We are at crossroads in the history of maternal and child health in the US. While a wealth of scientific discovery has shown us the far reaching yet modifiable effects of critical and sensitive periods in early life on health across the life course, the social gradient in health is steeper than in any other developed nation. This linear decrease in health that comes with decreasing social position leads to alarming inequalities in US health. Meanwhile, despite important gains in insurance coverage through the ACA, our current patchwork system of care for children and families is ill equipped to address these inequalities, particularly in a range of new morbidities related to developmental, behavioral and mental health as well as obesity. What is more, perceptions of ACA coverage expansions as a sufficient solution to our ill health puts our fragile maternal and child health infrastructure in jeopardy of being relegated to safety net status, precisely when science and social realities compel us to transform it into a higher functioning system that takes a life course approach to tackling the social gradient in health. This is the challenge that the new MCHB director has posed to the field by adopting the forward leaning moniker MCH 3.0. [1]

It is precisely at this crossroads that California must leverage the collective capacities of its 16 MCH training programs to promote the kind of collaborative, cross-disciplinary approach that will prepare our next generation of MCH leaders to transform the field from one historically focused on infant mortality to one that situates perinatal health into the broader systems and policy context of our changing health care system. This will require that we build relationships with our state and local health departments and link to new national networks that share many of our goals, like IHI’s 100 Million Lives Campaign, ReThink Health, NICHQ, Help Me Grow, and the IOM Roundtable on Population Health. We need to foster the knowledge, skills, and relationships among our trainees that will prepare them to target larger levers of change and move from incremental and siloed approaches to those that can be brought to scale for real impact.

We need to shift the MCH paradigm from one that views our contribution as something that can be “carved-out” of the larger health system to one that embraces our lifecourse orientation as the lynchpin of a comprehensive and networked approach that is able to effectively address the alarmingly steep social gradient in health in the US.