The webinar discusses the limitations of using averages in population health and health equity research, highlighting that averages can obscure important individual and contextual disparities. It emphasizes the need to move beyond mere disparity description towards understanding the underlying causes of health inequity, encouraging a multidisciplinary approach to address these complexities. Key messages include the importance of situating health risks within broader social, political, and geographical contexts for more effective health equity research.

2. Overview of the webinar
• Using averages in
population health
& health equity
research
• What do averages
hide?
• Why go beyond
and possible ways
• Key messages
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3. Measuring population health using averages
Typically proxy of health status, disease
prevalence or health services coverage and/or
utilisation
• Allow comparison across or within
population across space and time
• Identify inequalities across populations
• Identify priorities for population health
interventions and essential tool for
health services monitoring and planning
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Balarajan Y, Selvaraj S, Subramanian S. Health care and equity in India.
Lancet 2011;377:505–15. doi:10.1016/S0140-6736(10)61894-6

4. Understanding averages
• a number expressing the
central or typical value in a
set of data, in particular the
mode, median, or (most
commonly) the mean…
• A summary measure for a
population health attribute –
decontextualised by design
• Averages over time does not
tell us anything about “for
whom”
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5. What do averages hide?
• Aggregations of
unrelated and non-
uniform population
groups
• Contexts
• Unevenly distributed
advantages and
disadvantages
• Social structures that
operate unfairly across
time, space and/or
person
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6. What do averages hide
(Not) all (wo)men are “created” equal
•Bio-medical (cf. Barker hypothesis)
•Psycho-social (cf. poor households, biological and
social effects of discrimination)
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1

7. Not all opportunities are accessible equally
•Myth of equality=equity (cf. accumulation of
disadvantages)
•Environmental (cf. distribution of parks and
recreation, town resources allocation)
•Socio-political (cf. access to social networks and
power structures)
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What do averages hide 2

8. What do averages hide
Not all contexts affect processes or outcomes equally
•Differing contexts: Multiple interacting contexts
ranging from individual, to household to society
•Differing interactions between contexts and
processes: All household members are not similarly
affected by the same biological illness/health
problem
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3

9. why go beyond
• the more interesting question: From how much to why or how?
• Health inequity as a wicked problem, Complexity
• Social construction (norms, values, social structures) and path dependence
• Macro processes (cf. macro-economic changes or policy) producing micro-
effects
• Action/implementation/solution orientation
• Ethical imperative: not only an issue of disparity, but of equity i.e., not only ”Is
there a difference”, but is it unfair and/or acceptable 9

10. Possible ways of looking beyond
• Going beyond individual risk: Situating the individual (risk) within a
household, neighborhood, geography, society and time – going beyond
public health as risk-modification approaches to engaging with public
health as a socio-cultural and political phenomenon
• Tapping into current body of knowledge across disciplines. Eg. Theory-
driven inquiry, using conceptual frameworks, life-course epidemiology,
psycho-social processes, qualitative and social science methods
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11. Key messages
• Averages are useful comparison tools for
population health
• Averages hide various individual, household,
geo-spatial and social differences in contexts
• Health equity research needs to move beyond
describing disparity to explaining inequity
• Both for scientific and ethical reasons, health
equity research needs to engage with why/how
questions than only unpacking individual risk
• Many disciplines outside mainstream bio-
medicine have engaged with the issue of social
inequity, which can be used for health equity
research
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