U.S. Surgeon General Dr. Vivek Murthy, right, speaks during a conversation with Gov. Janet Mills, left, and others about the importance of social connection and its impact on health at the University of Southern Maine in Portland on Friday. Gregory Rec/Staff Photographer

Maintaining strong social connections – to avoid feelings of loneliness and isolation – has not traditionally been part of the public health discussion.

But it should be, said U.S. Surgeon General Dr. Vivek Murthy during a panel discussion in Portland on Friday.

“We know topics like smoking and obesity are classic public health issues, but it turns out loneliness and isolation are just as important,” said Murthy, who took part in the panel discussion Friday with Maine Gov. Janet Mills and Sarah Squirrell, Maine’s director of behavioral health, at the University of Southern Maine’s Hannaford Lecture Hall.

The discussion was moderated by Jeanne Lambrew, former Maine health and human services commissioner, who now is the director of health care reform at The Century Foundation.

Murthy, based in part on his experiences with loneliness as a child, wrote a book published in 2020 called “Together: The Healing Power of Human Connection in a Sometimes Lonely World.” The book came out the same year that the global pandemic upended society, closing schools and workplaces, and shutting down sports, activities, concerts and most gatherings.

The restrictions on gatherings exacerbated society’s problems with isolation, and society has been returning to normal slowly.

U.S. Surgeon General Dr. Vivek Murthy speaks with Gov. Janet Mills, Sarah Squirrell, director of the Office of Behavioral Health, and Jeanne Lambrew, former commissioner of Health and Human Services about the importance of social connection and its impact on people’s health at the University of Southern Maine in Portland on Friday. Gregory Rec/Staff Photographer

Research shows people who suffer from loneliness are more likely to be depressed, at risk of dying by suicide, and have a greater risk of heart disease, stroke and dementia, said Murthy.

It is also difficult for people to get together with others in rural parts of the state where residents often live far apart and populations are tiny. Maine is the least densely-population state east of the Mississippi River.

Mills said Maine people are “fiercely independent” and “hardy” but also welcoming and care for each other. But Mainers need to remember that “they are not Superman” and make sure they ask for help when needed, Mills said.

Mills said that during the pandemic, she learned how important it was to keep the social connections going, even when gathering in person was difficult. She said she remembers reading a lot of letters people would send her, and she would take the time to write back.

But it’s not only rural areas or pandemic restrictions that cause loneliness, Mills said.

“You can be lonely in a crowded classroom, and you can feel very isolated in a dining hall with 100 people in it,” Mills said.

Maine has the 21st highest suicide rate in the nation, at 17.7 deaths per 100,000 population annually, according to the U.S. Centers for Disease Control and Prevention.

Nationally, suicide rates correspond strongly with rural populations.

Montana, Alaska and Wyoming have the highest rates of death by suicide – all with more than 25 per 100,000 population, while densely-populated states such as Massachusetts, New Jersey, New York and Maryland have low rates, each with less than 10 per 100,000 per year.

Murthy said he’s concerned about younger people being “tethered” to devices, such as smart phones, and not socializing as much even when they are around other people. In visits to college campuses and high schools, he has noted a sharp difference in how loud students were at schools that restricted phone use versus schools without such restrictions.

It’s not just devices, though. Murthy, 47, recalled that when he was in elementary school, before cellphones were ubiquitous, the “scariest place was lunchtime, and wondering if there was someone to sit next to.”

Murthy said he even struggled with loneliness as an adult. After he finished his first stint as surgeon general in the Obama administration, he felt isolated from friends he had not kept up with, and he didn’t have good work connections from his time in the White House. He started by calling two old friends, and they’ve been close ever since, even referring to each other as “brothers.”

“The deepest connections we have are how we reach out and look out for one another,” Murthy said.