Dr. Williams Answers ChatGPT's Clarifying Questions on Public Health Liberation Theory

I. THEORETICAL CONSTRUCTS

1. Public Health Economy: Ontological Status: Is the public health economy primarily an analytical lens, a structural system, or a unifying discipline? Does it have ontological standing—i.e., can it be studied empirically as a “thing” with defined boundaries—or is it better understood as a meta-framework for integrating disparate determinants?

The public health economy is all of those. It is an analytical and synergistic lens of structural and disciplinary determinants while also as a basis for intervention. The public health economy has high explanatory power to elucidate what is happening and why. Public health realism is a key concept to establish a universal rationality - agents who act out of their self-interests and whose collective conduct contribute to anarchy within the public health economy. They compete to manifest their own self-interests. 

Look at the public health rollbacks under Trump in 2025. Until Public Health Liberation theory, public health had few theories of its own to explain the political influence on public health. I would like to think that PHL theory broaden terms like "political determinants of health" and "structural racism" to real-world applicability. Essentially, the public health economy says that there is a separate "economy" at macro and micro levels - a unitary discipline comprised of legal, political, social, economic, legislative (e.g., oversight of agencies), regulatory (e.g., lax or strong), judicial, technocratic (e.g., research industrial complex), and other structural determinants that define and shape public health. 

We should eschew reductionist "frameworks" on this account because we are talking about highly complex systems that exceed our current capacities in data collection and analysis. Rather, we should elevate our understanding to be more unifying across disciplines and move toward complexity in conceptualization, research, and practice. A "framework" reinforces the interest-driven dynamics of the public health economy without practice. Even if a "framework" is established, it is meaningless because public health economies differ significantly.

2. Hegemonic Theory and Public Health Realism: Are you defining public health realism as a descriptive theory of how health agents behave under power asymmetries, or also as a normative critique of bad-faith action?

Yes, public health realism explains the underlying motivations of agents or classes of agents (people, corporations, socioeconomic networks, etc.) The central premise is that interest, often defined in terms of profit or financial pooling to maximize self-interests (e.g., membership organizations), motivates action. No, it's not a normative critique of bad-faith actors alone. Everyone in the public health economy has a set of defined interests and forms of vertical and horizontal integration. It can be understood as a critique and view outside of ourselves.

Does hegemonic theory in your framework map more closely to Gramscian cultural hegemony or institutional/policy capture? Do you see a distinction?

It's not that simple as Gramscian cultural hegemony because everyday people can be voluntarily or involuntarily incentivized to be contributors to the hegemonic order. In our theory, it is incorrect to assume an oppressive or dominant class as the cause of disorder in the public health economy. If that's the case, then there can be no popular uprisings and revolutions.

Here is an example in the education space.

Truth. Are We Ready for It? Incentives and Persistent Educational Disparities
“A system that appears designed more to benefit adults than to educate children, particularly children of color from low-income families who need it most…It's particularly insidious because everyone can point to their piece - "We're paying teachers well!" "We're building new schools!" "Graduation rates are up!" - while the fundamental mission of actually educating children, especially those who need it most, gets lost.” - Claude AI 

Racial and income educational disparities persist in the US. Yet, even in well-resourced cities like Washington, DC, these disparities remain acute and chronic. What is going on? The Truth: Deep educational disparities that resemble educational apartheid are deeply rooted in the financial incentives and punitive disincentives. 

Dr. Christopher Williams applied his knowledge of the educational ecosystem in Washington, DC, to lay out the Truth. Money plays a major role as a tool of silence and obedience. 

In no particular order 

TEACHERS’ UNION - Negotiates high educator salaries. One of the highest pay rates in the country. Seeks overhaul in teacher evaluations No public data on educator performance - trends in scoring and test performance in basic skills, subject content, professional pedagogy, and performance evaluations, including by school, LEA, and ward. Ongoing assessment and opposition to the quality of the DC educational system, including poorly serving students of color and low-income students, is not primarily in their financial interest or organizational mission. 

PRINCIPALS AND ASSISTANT PRINCIPALS - Principals and assistant principals fear being fired if they expose educational inequality, despite urgent student and school needs and disparities. Under mayoral control, principals, assistant principals, and master educations are on limited term appointments. They remain silent to protect their jobs, even if that perpetuates deep educational disparities and create the appearance of equal opportunity in education. Noncompliance with the culture of silence risks dismissal. Obedience secure personal and family income stability. 

SCHOOLS (Traditional & Charter) - Avoid admitting failure to serving low-income and students of color. Acknowledgment could lead to lawsuits or loss of charter funding. Public charters operate like businesses — rely on fundraising, public dollars, and real estate. Graduation of unprepared students is normalized to protect image and income. 

ELECTED OFFICIALS (Mayor + Council) - Downplay the crisis, overplay “progress.” Rely on teachers, schools, unions, contractors for campaign donations. Refusing to confront the problem avoids political fallout and election loss. Acknowledging the culture of silence and financial incentives would damage their reputations and alliances. 

CONTRACTORS - Receive large city contracts for school construction/renovation. Billions of dollars have been awarded over the last 20 years. These projects rarely address racial/income disparities. Renovation or new school construction itself has not shown significant effects on learning outcomes in the literature. Publicly addressing educational apartheid would jeopardize future contracts. Ribbon-cuttings serve as political theater to fake political commitment to public education. 

MEDIA - The mayor secures their silence by purchasing ad space for government initiatives with the understanding that they will not put a spotlight on the educational failings of her administration. Outlets won’t risk coverage that could end or dampen ad revenue. Without media attention, students and parents remain unaware of systemic failures.

3. Liberation vs Anti-Racism: Is anti-racism being critiqued primarily for its epistemic dependence on dominant institutions, or for its practical ineffectiveness in mobilizing communities?

Think about it. Anti-racism relies on "othering" as opposed to liberation. The two are not necessarily mutually exclusive, however. Let's take the Civil Rights Movement and the Montgomery Bus Boycott. Liberation concerned the solidarity of African Americans and their very targeted and strategic planning. Without the liberation mindset ("What we can do for ourselves"), they would not have been successful. They created their own transportation network to affect the economic calculus. There is another cynical view of anti-racism. It is like a well that never runs out. Instead of well water, it's the suffering of others that become life-giving. Disparities and structural inequity (e.g., racism, classism) can be turned into research, books, careering, branding, speakership, etc. to turn a profit while the communities remain stuck in these poor environments. 

 Is your argument that anti-racism—particularly as deployed by elite institutions—is structurally incapable of driving equity unless it is subordinated to a liberation logic?

The manuscript doesn't create all the connections for the reader, but yes. The conduct of institutions is directly tied to their interests. Why no liberation? Because their interests flow from accruing benefits from the suffering - an academic and descriptive exercise to give the appearance of allyship. This is what we call hegemony. That's what hegemons have perfected - extraction from you, benefit for me.

4. Morality Principle vs Traditional Bioethics: How do you reconcile the Morality Principle (intervene regardless of empirical certainty) with dominant bioethical paradigms like “do no harm,” evidence thresholds, and professional neutrality?

"Do no harm"? I won't say much about this, but I will suggest a topic - the US healthcare system and research industrial complex.

Do you see the Morality Principle as a public health doctrine in its own right, akin to precautionary principle in environmental policy?

Well, the public health opposition to Trump administration's policies in 2025 shows that the morality principle resonates. You have public health professionals who are protesting, going on social media, marching, writing, etc. The problem is that it took policy to affect their direct interest to spur political engagement. This scenario is perfectly explained by public health realism. It's a sad state of affairs in America - that here has to be heightened real or perceived threats to personal, corporate, or industry interests for action.

II. EPISTEMOLOGY, MEASUREMENT, AND VALIDATION

5. Illiberation as a Measurable Construct: Is illiberation conceptualized as a latent psychological state, a sociological condition, or both?

Both. It's a latent psychological state because people make a series of decisions - consciously or not - that seek to ensure survival. You need money to survive, to eat, to have shelter, and to take care of one's family. It's a sociological condition because it affects us all. The reality in America is that we are not as free as we think we are. There are considerable barriers that hinder self-expression, speech, dissension, and divergent perspectives. We are conditioned by employment, social, political, industry, and economic considerations and systems. It's as if though conditions of employment, social access, and opportunities are all laid out in an unwritten contract, "Don't say anything outside the norm unless you want to pay the price."

Do you envision developing a psychometric or survey-based index to measure it? If so, would its dimensions include fear, self-censorship, belief in futility, and complicity?

Yeah, this tool could be developed and tested.

6. Liberation Safe Spaces: Empirical Study: How would you advise researchers to evaluate the existence or quality of liberation safe spaces?

I eschew a research-intensive approach to liberation safe spaces. It could be understood as an other delay tactic for action. So no, research and liberation safe spaces do not go hand-in-hand.

Are there observable markers—like collective agency, narrative coherence, or resistance behaviors—that could operationalize this?

I am not interested in this concept.

7. Theory of Health Inequity Reproduction (THIR): Quantification: You present THIR as a general theory with an elegant equation. Will there be numeric estimation of “constraints,” “financial impact,” or “calls for change”?

I would be interested, certainly. There is no funding toward our direction, so it will remain theoretical at the moment. It should be mentioned, though, that much of what we're talking about is qualitative (e.g., calls for change, constraints as in social norms).

Is the constant (C) conceptualized as cultural inertia? Or as a proxy for intergenerational structural inequality?

The constant is epochal. Our current constant can be characterized by: 1) economic elitism and increasing bifurcation of the economy, 2) political polarization, 3) political non-competitiveness, 4) one-party rule across most local and state, and district polities, 5) retrenchment of civil liberties and civil rights, including constitutional rights under the Equal Protection and Due Process clauses, 6) social isolation and community disintegration, 7) ideological purity, 8) superficial knowledge production, 9) anti-regulatory judicial activism, 10) worsening educational and economic inequality, and 11) the age of populism (2008 - now).

📚 III. DISCIPLINARY AND HISTORIOGRAPHIC POSITIONING

8. Transdiscipline vs Interdiscipline: You contrast transdiscipline with interdiscipline by insisting on a “general theory.” What specifically disqualifies existing health equity paradigms from meeting that bar?

They don't borrow enough from other disciplines to develop and explain health inequity. That was the point of the public health economy and public health realism. The idea is to use the other stuff for a grand theory that goes toe-to-toe with economics.

Do you see PHL as analogous to how ecology emerged in biology—a unifier of systems—or is it more akin to critical race theory in law—an epistemological break?

No, these were too specialty-focused and technical, as opposed to forming a system of theory and practice for the people. Most Americans have never heard of ecosocial theory. Most Americans hadn't heard of critical race theory until it was weaponized. Even more, the public health economy, but it is the singularity of the "public health economy" that could resonate with everyday Americans. 

9. Integration of African American Emancipatory Traditions: The manuscript is unusually successful at integrating Black history, philosophy, religion, and social movements into a public health theory. Are you advocating for a formal African American epistemology as part of public health methodology (i.e., not just inclusion, but methodological grounding)?

Skip.

10. Where Does PHL Sit in Public Health Canon? 

No idea. It matters little to me.

How do you want PHL to be positioned relative to social determinants, syndemics theory, ecosocial theory (Krieger), structural competency, and the precautionary principle?

No idea. It doesn't matter to me. As far as I am concerned, those theories have been academic discussion with little impact on the performance of the public health economy. I am not shading those very talented scholars, but the reality is that their theories embodied the technocratic state.

Would it be fair to say that PHL seeks to subsume and reformulate these as limited or derivative constructs?

Of course, they are framed to benefits the framers - high academic to be highly cited and secure tenure, grantmaking, and prestige. Again, no offense.

⚙️ IV. STRATEGIC AND POLITICAL IMPLICATIONS

11. PHL and Institutional Backlash: Do you anticipate resistance from public health academia due to the manuscript’s deep indictment of funding models, research incentives, and tokenized anti-racism?

I don't care. It does not affect me. The Trump administration is the single biggest threat to public health funding ever, but equity scholars and communities have been asking for reform for a long time. It is out of our hands now. What has occurred - I want to be very clear about this - we have been ignored. Absolutely ignored. We have encountered people and institutions that have never felt that they needed to listen to communities or community voices unless it involved research (e.g., "community-based participatory research").

If institutions attempt to co-opt PHL language without changing power structures, what is the safeguard? 

Safeguard? There is no safeguard. Then, they don't have a coalition. Politically, this means that the progressive clause will be defeated at the polls with greater frequency. That means public health has no base of support. I recently put it this way in a LinkedIn comment to Tom Frieden, former CDC director, on his post about his new book, "If public health does not situate itself within the public health economy of power, money, and public persuasion...it's all for nothing. To move the field forward, a shift from technocratic norms and practices ("data equity", "data systems", "data gathering") to people-centered public health agenda-setting and engagement is vital. It likely requires a new and independent public health workforce. Without "people power", public health cannot survive in the age of populism."

That's me holding back. In fact, academic institutions have taken in tens of trillions in public funding and acted quite arrogant and elitist toward community's everyday challenges. Neighborhoods right on their doorstep could have just as well been hundreds of miles away. All those norms and attitudes are catching up with academic public health and the Academy in general. I am not gloating. I am actually quite frustrated because they needed to listen more. They need to concede power-sharing and co-leadership, which they weren't willing to do without being made to. Now, it is costing them billions of dollars.

12. Liberation as a Precondition for Intervention: If flourishing liberation is a precondition for effective public health action, how should this affect funder priorities? Funders should invest in normalizing political and social engagement. Are you arguing that a grant to “intervene” in a community without addressing illiberation may do more harm than good? 

Of course, it calls into question "intention". If a community returns to prior state of limited capacity and suffering after a three-year grant, whose interests did the grant serve - the community or the research? Think about it.

🔄 V. SYSTEMS THINKING AND MODELING

13. Agent-Based Modeling Potential: Could the Theory of Health Inequity Reproduction be adapted to simulate the public health economy using agent-based models? (e.g., modeling agent constraints, financial shocks, and liberation tipping points?) 

Perhaps, but I am not a fan of more research, modeling, and data analysis. Spend that time affecting change in real time. 

Would such simulations help in scenario planning for urban policy reforms or institutional reorganizations? 

Likely not. Those who lead these planning models tend to parachute into community and will also have an interest agenda. I have also spoken of the arrogance and condescension previously. If this planning occurs in government, then it will reflect government interests. In DC, we have a mayor who pledges her allegiance to the "growth" model of governance. She directs her agencies to remove or get around any barrier in the path of development. Her government has removed communities from small area planning area by creating new planning districts and designations. It has also conducted health assessments that downplay community harm to ensure development deals and deliverables.

14. Anarchy in the Public Health Economy: You describe the public health economy as “anarchical.” Do you mean lack of governance, lack of ethical coherence, lack of epistemological rigor, or all three?

All of it. It's like imagining city traffic with no rules or a common moral code among drivers. That's the public health economy.

Could PHL propose a typology of anarchy (e.g., regulatory, moral, epistemic) to better classify institutional failure?

Sure, funding is needed. Let's go through the District of Columbia Housing Authority. The largest landlord in Washington, DC.

1) DCHA was engaged in violations of landlord laws in public health and safety. Trap or drug houses were allowed to flourish, bring in violence and drug markets. DCHA divested from basic maintenance causing mold, poor air quality, and adverse public health harm.

2) A series of executive directors didn't clean up the mess - paid lip-service to communities, negligible improvements, and sought redevelopment to benefit construction and developer interests while displacing population. DCHA used the neglect that it caused to justify to the federal government that properties were obsolete.

3) The DCHA board failed to exercise authority and oversight of the agency. Most were industry-informed mayoral and Council appointments. HUD found that the agency was not independent of the mayor.

4) The Housing Committee Council chair, Anita Bonds, was key. She overlooked agency dysfunction and the harm that DCHA was doing to its residents. She was closely tied to the development and construction industries and a close ally of the mayor. 

5) Since the Housing Committee chair held a lot of the power for Council oversight of DCHA, Council was complicit in DCHA's decline. 

6) HUD waited until the absolute worst point in the crisis to act. It found dozens of citations against DCHA. It largely acted because of media coverage of corruption. DCHA's decades of harm was not HUD's primary basis for intervention.

🧩 VI. IMPLEMENTATION, TRAINING, AND THE FUTURE

15. Training the PHL Practitioner

What are the core competencies for a “PHL practitioner”? Should schools of public health offer PHL tracks or degrees?

Skip.

Are there accrediting structures or curriculum models you envision that would ground the training in both theory and liberation praxis? 

That a key barrier because these accreditation agencies are too single disciplinary focused. It is not clear if public health reform can arise from within. 

16. Institutionalizing Liberation Safe Spaces: Can PHL safe spaces exist within universities, hospitals, and government, or are these inherently hegemonized spaces? 

Sure, but they shouldn't unless it gives give space and funding without conditions, oversight, or involvement.

17. Legal Pathways and Public Health Law: You briefly invoke legal tools (e.g., injunctions in Flint). Do you envision public health law as a core strategic arm of PHL? 

Here again, we have added fragmentation. Public health law has spun off into its own specialty. As opposed to integrating law into public health training, it is a law school track. Every public health student should have exposure to emancipatory law.

Is there potential to develop a legal doctrine based on illiberation or the Morality Principle to challenge state inaction? 

Interesting question. Yes, but several legal doctrines should need to be relaxed - standards of "irreparable harm" as in legal theories for evaluating a request for injunctive relief or the "cognizable and concrete injury" doctrine.

18. PHL Data Infrastructure: Should public health data infrastructure evolve to include metrics aligned with PHL (e.g., real-time liberation indices, health equity disruption scores)? How should quantitative vs qualitative data be balanced to reflect liberation-centered epistemology?

The greatest shift that needs to happen is epistemic. Public health just needs to take in more information - the public health economy - the researchers, teaching faculty, professionals in the fields,  and students. More involvement in communities would rightsize technocratic epistemologies and myopic views of health inequity.

Final Clarifying Question
19. Is This Manuscript the Foundational Text or the Manifesto: Do you view this paper as the first articulation of PHL (a prelude to more formal theory papers), or is it a foundational manifesto—like Frantz Fanon’s Wretched of the Earth or Paulo Freire’s Pedagogy of the Oppressed—that defines the canon?

Skip.