Toxic Stress

“Speed kills,” warns the traditional highway sign about the dangers of haste and traffic deaths. Now, we know that stress kills, too.

Toxic stress, at any rate. The human body’s response to normal amounts of stress—say, a bad day at the office—is likely to be brief increases in the heart rate and mild elevations in hormone levels. But a toxic stress response, stemming from exposure to a major shock or prolonged adversity such as physical or emotional abuse, can wreak far more havoc.

In children, science now shows that toxic stress can disrupt the developing brain and organ systems.

The accumulated lifelong toll of stress-related hormones sharply raises the risk of chronic diseases in adulthood, ranging from heart disease and diabetes to depression and atherosclerosis.

Thus, the message from a panel of experts to the Robert Wood Johnson Foundation’s Commission to Build a Healthier America was at once simple and challenging: Create a healthier environment for—and increase coping mechanisms and resilience in—the nation’s most vulnerable and stress-ridden children and families.

At a June 19 meeting in Washington, DC, the commission heard testimony from a child development specialist, an economist, and community development professionals, among others. Together, they described more of the social and economic effects of toxic stress, but also the evidence that significant investments in individuals, families and communities can turn the tide.

In its previous incarnation from 2008-2009, the commission advanced the conclusion that where a person grows up, lives, works, plays, and prays—one’s “ZIP code,” in effect—plays a greater role in determining health status than his or her genetic code. This week, the relaunched commission heard more about how this dynamic plays out for children and families in the poorest areas across the nation, where the combination of low incomes, subpar education, and often race and ethnicity, combine to create a conspiracy against health.

“We are living through a revolution in biology” that provides the explanation for “why and how ZIP code affects health outcomes,” explained Jack Shonkoff, director of Harvard’s Center on the Developing Child, a Robert Wood Johnson Foundation grantee. “We are in big trouble if we don’t recognize” the powerful evidence that even in the womb, the effects of prolonged exposure to stress are “built into our bodies,” potentially altering everything from immune function to insulin resistance, and leaving behind the biological signs of inflammation that are linked to multiple chronic conditions.

For children and families in poorer ZIP codes, the result is a vicious cycle in which children and their families have less capacity to process and cope with what befalls them—be it low-wage work, unemployment, or bouts of homelessness. Elisabeth Babcock, president and CEO of the Crittenden Women’s Union, a Boston-based organization that helps low-income women and families, described in written testimony “noticeable differences in the ways the families we serve exhibit the executive functioning skills of self-regulationworking memory, andmental flexibility, compared to the general population.” Those deficits, she wrote, are consistent with the evolving science of “the toxic impact of child trauma and persistent poverty on brain development.”

Fortunately, there is also evidence of what can be done to combat the effects of toxic stress and more broadly, to build greater resilience into children and families. Arthur J. Rolnick, senior fellow and co-director of the Human Capital Research Collaborative at the Humphrey School of Public Affairs at the University of Minnesota, pointed to the nearly four-decade-old Perry Preschool study, which has tracked a group of more than 100 African Americans who, as 3- and 4-year olds, were enrolled in a high-quality preschool educational program in Michigan in the 1960s. These children were more likely than their peers to complete high school and, as adults, to be employed and have higher earnings, all of which are correlated with better health. Although the program was costly—adjusted to today’s dollars, about $11,000 per child per year—it produced an annual economic rate of return, after inflation, estimated at 18 percent.

A similar program at the national level that also engages and mentors parents of preschoolers could “double the impact” of the Perry Preschool program, Shonkoff said.  “We have to transform the lives of adults as well as kids,” he said. “The critical need is to identify resources [for communities and states] that want to be innovators,” he added, urging the commission to be bold in recommending new experiments to test protecting children and families from the effects of toxic stress.

The commission is scheduled to make its final report in Washington, D.C., on September 12.

Susan Dentzer is the senior policy adviser for the Robert Wood Johnson Foundation. She was the editor-in-chief of the journal Health Affairs.This post originally appeared in the RWJF Culture of Health Blog on June 21, 2013.

4 replies »

  1. This essay is bald faced, liberal do-gooder, let’s-improve-everyone’s-neighborhood bullshit. As the product of an immigrant, high-stress, low-income household, I deeply resent this insipid perpetuation of victim mythology.

    People make choices. My parents, despite horrendous medical luck and the utter lack of any familial support system or close friends, stayed in this country for my sake. They also ingrained in me an indomitable work ethic and belief in the four wheels of success: faith, family, academics, and athletics. (They’re not pillars of success because pillars are static; wheels move you.) Here’s what they chose not to do: violate their marriage vows; bear children out of wedlock; use or abuse drugs or alcohol; commit crimes; whine about their fate; ask for handouts or public assistance; or, let me believe that I had any less right to pursue opportunity than someone who went to Dartmouth and Harvard. Their lessons powered me through a first-class education and early satisfaction of all my student loans.

    Dentzer’s essay is just facile code for raising taxes, preferences, preservation of protected classes of people, and throwing good money after bad to people who don’t give a flip about themselves or their kids. The author’s ignorance is so all encompassing that she fails to make even passing reference to the impact of personal initiative or making positive choices even in suboptimal conditions.

    Having looked at her bio on the RWJ website, it would not surprise me to learn that she’s not live a minute of what she claims to be expert in. If my mother was alive today, I suspect that she would give our dear author a substantial and stern lecture on both the meaning and value of stress. But, then again, she might just as likely regard our dear author as unworthy of the time and effort.

  2. This, of course, has been known for decades. But high tech bio-medicine has generally resisted the stress concept. Now neuroscience is our tool to win over the skeptics.

    If we fully engage this it will be bio-medicine’s next revolution.

    see- http://www.medpagetoday.com/Columns/At-Large/25472

    Dr. Rick Lippin
    Southampton, Pa