"The Embarrassment of Riches;" an historical theme for a children's health agenda in 21st century America.

How can the United States use its immense wealth to create an agenda for children in the 21st century? The field of maternal and child health must strengthen and broaden the social strategies needed to overcome the changing demography and diminished political place of children in society, globally. Four approaches are proposed: First, adopting a life-course orientation emphasizes the continuities of the early part of life with the conditions, developmental tasks, and health problems of the rest of the life cycle; it makes maternal and child health relevant to health and well being across the entire life span. Second, shifting to a focus on the multiple determinants of population health will overcome the limitations of a medical model that is narrowly concerned with etiological risk factors for disease and medical interventions; in particular, poverty among children must be addressed on a global scale. Third, promoting social justice for children demands an open political discussion of the moral and ethical foundations of child health. Finally, preventing health problems across the life span requires a new set of population level, univeral intervention strategies. These fundamental principles are proposed to stimulate a discussion of how to make our field more influential in the 21st century.