When industrialist James B. Duke created The Duke Endowment in 1924, he said he hoped the charitable foundation's work would "make provision in some measure for the needs of mankind along physical, mental and spiritual lines." Today, the Endowment still works to uphold the legacy of Mr. Duke, a visionary leader who also founded Duke Energy and Duke University. Over the past nine decades, The Duke Endowment has distributed more than $3.6 billion in grants. Mr. Duke's philanthropic vision remains at the heart of grant-making efforts in the Endowment's Health Care, Child Care, Higher Education and Rural Church program areas. As it adapts to today's complex challenges, the Endowment is deepening its focus on prevention and early intervention, striving to intercept social problems before they take root. That philosophy of "working upstream" powers the Endowment's ongoing push for a major expansion of the Nurse-Family Partnership in the Carolinas. That effort has spawned the nation's first "Pay for Success" project aimed at improving health outcomes for mothers and children living in poverty. The philosophy of early intervention also drives a major new emphasis by the Endowment on early childhood issues. Initially, this new emphasis will be seen in the Endowment's special initiatives, such as its work with Blue Meridian Partners - a collaborative effort among 12 funders seeking to expand evidence-based programs serving economically disadvantaged children.