in part-time work.

The key to part-time work for many Boomers is to combine their passion with an income-generating opportunity. George Fraser, managing director at the Fraser Group of Retirement Benefits Group, tells PlanAdviser.com, “[Retirees] can look for things they already like to do and get paid for it. Let’s say I like golf, but rather than pay for a membership, I get a part-time job at the club. If I like to ski, I could get work as a ski instructor.”

I can attest to this strategy. For several years after I first retired as a direct marketing professional, I pursued my passion for writing, both for personal enjoyment and for part-time income. In addition to writing articles and books for my own benefit, I freelanced for a few clients, generating modest but steady income. This offered me a bit of "fun money" and reinforced my professional self-esteem.

Even if your passion is not in the same area as your career, you can pursue something that could turn into part-time work. It doesn't have to be anything very lucrative. Your goal should be to do something you enjoy while bringing in a little extra money. The idea is to reduce some of the financial pressure by supplementing your other sources of retirement income.  

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Is America Ready for an Aging Population?

It is not as if we did not know it was coming -- but new data recently released by the U.S. Census Bureau suggests an America that is aging, with people generally living longer. According to the Census Bureau:

• Between 2010 and 2020, median age in the U.S. grew older due to an increase in the older population.
  • In 2020, there were 55.8 million people age 65 and over in the United States (16.8% of the total population), up 38.6% from 40.3 million in 2010. This growth primarily reflected the aging baby boom cohort.
  • Centenarians grew 50% since 2010, the fastest recent census-to-census percent change for that age group.
  • For people age 70 and over, the male population experienced a larger growth rate between 2010 and 2020 (42.2%) than females (29.5%).
• In 1970, after all the Baby Boomers (1946-1964) had been born, half of the population was younger than 28.1 years old. By 2020, the median age was 38.8, an increase of more than 10 years over the past five decades.
  • In 2020, the population age 45 and over accounted for 42% of the total population, up from 27% in 1940, the census before the Baby Boom began.
  • The share of the population age 65 and over more than doubled between 1940 and 2020, from less than 7% to nearly 17%.

• Among the states in 2020:
  • Fourteen states had a median age over 40, twice as many as in 2010.
  • Twenty-five states had higher shares of population age 65 and older than Florida had in 2010 (17.3%), when it had the highest share of any state. In 2020, Maine had the highest share at 21.8%, followed by Florida (21.2%) and Vermont (20.6%).

These statistics tell a cautionary story when it comes to Medicare, Medicaid and Social Security. With a burgeoning older population, a looming question about these social programs is, of course, their solvency. The statistics have other implications; for example, there will be a greatly expanded need for caregivers to serve aging Americans in their homes, as well as an increase in the availability of independent living, assisted living and skilled nursing facilities.

It is important to understand that this is not just occurring in the U.S. but around the world. According to the World Health Organization:

By 2030, 1 in 6 people in the world will be aged 60 years or over. At this time the share of the population aged 60 years and over will increase from 1 billion in 2020 to 1.4 billion. By 2050, the world’s population of people aged 60 years and older will double (2.1 billion). The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million.

While this shift in distribution of a country's population towards older ages – known as population ageing – started in high-income countries (for example in Japan 30% of the population is already over 60 years old), it is now low- and middle-income countries that are experiencing the greatest change. By 2050, two-thirds of the world’s population over 60 years will live in low- and middle-income countries.

Is America -- and the rest of the world -- ready to meet the challenges associated with an aging population?

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"Cannonballs, Curveballs and Windfalls"

The third iteration of a landmark retirement study by Age Wave, Edward Jones and The Harris Poll has just been released. It sheds some intriguing light on three types of events that retirees have experienced: "Cannonballs, curveballs and windfalls." 

According to the study:

Since retiring, a large majority of retirees (75%) have experienced cannonball events, major challenges that can derail a plan, or curveballs, relatively minor occurrences that cause setbacks. According to the research, the most common cannonballs and curveballs include having a family member or close friend pass away (42%), personal health issues (30%), coping with a spouse’s or partner’s health issues (21%) and significant financial setbacks (20%). The most impactful, however, are widowhood and divorce, which retirees say are profoundly disruptive to their lives. For some, retirement itself can be a cannonball, as 3 in 10 retirees (29%) said they were forced to retire unexpectedly.

On the other hand, 80% of retirees have experienced at least one windfall event, a positive gain often described as “good fortune” or a “blessing.” The most fulfilling windfalls for retirees include becoming a grandparent, taking a dream vacation and discovering a new or renewed purpose in life. One of the biggest surprises was that aging and retirement itself appear to provide a kind of windfall to many. The study revealed that feelings of freedom, happiness and resilience all peak in retirement, while anxiety hits its lifetime low.

The study suggested that pre-retirees and current retirees know they will face challenges and are willing to make "course corrections." The study defined course corrections as the positive actions that pre-retirees and retirees are already taking or considering to improve their retirement journeys. Course corrections are motivated, and often necessitated, by life events that change the circumstances and goals of one’s life plan.

The study breaks retirement into four key pillars: Health, Family, Purpose and Finances. Sample course corrections in each of the four pillars include:

• Health: Habits including healthy diet, regular exercise and mental stimulation can dramatically improve healthspan, lifespan and well-being in retirement
• Family: Spending more quality time with family (and less time with toxic people) can be very fulfilling, but setting emotional and financial boundaries can be just as worthwhile
• Purpose: There are many personal paths to purpose, and people can explore familiar options — trying new things, expanding their social circles to enrich their lives and even reinventing themselves with new dreams
• Finances: Given the many tools beyond the basics of increasing savings and minimizing debt, it is wise to seek trusted, holistic guidance when considering options and weighing tradeoffs.

To access the full report, “Resilient Choices: Trade-Offs, Adjustments and Course Corrections to Thrive in Retirement” visit https://www.edwardjones.com/newretirement

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The Loneliness and Isolation Epidemic

Recently, the United States Surgeon General, Dr. Vivek Murthy, released a new Surgeon General Advisory calling attention to the public health crisis of loneliness, isolation, and lack of connection in our country. Even before the onset of the COVID-19 pandemic, approximately half of U.S. adults reported experiencing measurable levels of loneliness.

According to Dr. Murthy, “Our epidemic of loneliness and isolation has been an underappreciated public health crisis that has harmed individual and societal health. Our relationships are a source of healing and well-being hiding in plain sight – one that can help us live healthier, more fulfilled, and more productive lives.”

The notion of a loneliness and isolation epidemic should be startling news to many people, but it may come as no surprise to older adults. As we age, loneliness and isolation become increasingly common. Unfortunately, as the Surgeon General Advisory states, there are health implications: "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 Surgeon General’s Advisory lays out a framework for the United States to establish a National Strategy to Advance Social Connection based on six foundational pillars:

1. Strengthen Social Infrastructure: Connections are not just influenced by individual interactions, but by the physical elements of a community (parks, libraries, playgrounds) and the programs and policies in place. To strengthen social infrastructure, communities must design environments that promote connection, establish and scale community connection programs, and invest in institutions that bring people together.
2. Enact Pro-Connection Public Policies: National, state, local, and tribal governments play a role in establishing policies like accessible public transportation or paid family leave that can support and enable more connection among a community or a family.
3. Mobilize the Health Sector: Because loneliness and isolation are risk factors for several major health conditions (including heart disease, dementia, depression) as well as for premature death, health care providers are well-positioned to assess patients for risk of loneliness and intervene.
4. Reform Digital Environments: We must critically evaluate our relationship with technology and ensure that how we interact digitally does not detract from meaningful and healing connection with others.
5. Deepen Our Knowledge: A more robust research agenda, beyond the evidence outlined in the advisory, must be established to further our understanding of the causes and consequences of social disconnection, populations at risk, and the effectiveness of efforts to boost connection.
6. Cultivate a Culture of Connection: The informal practices of everyday life (the norms and culture of how we engage one another) significantly influence the relationships we have in our lives. We cannot be successful in the other pillars without a culture of connection.

This is a fairly remarkable acknowledgment by the U.S. government that loneliness and isolation require serious attention. You can read the entire Surgeon General Advisory here: https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf

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