Assessing Public Health Liberation Theory: Validity in Light of 2025 US Public Health Events

Abstract

November 10, 2025

This paper critically examines the validity of Public Health Liberation (PHL) theory proposed by Williams et al. (2022) through the lens of contemporary public health events in the United States during 2025. The analysis evaluates PHL's core theoretical constructs—including the public health economy, liberation/illiberation, public health realism, and hegemony—against empirical evidence from recent anti-science legislation, federal public health agency restructuring, persistent health disparities, and environmental racism. The assessment reveals substantial empirical support for PHL's theoretical framework, particularly its predictions regarding anarchic dynamics in the public health economy and hegemonic control. However, the discussion section explores alternative theoretical frameworks, notably Structural Competency Theory and Critical Race Theory in Public Health, which may offer complementary or superior explanatory power for certain phenomena. The paper concludes that PHL demonstrates considerable validity but requires further empirical testing and potential integration with established theoretical frameworks.

Keywords: Public Health Liberation, health equity, public health theory, structural violence, health disparities, environmental racism, anti-science movements

Want to see if these results can be replicated: Search, "Read and re-read 10 times. Then assess validity of this theory in light of events in the US in 2025. Make sure you look over the news thoroughly with respect to public health. Then write an academic paper on this theory's validity. Use academic constructs. In discussion, discuss if there is another related theory with stronger validity in light of events in the US in 2025."

1. Introduction

The Public Health Liberation (PHL) framework, introduced by Williams et al. (2022), represents an ambitious transdisciplinary approach to understanding and addressing persistent health inequities in the United States. Central to PHL is the concept of the "public health economy"—defined as the totality of economic, political, and social drivers impacting community health and well-being. The theory posits that this economy operates in a state of anarchy, characterized by competing factions pursuing self-interest without central organizing principles, thereby reproducing vast health inequities.

This paper evaluates PHL's validity by examining empirical evidence from 2025 US public health events. The assessment focuses on five key areas: (1) anti-science legislative movements, (2) federal public health agency restructuring, (3) persistent racial health disparities, (4) environmental racism, and (5) the COVID-19 pandemic's lasting impacts. Through systematic analysis of these contemporary events, we assess whether PHL's theoretical constructs adequately explain observed phenomena and predict emerging patterns in public health governance and outcomes.

2. Theoretical Framework Review

2.1 Core Constructs of PHL Theory

PHL articulates several novel theoretical constructs:

Public Health Economy: The anarchic system of interactions among economic, political, and social agents that impact community health, characterized by perpetual competition for resources and power without central organizing principles (Williams et al., 2022).

Liberation and Illiberation: Liberation represents a philosophized mindset enabling emancipation from constraints on thought, expression, and collective action toward health equity. Illiberation, conversely, denotes "a varying state of immobility, self-oppression, or internalized fear or silence that is both environmentally conditioned and internally maintained" (Williams et al., 2022, p. 12).

Public Health Realism: Drawing from international relations theory, PHL posits that agents within the public health economy act primarily from self-interest defined as power, with moral imperatives subsumed under self-interest due to lack of common principles and central authority.

Hegemony: The system of beliefs and attitudes that reinforce existing social arrangements and mal-distribution of resources, wherein dominant powers exercise control through rulemaking, gatekeeping, issue framing, and resource distribution.

Theory of Health Inequity Reproduction (THIR): A mathematical conceptualization suggesting that health inequity reproduction is the product of a structural constant multiplied by the quotient of (calls for change × financial impact) divided by constraints.

2.2 Predictions and Testable Propositions

PHL generates several testable propositions:

1. The public health economy will demonstrate anarchic characteristics with contradictory and incompatible priorities across sectors

2. Agents with disproportionate power will engage in hegemonic control to maintain their relative power position

3. Illiberation will constrain liberation movements and prevent effective collective action

4. Moral imperatives will be subsumed under self-interest in the absence of central authority

5. Health inequity reproduction will persist absent dramatic increases in positive constraints, financial impacts, or liberation-driven calls for change

3. Methodology

This assessment employs a theory-driven case study approach, examining five domains of 2025 US public health events against PHL's theoretical predictions. Data sources include peer-reviewed literature, government reports, investigative journalism, and public health surveillance data. Each domain is analyzed for consistency with PHL constructs, noting both confirmatory and disconfirmatory evidence.

The validity assessment uses three criteria:

1. Internal Consistency: Do observed events align with PHL's theoretical predictions?

2. Explanatory Power: Does PHL adequately explain causal mechanisms underlying observed phenomena?

3. Predictive Utility: Would PHL have predicted these events based on its theoretical framework?

4. Empirical Assessment

4.1 Anti-Science Legislative Movements

Empirical Evidence

More than 420 anti-science bills attacking longstanding public health protections—including vaccines, milk safety, and fluoride—were introduced in statehouses across the United States in 2025, with approximately 30 bills enacted or adopted in 12 states. At least 350 of these 420 bills were related to vaccines, targeting immunizations from various angles including barring discrimination against unvaccinated individuals, creating criminal offenses for vaccine harm, and requiring blood banks to test for vaccination evidence.

An Associated Press investigation found that this wave of legislation was pushed by individuals with close ties to Health and Human Services Secretary Robert F. Kennedy Jr., with Trump administration officials directing activists to push anti-science legislation in the states.

PHL Validity Assessment

Strong Support: This phenomenon strongly validates PHL's concept of the anarchic public health economy. The systematic undermining of century-old public health protections through state legislation demonstrates the absence of central organizing principles PHL predicts. Multiple competing "factions" (anti-vaccine activists, state legislators, public health professionals, pharmaceutical companies) pursue conflicting agendas without coordination.

The anti-science movement exemplifies PHL's public health realism principle that agents pursue self-interest defined as power. Four national groups connected to Kennedy—MAHA Action, Stand for Health Freedom, the National Vaccine Information Center, and the Weston A. Price Foundation—supported these bills, demonstrating organized pursuit of power through rulemaking. This confirms PHL's proposition that "agents exercise power through rulemaking, gatekeeping, issue framing, [and] resource distribution."

The phenomenon also validates PHL's hegemony theory. The anti-science movement's connection to federal leadership represents an attempt to establish hegemonic control over public health discourse and policy. The National Vaccine Information Center reported that in 2015 it opposed six times as many bills as it supported, but last year it supported more than twice as many bills as it opposed, demonstrating a dramatic shift in relative power consistent with hegemonic consolidation.

Illiberation Evidence: The systematic nature of this legislative campaign suggests public health professionals may be experiencing illiberation—unable to effectively counter false scientific claims due to perceived threats to employment, funding, or professional standing. This aligns with PHL's prediction that illiberation constrains effective resistance.

4.2 Federal Public Health Agency Restructuring

Empirical Evidence

The Department of Health and Human Services announced plans in March 2025 to cut 10,000 full-time jobs across several agencies, effectively shuttering or downsizing multiple departments at the CDC and other health agencies. By late March, the Trump administration announced a major restructuring that would cut 20,000 full-time jobs—25% of HHS staff.

The CDC was expected to lose roughly 2,400 employees, or about 18% of its staff, with workers across divisions dedicated to tobacco control, injury prevention, workplace safety, birth defects, reproductive health, and substance abuse receiving reduction-in-force notices. Several parts of CDC devoted to health threats that aren't infectious were being spun off into the soon-to-be-created Administration for a Healthy America.

The Trump administration considered eliminating the CDC's Division on HIV Prevention, with discussions about shifting HIV prevention efforts to another HHS agency.

PHL Validity Assessment

Strong Support: The systematic dismantling of public health infrastructure validates PHL's anarchic public health economy construct. The restructuring demonstrates contradictory priorities—claiming to improve efficiency while eliminating specialized expertise in critical areas like HIV prevention, violence prevention, and injury prevention. This exemplifies the "anarchy" PHL describes: actions in one domain (administrative efficiency) directly undermine goals in another (public health preparedness and disease prevention).

The restructuring strongly supports PHL's public health realism framework. HHS Secretary Kennedy drew a direct line between problems with America's overall health and the way HHS has been set up, stating "throwing more money at health care isn't going to solve the problem", framing the restructuring as serving the public good. However, the selective targeting of programs addressing health equity (HIV prevention, violence prevention) while maintaining other functions suggests self-interest over moral imperative, consistent with PHL Principle 5: "Moral imperatives are subsumed under self-interests."

Hegemonic Control: The restructuring exemplifies hegemonic power exercised through "rulemaking, gatekeeping, issue framing, [and] resource distribution" (Williams et al., 2022). By controlling which programs survive and which are eliminated, the administration exercises gatekeeping power over the public health agenda. The framing of cuts as "efficiency" rather than ideology represents hegemonic discourse control.

Morality Principle Violation: PHL's Morality Principle states there is a "moral obligation to immediately intervene in the public health economy regardless of what is scientifically known" when harm is apparent. The systematic elimination of proven public health programs violates this principle, suggesting that dominant powers do not operate under liberation philosophy but rather under public health realism's self-interest paradigm.

4.3 Persistent Racial Health Disparities

Empirical Evidence

According to CDC data, in 2022 the average life expectancy at birth for Black/African Americans was 72.8 years (76.5 for females, 69.1 for males), compared to 84.5 for Asian Americans, 80.0 for Hispanic/Latinos, 77.5 for whites, and 67.9 for American Indians and Alaska Natives. Black communities in the United States face disproportionately higher risk of heart disease, stroke and hypertension, with these gaps contributing to equally disproportionate high death rates.

At birth, Black people have shorter life expectancies compared to White people (70.8 vs. 76.4 years), and they experienced a larger decline in life expectancy than White people between 2019 and 2021, with it falling by 4.0 years. Black people have the highest rates of infant mortality and maternal mortality across all racial and ethnic groups, and experienced the largest increase in maternal mortality when compared to pre-pandemic levels.

The maternal mortality rate for Black pregnant people is the highest in the nation, at 69.9 deaths per 100,000 live births, and the infant mortality rate among non-Hispanic Blacks is 2.4 times the rate for non-Hispanic whites.

PHL Validity Assessment

Strong Support: The persistence and worsening of racial health disparities despite decades of public health interventions strongly validates PHL's Theory of Health Inequity Reproduction (THIR). According to THIR, health inequity reproduction persists when calls for change and financial impacts are insufficient to overcome constraints, multiplied by a structural constant representing deeply entrenched inequities.

The data confirm PHL's argument that the "cumulative effects of less noticeable health inequity reproduction" stem from contradictions in the public health economy. Income inequality challenges many Black households, whose median income in 2022 was $52,860 in comparison to $81,060 for non-Hispanic white households, and Black households are twice as likely as white households to be living in poverty. This economic dimension interacts with health care access, environmental exposures, and historical trauma—the very complexity PHL's "public health economy" construct attempts to capture.

Historical Trauma Validation: PHL emphasizes historical trauma as a social determinant of health, defined as "the residual physical, emotional, and psychological effects of intergenerational injury" (Williams et al., 2022). The historical mistreatment of Black Americans in medicine has led to a deep and understandable mistrust of the U.S. health care system, and this mistrust has perpetuated health disparities, as Black people may be less likely to seek care. This validates PHL's integration of historical trauma into its philosophical framework.

Liberation Gap: The persistent disparities despite awareness and intervention efforts suggest widespread illiberation among both affected communities and would-be allies. PHL predicts that "flourishing illiberation" prevents effective collective action. The failure to eliminate these disparities after decades of research and policy attention supports this construct's validity.

Moderate Limitation: While PHL explains persistence of disparities, it provides less specific guidance on why certain disparities worsen while others improve. The differential changes in life expectancy during COVID-19 suggest additional complexity that THIR's general formula may not fully capture.

4.4 Environmental Racism

Empirical Evidence

According to a 2021 EPA study, in the United States people of color breathe more particulate air pollution on average, a finding that holds across income levels and regions of the country. The researchers found that the burden was 35% higher for people living in poverty in general and 28% higher for People of Color, with Black people specifically having a burden level 54% greater than that of the overall population.

A 2021 report highlights concerns about industrializing the stretch of land between Baton Rouge and New Orleans, dubbed "Cancer Alley," in Louisiana, where pollutants from current developments are putting local people, most of whom are Black, at risk of cancer and respiratory conditions. The developer FG LA LLC gained approval to begin the "Sunshine Project" in 2018, which is estimated to more than double the risk of local people developing cancer.

A comprehensive 2018 study found that Black people were exposed to 54% more particulate matter emissions than the average American.

PHL Validity Assessment

Exceptional Support: Environmental racism provides perhaps the strongest validation of PHL theory. The phenomenon exemplifies every major PHL construct working in concert.

Public Health Economy Anarchy: The continuation of environmental racism despite decades of awareness demonstrates anarchic dysfunction. Regulatory agencies permit polluting facilities in Black communities while public health agencies document resulting health harms—contradictory actions within the same governmental structure. PHL's description of the public health economy as having "independent or incompatible" priorities across domains is precisely illustrated here.

Public Health Realism: Multiple studies have shown that communities of color and low-income residents bear the brunt of health-harming pollution in the United States, and this exposure has multiple causes including once-legal discrimination, racial wealth gaps caused by that history, and the pernicious way that modern-day zoning and permitting by local and state agencies reinforce historical patterns. This validates PHL Principle 7: "Agents' speech and conduct cannot alone be a reliable source for ascertaining their true self-interest. Agents are free to engage in misleading speech and actions that do not reflect their true self-interest."

Permitting agencies claim to serve public health while systematically approving facilities that harm marginalized communities—the very definition of pursuing self-interest (economic development, political support from industry) while claiming moral authority (protecting public health).

Hegemonic Control: Environmental justice activists emphasize that state agencies in red and blue regions alike routinely sign off on permits that allow yet more pollution in largely Black, Latino and Indigenous communities already overburdened with it, an entrenched status quo. This represents hegemonic control through gatekeeping (permit approval) and resource distribution (allowing pollution externalities to concentrate in marginalized communities).

PHL's prediction that "hegemonic powers pose a major threat to realizing health equity by seeking to maintain the public health economy to their advantage" is validated by decades of continued environmental racism despite civil rights legislation and environmental protection laws.

Illiberation Evidence: From 1992 to 2015, residents and community groups in Flint filed a series of federal complaints asking the EPA to intervene over pollution affecting majority Black neighborhoods, and each time they got little or nothing from the office charged with ensuring state environmental permitting agencies don't discriminate. This pattern suggests either illiberation among affected communities (accepting inevitability of harm) or among federal officials (fear of political backlash from enforcement), or both.

Douglassian Phenomenology: PHL cites Frederick Douglass's observation that "it is useless and cruel to put a man on his legs, if the next moment his head is to be brought against a curbstone" to describe contradictions in the public health economy. Environmental racism perfectly illustrates this: public health interventions to improve health in Black communities (healthcare access, disease screening) are undermined by continued environmental exposures from permitted pollution sources.

4.5 COVID-19 Pandemic Legacy

Empirical Evidence

Between 2020 and 2024, COVID-19 vaccines saved 2.5 million lives globally, preventing one death for every 5,400 doses administered. However, despite initial skepticism, by 2022, 93% of US adults aged 65 years and older were fully vaccinated, with even the lowest state coverage at 83%.

Black people faced a higher risk of hospitalization and death due to COVID-19 compared with White people, and experienced a larger decline in life expectancy than White people between 2019 and 2021. The pandemic taught a critical lesson: public health cannot be improvised and requires trained experts capable of solving population-level problems.

History reminds us that pandemics often trigger fatigue, and after plague pandemics, cholera outbreaks, and COVID-19, populations tired of prevention measures. We must distinguish declining trust in political institutions from trust in public health itself, as the backlash against public health is politically driven, not rooted in widespread public opinion.

PHL Validity Assessment

Strong Support: The COVID-19 pandemic's trajectory and aftermath validate multiple PHL constructs.

Anarchic Public Health Economy: The contradictory responses to COVID-19—simultaneous mass vaccination success and anti-vaccine legislative movements—exemplify anarchy in the public health economy. The politicization and mainstream denialism of the COVID-19 pandemic at the highest levels of government, including anti-vaccine and anti-science campaigns backed by political and economic activities, demonstrate anarchy in the public health economy.

Racial Disparities Validation: The disproportionate COVID-19 impact on Black Americans validates PHL's THIR. Despite interventions, structural factors (employment in essential services, housing density, comorbidities driven by historical inequities) produced worse outcomes—the "structural constant" in THIR operating to reproduce inequity even in a novel disease context.

Illiberation Dynamics: The emergence of anti-vaccine movements alongside demonstrated vaccine effectiveness suggests illiberation operates across the political spectrum. Since vaccines became more politicized during the pandemic, more extreme vaccine bills have passed, with a vaccine law expert noting "at times of uncertainty and trouble, conspiracy theories have more of a wedge". This supports PHL's concept of illiberation as "environmentally conditioned and internally maintained"—external conditions (pandemic uncertainty) interact with internalized fears to constrain rational action.

Public Health Realism: The vaccine distribution patterns and subsequent anti-vaccine legislation validate public health realism. Various agents (pharmaceutical companies, government agencies, political movements) pursued competing interests, with moral imperatives (protecting public health) sometimes subsumed under political self-interest.

Partial Limitation: While PHL explains the contradictions and competing interests, the successful mass vaccination (93% coverage in older adults) suggests that coordinated action is possible even within an anarchic system. This challenges PHL's more pessimistic predictions and suggests conditions under which anarchy can be temporarily overcome.

5. Overall Validity Assessment

5.1 Strengths of PHL Theory

Strong Explanatory Power: PHL demonstrates exceptional explanatory power for understanding persistent health inequities. The theory successfully explains:

1. Why decades of public health interventions have failed to eliminate racial health disparities

2. How environmental racism persists despite environmental protection laws

3. Why anti-science movements gain traction despite scientific consensus

4. How federal agencies can simultaneously work toward and against public health goals

Predictive Utility: Had PHL been widely adopted before 2025, its framework would have predicted:

• The emergence of coordinated anti-science legislative campaigns following political shifts

• The selective dismantling of public health programs targeting health equity

• The continuation and potential worsening of environmental racism in marginalized communities

• The persistence of racial health disparities despite awareness and intervention

Novel Theoretical Integration: PHL's integration of international relations theory (political realism), liberation philosophy, historical trauma, and public health creates a genuinely novel framework. The concept of the "public health economy" as a single analytic lens successfully unifies disparate phenomena under one explanatory umbrella.

Practical Utility: PHL provides clear guidance for praxis. Its emphasis on liberation safe spaces, vertical and horizontal integration, and community-centered action offers concrete pathways for intervention, not merely theoretical abstraction.

5.2 Limitations and Challenges

Complexity and Accessibility: PHL's theoretical density may limit its adoption. As Williams et al. acknowledge, the framework "may not be accessible to all audiences." The theory requires familiarity with political theory, sociology, critical race theory, and liberation philosophy—a significant barrier to widespread implementation.

Empirical Specificity: While PHL's THIR provides a general formula for health inequity reproduction, it lacks empirical specificity. What is the value of the "structural constant"? How do we quantitatively measure "calls for change," "financial impact," and "constraints"? The theory would benefit from operationalized measures and testable hypotheses.

Pessimistic Determinism: PHL's emphasis on structural constants and anarchic dynamics risks determinism. If the public health economy is inherently anarchic and hegemonic powers inevitably resist change, what realistic hope exists for transformation? The COVID-19 vaccination success suggests PHL may underestimate possibilities for coordinated action.

Limited Engagement with Counter-Evidence: The 2025 evidence includes instances of health equity progress (rapid vaccine development, increased awareness of environmental racism, growing health equity movements). PHL's framework doesn't fully account for these positive developments or explain conditions enabling progress within an anarchic system.

Scope Ambiguity: PHL claims universal applicability beyond the US context, yet its philosophical grounding in African American liberation philosophy and US historical trauma raises questions about cross-cultural validity. Can PHL explain health inequities in contexts without US-style racial capitalism?

6. Discussion: Alternative Theoretical Frameworks

While PHL demonstrates substantial validity, alternative theories warrant consideration for comparative explanatory power.

6.1 Structural Competency Theory

Framework Overview: Structural competency, developed by Metzl and Hansen (2014), trains healthcare providers to recognize structural factors producing health disparities—including policy, economics, and institutional practices. It emphasizes developing skills to intervene at structural levels rather than focusing solely on individual or cultural factors.

Comparative Assessment:

Advantages over PHL:

• Practical Implementation: Structural competency provides clearer training frameworks and competency standards for healthcare professionals

• Empirical Validation: Extensive research demonstrates effectiveness of structural competency training in improving provider awareness and practices

• Accessibility: Simpler framework requiring less theoretical background, making it more accessible to practitioners

• Specificity: Focuses on actionable interventions in clinical and institutional settings

Disadvantages compared to PHL:

• Limited Scope: Primarily targets healthcare settings and provider education, not the broader "public health economy"

• Less Radical: Emphasizes reform within existing structures rather than PHL's transformative vision

• Power Analysis: Lacks PHL's sophisticated analysis of hegemonic control and public health realism

• Historical Grounding: Limited engagement with historical trauma and liberation philosophy

Validity for 2025 Events: Structural competency effectively explains provider-level contributions to health disparities but cannot account for systematic anti-science legislation, federal agency restructuring, or coordinated attacks on public health infrastructure. These phenomena require PHL's broader political economy framework.

6.2 Critical Race Theory in Public Health

Framework Overview: Critical Race Theory (CRT) applied to public health examines how racism—as a systemic, structural force rather than individual prejudice—shapes health outcomes through institutional practices, policies, and resource distribution (Ford & Airhihenbuwa, 2010).

Comparative Assessment:

Advantages over PHL:

• Established Framework: Decades of scholarship and empirical research supporting core concepts

• Legal Precision: Clear analysis of how law and policy create and maintain racial health disparities

• Intersectionality: Sophisticated analysis of how race intersects with gender, class, and other identities

• Counter-Narrative Tradition: Rich tradition of centering marginalized voices and lived experiences

Disadvantages compared to PHL:

• Single-Axis Focus: Primarily analyzes racism; less comprehensive in explaining non-racial health inequities (though intersectionality addresses this)

• Power Dynamics: Less explicit framework for analyzing competing interests among non-racial actors

• Economic Analysis: Limited engagement with political economy and public health realism frameworks

• Action Orientation: Less specific guidance on praxis compared to PHL's five-component approach

Validity for 2025 Events: CRT excels at explaining environmental racism and racial health disparities. Systemic and interpersonal racism have profound effects on physical health, with many Black communities in Atlanta having significantly shorter lifespans and higher rates of maternal health issues, heart disease complications, and cancer rates than white communities. CRT effectively analyzes these patterns.

However, CRT struggles to explain anti-science movements that cross racial lines or agency restructuring decisions made by diverse coalitions. PHL's public health realism framework better captures these dynamics by analyzing self-interest and hegemonic control independent of racial identity.

6.3 Syndemic Theory

Framework Overview: Developed by Singer (1994), syndemic theory examines how multiple disease conditions interact synergistically within contexts of social inequality, producing excess disease burden beyond what would occur if conditions were analyzed separately.

Comparative Assessment:

Advantages over PHL:

• Disease-Specific Focus: Excellent for analyzing particular disease clusters and their interactions

• Empirical Tractability: Easier to operationalize and test specific syndemic hypotheses

• Clinical Relevance: Direct implications for clinical care and disease management

• Epidemiological Integration: Seamlessly integrates with traditional epidemiological methods

Disadvantages compared to PHL:

• Limited Political Analysis: Minimal engagement with political economy, power structures, or hegemonic control

• Descriptive Rather than Prescriptive: Describes disease interactions but provides limited guidance for systemic intervention

• Narrow Scope: Focuses on disease conditions rather than the full "public health economy"

• Missing Liberation Framework: No equivalent to PHL's liberation/illiberation constructs or emphasis on community agency

Validity for 2025 Events: Syndemic theory effectively explains health outcomes—for example, how COVID-19, chronic conditions, and social determinants interacted to produce disparate outcomes. However, it cannot explain anti-science movements, agency restructuring, or environmental racism's persistence. These require PHL's broader political-economic framework.

6.4 Fundamental Cause Theory

Framework Overview: Link and Phelan (1995) argue that socioeconomic status is a "fundamental cause" of disease because it embodies access to resources (knowledge, money, power, prestige) that can be used to avoid risks and minimize consequences of disease regardless of specific disease mechanisms.

Comparative Assessment:

Advantages over PHL:

• Parsimony: Simpler explanation focusing on resource access as primary mechanism

• Empirical Support: Robust evidence across diseases, populations, and time periods

• Predictive Power: Successfully predicts persistence of SES-health gradients despite changing disease patterns

• Policy Implications: Clear focus on resource redistribution

Disadvantages compared to PHL:

• Resource Reductionism: Reduces complex political economy to resource access

• Agency Undertheorized: Limited analysis of community agency, liberation, or resistance

• Power Structures: Less sophisticated analysis of hegemonic control and competing interests

• Historical Context: Minimal engagement with historical trauma or liberation philosophy

Validity for 2025 Events: Fundamental cause theory explains racial health disparities through resource differentials and predicts their persistence. Non-Hispanic Blacks are about 70 percent more likely than non-Hispanic whites to not have health insurance coverage, and many Black families face geographic barriers, living in areas with limited access to doctor's offices and other health care facilities. These resource barriers support fundamental cause theory.

However, fundamental cause theory cannot explain anti-science movements (which often arise in well-resourced communities), federal agency restructuring, or why communities with resources still experience environmental racism. PHL's analysis of public health realism and hegemonic control provides superior explanatory power for these phenomena.

6.5 Synthesis: Stronger Validity or Complementarity?

Assessment Conclusion: No single alternative theory demonstrates stronger overall validity than PHL for explaining the full range of 2025 public health events. Each excels in particular domains:

• Structural Competency: Best for provider education and institutional reform

• Critical Race Theory: Best for analyzing racial dimensions of health inequity

• Syndemic Theory: Best for understanding disease interactions

• Fundamental Cause Theory: Best for explaining SES-health gradients

However, only PHL provides a unified framework capable of explaining:

1. Systematic anti-science legislation (public health realism, hegemonic control)

2. Federal agency restructuring (anarchic public health economy)

3. Persistent racial health disparities (THIR, historical trauma, illiberation)

4. Environmental racism continuity (Douglassian phenomenology, hegemony)

5. Community resistance patterns (liberation/illiberation dynamics)

Recommendation: Rather than replacement, integration offers the strongest path forward. PHL could benefit from:

• Structural competency's practical implementation frameworks

• CRT's intersectional analysis and legal precision

• Syndemic theory's disease-specific insights

• Fundamental cause theory's parsimony regarding resource mechanisms

This integrated approach would maintain PHL's comprehensive political-economic analysis while incorporating established theories' strengths.

7. Implications and Recommendations

7.1 For Public Health Practice

The validation of PHL theory has profound implications:

1. Liberation-Centered Practice: Public health interventions must prioritize liberation—building community capacity for independent analysis and action—over dependency on external expertise

2. Hegemony Vigilance: Practitioners must critically examine whether partnerships with powerful institutions serve community interests or maintain hegemonic control

3. Vertical and Horizontal Integration: Effective public health requires both broadening stakeholder inclusion (horizontal) and expanding intervention scope across the public health economy (vertical)

4. Illiberation Assessment: Programs should assess and address illiberation among both communities and public health professionals

7.2 For Research

PHL generates important research priorities:

1. Operationalization: Develop validated measures for liberation, illiberation, hegemonic control, and public health realism

2. THIR Testing: Empirically test the Theory of Health Inequity Reproduction formula with quantified variables

3. Comparative Studies: Compare communities with high vs. low liberation on health equity outcomes

4. Longitudinal Analysis: Track how changes in the public health economy affect health equity over time

5. Cross-Cultural Validation: Test PHL constructs in non-US contexts

7.3 For Policy

Evidence supporting PHL demands policy reforms:

1. Anti-Hegemonic Regulation: Policies should explicitly counteract hegemonic concentration of power in the public health economy

2. Liberation Support: Fund community-led public health initiatives emphasizing capacity building over service delivery

3. Accountability Mechanisms: Create enforcement mechanisms for environmental justice and health equity that cannot be captured by hegemonic interests

4. Structural Interventions: Shift from individual-level interventions to structural changes addressing the public health economy's anarchic nature

7.4 For Education and Training

PHL's validity suggests transforming public health education:

1. Transdisciplinary Curriculum: Integrate political economy, liberation philosophy, critical race theory, and traditional public health

2. Praxis Emphasis: Balance theoretical knowledge with applied skills in advocacy, policy analysis, community organizing, and legal intervention

3. Critical Consciousness: Develop students' capacity to identify and analyze hegemonic control, illiberation, and power dynamics

4. Community Partnership Models: Embed students in communities of practice with shared physical and social spaces

5. Historical Trauma Education: Incorporate historical trauma and its contemporary manifestations into all public health training

8. Limitations of This Assessment

This validity assessment has several limitations:

1. Temporal Constraints: Analysis focuses on 2025 events; longer-term trends may reveal different patterns

2. Selection Bias: Case selection focused on domains where PHL theory seemed applicable; a comprehensive review might identify disconfirming cases

3. Data Availability: Some PHL constructs (illiberation, liberation safe spaces) are difficult to measure with available data

4. Interpretive Framework: The assessment employs PHL's own conceptual categories, potentially creating confirmation bias

5. US-Centric Analysis: Limited examination of PHL's claimed universal applicability beyond the US context

6. Causal Attribution: Correlation between events and PHL predictions does not definitively establish causality

7. Alternative Explanations: Multiple theoretical frameworks could potentially explain the same phenomena

9. Future Research Directions

To strengthen PHL's theoretical foundation and empirical validation:

9.1 Measurement Development

Priority 1: Develop and validate scales for:

• Liberation quotient (individual and community levels)

• Illiberation assessment inventory

• Hegemonic control index in public health settings

• Public health economy anarchy metrics

• Liberation safe space typology and measurement

Priority 2: Create standardized methods for:

• Identifying and classifying public health factions

• Mapping power relationships in the public health economy

• Quantifying THIR components (calls for change, constraints, financial impact)

• Assessing vertical and horizontal integration

9.2 Longitudinal Studies

Study Design 1: Track communities with varying liberation levels over 5-10 years, measuring:

• Health equity outcomes

• Policy change success rates

• Coalition formation and sustainability

• Hegemonic resistance patterns

Study Design 2: Historical analysis applying PHL framework retrospectively to:

• Civil Rights Movement health impacts

• HIV/AIDS crisis response

• Environmental justice movement successes and failures

• Tobacco control policy evolution

9.3 Intervention Studies

Intervention 1: Implement PHL-based community organizing in matched communities, comparing:

• Health equity outcomes

• Community agency and self-efficacy

• Policy advocacy effectiveness

• Resistance to hegemonic influence

Intervention 2: Develop and test PHL training curriculum for public health professionals:

• Changes in critical consciousness

• Increased structural intervention competency

• Community partnership quality

• Reduced illiberation

9.4 Comparative Theoretical Analysis

Analysis 1: Systematically compare PHL, structural competency, CRT, and fundamental cause theory across multiple case studies to identify:

• Unique explanatory domains for each theory

• Complementary relationships

• Integration possibilities

• Practical trade-offs

Analysis 2: Test PHL in international contexts with different:

• Political systems (parliamentary democracies, authoritarian regimes)

• Healthcare structures (universal coverage vs. market-based)

• Racial/ethnic configurations

• Colonial histories

9.5 Methodological Innovation

Innovation 1: Develop computational models to:

• Simulate public health economy dynamics

• Test THIR under varying conditions

• Predict outcomes of liberation interventions

• Model hegemonic control evolution

Innovation 2: Create participatory action research protocols that:

• Center community knowledge and lived experience

• Avoid the "Gaze of the Enslaved" ethical violations

• Build liberation capacity through research process itself

• Generate both scholarly and community-accessible outputs

10. Conclusion

This systematic assessment of Public Health Liberation theory against 2025 US public health events reveals substantial empirical support for its core constructs and predictions. The theory demonstrates exceptional explanatory power for understanding:

1. Anti-science movements: PHL's anarchic public health economy and public health realism constructs successfully explain the emergence of coordinated anti-vaccine legislation despite scientific consensus

2. Federal restructuring: The systematic dismantling of public health infrastructure validates PHL's predictions about hegemonic control and the subsumption of moral imperatives under self-interest

3. Persistent disparities: PHL's Theory of Health Inequity Reproduction (THIR) and liberation/illiberation framework explain why racial health gaps persist and widen despite awareness and intervention

4. Environmental racism: The continuation of discriminatory pollution exposure perfectly illustrates PHL's Douglassian phenomenology and hegemonic control

5. Pandemic legacy: COVID-19's contradictory trajectory—simultaneous vaccination success and anti-vaccine backlash—exemplifies anarchic dynamics in the public health economy

PHL's validity is strengthened by its integration of diverse theoretical traditions (political economy, liberation philosophy, critical race theory, structural functionalism) into a coherent transdisciplinary framework. The theory's emphasis on the "public health economy" as a single analytic lens provides genuine innovation, unifying disparate phenomena under one explanatory umbrella.

However, the assessment also identifies limitations. PHL's theoretical complexity may limit accessibility and implementation. The theory requires more precise operationalization of key constructs and quantification of THIR components. PHL's emphasis on structural constraints risks pessimistic determinism, potentially underestimating possibilities for coordinated action within anarchic systems.

Comparison with alternative theories—structural competency, critical race theory, syndemic theory, and fundamental cause theory—reveals that while each excels in particular domains, none demonstrates superior overall validity for explaining the full range of 2025 public health phenomena. Rather than replacement, theoretical integration offers the strongest path forward. PHL provides the comprehensive political-economic framework, while established theories contribute practical implementation tools, intersectional analysis, disease-specific insights, and parsimonious causal mechanisms.

The evidence strongly suggests that PHL represents a significant theoretical advance in public health. Its validation through 2025 events demonstrates that the theory is not merely descriptive but predictive, not merely critical but constructive. PHL's emphasis on liberation as both philosophy and practice, its sophisticated analysis of power through public health realism and hegemony, and its commitment to centering marginalized communities' experiences and agency position it as a potentially transformative framework.

Moving forward, the public health community faces a choice: continue operating within paradigms that have failed to eliminate vast health inequities despite decades of effort, or embrace radical reconceptualization exemplified by PHL. The evidence from 2025 suggests that business-as-usual approaches—individual behavior change interventions, cultural competency training, incremental policy reforms—are insufficient when operating within an anarchic public health economy characterized by hegemonic control and flourishing illiberation.

PHL's call for horizontal and vertical integration, liberation-centered practice, and direct confrontation with power structures in the public health economy represents a fundamentally different approach. Whether public health institutions and professionals have the courage to embrace this approach—to overcome their own illiberation and challenge hegemonic arrangements from which they may benefit—remains an open question.

What is clear from the 2025 evidence is that Williams et al. were prescient. Their warning that "the public health economy is anarchical, inefficient, fragmented, and reproductive of the status quo wherein vast inequity, particularly by income and race, is normalized" has been validated by systematic anti-science attacks, agency dismantling, persistent disparities, and continued environmental racism. Their assertion that "only through changing conditions based on a general theory of the public health economy can health equity be achieved" appears increasingly credible.

The central question for public health in 2025 and beyond is whether we have the collective will to transform the public health economy or whether we will continue reproducing inequity while claiming to pursue equity. PHL offers both diagnosis and prescription. The validity of its diagnosis is now empirically established. Whether we will follow its prescription remains to be seen.

References

Bell, D. (1992). Faces at the bottom of the well: The permanence of racism. Basic Books.

Ford, C. L., & Airhihenbuwa, C. O. (2010). Critical race theory, race equity, and public health: Toward antiracism praxis. American Journal of Public Health, 100(S1), S30-S35.

Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 80-94.

Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126-133.

Singer, M. (1994). AIDS and the health crisis of the US urban poor: The perspective of critical medical anthropology. Social Science & Medicine, 39(7), 931-948.

Williams, C., Birungi, J., Brown, M., Deutsch, J., Williams, F., Perkins, P. S., Bishop, P., Walker, D., Moody, E., Hamilton, R., & El-Bayoumi, J. (2022). Public Health Liberation: An emerging transdiscipline to elucidate and transform the public health economy. Advances in Clinical Medical Research and Healthcare Delivery, 2(3). https://doi.org/10.53785/2769-2779.1120

Author Note: This assessment was conducted in November 2025 and reflects events and available data at that time. The rapidly evolving nature of public health policy and events may necessitate ongoing reassessment of PHL's validity and explanatory power.