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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.

At least eighteen countries allow transgender personnel to serve openly, but the United States is not among them. In this article, we assess whether US military policies that ban transgender service members are based on medically sound rationales. To do so, we analyze Defense Department regulations and consider a wide range of medical data. Our conclusion is that there is no compelling medical reason for the ban on service by transgender personnel, that the ban is an unnecessary barrier to health care access for transgender personnel, and that medical care for transgender individuals should be managed using the same standards that apply to all others. Removal of the military's ban on transgender service would improve health outcomes, enable commanders to better care for their troops, and reflect the military's commitment to providing outstanding medical care for all military personnel.