Several years ago, a legislator spoke clearly of the wishful unawareness we often confront in public health. After a session of frank exchange in his committee about teen pregnancy in Arkansas, he said, "Dr. Elders, until you became the health department director, we didn't have this problem." The facts paint a startling scenario for such people. We have not provided an environment in which our children can flourish. Instead, we have allowed the number of children who are economically, educationally, and medically disadvantaged to grow. Called "at-risk," their existence is an affront to democratic ideals, especially the belief that all have an equal chance for prosperity. It is time for true reform, but before that can happen, we must face the state of our children's health. After this, we must set to work at effective strategies. [ABSTRACT FROM AUTHOR]