In this review we summarize existing literature on the overall health and well-being of the U.S. population. We review data indicating that exposure to trauma, especially early in life, is an important determinant of health status. Throughout the review, we refer to a condition called toxic stress. Researchers at Harvard's Center for the Developing Child distinguish toxic stress from positive and tolerable stress. They define toxic stress as involving: "...strong, frequent, and/or prolonged adversity such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship without adequate adult support. This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult."
We first summarize measures of our health status in contrast to other areas of the world. We conclude that there are fundamental concerns with our overall health that should prompt a focused public health response. Throughout the document we use the World Health Organization's definition of health. In this definition, health involves more than the absence of disease. It also includes an individual's ability to realize his/her full potential through active participation in meaningful social roles.
We also use the concept of human capital to discuss the consequences of toxic stress. Human capital is the overall ability of a population to be economically productive. It is like financial capital in that it represents the human resources necessary for economic activity. When our human capital is weakened, it decreases our ability to have productive communities and a successful nation.
Exposure to toxic stress is an important cause of the decline in our overall well-being and human capital. We review the emerging science about the ways in which stress interacts with inborn strengths and vulnerabilities to produce changes in our brain, hormonal and immune systems. These changes, in turn, are associated with behavioral and general health.
In the third section, we summarize the rapidly growing literature on the effects of toxic stress on health and behavior. We have long known that social factors (e.g., poverty, racism, inequality, violence) are important determinants of health and mental health. We review the consequences these social determinants by highlighting the well-established relationship between adversity, particularly in childhood, and later behavioral health and health problems. (author introduction)