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Three Horizons

Three Horizons is a simple and intuitive framework for thinking about how we can efficiently and effectively guide systems change. The framework was developed by Bill Sharpe of the International Futures Forum and has been influential in many fields of study, including economics, philanthropy, and sociology.

Three Horizons can provide a useful framework for thinking about how to most efficiently bring about and nurture systems that create more equitable outcomes in population health and well-being.

The Status Quo

The H1 line represents what we might call “business as usual”–the current system model that is most prevalent in today’s world. In terms of health and well-being, H1 represents all of the myriad factors (societal, institutional, political, interpersonal, etc.) that influence our ability to thrive.

The Three Horizons framework operates on the assumption that H1 is not sustainable – at least not indefinitely – and therefore is bound to eventually decline. The decline of H1 will happen both because 1) it contains certain flaws that make it fundamentally unfit for its purpose, and 2) because of the eventual rise of better ways of accomplishing that purpose (the emerging future represented by line H3).

H2+ and H2- Innovations

When considering H2, the key question is how these innovations will positively or negatively affect the transformation from H1 to H3. H2+ refers to innovations that help hasten that transition, while H2- refers to innovations that tend to delay the transition by supporting the continuation of H1.

Innovations That Perpetuate the Status Quo

To help understand the difference, consider an example of a hypothetical H2- technology related to health and well-being. Specifically, let’s imagine that community leaders developed a new system for connecting their residents to emergency medical services faster, more efficiently, and at a lower cost.

In most ways, this would be a very positive innovation, because urgent services like emergency medical care are an important part of any healthy community.

However, this innovation is not likely to hasten the transition to an H3 system that produces more equitable health and well-being and that supports thriving. Why? Because it still approaches the problem (excessive demand for urgent services) using the conventional means of H1 (increasing access to those services).

In fact, by making the H1 system more efficient, it may even slow down the transition to H3. Public officials, observing a decrease in negative health outcomes (e.g., fewer deaths from emergencies like trauma and cardiac arrest) may consider this an adequate way to solve (or at least manage) the community’s most urgent health problems. As a result, they may feel less motivated to invest in “bigger picture” programs and policies that address the foundational problems at the root of the community’s challenges.

It is important to understand that H2- innovations are not necessarily bad. We simply need to be conscious of the way they can impede the transition to H3, and weigh this factor when considering public health investments.

Innovations That Usher in H3

Now let’s consider an H2+ innovation: The vital conditions for health and well-being framework.

Vital conditions is a framework that identifies the conditions we all need all the time to reach our full potential for health and well-being. It includes measurable factors like humane housing and reliable transportation, as well as more subjective factors like a sense of belonging and the ability to shape the future of one’s community.

This framework provides a new way of thinking about population health and well-being, to move beyond “band-aid” solutions (like increasing access to urgent services) and focus on implementing long-term system changes that create thriving communities.

In doing so, the vital conditions framework helps to usher in a new, more sustainable “H3” ecosystem that enables more equitable health and well-being.

How to Use the Three Horizons Framework

The Three Horizons framework is often used for group brainstorming, though anyone can use it at any time when conceptualizing different paths for the future. The strength of Three Horizons is that it provides a simple, understandable continuum to help achieve clarity around the best path forward. It is particularly helpful for building consensus when discussing competing priorities or pathways.

Used in any context, Three Horizons can be a powerful tool for deciding which innovations and approaches to focus on for the greatest long-term impact.