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 Three Horizons framework is depicted as a simple graph with three timelines. The X (horizontal) axis of the graph represents time, and the Y (vertical) axis represents the prevalence of each timeline at a given point.
As a whole, the graph depicts the way in which current, inherently flawed systems eventually give way to better and more sustainable systems, and the factors that can either support or hinder this transition.
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).
Here are a few of the characteristics of our H1 system as it relates to health and well-being:
The Desired Future
H3 represents the better, more sustainable, and more just system we want to replace H1–an ecosystem that produces more equitable health and well-being, and that supports thriving for all people everywhere.
To some extent, the Three Horizons framework considers the rise of H3 inevitable if given enough time. However, by making strategic and intentional choices about how we solve the problems inherent in H1, we can bring about the rise of H3 much sooner.
Disruptive Innovation
H2 sits between H1 and H3 and represents disruptive innovation, which can take many different forms, including technological innovation, new paradigms of thinking, and novel approaches to overcoming existing challenges.
However, not all H2 innovations help to usher in the rise of H3. That’s because there are two different kinds of H2 innovations, known as H2+ and H2-.
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.
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.
