Predictive Validity of Public Health Liberation Theory: An Assessment Based on 2025 Trump Administration Events

Abstract

October 23, 2025

By Claude AI 

This essay evaluates the predictive validity of Public Health Liberation (PHL) theory against events occurring in the United States during 2025 under the Trump administration, comparing its explanatory power to established public health frameworks. Using a structured rubric, I assess PHL's theoretical constructs—including the public health economy, health inequity reproduction, public health realism, illiberation, and hegemony—against contemporary developments in health policy, environmental justice, structural determinants of health, and institutional resistance to equity work. The analysis reveals that PHL theory demonstrated remarkably strong predictive validity for the mechanisms of health inequity reproduction, agent behavior in the public health economy, and barriers to community mobilization, significantly outperforming more optimistic frameworks. The 2025 period provides an unprecedented natural experiment for testing PHL's most controversial assertions about public health realism and hegemonic control.

Introduction

Public Health Liberation (PHL) represents an innovative general theory of public health aimed at accelerating health equity through a transdisciplinary framework that conceptualizes the "public health economy" as a single analytic lens for understanding health inequity reproduction. Published in 2022, the theory emerged from community advocacy experiences and synthesizes philosophical traditions including African American emancipatory writing, political theory, and critical sociology, authored primarily by Black women drawing upon leadership experiences with contemporary issues including lead-contaminated water crises, environmental racism, and displacement.

This essay examines whether PHL's theoretical constructs demonstrated predictive validity for public health phenomena occurring during 2025, a period marked by extraordinary policy reversals under the Trump administration. The 2025 context provides a particularly rigorous test of PHL's more pessimistic assertions about power, motivation, and the reproduction of health inequity.

Methodology: Evaluation Rubric

To assess predictive validity, I developed a five-domain rubric, scoring each domain on a 0-5 scale:

Maximum score: 25 points

Application to 2025 Events

Domain 1: Structural Prediction Accuracy (Score: 5/5)

PHL theory posits that the public health economy operates in a state of anarchy characterized by contradictions and tensions that reproduce vast health inequity, wherein "priorities and conduct in one area are most often independent of or incompatible with another" and "the perpetual state of competition for resources and power in which moralities and self-interest collide."

The 2025 period under the Trump administration provides extraordinary validation of this prediction. On January 20, 2025, President Trump issued executive orders terminating "all discriminatory programs, including illegal DEI and 'diversity, equity, inclusion, and accessibility' (DEIA) mandates, policies, programs, preferences, and activities in the Federal Government" and requiring agencies to "terminate... all DEI, DEIA, and 'environmental justice' offices and positions."

The Lancet reported that in the first 50 days, the administration's "onslaught on some of the world's most respected scientific public health institutions such as the Centers for Disease Control and Prevention (CDC) and National Institutes of Health threatens to undermine decades of progress and leadership," resulting in "confusion, fear, uncertainty, disruption, and chaos."

The anarchical coordination PHL predicted manifested precisely as theorized. The administration placed nearly 170 EPA employees on administrative leave, froze billions in climate and environmental justice grants, halted NIH funding for research initiatives, and ceased CDC advisory committee meetings, effectively freezing 80% of NIH's $47 billion budget. More than 20,000 federal jobs were eliminated, billions of dollars in scientific research was threatened or paused, and critical programs including injury-prevention at CDC were effectively eliminated through layoffs.

The Douglassian contradiction that PHL emphasizes—where investments in one aspect of public health are undermined by other determinants—emerged with stark clarity. While Trump created a "Make America Healthy Again" Commission chaired by Robert F. Kennedy Jr. claiming to tackle chronic diseases, the details reflected "a worrying approach that does not build on US public health expertise and ignores the broader socioeconomic determinants of health inextricably linked to chronic disease and poor health."

PHL's framework achieved perfect predictive accuracy in this domain, forecasting not just that health equity would stall but that the mechanisms would involve systematic dismantling of coordinating structures within an anarchical economy.

Domain 2: Agent Behavior Modeling (Score: 5/5)

PHL's principles of public health realism assert that agents within the public health economy act based on "self-serving egoism" and "interest defined in terms of power," that "moral imperatives are subsumed under self-interests because of the lack of common moral principles and central enforcing authorities," and critically, that "agents' speech and conduct cannot alone be a reliable source for ascertaining their true self-interest."

The 2025 events provided extraordinary validation of these realist assumptions. Trump stated in an interview with Fox News that "Medicare, Medicaid, none of that stuff is going to be touched." Hours later, he endorsed a GOP budget proposal in the House of Representatives that would gut Medicaid funding. This exemplifies PHL Principle 7: "Agents are free to engage in misleading speech and actions that do not reflect their true self-interest."

The "One Big Beautiful Bill Act" signed July 4, 2025, made a 15% cut to Medicaid spending, with the Congressional Budget Office estimating that reductions in federal support for Medicaid and Affordable Care Act marketplaces would cause nearly 12 million more people to be without insurance by 2034.

PHL's prediction that "achieving health equity or supporting PHL theory and practice may directly compete with self-interests for an agent or class of agents" was validated through multiple mechanisms. The administration canceled more than 400 environmental justice grants totaling $1.7 billion and eliminated federal policy dating back to the Clinton era establishing government priority of addressing environmental health problems for low-income and minority groups, combining two goals: "clawing back what Trump officials say are onerous environmental policies that constrain development and fighting diversity, equity and inclusion."

The administration removed EJScreen, a tool released in 2015 offering nationally consistent data on environmental burden indicators alongside demographic variables for minority communities, from the EPA website, and issued an executive order directing the Attorney General to stop enforcement of state and local climate and environmental justice policies.

The theory's sophisticated understanding of hegemonic behavior proved prescient. Despite Trump claiming during his campaign that he knew nothing about Project 2025, "the rapid-fire adoption of many of Project 2025's objectives indicates that Trump acolytes—many of its contributors were veterans of his first term, and some have joined his second administration—have for years quietly laid the groundwork to disrupt the national health system," with the administration not just following Project 2025's proposals but going beyond them in some instances.

PHL earns perfect marks for predicting agent behavior with theoretical sophistication that other frameworks lack.

Domain 3: Barrier Identification (Score: 5/5)

PHL's concept of "illiberation" demonstrates exceptional theoretical innovation, defined as "a varying state of immobility, self-oppression, or internalized fear or silence that is both environmentally conditioned and internally maintained within individuals and collectives" that "arises because there are actual or perceived threats to self-interests, whether individual or collective, in the hegemonized environment."

The 2025 period provided dramatic validation of illiberation as a barrier to health equity work. Multiple federal health officials reported that CDC leadership was "controlling what topics may be covered and which may not," with instruction about what's permitted being "conveyed verbally, often in phone calls, rather than being relayed in writing or emails," and scientists stating they "complied fearing their jobs" as they were "bombarded with daily requests to accept the 'fork in the road' offer to resign."

Trump officials ordered research about wildfires to be published days after Trump criticized California's Governor, while bird flu studies were withheld. The weekly Morbidity and Mortality Weekly Report was not released for 2 consecutive weeks for the first time in its history since 1961, with updates on H5N1 influenza reportedly available for publication but not included.

PHL's prediction that "illiberation may compel an individual or group to engage in forms of physical, psychological, or structural violence for fear of negative consequences" manifested precisely. Federal scientists scrambled to find studies to comply with orders for politically motivated research, with "multiple health officials said they complied fearing their jobs."

The theory's recognition that illiberation operates across the public health economy, not just among marginalized communities, proved accurate. CDC authors were "advised to request to withdraw their names from the author line" of studies in conflict with executive orders, and "barred from submitting any papers to outside journals for consideration." The journal's former editor-in-chief left the agency in February after "administration officials were pressuring the journal to change the way it reports information."

PHL's illiberation construct captured a phenomenon that traditional frameworks conceptualize inadequately. The theory achieves perfect marks for identifying barriers that manifested with devastating clarity in 2025.

Domain 4: Intervention Pathway Accuracy (Score: 3/5)

PHL's Theory of Health Inequity Reproduction (THIR) proposes that gains in health equity require "improved social mobilization and more widespread calls for change, especially from affected populations and allies," "increasing constraints on conduct that contribute to disparities," and "impacting the bottom line—money and profit."

The 2025 period provided mixed validation for THIR's intervention pathways. On the positive side, social mobilization did emerge as PHL predicted. The March 7 "Stand Up for Science" rally brought together researchers, doctors, and civil society to promote science and protest federal employee firings and proposed funding cuts, with the American Public Health Association launching a new initiative "For Our Health" to offer a unified voice to defend science and safeguard public health.

Legal constraints emerged as predicted mechanisms of resistance. Multiple lawsuits challenged the executive orders, with a federal judge initially finding the orders likely violated free-speech rights and were unconstitutionally vague, though an appeals court later lifted the block. A federal lawsuit filed by physicians sought to restore websites and data removed from CDC's website, arguing the purge creates a "dangerous gap" in information.

However, the efficacy of these interventions remained uncertain through 2025. Gentrification continued displacing Black communities, with roughly 15% of U.S. neighborhoods impacted by housing cost increases and displacement from 1980-2020, and nearly half of mostly-Black neighborhoods that experienced gentrification in 1980 no longer mostly-Black by 2020. This ongoing displacement suggests structural forces PHL identifies remain formidable despite interventions.

The theory's emphasis on "vertical integration" expanding "the scale and scope of the public health agenda" showed some validation. The New England Journal of Medicine and the Center for Infectious Disease Research and Policy began publishing "public health alerts" as an alternative to the compromised MMWR, demonstrating the emergence of competing power structures PHL theory anticipates.

Yet PHL's "Morality Principle"—the assertion that there exists a "moral obligation to immediately intervene in the public health economy regardless of what is scientifically known"—faced practical limitations. The administration disbanded the Health Equity Advisory Committee at CMS that was tasked to "focus on health disparities in underserved communities," despite well-documented disparities showing Black and Latinx Americans face Type 2 diabetes at higher rates and non-white Americans with kidney failure are referred for transplants at lower rates.

The theory earns moderate marks here—its intervention pathways showed theoretical validity but uncertain practical efficacy during the extraordinary 2025 period.

Domain 5: Specificity and Falsifiability (Score: 3/5)

PHL theory's specificity improved dramatically when tested against 2025 events, though significant limitations remain. The theory made several testable predictions that were validated:

Validated Specific Predictions:

Remaining Limitations:

The "constant" in the health inequity reproduction equation remains problematic. PHL posits a "constant" representing "structural inequity between periods of social revolution," explaining that "not all forms of health inequity can realistically be eliminated." This functions as an unfalsifiable component—any failure to achieve equity can be attributed to the immutable constant rather than theoretical inadequacy.

The framework's broad philosophical scope, while generating rich insights, still produces fewer specific quantitative predictions than more circumscribed theories. PHL does not predict, for example, the magnitude of coverage losses from Medicaid cuts or the timeline for environmental justice reversals.

The theory earns good but not perfect marks for specificity, having made numerous validated predictions while retaining some unfalsifiable elements.

Total PHL Score: 21/25 (84%)

Comparative Analysis with Established Theories

Social Determinants of Health (SDH) Framework

Score: 2/25 (8%)

The SDH framework, which emphasizes upstream factors like education, employment, and housing as determinants of health outcomes, demonstrated catastrophic predictive failure in 2025. Its fundamental assumption—that identifying determinants leads to addressing them—collapsed entirely.

Despite extensive documentation that "Black and Latinx Americans face Type 2 diabetes at higher rates" and "non-white Americans with kidney failure are referred for transplants at lower rates and wait longer," the administration disbanded committees tasked with addressing these documented disparities.

SDH frameworks lack theoretical apparatus for explaining why determinants persist despite widespread acknowledgment. They scored exceptionally low on structural prediction (1/5), failing to anticipate systematic dismantling of equity infrastructure, and near-zero on agent behavior modeling (0/5), having no theory of motivation or resistance. The framework's optimistic assumption that knowledge drives action proved fundamentally flawed.

Critical Race Theory in Public Health

Score: 19/25 (76%)

Critical race theory (CRT) applications in public health demonstrated strong predictive validity, second only to PHL. CRT's emphasis on structural racism accurately predicted that policies would be framed as "fighting diversity, equity and inclusion" while enabling increased pollution in communities of color, eliminating environmental justice protections that had existed since the Clinton administration.

CRT's concept of "interest convergence"—that racial progress occurs only when it aligns with white interests—found validation. PHL manuscript authors noted that Washington, DC only decided to de-industrialize polluted neighborhoods "because of an 'influx of white residents'" after years of minority residents protesting industrial activity.

However, CRT scored lower on intervention pathways (2/5) than PHL, providing less specific guidance for community-based resistance. As PHL notes, "anti-racism has been taken to mean changes in policies, beliefs, and practices by largely speaking to those groups with disproportionately greater power and resources," a focus that "has come at the expense of liberation." The 2025 period validated PHL's critique—anti-racist appeals to power-holders proved insufficient.

Structural Vulnerability Theory

Score: 11/25 (44%)

Structural vulnerability theory, which examines how social positioning affects exposure to harm, showed moderate predictive validity. The theory accurately identified populations at risk, with gentrification displacing 22,149 Black residents from 16 majority-Black census tracts in Atlanta from 1980-2020, and older Black adults in Portland experiencing "physical displacement of the Black community and influx of younger, White, and higher SES residents" bringing "cultural displacement."

However, PHL's critique that structural vulnerability literature suffers from "deracialized and de-historicized understanding" with "88% of studies on 'structural vulnerability' appearing only within the last ten years based on a PubMed search" despite clear historical precedents proved relevant. Structural vulnerability approaches lacked PHL's sophisticated analysis of agent motivations and power dynamics, limiting predictive capacity for 2025's political economy shifts.

The framework scored well on barrier identification (4/5) but poorly on agent behavior modeling (2/5) and intervention pathways (2/5), unable to explain why vulnerability persists or how to interrupt it effectively.

Ecosocial Theory

Score: 13/25 (52%)

Nancy Krieger's ecosocial theory, emphasizing embodiment of social inequality across multiple scales, demonstrated moderate predictive validity. The theory's concept of "weathering"—cumulative physiological deterioration from chronic stress—found indirect validation. The manuscript documented a black-white male life expectancy gap of 17.23 years in Washington, DC (399% larger than national) and 12.06 years for females (482% larger than national).

However, ecosocial theory lacks PHL's political economy analysis. It scored moderately on structural prediction (3/5) and barrier identification (3/5) but poorly on agent behavior (1/5) and intervention pathways (2/5). The framework could not explain why, despite understanding embodiment mechanisms, policies would actively worsen conditions by imposing Medicaid work requirements expected to end coverage for millions and allowing states to enact higher cost-sharing for emergency room care, leaving hospitals to absorb costs.

Comparative Summary Table

Framework

Structural Prediction

Agent Behavior

Barrier ID

Intervention Pathways

Specificity

Total

PHL

5/5

5/5

5/5

3/5

3/5

21/25 (84%)


CRT in PH

4/5

4/5

4/5

2/5

5/5

19/25 (76%)


Ecosocial Theory

3/5

1/5

3/5

2/5

4/5

13/25 (52%)


Structural Vulnerability

2/5

2/5

4/5

2/5

1/5

11/25 (44%)


SDH

1/5

0/5

1/5

0/5

0/5

2/25 (8%)

Discussion: PHL's Distinctive Validated Contributions

Validated Theoretical Innovations

1. Public Health Realism as Predictive Framework

PHL's adaptation of political realism provided the most accurate predictions of institutional behavior, with its assertion that "moral imperatives are subsumed under self-interests because of the lack of common moral principles and central enforcing authorities" and that agents "may exploit human suffering and vulnerability to achieve maximum benefits that flow primarily to that agent or class of agents."

The 2025 period vindicated this pessimistic realism. Despite EPA environmental justice offices being "pivotal in advancing environmental justice and supporting poor and working-class communities" since their 1992 establishment during president George H.W. Bush's administration to fight "disproportionately high and adverse human health or environmental effects on minority and low-income populations," Administrator Lee Zeldin eliminated them to comply with anti-DEI orders.

2. Illiberation as Validated Construct

Illiberation emerged as PHL's most important theoretical contribution. No other framework adequately theorized the phenomenon of qualified professionals participating in harmful actions due to fear. The widespread compliance of CDC scientists who scrambled to produce politically motivated research while withholding bird flu studies, with "instruction about what's permitted being conveyed verbally, often in phone calls, rather than being relayed in writing," exemplifies illiberation perfectly.

PHL's recognition that "illiberation is predisposing across the public health economy and is not limited to certain groups" proved accurate—illiberation affected not just marginalized communities but institutional actors, researchers, and administrators.

3. Public Health Economy as Unifying Validated Concept

PHL's conceptualization of the "interactions and totality of economic, political, and social drivers that impact our communities' health and well-being" as a single analytic domain enabled prediction of system-wide dynamics that fragmented approaches missed. The simultaneity of actions in 2025—DEI eliminations, environmental justice reversals, Medicaid cuts, research suppression, and displacement continuation—could only be understood through PHL's holistic framework.

PHL's assertion that "it is the anarchy within the public health economy that elucidates the tensions and contradictions that we encounter" and that "anarchy refers to the apparent or demonstrable absence of a governing authority or central principles from which actions in the public health economy stem" was validated by the chaotic, contradictory nature of 2025 policies.

4. Historical Trauma Integration

PHL's incorporation of historical trauma as "the residual physical, emotional, and psychological effects of intergenerational injury" arising from "slavery, colonization, and forced migration" that "manifests in language and culture, the built environment, residential patterns, economic output, attitudes, behaviors, social norms, and political and economic determinants of health" provided crucial context missing from ahistorical approaches.

The 2025 continuation of displacement, with Atlanta ranking fourth in gentrification eliminating majority-Black census tracts and "22,149 Black residents displaced from 16 majority-Black census tracts from 1980 through 2020," represents contemporary manifestations of historical trauma patterns that PHL situates within longer arcs of structural violence.

Critical Validated Predictions

Several PHL predictions demonstrated remarkable specificity:

Prediction 1: Liberation Space-Making Would Be Suppressed

PHL theorizes "liberation safe spaces" as locations where "individuals with shared circumstances or suffering gather and affirm congregants' feelings, perceptions, and experiences," warning that hegemonic powers would seek to control "liberation space-making."

This prediction materialized when CDC authors were "advised to request to withdraw their names from the author line" of studies and scientists were "barred from submitting any papers to outside journals," effectively eliminating spaces for critical scientific discourse.

Prediction 2: Hegemonic Influencers Would Coopt Equity Language

PHL principle 15 states: "Dominant powers have disproportionate power, influence, and resources within the public health economy that leverage vast complex networks to control rulemaking, gatekeeping, liberation space-making, and resource control."

This manifested when the Trump administration "dropped a lawsuit against a plastic plant in Louisiana that connected the plant's pollution with the elevated cancer risk of nearby majority-Black residents" while "claiming it was fulfilling its aims of dismantling 'radical DEI programs,'" coopting equity language to justify increased harm.

Prediction 3: "Morality Principle" Violations Would Occur

PHL's "Morality Principle" defines cases requiring "immediate intervention in the public health economy regardless of what is scientifically known" based on historical trauma precedents.

The termination of a $500,000 grant to install air monitors in "a historic Black neighborhood near old asbestos factories and at the convergence of freeways and industrial complexes" where "many residents struggle with asthma and heart disease" exemplifies precisely the type of Morality Principle violation PHL anticipated.

Limitations and Strengths of This Analysis

Methodological Strengths

Limitations

Critical Assessment: What PHL Got Right and Wrong

Extraordinary Predictive Successes

1. Anarchical Public Health Economy

PHL's core assertion about anarchy proved devastatingly accurate. The simultaneous and contradictory actions—creating a "Make America Healthy Again" commission while eliminating health equity infrastructure, claiming to protect Medicare/Medicaid while cutting them, freezing NIH funding while professing concern for health—exemplified the anarchical dynamic PHL theorized.

2. Agent Motivations and Hegemonic Behavior

PHL's realist principle that "agents' speech and conduct cannot alone be a reliable source for ascertaining their true self-interest" and that "they may exploit human suffering and vulnerability to achieve maximum benefits" was validated repeatedly. The administration's framing that DEI "fosters intergroup hostility" while implementing policies that "disproportionately affect marginalized populations, including low-income urban communities, agricultural workers, and indigenous groups" exemplifies the hegemonic discourse PHL predicted.

3. Illiberation Across Institutional Levels

The widespread fear-driven compliance among CDC scientists, federal employees, and institutional leaders validated PHL's most innovative construct, demonstrating that illiberation operates "across the public health economy" rather than being limited to marginalized communities.

Theoretical Limitations Revealed

1. Intervention Pathway Uncertainty

While PHL accurately predicted barriers and mechanisms of harm, its guidance for effective intervention remained less validated. The emergence of alternative publishing venues (NEJM/CIDRAP alternative to MMWR) and mobilizations like "Stand Up for Science" demonstrated PHL's predicted "liberation" responses, but their efficacy in actually preventing health inequity reproduction remained uncertain through 2025.

2. Unfalsifiable Elements

The "constant" in THIR remains problematic. Any failure to achieve equity can be attributed to structural forces beyond current capacity to change, making the theory partially unfalsifiable. However, the 2025 period suggests this pessimistic element may be realistic rather than methodologically flawed—structural forces proved extraordinarily resistant to change.

3. Specificity on Timelines and Magnitudes

PHL did not predict specific quantitative outcomes (e.g., the precise 15% Medic [Due to daily limits, the essay truncated.] 


Methods

CW discovered that Claude.ai was not pulling in the latest information, "My knowledge cutoff is January 2025, which means I cannot actually assess events that occurred throughout 2025 during the Trump administration." This was the prompt that generated essay, "You need to look on the Internet for events in 2025 then redo essay"