On November 8, 1995, the largest Republican landslide of the 20th century occurred. The number of new seats in state legislatures tell the story: Republicans - 472 and Democrats - 11. This massive reversal of party control means the general public has spoken; significant changes are to occur in how government conducts its business. It is less clear, however, as to what specifics of change the public has demanded. At the federal level, fiscal accountability appears to be the driving force, while at the state level, responsive and effective government programs appear to be the order of the day.
Child advocates know children are at serious risk of losing as priorities are reset. Times of change also present opportunities to influence outcomes to the betterment of children. The articles in this issue of Pediatrie Annals demonstrate a sophisticated understanding of political process and actions necessary for child advocates to be effective in the political arena.
Pediatricians cannot take a back seat in the process of influencing political change - our vested interests are just too great. Knowledge about the public policy formulation process is an essential tool for the physician who chooses to practice political medicine. Most important is understanding the interplay within the various foci of control within government and how they can be influenced from the private sector. The fourth "estate," or the media, often has been cited as the vehicle for influencing political outcomes. The effectiveness of the media in this regard has only increased as we have entered the era of computerassisted information transfer. The information explosion accompanied by the ability to manage vast amounts of data has allowed for a rapid diffusion of political control within the media. Only a few years ago, political scientists would cite a limited number of media sources as the influential components of the "fourth estate." Today, we have the opportunity to disseminate information and influence others in ways never dreamed of in the past.
Well-organized special interest groups have become the proverbial "fifth branch of government" bringing vested points of view on every political issue. Unfortunately, too often special interest groups are viewed negatively by pediatricians. We need to realize that we too constitute a special interest group and that we must build coalitions with other groups of a similar mind to advocate for common political gain. This issue of Pediatrìe Annals views the political process from a number of different perspectives. These include federal, state, media, special interest groups, academic medicine, and individual advocacy. There is plenty of room for all pediatricians to contribute to the process. Each effort, however small, contributes to the overall change process that will have lasting effects for many years to come.