Seminar Series

Social disadvantage is an important concept in health inequality research and policy. This study aimed to draw insights from the general public about the concept of social disadvantage using LEGO® SERIOUS PLAY® (LSP), a small-group facilitated thinking technique. We conducted a total of nine in-person LSP sessions with the general public in the state of Maryland in the United States between January and May 2025 (a total sample size of n=65). Each session had four to ten participants, was guided by one facilitator, and lasted approximately five hours. We analyzed transcribed data of participants’ stories behind their LEGO models of hardship using thematic analysis. The most prominent theme that emerged is dynamics and experiences of hardship, in which participants emphasized how problems come together and explode as the cascade/domino effect and how they feel in such precarious situations—feeling trapped, and there is no margin for error. In addition, the theme, hidden injuries, emerged as participants understood life hardship not merely as unfortunate situations people fall into but also as situations society is unwilling or reluctant to see. Furthermore, our participants loudly spoke of systemic issues as an important cause of hardship (systemic and social barriers). Our findings point to a need for an expansion of focus in academic and policy discussion to the mechanisms, dynamics, and experiences of social disadvantage. Our study also underscores the importance of asking people in a way that they are able and willing to share their stories, demonstrating LSP as a promising method.

Yukiko Asada’s research contributes to establish sound foundations of fairness in health systems and the health of populations locally, nationally, and globally. Asada is a population health researcher focusing on ethical issues in population health. Her program of research articulates the concept of health inequity, advances the measurement of health inequity, and promotes public dialogues on health inequity. Prior to joining McMaster University, she was a faculty member in the Department of Bioethics, National Institutes of Health (NIH) Clinical Center in the United States and a senior investigator in the NIH intramural research program with a focus on health disparities/inequalities and ethics and a professor in the Department of Community Health and Epidemiology at Dalhousie University. She obtained a PhD in Population Health from the University of Wisconsin-Madison.