"Behold the turtle-he makes progress only when his neck is stuck out." The Robert Wood Johnson Foundation stuck its neck out when it made the decision to invest in the Turning Point Initiative. Turning Point is an innovative effort focused not on providing direct services, but rather on implementing far reaching system changes and spurring new partnerships. These both are critical strategies to improving the public's health in the 21st century, there are not many funders-even government itself continues to back off-value the importance of transforming and building the capacity of the public health system. Yet it is a renewed public health system, with nontraditional partnerships that can provide strong leadership and bring about improved health outcomes in the years ahead. The first 4 years of this next 100 have already been incredibly challenging and all states, not just the official Turning Point states, are better positioned to rise to the challenges due to what has been learned and experienced through Turning Point.

One of the many unique attributes of Turning Point is that it gave states the opportunity to focus on one or more of 5 major system innovations-all vitally important for the future: leadership, technology, social marketing, public health law, and accountability.

Because North Carolina's planning phase of Turning Point called for a major investment in social marketing as a critical strategy for addressing the state's leading causes of death, North Carolina was very pleased to participate in the Social Marketing Collaborative. It was enlightening and invigorating to engage in a systematic way with the whole body of science for identifying, implementing, and evaluating effective strategies to achieve health-directed behavioral changes. The notion of creating opportunities based on research for "exchanges" to ensure people get what they want in exchange for changing risky health behaviors can galvanize creative solutions. Making healthy behaviors "fun, easy, and popular" is a message that easily translates across all states.

Which gets to the second point-a core mission of the Social Marking Collaborative is to make social marketing a routine part of how business gets done in public health. In the increasing fiscal crises of the states and the nation, as well as the call for increased accountability, it is critical that all states institutionalize best practices in reducing health risks-and that means making certain that strategies are well researched within the populations that we are trying to have the greatest impact upon in improving health. Eliminating disparities and reducing behavioral risks are clearly primary challenges for all states.

The Collaborative also developed real products to assist states in implementing social marketing best practices. CDCynergy-Social Marketing Edition1 is the signature product of the Collaborative and may become a critical tool to use in future initiatives to secure federal funding. Other publications of the Collaborative include The Basics of Social Marketing, 2Social Marketing and Public Health: Lessons from the Field, 3 and The Manager's Guide to Social Marketing, 4 which also were developed and distributed to build state's capacities to implement effective behavior changes. To ensure states are able to implement social marketing strategies, "end-user" and "train the trainer" efforts using these tools were tested, evaluated, and disseminated to the states.

Given that 50% of health status continues to be based on behavioral risk factors or lifestyle decisions, it is of paramount importance that public health make a greater commitment to implementing research-based social marketing strategies that are effective in changing behaviors. Continuation of the work of the Social Marketing Collaborative to provide national leadership on social marketing and be a resource for all states is critically important.

The Turning Point initiative was also right on target in creating an Information Technology Collaborative. Clearly public health's biggest opportunity for success in the 21st century and the biggest risk of failure lie in the development of adequate technology systems. Data-it's collection, analysis, and dissemination in effective health communications-will determine the effectiveness of public health interventions. As one example, social marketing strategies must be supported by meaningful analysis of researched data to design effective interventions.

The Technology Collaborative accomplished a national survey of local and city health departments on software use, has a state level survey underway, and has gone online with a Public Health Information Systems Catalog. The Collaborative identified in a systematic way the reality that exists in every public health jurisdiction: that resources are grossly inadequate both for purchase of systems and also for technical assistance.

The recommendations clearly make the point that policy makers must consider the front line of public health in developing technology initiatives. The federal government must provide funding and technical assistance and include manpower needs as new technology sitemaps are in the developing stages. Communications across the systems as determined by standards that are clearly articulated is essential.

So, behold the turtle as it sticks its neck out into the 21st century. Through the work of Turning Point, the public health system is making progress. When working in systems changes and partnerships and when striving to improve health outcomes, the stakes are high, and the work is complex. The experiences of the Turning Point Social Marketing and Information Technology Collaboratives represent tremendous contributions and future opportunities to improve health outcomes within all states. It is incumbent upon leaders in public health at the local, state, and federal levels to sustain this momentum.

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