Virginia has always had a great affinity for the opinions of her people. Turning Point provides many unique opportunities to strengthen and transform public health; yet, duration and funding levels represent real challenges. What can we accomplish in two or three short years with limited financial resources? The answer is "a lot" - as long as the community is involved.

While community involvement is the key to sustaining Turning Point, questions remain. How do we engage the community? What will make Turning Point interesting to the average citizen? This is difficult to answer because every community is unique. The most effective case for change is a strong sense of urgency that fosters a dramatic need to chart a new course. We have not yet created that sense of urgency to improve public health in Virginia. One reason may be that Virginia is a healthy place to live. In 1997, the Virginia ReliaStar Health Ranking moved up to 6th place. (The ReliaStar Health Rankings are an overall measure by state of the general health of the population of the United States published by the ReliaStar Financial Corporation.)

Listen to the Community

Our first step in achieving this important element in the Turning Point process is to listen to the community and find out what they recognize as important. From that knowledge, we can build a sense of urgency for change. Jeffrey L. Lake, Assistant Commissioner for the Virginia Department of Health, has a saying: "Some days you go to school to teach, and some days you go to school to learn." Turning Point is a chance for us to learn.

Virginia has plans to reach out to citizens concerning the future roles and responsibilities of public health. A statewide telephone survey, key informant discussions, and regional forums are underway. Steering Committee members talked about identifying the "hook" that will bring the community to the table for an active discussion. Will a forum on improving community health bring in anyone new? Those who work in the field of public health are very good at reaching out to the health care providers to obtain input. Turning Point demands that we do much more to reach our customers and to build and sustain partnerships with diverse groups.

To sustain an initiative, it is important to collaborate with community leaders early, for both the "lift off" as well as the "landing." Without community involvement and support, the longevity of projects is doubtful.

Lessons learned about involving communities are:

• Ensure diversity among those to whom you "reach out."

• Listen actively to the community.

• Value their input.

• Be open to hearing things that you do not like or with which you do not agree.

In Virginia, we are viewing Turning Point as an opportunity to learn more about how public health is perceived by others, not just how we understand public health.

Examples of Success

Virginia is drawing on experience from a number of valuable programs at the state and local levels and in the private sector. The Virginia Hospital and Healthcare Association's (VHHA) Indicators for Healthy Communities 1997 report and Norfolk's Real Alternatives to Pregnancy (RAP) program are two such examples that emphasize community involvement as essential to success.

Indicators for Healthy Communities 1997 was initiated to provide data to Virginia hospitals and health systems to set priorities for community health initiatives. According to Barbara Brown, PhD, Director of Clinical Information Services at VHHA, "Member hospitals and health systems need data to assess, compare, and measure community health." VHHA established a Community Health Assessment and Accountability Task Force. Its membership included hospitals, health systems, consumers, insurers, public health, local and state government, chambers of commerce, a poverty law center, community foundations, YMCA and United Way. VHHA saw the importance of bringing differing views together. To ensure that comprehensive data about community health would fit the need envisioned, VHHA sought input from communities, not only the interests of health care providers. Community leaders have provided additional feedback to VHHA to make subsequent Indicators for Healthy Communities reports more useful.

Norfolk's RAP program seeks to reduce the incidents of teen pregnancy. RAP actively engaged key community leaders to ensure the initiative had community exposure as well as access to important resources. Norfolk found that while leaders were excellent  at developing a vision, RAP needed more direct community involvement for project implementation. According to Shirley Tyree, Director of Norfolk's RAP Program, as well as the local Turning Point partnership Coordinator, one of the most effective tools for the RAP program was cultivating other employees within an organization to  implement the project. With a vision from the top and support from management, Norfolk found a ready workforce to reach out directly to citizens and develop strategies to reduce teen pregnancies.

Developing a Plan for Community Involvement

Virginia has established planning teams for regional forums in order to draw on community resources. These community leaders will identify issues that will mobilize their community regarding its health. Involving the community at each step along the way ensures that we keep the community's vision for the future of public health in sight. Accordingly, Virginia has planned second year activities to be based completely on feedback from the community. The process of analyzing information and developing recommendations for the Governor and General Assembly will be rooted in community input. The end result will determine how successful we are at achieving our goal to improve community health.

To access information about Virginia's Turning Point initiative, please visit our Web site at www.vdh.state.va.us/tpoint/index.htm. VHHA's Indicators for Healthy Communities 1997 are also accessible via the American Hospital Association home page at www.aha.org. Click on the "Advocacy and Representation" link. Once connected, look for "Virginia Indicators."

Jeffrey L. Wilson is Turning Point Coordinator for the Virginia State Partnership. Three community partnerships in Virginia are recipients of Turning Point grants: Norfolk Turning Point Partnership, The New Century Council in southwest Virginia, and Healthier Community Advisory Group in Prince Williams County.