Joseph: We are reducing our own lifespan

For decades, society’s commonly-held perspective on mental illness was that our past is prologue. In other words, our past experiences shape who we become, how we perceive the world, and ultimately, determine the possible mental diseases that we may develop.

Such ideas are prevalent throughout Freudian Theory and were instrumental in shaping the world’s concept of mental illness throughout the 20th century. This is true in part and supported by modern day scientific research.

However, we cannot exclude the effect that our own present-day decisions have on our mental wellness on a day-to-day basis.

For instance, if one decides to drink too much one night and feels irritable or moody the next day, one’s moodiness likely had nothing to do with one’s early childhood experiences.

Famed psychologist Erik Erikson argued that if everything goes back to childhood, then everything is somebody else's fault and taking responsibility for oneself is undermined. I believe Erikson is right and that this is the case with physical illness, as well.

Just last week, U.S. Senate leadership announced that the historic August recess would be canceled in order to give lawmakers time to pass spending bills before the Sept. 30 deadline.

Healthcare spending continues to be one of the largest items in the U.S. budget that will be debated by Congress. Rightfully so, as healthcare spending continues to rise faster than inflation and some estimates put healthcare spending at 26 percent of our economy by 2026.

Such data leads us to ask ourselves certain important questions. How is this happening? Why is this happening?

Many answers are proffered, some complex, some simple. The blame is cast in various directions -- insurance companies for rising premiums, drug companies for price gouging, healthcare systems for knowingly, unfortunately and unethically continuing to use misguided volume-based incentive structures.

However, one thing we do know and can all admit if we are to be honest with ourselves as healthcare consumers is that we are all to blame.

When it comes down to whether one develops a disease, modifiable risk factors account for up to 50 percent of the morbidity and costs of the disease itself, sometimes even more.

What are modifiable risk factors? Things like smoking, excessive drinking, unhealthy sexual behavior, living a sedentary lifestyle -- many of the things we all know we should not do but still do anyway.

Our population is no longer dying in swaths from epidemic outbreaks of viruses or bacteria anymore. We are dying because of the choices we are making.

Even our Commander in Chief is culpable. Just this past January, President Trump’s personal physician, Dr Ronny Jackson, indicated that Trump could have lived into the 22nd Century if he made the decision to eat a healthier diet.

“I told the president if he'd had better diet over the last 20 years he could have lived to 200 years old," Jackson said.

Healthcare systems, which traditionally have played the role of treating the sick back to wellness, have taken on the increasing responsibility of keeping us well and healthy.

For years, healthcare systems and biomedical academia researched and developed treatments and systems of care to keep really sick people alive. They have gotten quite good at it.

So much so that the sick from around the globe continue to travel to the U.S. for the most advanced treatments.

However, with such advances in treatments, in combination with an ongoing lack of equal funding aimed at diminishing risk factors for disease, it is not surprising that we are continuing to see such high healthcare expenditures. People continue to get sick and live longer with more severe illnesses.

With the ongoing changes in the incentive structure for healthcare systems and changes in how their performance is measured, the focus is shifting more and more toward wellness.

Unfortunately, I do not think focus is shifting quickly enough. According to research funded by The Robert Wood Johnson Foundation, public health expenditures continue to remain around 3 percent of 3.36 trillion U.S. annual health expenditures.

This lack of funding flies in the face of substantial evidence demonstrating the cost savings and economic returns that investment in public health initiatives yields.

Numerous studies report that every $1 spent on public health initiatives such as smoking cessation or exercise programs leads to greater than $5 in societal savings, saving lives in the process. Good health does not start in the hospital or in a Doctor’s office, it starts at home.

Some of the greatest strides toward improving the lifespan and diminishing the morbidity of the human race were made from stunningly simple public health interventions such as improving the cleanliness of drinking water and implementing municipal trash collection and mass vaccination.

Despite these compelling historical facts, lobbying expenditures for public health initiatives continue to be dwarfed by expenditures for the sick industry which includes pharma, healthcare IT, insurance companies, and others.

We need to keep this in mind, be vocal, let our politicians know, and most importantly, do the things we know we are supposed to do to live healthy lives.

There is truth to the old adage, an apple a day keeps the doctor away.  So go eat your fruits and vegetables.

Dr. Joseph is a Psychiatrist who has worked in leadership positions at some of the world’s premier medical institutions. He is an ongoing expert advisor to Florida Medicaid on topics pertaining to Mental Illness and Integrated Care. Dr. Joseph holds a Health Policy Fellowship from the George Washington University. The opinions in this article are his own and do not reflect that of his employer.