Developed by Dr. Rishi Manchanda, founder of HealthBegins, the Upstream Strategy Compass is a tool commonly called the “3×3 Matrix.” This tool provides a wealth of information at a glance, with three columns addressing individual, community, and societal levels of action, and three rows labeled primary, secondary, and tertiary to describe levels of prevention.
The 3×3 made its debut in 2014, at a HealthBegins social determinants of health workshop in New Mexico. Dr. Rishi Manchanda, founder and CEO of HealthBegins, developed the 3×3 to help solve a problem. In every community he had visited, leaders from healthcare, public health, and community-based organizations were using the term “social determinants of health” but defining it differently.
“It was like the parable of the six blindfolded men coming across an elephant for the first time,” Dr. Manchanda recalls. “One felt the tusk, one touched the tail, one felt the trunk, and so on. From their frame of reference, each one then described this new animal, assured that their own mental picture of the elephant was correct.” As stakeholders defended their own understanding of social determinants of health, they found it challenging to agree on solutions and chart a strategy for collective action.
To get everyone on the same page, Dr. Manchanda decided to try something new in that conference ballroom in New Mexico. He drew a 3×3 grid on giant pieces of butcher paper affixed to a wall. He labeled the three columns individual, community, and societal to describe levels of action, and then labeled the rows primary, secondary, and tertiary to describe levels of prevention.
Dr. Manchanda then invited stakeholders to consider people experiencing housing instability within a specific geographic area. He asked that they write potential solutions on sticky notes, and then place those notes on the grid. In short order, participants filled the giant, nine-square grid, creating a visual map of potential solutions to improve social and structural drivers of health equity for a priority population.
As they worked with the 3×3, something remarkable happened. Instead of getting bogged down by their different definitions, stakeholders started acknowledging the work, ideas, and perspectives of others. They discussed concrete opportunities where each stakeholder could lead, partner, and support the others. Together, they mapped a shared, comprehensive portfolio of strategies to improve social and structural drivers of health equity across levels of prevention and action.
Where are you? Where are you going? These two simple but important questions, when placed within the context of the 3×3, open doors of understanding in those seeking to improve the lives of others—and with that broadened understanding comes progress.