About the Author

Author Picture

Amanda Merck

Merck completed her MPH with a concentration in Physical Activity and Health. She curates content for Salud America! (@SaludAmerica), a Latino childhood obesity prevention project based at the Institute for Health Promotion Research at UT Health San Antonio. She focuses on the latest research, resources, and stories related to policy, systems, and environmental changes to enhance equitable access to safe places for kids and families to walk, bike, and play.

Connect with Amanda:
Twitter Link

Articles by Amanda Merck

California’s Epic Response to Toxic Stress and ACEs


California’s Epic Response to Toxic Stress and ACEs

California is leading the nation in addressing toxic stress and adverse childhood experiences (ACEs), such as neglect, divorce and exposure to violence, which can harm long-term health. Guided by evidence and a public health approach, California developed a series of legal and conceptual frameworks to support statewide screening for ACEs, coordinate within and outside state government, and assess best practices in trauma-informed care across the state. This progress ramped up when Gov. Gavin Newsom created the Office of the California Surgeon General  in 2019 and appointed Dr. Nadine Burke Harris to the position. In December 2020, Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and ...

Read More

45% Spike in People Walking Killed by People Driving, Says ‘Dangerous by Design’ Report


45% Spike in People Walking Killed by People Driving, Says 'Dangerous by Design' Report

America’s approach to road safety continues to fail, especially for pedestrians. The number of people walking who have been struck and killed by people driving grew 45% from 2010 and 2019, according to the new Dangerous by Design report from Smart Growth America and the National Complete Streets Coalition. Why? Policymakers in cities and states across the country continue to trust unsafe street design practices that prioritize speed for people driving, enable larger vehicles, and rely on police enforcement and ineffectual education campaigns to promote safety. Experts urge federal, state, and local leaders to adjust road design to prioritize pedestrians and other forms of active travel such as bicycling, as well as quit blaming individuals and relying on police. The Most ...

Read More

Tell CDC: Add Social Risk Codes to Better Classify Disease Diagnoses, Symptoms (ICD-10-CM)


Tell CDC: Add Social Risk Codes to Better Classify Disease Diagnoses, Symptoms (ICD-10-CM)

Social risk contributes significantly to poor health. These social risks—also known as social determinants of health—include food insecurity, housing instability, transportation insecurity, financial strain, and more. But without the right terminology about social risk, doctors and other healthcare workers may struggle to identify, support, and report patient’s social needs, which can harm health and hinder research. This is particularly problematic for Latinos and others who are overburdened by social risks. This why the Gravity Project, a coalition of experts on social risk, is recommending code changes and updates to CDC National Center for Health Statistics’ International Classification of Diseases-Clinical Modification, Tenth Revision (ICD-10-CM), which provides a ...

Read More

Toxic Stress in Education and How to Prevent it


Toxic Stress in Education and How to Prevent it

Trouble concentrating in class. Not completing homework. Behavioral difficulties. Absenteeism. These outcomes are linked to exposure to adverse childhood experiences (ACEs). ACEs, such as abuse or parental substance abuse, can trigger the biological toxic stress response and hinder school learning, behavior, attendance, and academics. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Salud America! is exploring the report as part of its 11-part series on toxic stress. Below are primary prevention, early detection, and early intervention strategies for education personnel to address ACEs and toxic stress among Latino and ...

Read More

Toxic Stress in the Justice System and How to Prevent It


Toxic Stress in the Justice System and How to Prevent It EJ USA

Exposure to adverse childhood experiences (ACEs), such as poverty or abuse, is a known risk factor involvement in the justice system. And, involvement in the justice system may be an indicator of toxic stress. Thus, the justice system plays an important role in preventing the effects of ACEs and toxic stress. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Salud America! is exploring the report as part of its 11-part series on toxic stress. “Factors that underlie connections between victimization or trauma and later criminal justice involvement provide a window into areas for primary and secondary intervention ...

Read More

Toxic Stress in Early Childhood and How to Prevent It



Since the turn of the century, research has highlighted the importance of early life experiences on long-term health and social outcomes. While childhood exposure to severe or prolonged toxic stress can negatively impact the brain, body, and behavior, early interventions can increase the odds of positive health and social outcomes. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Salud America! is exploring the report as part of its 11-part series on toxic stress. “The pervasive, high prevalence of [adverse childhood experiences (ACEs)] and the enormous costs of health, economic, criminal justice, and other downstream effects ...

Read More

How to Use Social Service Strategies to Address Toxic Stress


How to Use Social Service Strategies to Address Toxic Stress

The child welfare system plays a critical role in identifying, investigating, and intervening to protect children facing abuse and neglect. However, the child welfare system traditionally isn’t as focused on preventing abuse and neglect. Because abuse and neglect are among the adverse childhood experiences (ACEs) associated with toxic stress and some of the most common and serious health and social conditions, the social services sector is needed to help prevent these experiences before they occur. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. She, along with numerous health and child welfare professionals, wants to engage a ...

Read More

Using Public Health Strategies to Address Toxic Stress


Using Public Health Strategies to Address Toxic Stress

Exposure to domestic violence and other adverse childhood experiences (ACEs) can trigger the toxic stress response for a long time, disrupting brain and body development and contributing to some of the most serious health conditions facing our society. Public health can help prevent, detect, and mitigate toxic stress. That’s why Dr. Nadine Burke Harris’ recent Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health calls on public health leaders to address ACEs and toxic stress among Latinos and all people. “The public health field plays an important role in ensuring that communities have healthy environments that support healthy behaviors and reduce risk of harmful exposures,” Burke Harris’ roadmap ...

Read More

Healthcare Strategies for Preventing and Addressing ACEs and Toxic Stress


Healthcare Strategies for Preventing and Addressing ACEs and Toxic Stress

Through prolonged activation of the toxic stress response, adverse childhood experiences (ACEs), like neglect and poverty, disrupt the development of brain architecture and other organ systems and are strongly associated with some of the most common and serious health conditions facing our society. This means toxic stress is a health condition with clinical implications. The healthcare system can play a central role in preventing, detecting, and mitigating toxic stress. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Salud America! is exploring this as part of its 11-part series on toxic stress. Below are primary, secondary, ...

Read More