Dr. Christopher Williams Answers Claude's Questions about CR Framework

First Round

Theoretical Framework and Methodology

1. On the Public Health Economy concept: Your work conceptualizes the "public health economy" as the second major economy alongside the traditional growth/employment economy, arguing it elucidates contradictions that reproduce health inequity. How do you envision practitioners operationalizing this framework to identify specific intervention points within existing health systems? What metrics or indicators best capture the performance of the public health economy in different communities?

The public health economy has to be experienced to be understood because public health economies (city-, state-, regional-, and national-levels) differ significantly - particularly spatiotemporally. As an expert in my community of practice, I can tell you about economic, social, political, legal, regulatory, and educational influences on health. I can also exercise diverse skills sets in advocating for change - responding to regulatory proposals and permits, economic analysis, original data collection, CBPR, community mobilization, interfacing with agencies and government officials, and providing policy analyses. The scope and acuity of challenges in the public health economy require a new kind of training and practice. We are not even close to the public health practice that Public Health Liberation envisions. We are tempted to constantly have "metrics". That's part of the problem really. Public Health Liberation is presenting an epistemic challenge to public health away from laboratory knowledge production toward synthesis that draws across disciplines. Data needs to be situated within contextual factors, including lax legislative and regulatory oversight, political culture that includes classism and racism, etc.

In terms of the metrics, that is what the novelty or innovation of Public Health Liberation theory becomes handy. First, it is challenging public health to unify those ideas and constructs that can expand our vocabulary such as "regulatory capture", findings of fact", "cognizable injury", "urban colonialism", "housing costs inflation". Then, we take our new lexicon to train and practice differently. It's a whole new way of thinking.

2. Regarding your Critical Race Framework: Your dissertation created the first public health critical appraisal tool for studies using racial taxonomy, addressing measurement error and validity issues. Given that AI models have assessed 80% of your Public Health Realism principles as having "strong" or "very strong" validity, how do you see the role of artificial intelligence in validating and scaling critical race methodologies in public health research?

Now that is the question. There are many unknowns. It is not certain that this will hold up as a "valid" validity methodology. There needs to be more discussed in the literature. I used it because, "Why not?" They had similar findings to the human raters from the Critical Race Framework, so I believe that it could be a valid method. Time will tell.

Novel Theoretical Constructs

3. On the "Gaze of the Enslaved": This is one of several new constructs that emerge from Public Health Liberation theory, along with concepts like "illiberation" and "liberation safe spaces". Can you elaborate on how the "Gaze of the Enslaved" functions as an analytical tool and how it differs from other critical perspectives in public health research?

The point of "Gaze of Enslaved" is to draw a direct line from exploitation of enslaved people to contemporary research. The Gaze of the Enslaved is meant as a throughput. It is not only a direct indictment of current research practices through an African American philosophy and morality, but also a warning that these practices are being monitored and tracked, which they are. There are other names - "drive-by research" and instrumental use of communities. The seven Principles of Research Ethics have aged poorly.

4. Regarding "Public Health Realism": This theory appears to be a central component of Public Health Liberation with 16 established principles. How does Public Health Realism challenge conventional epidemiological approaches to causality and intervention design?

It questions whether the researcher is designing and evaluating for their own interests or the interests of the community. Public Health Realism does not give any research question or researcher the benefit of the doubt. Despite the massive investments the US has made in public health in the last 20 years, we are failing to advance public health, especially in income and racial disparities. In the 20-year follow to the 2003 landmark study, Unequal Treatment, the National Academies of Sciences, Engineering, and Medicine concluded, "The U.S. has made little progress in advancing health care equity over the past two decades, and racial and ethnic inequities remain a fundamental flaw of the nation’s health care system". We're not making progress because everyone is doing everything to maximize public health outcomes.

Practical Applications and Community Engagement

5. On community-based praxis: Your work emphasizes transdisciplinary knowledge informed by real-world challenges, particularly with public housing communities in Washington, DC. How do you balance the rigorous theoretical framework development with the immediate practical needs of affected communities? What have you learned about the pace of academic theory-building versus community urgency for solutions?

It's not that hard. Look at public health's response to the Trump administration's policies. They did exactly what Public Health Liberation called for, especially in terms of vertical integration. They marched, wrote editorials, demonstrated negative impacts using data, created websites and social support for fired or laid-off employees, engaged their legislators, built websites, and posted on social media. This is tied to the "interest" position of public health realism, of course. What Public Health Liberation is saying is that public health must have as its default position and capacity far greater vertical and horizontal integration. It appears that the discipline can do it. It just chooses not to do it as well for communities.

6. Environmental justice applications: Your recent work on how the Supreme Court's overturning of Chevron deference might create new pathways for environmental equity suggests practical legal applications of your theoretical framework. How do you see Public Health Liberation theory informing legal strategies and policy advocacy in environmental racism cases?

Now, judges have far greater latitude to provide independent judgment over regulatory or agency decisions. That is a major step in ensuring that the judiciary is a co-equal branch of government. If agencies misapplied or impartially applied the law inconsistent with regulatory standards, then communities should take that government agency to court.

Methodological Innovation and Validation

7. On the intersection of quantitative and qualitative approaches: Critical Race Theory in public health emphasizes experiential knowledge and challenges the apparent objectivity of research, yet your Critical Race Framework includes sophisticated quantitative tools. How do you navigate the tension between CRT's emphasis on narrative knowledge and public health's reliance on statistical evidence?

It's simple. In using race variables, researcher should apply the same standards that it would any other variable. How one "feels" and "thinks" about race and human grouping is irrelevant to the scientific question. The Critical Race Framework is abundantly clear on that front.

8. Regarding interdisciplinary synthesis: Public Health Liberation draws from political theory, sociology, women's studies, African American emancipatory writing, and community psychology. What are the biggest challenges in creating coherent transdisciplinary frameworks, and how do you maintain theoretical rigor while crossing disciplinary boundaries?

Well, that's the million-dollar question, right? I am working on this synthesis, except a major problem is that many theories fail to follow through on testing their theories. It's like building from the ground up. There are ways that I have leveraged original and secondary data analysis on public health economic analysis. As we stated, the field is "emerging". A single organization or person cannot do it alone, but we can provide a solid foundation. The public health discipline needs to move. That's ultimately what we are saying in the manuscript.

As to the rigor, we work with communities, gather data, and perform appropriate reliability and validity testing. It's what I did in the Critical Race Framework and other studies, including a study on the neighborhood effects on mental health.

Future Directions and Scaling

9. On institutional transformation: Your work is described as seeking to "transform public health into an engine of equity and justice". What would successful institutional adoption of Public Health Liberation look like in schools of public health, health departments, or healthcare systems?

In schools, it has to be transdisciplinary. Public health students and faculty need to understand government budgeting (e.g., debt, borrowing, where it's spending or not spending its money and why), community networks, communication theory (e.g., how information moves through communities, how to leverage email and news platforms, how to organize), law (e.g., what does the law or regulation say, how to conduct case law searches, how to file pro se, etc.). The list going on. In the aggregate, public health looks vastly different - different skills, vocabulary, transience across different disciplines within the public health economy, and types of practices.

In terms of health departments and healthcare systems, I am not sure that the vision of Public Health Liberation and the public health economy best function within major institutions that have disfavored community investment and agency.

10. Regarding the next generation: Given that public health education has been slow to integrate critical race theories meaningfully, how should public health curricula be restructured to center liberation philosophy and Public Health Economy analysis from the beginning rather than as an add-on?

First, students should not wait for them to integrate critical race theories. The students are the future of public health and should own that. They should feel "liberated" to bring those theories and methodologies to classroom discussions and assignments. They should do practicums within a community of practice and seek to integrate public health economic synthesis. If we wait for public health education to reform, we won't see change. If we show them the way and they realize that they are increasingly isolated ideologically and politically, then maybe they will change.

Second Round

1. On the Epistemic Challenge: You mention that Public Health Liberation presents an "epistemic challenge to public health away from laboratory knowledge production toward synthesis that draws across disciplines." This seems to challenge not just what we study, but how we know what we know. Can you elaborate on what this epistemic shift looks like in practice? When you say "data needs to be situated within contextual factors," are you arguing for a fundamentally different relationship between evidence and knowledge than what currently exists in public health?

Too often, I see researchers collect a bunch of data points, throw them in a statistical model, then extrapolate all sorts of conclusions without actually having meaning insight into how public health economies perform. Ok, "So you show the influence of neighborhood effects on depression? Ok, so what?" These researchers cannot typically answer any questions about the political, economic, social, legal, or regulatory questions to explain the persistence of structural inequities in a given public health economy. This point is related to "Gaze of the Enslaved" and "Public Health Realism". It also does not help that journals are notoriously hostile to analysis and research beyond their discipline.

The big point here is that public health is best understood when it is contextualized and the only way to contextualize it is to synthesize factors across the public health economy. Perhaps, the community has never organized, so elected officials didn't sense any upset. Perhaps, the economic planning priorities for the city aren't considering social costs, meaning communities may seek a health or social impact assessment.

2. The "Gaze of the Enslaved" and Research Ethics: Your description of the "Gaze of the Enslaved" as both an indictment and a warning that practices are being "monitored and tracked" is particularly striking. You mention that "the seven Principles of Research Ethics have aged poorly." Which specific principles do you see as most problematic, and how would a liberation-centered approach to research ethics differ from current IRB frameworks? Are you suggesting that the very structure of research ethics needs to be reconceptualized?

Basically, researchers often satisfy IRB requirements by saying, "Oh this study will help research participants because they will receive a gift card and contribute to knowledge." So, that tells you there why the US is failing to close gaps. IRBs rely on Principles of Research Ethics, which do not call for sustainability or structural interventions. It's basic research ethics in my book. We can and ought to be doing more. Institutions could offer pro bono legal counseling and capacity-building such as grant writing and nonprofit start-up assistance, among other forms of assistance.

3. The Paradox of Institutional Transformation: There's an interesting tension in your responses: you envision transdisciplinary education requiring skills like government budgeting, community organizing, and law, yet you express skepticism about "major institutions that have disfavored community investment and agency." How do you reconcile the need for institutional transformation with this skepticism? Are you advocating for building parallel institutions, or do you see a path for transforming existing ones?

I was only responding to your question. I don't think institutions want change. They will engage in tokenism and other superficial stuff as long as they can. Unless they are directed to, a training reform is unlikely. One, schools would need to work with accreditation agencies, which will mean staff support and collaboration across institutions to encourage new accreditation standards on the part of accreditors. Second, there is a disincentive in place because they all compete against each other - for students, faculty, and funding.

4. Public Health's Response to Crisis: Your observation about public health's response to the Trump administration is fascinating - you suggest the field demonstrated exactly the kind of vertical integration Public Health Liberation calls for when their own interests were threatened. This raises questions about the "interest" position in Public Health Realism. How do we move from crisis-driven integration to default practice? And how do we ensure that this integration serves community interests rather than professional self-preservation?

This is not disparaging public health specifically, but people change when their interests are affected. Are Trump's policies enough for public health to adapt and innovate? It depends really. Much of the discourse now is to return to previous funding levels. There are also some shake-ups in public health school leadership. There is also some talk about more community engagement. It is not certain if this signals that the field is seeking meaningful and radical reform. I'm skeptical given past history. Public health has been behind the eight-ball on diversity for a long time.

5. The Vocabulary of Liberation: You introduce powerful new terms like "regulatory capture," "urban colonialism," and "inflationary policies" as part of expanding public health vocabulary. How do you see this new lexicon reshaping not just how we think, but how we organize and advocate? Are there specific examples of how these concepts have shifted understanding or strategy in your work with DC communities?

Well, public health is just more conversant. One of the criticisms that I heard early in my public health education from someone whom I'd met outside of school was that she didn't feel that public health people were that useful. They didn't know enough beyond public health in your opinion. That was a fair criticism indeed. That's the perception that I am trying to change.

6. The "Million Dollar Question" of Synthesis: When discussing transdisciplinary challenges, you acknowledge it's "building from the ground up" because "many theories fail to follow through on testing their theories." This seems to be a critique of both traditional public health and other critical theories. How do you avoid this same trap? What does "testing" look like for Public Health Liberation theory, and how do you maintain accountability to communities while developing theoretical frameworks?

That's what I am working on. Trump 2.0 is a good test case for much of Public Health Liberation theory - factionalism, public health economy, public health realism. AI is helping me with validity.

7. Student Agency and Institutional Resistance: Your advice to students to "not wait" and to bring critical race theories to classrooms now is compelling, but it also places significant risk on students. How do you support students who take this approach when they encounter institutional resistance? Have you seen examples of students successfully implementing this strategy, and what conditions made it possible?

Resistance? No one cares about institutional resistance. Let them be. That's my point - a liberatory stance. It's a point that we made in the Public Health Liberation manuscript. The focus on anti-racism - asking for permission - has come at the expense of liberation - investing in collective action and thought.

8. The Measurement Question: You describe the constant demand for "metrics" as "part of the problem," yet your Critical Race Framework includes sophisticated quantitative tools. How do you distinguish between harmful measurement practices and useful ones? When communities are demanding accountability from institutions, don't they often need the very metrics you're critiquing?

We have overrated data. In many situations, well-organized communities with adequate data and a battle cry that persists can move the needle. I have seen this in my own community. In fact, many of the great moral movements of this country have more heavily relied on winning political and public opinion than obtaining significant p-values. We have to balance when a research- or data-focus is appropriate...and when we need to organize and march.

9. Environmental Justice and Legal Strategy: Your analysis of the end of Chevron deference is intriguing - you see it as empowering communities to challenge agency decisions. But isn't there also a risk that this could weaken environmental protections overall? How do you balance the potential for community victories against the possibility of corporate interests also benefiting from weakened agency authority?

We don't know. It's exciting and daunting, but the status quo was untenable. We couldn't have judges prevented from questioning agency decision unless in the case of egregious or blatant violations of the law - not just in environmental regulation. We saw Chevron as a barrier in economic planning in Washington, DC, which had the highest Black displacement. That's the real answer, but the point that I was making is that the end of Chevron deference opens a door. Communities should take it.

10. The Twenty-Year Failure: Your reference to the lack of progress since "Unequal Treatment" is sobering. You argue this is because "everyone is doing everything to maximize public health outcomes" - but this seems counterintuitive. Can you unpack this? Are you suggesting that the problem is misaligned incentives, or something deeper about the nature of how public health defines "outcomes"?

I think you missed my sarcasm. I was saying that we cannot assume everyone is acting in good faith if a 20-year report says that hardly anything is changing. I think that they also misdiagnosed the problem. The researchers behind the original report have been well-cited. That IOM report opened billions in public health research, except we got a lot of knowledge production with no significant change. That's not accidental. It's systemic - reward polite research without action and accountability. It's sad to say, but it was enough to keep greater calls for reform at bay - at least within academia. We are seeing the political consequences of estranged and insular research.

Third Round

1. The Intentionality of Failure: Your clarification about the sarcasm in "everyone doing everything to maximize public health outcomes" is striking. You're arguing that the 20-year lack of progress since "Unequal Treatment" isn't accidental but "systemic - intentionally so." This suggests a much more radical critique than simple misaligned incentives. Can you elaborate on what you see as the mechanisms through which this intentional maintenance of inequity operates? Are you suggesting that the research-industrial complex itself functions to absorb resources while preventing meaningful change?

In Public Health Liberation theory, we posited that the public health economy reproduces health inequity. So, yes, the research-industrial complex is a barrier, but so are other endless systems, policies, and belief systems. One of the most remarkable legal realities that we have faced in Washington, DC is how the government through the DC Office of Attorney General consistently defends unlawful action of the government. When plaintiffs file a suit, it is essentially their taxpayer dollars that are used to fight them. Mind you, the Attorney General's office has a public interest mission, but "rarely" finds that there is a conflict between their statutory obligation to defend the government and their public interest mission. In terms of public health, the DC Attorney General's Office fought every single lawsuit from DC's lead water crisis in the early aughts. One case took 16 years before it was settled.

2. Liberation vs. Anti-Racism: A Critical Distinction: Your observation that "the focus on anti-racism - asking for permission - has come at the expense of liberation - investing in collective action and thought" is particularly compelling. This seems to suggest that even well-intentioned anti-racism efforts can be co-opted into systems that maintain the status quo. How do you see this playing out concretely in public health institutions? What does liberation look like when it stops asking for permission?

Concretely? Say I am interested only in anti-racism, I might do research, write a book, make a film, or give a lecture series that pimps Black trauma and US racism as opposed to liberatory stances that affect the social and material condition of people. If you look at this dynamic, you will see that it's everywhere.

What does liberation look like? That depends, but it says that we get to own and act in accordance with moral principles of freedom, justice, love, and community to bring about a new social, economic, and political order. While Public Health Liberation disavows any form of violence, I acknowledge that violence has often been the only recourse to resolve deep moral questions. The Revolutionary War and Civil War are such examples in the US. However, war is not reserved for civilians, but for polities, governments, and the military. Everyday communities should look at non-violence at all times.

3. The Research Ethics Paradigm Shift: Your critique of IRBs satisfying requirements with "x-dollar gift cards" while avoiding structural interventions points to a fundamental problem in how we conceptualize research ethics. When you mention institutions could offer "pro bono legal counseling, among other forms of assistance," are you envisioning a model where research institutions become resource centers for communities? How would this change the relationship between researcher and participant?

Yes, they could be re-investing in those communities that is not to be confused as "research centers for communities". Given public health realism, we should be highly skeptical of institution-driven anything. What this means is a change in power. Those with a lot of it - whether resources, influence, economic strength - need to realize that they have to much of it. It is not necessary about a "change" in the relationship. Communities may not want or benefit from any relationship at all frankly. So what is the role of research institutions? To affect the social and material condition through high-impact and grounded research - give people tools. But research also needs to be redefined. Research could mean finding legal theories and regulatory statutes that can serve communities' advocacy, though it is also traditional public health, as in environmental air quality monitoring.

4. The "Gaze of the Enslaved" as Accountability Mechanism: Your description of the "Gaze of the Enslaved" as both indictment and warning that practices are being "monitored and tracked" suggests it functions as more than just an analytical tool - it's an accountability mechanism. Can you elaborate on what this monitoring looks like in practice? How do communities use this framework to hold researchers accountable? Contextual Knowledge vs. Statistical Modeling Your critique of researchers who "collect a bunch of data points, throw them in a statistical model, then extrapolate all sorts of conclusions without actually having meaningful insight into how public health economies perform" gets to the heart of the epistemic challenge. When you ask "So you show the influence of neighborhood effects on depression? Ok, so what?" - what would a Public Health Liberation approach to that same research question look like? How would it be designed and conducted differently?

Monitoring means looking at the latest research. Analyzing those articles through the ethics of Public Health Liberation and the Critical Race Framework. It also means emailing authors and journal editors about ethical and methodological concerns, which I have done.

Well, I did a study on neighborhood change and mental health. I produced three academic studies following intense collaboration with the community. The key is that I used preliminary data to enter into the public record and shared with DC Council at a time of heightened policy change - the DC Comprehensive Plan revision. The research showed an association between rapid neighborhood change and mental health. One manuscript innovated community-based research methods. It elevated community leaders as key stakeholders in researchers and challenged misconceptions that they were without any research expertise. We also hosted a webinar to discuss results. The final manuscript generated typologies that are key for understanding who is affected, how, and why. The findings strongly suggested that directly impacted groups and those who empathized with their vulnerability were likely key to understanding the mental health effects due to gentrification.

5. Trump 2.0 as Test Case: You mention that "Trump 2.0 is a good test case for much of Public Health Liberation theory - factionalism, public health economy, public health realism." Can you elaborate on what specific aspects of your theory you expect to be tested, and what you'll be looking for as evidence of validation or need for refinement?

There is a lot published in the Critical Race Framework Study. I have leveraged AI to assess Public Health Liberation theory relative to other public health theories to explain and contextualize current events. Though emerging, PHL has become highly ranked for its comprehensiveness and explanatory power. Again, the use of AI for theory validation is underdeveloped in the literature due to the newness of AI, but I think it is highly promising as a scientific methods.

6. The Balance of Data and Organizing: Your point about "well-organized communities with adequate data and a battle cry that persists" versus seeking "significant p-values" resonates with historical social movements. But how do you determine when research is appropriate versus when organizing should take precedence? Are there decision-making frameworks within Public Health Liberation theory for making these tactical choices?

Institutional Skepticism and Parallel Building: Your skepticism about institutional change is clear, but you're also working within academic and research frameworks. Are you essentially building parallel institutions through Public Health Liberation, or do you see your work as creating pressure that will eventually force institutional transformation? How do you navigate being both inside and outside these systems?

You want answers to question that posit cause-and-effect and templating. This is a line of thinking that is outdated. When evaluating the indeterminacy of the public health economy and effective strategies, it is highly context-dependent and theoretically and strategically rich. What works in this city is unlikely to work in another. What works in this neighborhood is not necessarily effective or relevant in another. Part of the issue that I have with public health theory and research is its distillation of complex realities. I named one issue in the Critical Race Framework Study - that of race essentialism in public health research, but this is part and parcel of other approaches that perpetuate crude simplicity.

7. The Chevron Gamble: Your pragmatic stance on Chevron deference - acknowledging it's "exciting and daunting" but that "the status quo was untenable" - suggests you're willing to accept significant risks for potential gains. This seems emblematic of a broader approach in your work. How do you balance calculated risks with community safety, especially when communities have the most to lose from failed strategies?

We do not know how this will all play out. That's the simple answer. While judicial capture - meaning a highly politicized and ideological judiciary - is a concern, it is too soon to see the long-term effects from the end of Chevron deference. In fact, anti-regulatory industries may very well regret the end of Chevron.

8. Public Health Conversancy: Your response about making "public health more conversant" and addressing the criticism that "public health people weren't that useful" beyond their narrow expertise points to a fundamental reimagining of public health practice. What would a Public Health Liberation-trained practitioner's skill set look like compared to current MPH graduates? How would their daily work differ?

The new public health workforce a la Public Health Liberation stands above all systems - regarding the interdependencies and connectedness of all these systems and practices as a research and ethical inquiry on the performance and health of the public health economy.