title: Toxic stress, behavioral health, and the next major era in public health.
abstract: Before the development of the germ theory in the late 19th century, infectious illnesses were largely uncontrollable and caused significant mortality. Implementing public hygiene, preventive, and treatment interventions created remarkable improvements in population health. Today's U.S. public health crises involve threats to health and human capital evidenced by multiple indicators of deteriorating wellbeing. These problems result from the interaction of risk and protective factors. Specifically, we argue that the interaction of genetic vulnerability and toxic stress are antecedents to a developmental cascade that undermines healthy development and human capital. We review relevant literature, summarize effective strategies to prevent or ameliorate this deterioration, and outline a theory of the mechanisms currently undermining our health. A series of strategies that we believe will constitute the next major era in public health are discussed, involving actions at the individual/family, community and societal level to reduce risk and strengthen protective factors. (PsycINFO Database Record
authors.affiliation: Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University.
authors.forename: David L
authors.initials: DL
authors.lastname: Shern
authors.affiliation: National Center for Trauma Informed Care.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Blanch
authors.affiliation: Department of Social Work, University of Denver.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Steverman
mesh_terms: D005190:Family; D059647:Gene-Environment Interaction; D015438:Health Behavior; D006801:Humans; D001523:Mental Disorders / Q000517:prevention & control* / Q000628:therapy*; D015201:Meta-Analysis as Topic; D008962:Models, Theoretical; D011634:Public Health / Q000639:trends*; D012111:Residence Characteristics; D012307:Risk Factors; D013315:Stress, Psychological; D014481:United States