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The U.S. population is sick, and we are only now beginning to recognize it.  We are the most obese population in the world.  We have the highest rates of mental illness in the world.  Our life expectancy is decreasing relative to other developed nations. All of this is in the context of the wealthiest nation and most expensive medical care system in the world.  What’s wrong?

While our health was once threatened primarily by infectious illnesses, our contemporary public health challenges have different causes.  As with infectious illnesses, it is the interaction of our biological vulnerabilities with environmental toxins that undermines our health.  The contemporary toxins, however, are not microorganisms but the effects of toxic stress and trauma. Just like John Snow’s careful study led to a cholera control strategy prior to the full elaboration of the germ theory, we now have compelling evidence for the long term impact of toxic stress and trauma on the development of behavioral and general health problems.  In fact, our knowledge of the mechanisms that undermine our health is much better than what Snow had available. 

We also know a lot about what can be done to address these effects – both by reducing exposure and by increasing resilience.  Addressing these problems is not easy, but it is not an impossible task.  When the early sanitarians proposed installing pipes in every household to bring in clean water and separate pipes to remove waste, it must have seemed impossibly complex and expensive.  However, armed with a convincing theory about epidemic infections, the infrastructure was conceptualized and implemented.  Fully implementing the proposed public health infrastructure will also be a challenge.  However, many individual interventions are already in place, and we have the knowledge necessary to implement others.  We already have a sufficient platform to build a coordinated strategy and approach. It is our hope that the data and integrative theory presented here will create the political will to develop a coordinated public health infrastructure to address these contemporary challenges.  From our perspective, this is the next great challenge in public health.

These materials were developed by authors Andrea K. Blanch, Ph.D.; David L. Shern, Ph.D.; and Sarah M. Steverman, Ph.D., M.S.W. 

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