This is the report and slides by the facilitators (International Futures Forum) of the 'Mobility and Active Healthcare' half-day workshop on 26 November 2018. This was the second workshop of the ‘Exploring the innovation landscape for health and technology’ series hosted by The Edinburgh Futures Institute and The Usher Institute at The University of Edinburgh in November and December 2018.

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Technology for Mobility and Health: Exploring the Innovation
Landscape
Edinburgh Futures Institute and Usher Institute Workshop, 26 November 2018
Introduction
This report provides the key outputs from the second of three workshops
investigating the innovation landscape for technology and health organised by the
Edinburgh Futures Institute and the Usher Institute and facilitated by Margaret
Hannah and Alan Russell from International Futures Forum. Participants came from
a range of backgrounds including academia, healthcare, local authority, independent
practitioners and third sector.
All three workshops are structured around the Three Horizons framework. The
framework maps a shift from the established patterns of the first horizon to the
emergence of new patterns in the third, via the transition activity of the second.
The first horizon – H1 – is the
dominant system at present. It
represents ‘business as usual’. We
rely on these systems being stable and
reliable. But as the world changes, so
aspects of business as usual begin to
feel out of place or no longer fit for
purpose. Eventually ‘business as
usual’ will always be superseded by
new ways of doing things.
The third horizon – H3 - emerges as the long term successor to business as usual.
It grows from fringe activity in the present that introduces completely new ways of
doing things but which turn out to be much better fitted to the world that is emerging
than the dominant H1 systems.
The second horizon – H2 - is a pattern of transition activities and innovations,
people trying things out in response to the ways in which the landscape is changing.
Some of these innovations will be absorbed into the H1 systems to improve them
and to prolong their life (we call them ‘H2 minus’) while some will pave the way for
the emergence of the radically different H3 systems (these we call ‘H2 plus’).
Dr Margaret Hannah, IFF Director of Health Programmes, also offered a brief
overview of Five Waves of Public Health innovation to illustrate the great advances
in public health since the 19th century (summarised below in their generic form –

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Margaret gave examples relevant to the mobility agenda over the past century and
more). These represent ways in which we have innovated to improve health in the
past and will continue to do so into the future.
The Three Horizons framework and
the five waves of population health as
they relate to mobility are explored in
more detail in the presentation
attached to this report as an appendix.
These inputs enabled a three-stage
process of conversation in small
groups to build a Three Horizons map
of the landscape of innovation around
the theme of technology for mobility
and health. The other workshops in
the series concentrate on community
and on the internet of things.
First Horizon Concerns
Participants, split into four small groups, were first invited to discuss their concerns
about current business as usual around mobility and health. Each small group fed
back from their discussion by presenting a few themes and issues on post-it notes.
During the plenary discussion around these points, the individual post-it notes were
clustered into more generic themes as follows:
Growing numbers of people
Demand outstripping supply (demographics)
Aging population
Air pollution
Current transport struggles in an expanded city (population growing by 7% in
last year?)
Mental health impact of commuting to lots of different jobs
Dominance of the automobile
How much longer can we privilege the automobile?
Automobile travel is normalised vs active travel which is
not
Poor policymaking
Stakeholder approaches are needed (including trust in ‘non-experts’)
Decisions being made by privatised transport systems (‘removing bus stops’)
Why do people need transport? Need? Usage? Who provides transport?
Fragmented, reactive infrastructure
Logic of city development is broken
Add-on reactive approach to transport infrastructure
‘bus lines’,’ bus deserts’ – introduce rural solutions in city? Explore.
Bus stop reductions and removing express routes. Do we need these? What
about just hailing a bus as they do in Israel?

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Inequalities
Need serious, meaningful dialogue with informed users
Digital empowering can be dis-empowering for those without access (example
given of cable cars in Medellin)
How do we keep people at home healthier for longer (and value)?
Lack of mapping between research domains to inform these questions
‘Lifecycle’ research should be part of the picture
This last point, about the need to consider the whole lifecycle of a person in thinking
about mobility triggered discussion of the Life Curve (see below) which shows on its
vertical axis symptoms of progressive decline in mobility and functionality. As
individuals and societies we should be aiming to postpone this decline as long as
possible – with resulting savings to health and social care budgets. This is a good
frame for including later years of decline in a life course approach to mobility and
health.
Introduction to the Five Waves of Public Health
In order to understand the innovation landscape for mobility and health in a wider
historic canvas, Margaret Hannah, who has a background in public health, presented
a few key features of the five waves of public health innovation which have each
played a significant part in improving population health over the last 170 years. The
waves are described in more detail in the presentation in the appendix to this report.
Margaret described the concerns which dominated during each ‘wave’ and how
these are reflected in today’s world – from responding to rapid urbanisation, the

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spread of communicable disease, a commitment to human rights and welfare, and
more recent attention to lifestyle and behaviour. Today a Fifth Wave of public health
is emerging in the face of concerns around the huge increase in complexity in our
lives, our interactions with each other, with work, community, society and the planet
and the uncertainties we face collectively, e.g. climate change, migration etc.
Margaret invited participants to consider all five waves in thinking about how best to
innovate in response to the concerns they had already identified with present
conditions.
Third Horizon Aspirations
After a short break, participants – still in small groups - were invited to consider the
direction of travel into the future and to articulate their aspirations for a future third
horizon. They also identified inspiring examples of this future already occurring in
the present.
Again there was a plenary feedback session in which individual post-it notes were
rapidly clustered under different themes as follows:
Citizen-led, integrated science in dialogue
A city driven by inhabitants, not by tourists or students
Citizen-led social science
A sense of ownership for personal health ‘Own your own numbers’
Safety – technology enables safe open spaces
A system that listens to people and actually implements change
Synthesise/tailoring information from /for different stakeholders
(knowledge/collaboration)
Physical activity is an integral part of health, wellbeing and care for all
Wellbeing by design
Prescribed physical activity
Integrated healthcare system – with city design
Better pedestrianisation in city
Careful, place-based, integrated planning and design
Moving easily around Edinburgh
Adaptive spaces
City and Campus Hubs
Joined up approach such as in London and Helsinki – how to get from A to B
An inter-generational approach to housing and transport
Examples of H3 in the present
In terms of inspiring examples, the following ideas were mentioned:
City leadership committed to the people
Cable cars in Medellin
Buses in Brazil
Integrative design
Citymapper – app for transport – integration takes place at user end of system

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Build infrastructure, then housing: eg 7N Architects Fountainbridge masterplan,
Polnoon in Glasgow
Social/cultural attitudes/norms
Children expected to walk to school in
Switzerland
Tokyo – school run with pedal/electric
Netherlands – cycling the norm, infrastructure
supports this
Usage and business mobiles around personal
devices (also bank accounts in Ukraine)
Park Run
Tai Chi
Having explored now the concerns with the H1 system and aspirations for H3,
Margaret was able to draw out some contrasts between the values and assumptions
that appear to prevail in the H1 and H3 patterns as follows:
Broad H 1 patterns:
- Segregated spaces in cities (living away from places of work etc) increases
need for mobility
- Top-down decision making, efficiency-driven
- Individual solutions, data private/proprietary
Broad H3 patterns
- Integrated spatial design – reducing the need for travel
- Citizen-led design
- Pooled/shared solutions
- Data shared but with appropriate safeguards
Exploring innovations
This contrast enabled the small groups now to consider the innovation landscape –
innovations in the second horizon. Each group considered existing or possible
innovations, including how these might be sustaining of the existing H1 pattern (ie in
tune with the broad values and assumptions described above) or transformative in
shifting the system towards the values and assumptions of H3.
The full list of suggested innovations is included in the Appendix. In plenary
discussion each group provided just a few innovation ideas to be discussed further:
- Health-related data used in schools
- Car-sharing, shared taxi journies
- Institutional courage vs institutional egos
- Fife SHINE programme
In order to help explore how innovations in H2 can be more transformative, Margaret
introduced the group to the deck of IFF Prompt Cards. These cards contain short,
pithy statements that can help nudge us out of familiar patterns and invite us to ‘try
other worldviews on for size’.

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Each person took a Prompt and in discussion a few of these were elaborated on to
illustrate the tensions between innovations which are sustaining (‘H2 minus’) and
innovations which have the potential to be transformative (‘H2 plus’). The results are
summarised in the table below.
Prompt Card H2 minus insights H2 plus insights
Flipping rather than
forcing
Can’t force the NHS/City
Council to change
Build a new system to
make the old one
obsolete
Integrity (the actual card
says: Identify the real
change agents, systems
and integrities)
Multi-national corporates
take over from public
services
Integrity comes from
citizen engagement, fact
checking and
transparency
Shift the balance from
control to participation
Data used to control,
decisions remain top-
down
Citizens engaged in
design and make their
own decisions about
mobility
Recognise the different
value patterns
Single bottom line – the
profit margin
Multiple bottom lines – for
people, planet and
purpose
Finally, Margaret asked about any features of the existing H1 system that we need to
retain in the future even as everything else changes. This is like “the baby” which we
would not want to throw out with the bath water. Sometimes exploring this question
can help to uncover foundational values that must be honoured in any future pattern.
This identified the following important points, specifically for the city of Edinburgh:
- Retain the historic essence of the city
- The historic pattern was designed before the car (Jane Jacobs)
- Affordable life (French protests are happening currently because this is being
disregarded)
Closing
The workshop closed with thanks to the participants, the promise of a written
summary report, looking forward to deepening and broadening the conversation in
the final workshop – and using the content to develop a Three Horizons Kit to enable
similar conversations in other settings and with other groups.
Margaret Hannah
Alan Russell
International Futures Forum
29 November 2018

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Appendix
H1 Concerns
H3 Aspirations and H3 in the present

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Innovation in H2

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Innovations in H2
Mapping of research
Pilot programmes of integrated approaches (eg Housing Association model)
Adaptive bus routes – young people
Is it democratising?
Is it socially redeeming?
Is it innovation?
Multiple impact considerations – clear, deep, wide, surface
Pursue multiple bottom lines – profit, people, planet, purpose
Evolving entrepreneurship (beyond commercial)
DDI and action research, EFI +++
App that maps all groups and places for ‘activity’
Co-design major goals, not just ‘safer, healthier’ etc.
Capture many more voices
Trials of new ways to get voices and data
Use on-line groups – FB, local newspapers
Walk to work days
Data integration and sharing – research, industry, policy
Redesign policy-making process
Professions – service integrity
Transparency through data? Fact checks
Integrity: US corporation vs public service
Procurement, project management skills (the producer)

10. Technology for Mobility and Health
Exploring the Innovation Landscape
Alan Russell
Dr Margaret Hannah

11. Agency
Uncertainty
Complexity
ScenariosPlans
Forecasts
Roadmaps Adaptive Pathways
Thinking About The Future

12. Pattern
Making sense of the landscape of change through three
perspectives on the future potential of the present moment
Time
Three Horizons

13. The managerial perspective, keeping things going
First Horizon: Sustaining Innovation
Today’s Dominant Pattern: a
system losing strategic fit and
therefore dominance over time
Pattern
Time
H1

14. The visionary perspective, aspiring to a better way
Third Horizon: Transformative Innovation
Pattern
The Future Pattern: a system in
tune with deeper trends that
eventually emerges as the new
dominant system—perhaps a
generation from now
Time
H3

15. The entrepreneurial perspective, eager to try new things
Second Horizon: Disruptive Innovation
Pattern
Zone of Transition: a
system seeking to exploit
the opportunities emerging
in a changing world
Time
H2
+–
sustaining transformative

16. A transformative innovation system that contains three
ways of acting in and seeing the world.
Three Horizons: Bringing it Together
Pattern
Time
H2
H3
H1
Entrepreneur
Manager
Visionary

18. First Wave: a response to
rapid urbanisation

19. Joseph Balzagette
1858

20. ‫‏‬By Matt-80 - Own work, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=203588

21. Second Wave: a response to
rapid spread of communicable
disease

22. ‫‏‬John Snow 1854

23. ‫‏‬Pandemic‫‘‏‬flu‫8191‏‬

24. Third Wave: a human
rights response

27. Fourth Wave: a behavioural
response to risk factors

28. London Transport Workers Study
Morris JM et al
Coronary heart disease and physical activity of work. (1953) Lancet
265, 1053-1057.

29. Fifth Wave: a salutogenic
response to complexity and
uncertainty in 21st Century
From‫“‏‬anti”‫‏‬to‫“‏‬pro”
From avoiding death at all costs to having
something to live for
You cannot be healthy alone – personal,
community, organisational, societal and
biosphere interactions all impact on health

30. Healthy environments and mobility in
the City: all 5 waves in action

31. ‫‏‬Present Concerns ‫‏‬ Promising Innovation
‫‏‬ Inspiring Examples
‫‏‬ Ideal System
Small group conversations
‫‏‬PATTERN
‫‏‬ The Baby?

33. or contact:
enquiry@iffpraxis.com
More information on Three Horizons and the
practice of Transformative Innovation which it
supports is available at:
IFF Practice Centre
www.iffpraxis.com