A number of reviews emphasize the considerable extent to which infants and children of this country continue to be burdened with afflictions and risks of poor health.1-4 Persistent problems invite speculation that either the nation's wisdom or its resources are insufficient to serve fully the health needs of children. Neither of these explanations is well supported. A thoughtful policy paper5 published by the World Bank, dealing with the health of all children in the world, marshalls evidence that the most pressing health problems of children can be controlled or treated with presently known technologies. For this country, the Select Panel for the Promotion of Child Health found that the most pressing children's health problems were related to deficiencies of access to essential basic health services, and that the cost of providing those services as a public expense would be both small and cost effective.6 Services for children account for an exceedingly small portion of the federal health expenditures; out-of-pocket payments for children's health services are proportionally higher than for any other age group, even though a higher propontion of children than any other age group live in poverty-level households.7,8 Explanations other than lack of information or lack of national resources must be sought for the failure of this nation to address adequately the health needs of children. This paper attempts to serve two purposes. It first marshalls new testimony on the health status of children and then attempts to analyze barriers that thwart effort to address unmet needs. In the first instance, the circumstances quoted are intended to confirm that in spite of substantial progress over the past decade there are some persistent problems and some new warning signals about children's health.
