Theoretical Intersections with Public Health Realism: A Transdisciplinary Analysis of 30 Theories and Concepts

Introduction

By Grok under the supervision of Dr. Christopher Williams

Public Health Realism (PHR), as articulated in the Public Health Liberation (PHL) framework by Williams et al. (2022), offers a transformative perspective on the public health economy—a system characterized by anarchy, where agents such as hospitals, policymakers, industries, and communities compete for resources and power, often prioritizing self-interest over collective health equity. This competition, rooted in the absence of a central governing authority, frequently reproduces health inequities, particularly affecting marginalized populations. The PHL framework, published in Advances in Clinical Medical Research and Healthcare Delivery, draws on political realism and other interdisciplinary concepts, using case studies like the Flint, Michigan, and Washington, DC lead-contaminated water crises to illustrate systemic failures driven by self-interest and lack of accountability (Williams et al., 2022).

PHR’s core principles include:

Anarchy: The public health economy lacks common principles or a central authority, leading to fragmented priorities (Williams et al., 2022, p. 15).
Self-Interest: Agents prioritize survival, influence, or profit over collective health (p. 15).
Power Dynamics: Power is exercised through financial assets, rulemaking, gatekeeping, and influence, with dominant agents controlling resources (p. 16).
Health Inequity Reproduction: Competition and self-interested actions perpetuate disparities, as seen in environmental racism and policy failures (p. 4).
Hegemonic Tendencies: Dominant agents maintain power, often exploiting vulnerable communities (p. 16).

This essay explores 30 theories, concepts, and terms from political science, economics, sociology, philosophy, public health, organizational studies, anthropology, and psychology that align with PHR, deliberately including both concepts mentioned in the PHL manuscript (e.g., Critical Race Theory, Social Determinants of Health) and novel ones to extend the framework’s theoretical foundation. Each theory is analyzed for its intersection with PHR, supported by high-quality, peer-reviewed citations, and linked to PHR’s principles through theoretical alignment and practical examples, such as the Flint and Washington, DC crises. The essay is structured academically, with a methodology, detailed analysis, discussion, and conclusion, aiming to solidify PHR as a transdisciplinary framework for health equity research.

Methodology

The 30 theories/concepts were selected based on their relevance to PHR’s principles, drawn from disciplines addressing competition, power, and systemic inequities. To ensure a comprehensive analysis, concepts explicitly cited in the PHL manuscript (e.g., Madisonian factionalism, structural violence, hegemony) were supplemented with novel theories identified through a literature review using databases like PubMed, JSTOR, and Google Scholar. Each theory was analyzed for:

Theoretical Alignment: Mapping its core tenets to PHR’s principles of anarchy, self-interest, power dynamics, and health inequity reproduction.
Practical Intersection: Linking to public health scenarios, particularly the Flint and Washington, DC water crises.
Citation Quality: Using peer-reviewed sources from reputable journals or publishers.
Prompts: 1) Scour the literature to support the idea of public health realism. What theories, terms, concepts, philosophies align with public health realism. Read the attachment thoroughly. Write extensive and analytical essay. 2) Redo, but go well-beyond those that appear in the manuscript. 3) This is a good start, but it can go further. Now, I want you to dig even deeper. Get 30 theories, concepts, terms, etc then assess (apply a score that you create) to public health realism theory to determine how closely it aligns with public health realism. Write an extensive essay and create a bar chart (public health realism is reference).4) Redo. I want you to take 30 concepts, terms, theories, etc...public health realism is the reference. Do scoring and essay based on that. 5) [Several prompts to create a radial illustration. 6) Ok, now go back and revise your last essay on the 30 terms. Write an extensive essay with high quality citations on each term, concept, etc and intersection with public health realism. Structure as an academic essay. 7) Ok, this is good. the descriptions and PHR intersections should be more fully discussed. Walk users through an overview of the term, theory, concept....

A qualitative scoring system (0–100) assessed alignment based on four equally weighted criteria (25 points each):

Anarchy (A): Does the theory describe a system without centralized governance? (0–25)
Self-Interest (SI): Does it emphasize self-interested behavior? (0–25)
Power Dynamics (PD): Does it address power struggles or resource control? (0–25)
Health Inequity Reproduction (HIR): Does it explain mechanisms perpetuating health disparities? (0–25)

PHR scores 100 (25 per criterion). Scores are reported as integers, reflecting theoretical fit.

Alignment of Theories/Concepts with Public Health Realism (Ranked)

Analysis of Theories and Concepts

Political Science and International Relations

Offensive Realism
- Overview: Offensive realism, developed by John Mearsheimer, posits that states in an anarchic international system aggressively maximize power to ensure survival, often at others’ expense (Mearsheimer, 2001). It assumes states are rational actors prioritizing security through dominance, leading to perpetual competition.
- Intersection with PHR: Offensive realism aligns closely with PHR’s depiction of the public health economy as anarchic, where agents like pharmaceutical companies pursue power (e.g., lobbying for patent protections) to maximize profits, often limiting access to affordable medications and reproducing health inequities. In the Flint crisis, state officials’ cost-cutting decisions reflect power-seeking behavior, prioritizing fiscal control over public health (Williams et al., 2022, p. 4). The theory’s focus on anarchy and self-interest mirrors PHR, though its health-specific application is less direct.
- Score: 92 (A: 25, SI: 25, PD: 25, HIR: 17)
- Citation: Mearsheimer, J. J. (2001). The Tragedy of Great Power Politics. W.W. Norton & Company.
Defensive Realism
- Overview: Kenneth Waltz’s defensive realism suggests states prioritize security over dominance in an anarchic system, maintaining their position rather than expanding power (Waltz, 1979). It emphasizes risk-averse strategies to ensure survival.
- Intersection with PHR: Defensive realism reflects PHR’s view of agents like health departments securing funding to maintain operations without addressing systemic inequities, as seen in Washington, DC’s delayed response to lead contamination until external pressure emerged (Williams et al., 2022, p. 4). This conservative self-interest reinforces health disparities, aligning with PHR’s anarchy and power dynamics, though less aggressively than offensive realism.
- Score: 88 (A: 25, SI: 20, PD: 20, HIR: 23)
- Citation: Waltz, K. N. (1979). Theory of International Politics. McGraw-Hill.
Constructivism
- Overview: Constructivism, articulated by Alexander Wendt, argues that norms, identities, and social interactions shape behavior in anarchic systems, with actors constructing their realities (Wendt, 1992). It emphasizes the role of shared meanings over material power alone.
- Intersection with PHR: Constructivism aligns with PHR by highlighting how norms, such as prioritizing acute care over prevention, perpetuate health inequities in the public health economy. In Flint, the norm of cost-efficiency over safety shaped government inaction, reinforcing disparities (Williams et al., 2022, p. 4). Its focus on norms reduces emphasis on self-interest, but it complements PHR’s anarchy principle.
- Score: 82 (A: 25, SI: 15, PD: 20, HIR: 22)
- Citation: Wendt, A. (1992). Anarchy is what states make of it: The social construction of power politics. International Organization, 46(2), 391–425. https://doi.org/10.1017/S0020818300007764
Global Health Governance
- Overview: Global health governance examines how international actors manage health challenges without a global authority, often marked by competition and cooperation (Frenk & Moon, 2013). It addresses power dynamics in global health policy.
- Intersection with PHR: This concept mirrors PHR’s anarchic public health economy, where global actors (e.g., WHO, governments) compete for resources, as seen in COVID-19 vaccine hoarding, which exacerbated inequities (Williams et al., 2022, p. 15). In Flint, national and local agencies’ fragmented responses reflect similar dynamics. It strongly aligns with PHR’s anarchy and power principles.
- Score: 87 (A: 25, SI: 20, PD: 20, HIR: 22)
- Citation: Frenk, J., & Moon, S. (2013). Governance challenges in global health. New England Journal of Medicine, 368(10), 936–942. https://doi.org/10.1056/NEJMra1109339
Elite Theory
- Overview: Elite theory, developed by C. Wright Mills, posits that a small elite controls resources and policy, shaping societal outcomes to their benefit (Mills, 1956). It emphasizes power concentration among a minority.
- Intersection with PHR: Elite theory intersects with PHR’s power dynamics, as elite institutions (e.g., universities, health organizations) prioritize research agendas benefiting their interests, marginalizing community needs. In Washington, DC, elite-driven policies delayed action on lead contamination, reinforcing inequities (Williams et al., 2022, p. 4).
- Score: 86 (A: 20, SI: 20, PD: 25, HIR: 21)
- Citation: Mills, C. W. (1956). The Power Elite. Oxford University Press.

Economics

Market Failures
- Overview: Market failures occur when markets fail to allocate resources efficiently due to externalities, public goods, or information asymmetries (Bator, 1958). Externalities, like pollution, impose costs on third parties, while public goods are underprovided.
- Intersection with PHR: Market failures align with PHR’s health inequity reproduction, as externalities like industrial pollution harm communities, as seen in Flint’s lead crisis (Williams et al., 2022, p. 4). Self-interested industries prioritize profits, exacerbating disparities, reflecting PHR’s self-interest and power dynamics.
- Score: 88 (A: 20, SI: 22, PD: 20, HIR: 26)
- Citation: Bator, F. M. (1958). The anatomy of market failure. Quarterly Journal of Economics, 72(3), 351–379. https://doi.org/10.2307/1882231
Prisoner’s Dilemma
- Overview: The prisoner’s dilemma, a game theory model, illustrates how self-interested choices lead to suboptimal collective outcomes, as rational actors fail to cooperate (Axelrod, 1984). It highlights the tension between individual and group interests.
- Intersection with PHR: This model reflects PHR’s self-interest principle, where agencies in Flint failed to cooperate, prioritizing individual budgets over collective health, leading to lead exposure (Williams et al., 2022, p. 4). It aligns with PHR’s view of competition undermining health equity.
- Score: 90 (A: 20, SI: 25, PD: 20, HIR: 25)
- Citation: Axelrod, R. (1984). The Evolution of Cooperation. Basic Books.
Moral Hazard
- Overview: Moral hazard occurs when protection (e.g., insurance) encourages riskier behavior, as the insured bear less consequence (Pauly, 1968). It is prevalent in healthcare and policy contexts.
- Intersection with PHR: In public health, providers may overprescribe treatments for profit, while governments might neglect preventive measures if costs are externalized, as seen in Washington, DC’s lax oversight of water safety (Williams et al., 2022, p. 4). This aligns with PHR’s self-interest and inequity reproduction.
- Score: 84 (A: 15, SI: 25, PD: 20, HIR: 24)
- Citation: Pauly, M. V. (1968). The economics of moral hazard: Comment. American Economic Review, 58(3), 531–537. https://www.jstor.org/stable/1813785
Tragedy of the Commons
- Overview: Hardin’s tragedy of the commons describes how individuals, acting in self-interest, deplete shared resources, leading to collective harm (Hardin, 1968). It applies to environmental and health resources.
- Intersection with PHR: Overuse of antibiotics or environmental resources (e.g., Flint River) harms vulnerable populations, aligning with PHR’s self-interest and inequity reproduction principles (Williams et al., 2022, p. 4).
- Score: 87 (A: 20, SI: 25, PD: 20, HIR: 22)
- Citation: Hardin, G. (1968). The tragedy of the commons. Science, 162(3859), 1243–1248. https://doi.org/10.1126/science.162.3859.1243
Rent-Seeking
- Overview: Rent-seeking involves expending resources to gain unearned benefits, often through policy influence, without creating new wealth (Tullock, 1967).
- Intersection with PHR: Industries seeking lax regulations (e.g., environmental standards) align with PHR’s self-interest and power dynamics, contributing to inequities like Flint’s water crisis (Williams et al., 2022, p. 4).
- Score: 89 (A: 20, SI: 25, PD: 22, HIR: 22)
- Citation: Tullock, G. (1967). The welfare costs of tariffs, monopolies, and theft. Western Economic Journal, 5(3), 224–232. https://doi.org/10.1111/j.1465-7295.1967.tb01923.x

Sociology

Social Conflict Theory
- Overview: Social conflict theory, rooted in Marxist thought, posits that society is characterized by inequality and conflict between groups over resources and power (Dahrendorf, 1959). It emphasizes structural tensions driving social change.
- Intersection with PHR: This theory mirrors PHR’s power dynamics and inequity reproduction, as wealthier groups secure better healthcare, exacerbating disparities. In Flint, marginalized communities bore the brunt of lead exposure due to systemic neglect (Williams et al., 2022, p. 4).
- Score: 92 (A: 20, SI: 22, PD: 25, HIR: 25)
- Citation: Dahrendorf, R. (1959). Class and Class Conflict in Industrial Society. Stanford University Press.
Elite Theory
- Overview: Elite theory, developed by C. Wright Mills, argues that a small elite controls resources and policy, shaping societal outcomes to their benefit (Mills, 1956).
- Intersection with PHR: Elite institutions in public health prioritize research and policies benefiting their interests, marginalizing community needs, as seen in Washington, DC’s delayed response to lead contamination (Williams et al., 2022, p. 4).
- Score: 86 (A: 20, SI: 20, PD: 25, HIR: 21)
- Citation: Mills, C. W. (1956). The Power Elite. Oxford University Press.
Critical Race Theory
- Overview: Critical Race Theory (CRT) examines how race and racism are embedded in societal structures, perpetuating racial inequalities through policies and practices (Delgado & Stefancic, 2017).
- Intersection with PHR: CRT aligns with PHR’s inequity reproduction, highlighting how systemic racism in the public health economy, such as environmental racism in Flint, disproportionately harms minority communities (Williams et al., 2022, p. 4).
- Score: 85 (A: 15, SI: 20, PD: 25, HIR: 25)
- Citation: Delgado, R., & Stefancic, J. (2017). Critical Race Theory: An Introduction. NYU Press.
Feminist Theory
- Overview: Feminist theory addresses gender inequalities, advocating for women’s rights and analyzing power dynamics through a gender lens (hooks, 2000).
- Intersection with PHR: Feminist theory intersects with PHR by illuminating how gender-based power dynamics contribute to health inequities, such as disparities in reproductive health access, which can be exacerbated by self-interested policies (Williams et al., 2022, p. 8).
- Score: 80 (A: 15, SI: 18, PD: 22, HIR: 25)
- Citation: hooks, b. (2000). Feminism is for Everybody: Passionate Politics. South End Press.
World-Systems Theory
- Overview: World-Systems Theory, developed by Immanuel Wallerstein, analyzes global economic systems, where core nations exploit peripheral ones, creating inequalities (Wallerstein, 1974).
- Intersection with PHR: This theory explains how global health policies favor wealthier nations, paralleling local disparities in Flint where marginalized communities were neglected (Williams et al., 2022, p. 4).
- Score: 84 (A: 20, SI: 20, PD: 22, HIR: 22)
- Citation: Wallerstein, I. (1974). The Modern World-System I. Academic Press.

Philosophy

Ethical Egoism
- Overview: Ethical egoism posits that individuals should act in their own self-interest, prioritizing personal gain (Rachels, 2003).
- Intersection with PHR: This aligns with PHR’s self-interest principle, as industries (e.g., tobacco) prioritize profits over health, contributing to inequities, as seen in Flint’s cost-cutting decisions (Williams et al., 2022, p. 4).
- Score: 88 (A: 15, SI: 25, PD: 22, HIR: 26)
- Citation: Rachels, J. (2003). The Elements of Moral Philosophy. McGraw-Hill.
State of Nature (Hobbes)
- Overview: Hobbes’ state of nature describes a pre-social condition of conflict without authority, necessitating a social contract for order (Hobbes, 1651).
- Intersection with PHR: The state of nature mirrors PHR’s anarchic public health economy, where agents compete absent governance, as seen in Flint’s unregulated water management (Williams et al., 2022, p. 4).
- Score: 90 (A: 25, SI: 25, PD: 20, HIR: 20)
- Citation: Hobbes, T. (1651). Leviathan. Penguin Classics.
Social Contract Theory
- Overview: Social contract theory, as articulated by Rousseau, posits that governance arises from agreements to counter anarchy (Rousseau, 1762).
- Intersection with PHR: This aligns with PHR’s anarchy principle, suggesting governance could mitigate competition, but self-interest in Flint undermined such agreements (Williams et al., 2022, p. 4).
- Score: 80 (A: 25, SI: 10, PD: 20, HIR: 25)
- Citation: Rousseau, J.-J. (1762). The Social Contract. Penguin Classics.
Utilitarianism
- Overview: Utilitarianism, developed by Bentham and Mill, advocates actions that maximize collective happiness (Mill, 1863).
- Intersection with PHR: While contrasting PHR’s self-interest, utilitarianism highlights trade-offs in public health decisions, where prioritizing overall health might overlook minority needs, as in Flint’s cost-driven policies (Williams et al., 2022, p. 4).
- Score: 70 (A: 15, SI: 10, PD: 15, HIR: 30)
- Citation: Mill, J. S. (1863). Utilitarianism. Parker, Son, and Bourn.
Libertarianism
- Overview: Libertarianism emphasizes individual liberty and minimal state intervention, prioritizing market solutions (Nozick, 1974).
- Intersection with PHR: Libertarian policies may oppose health regulations, aligning with PHR’s self-interest and anarchy, but potentially exacerbating inequities by favoring market-driven outcomes.
- Score: 78 (A: 20, SI: 25, PD: 18, HIR: 15)
- Citation: Nozick, R. (1974). Anarchy, State, and Utopia. Basic Books.

Public Health

Critical Public Health
- Overview: Critical public health critiques traditional approaches, emphasizing power, politics, and social justice in health systems (Greenhalgh & Wessely, 2004).
- Intersection with PHR: This perspective aligns with PHR’s power dynamics, critiquing elite-driven policies in Flint that neglected community health (Williams et al., 2022, p. 4).
- Score: 89 (A: 20, SI: 22, PD: 25, HIR: 22)
- Citation: Greenhalgh, T., & Wessely, S. (2004). ‘Health for me’: A sociocultural analysis of healthism in the middle classes. British Medical Bulletin, 69(1), 197–213. https://doi.org/10.1093/bmb/ldh013
Social Determinants of Health
- Overview: Social determinants of health are conditions (e.g., income, education) affecting health outcomes, shaped by resource distribution (Marmot, 2005).
- Intersection with PHR: These determinants align with PHR’s inequity reproduction, as poverty and racism in Flint exacerbated lead exposure impacts (Williams et al., 2022, p. 4).
- Score: 88 (A: 20, SI: 20, PD: 20, HIR: 28)
- Citation: Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099–1104. https://doi.org/10.1016/S0140-6736(05)71146-6
Syndemic Theory
- Overview: Syndemic theory examines how social and health conditions interact to worsen outcomes, particularly in marginalized groups (Singer, 2009).
- Intersection with PHR: Syndemics align with PHR’s inequity reproduction, as social stressors in Flint amplified lead-related health impacts (Williams et al., 2022, p. 4).
- Score: 84 (A: 15, SI: 20, PD: 20, HIR: 29)
- Citation: Singer, M. (2009). Introduction to Syndemics: A Critical Systems Approach to Public and Community Health. Jossey-Bass.
Eco-Social Theory
- Overview: Eco-social theory explores how social and ecological factors interact to shape health outcomes (Krieger, 1994).
- Intersection with PHR: This theory aligns with PHR’s inequity reproduction, as environmental neglect in Flint reflects social power imbalances (Williams et al., 2022, p. 4).
- Score: 87 (A: 20, SI: 20, PD: 20, HIR: 27)
- Citation: Krieger, N. (1994). Epidemiology and the web of causation: Has anyone seen the spider? Social Science & Medicine, 39(7), 887–903. https://doi.org/10.1016/0277-9536(94)90202-X
Health Capability Approach
- Overview: Sen’s health capability approach views health as a capability limited by social constraints, emphasizing freedom to achieve well-being (Sen, 1999).
- Intersection with PHR: This aligns with PHR’s inequity reproduction, as structural barriers in Washington, DC limited health capabilities for lead-affected communities (Williams et al., 2022, p. 4).
- Score: 82 (A: 15, SI: 15, PD: 22, HIR: 30)
- Citation: Sen, A. (1999). Development as Freedom. Oxford University Press.

Organizational and Policy Studies

Resource Dependence Theory
- Overview: Resource Dependence Theory posits that organizations compete for external resources, managing dependencies to survive (Pfeffer & Salancik, 1978).
- Intersection with PHR: Hospitals and NGOs compete for funding, prioritizing survival over health equity, as seen in Flint’s resource-driven decisions (Williams et al., 2022, p. 4).
- Score: 89 (A: 20, SI: 25, PD: 22, HIR: 22)
- Citation: Pfeffer, J., & Salancik, G. R. (1978). The External Control of Organizations: A Resource Dependence Perspective. Harper & Row.
Institutional Theory
- Overview: Institutional theory examines how organizational behavior is shaped by norms and institutional pressures (DiMaggio & Powell, 1983).
- Intersection with PHR: Norms prioritizing efficiency in Flint perpetuated neglect of water safety, aligning with PHR’s power dynamics and inequity reproduction (Williams et al., 2022, p. 4).
- Score: 84 (A: 20, SI: 15, PD: 22, HIR: 27)
- Citation: DiMaggio, P. J., & Powell, W. W. (1983). The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. American Sociological Review, 48(2), 147–160. https://doi.org/10.2307/2095101
Advocacy Coalition Framework
- Overview: The Advocacy Coalition Framework posits that coalitions of actors with shared beliefs compete to shape policy (Sabatier, 1988).
- Intersection with PHR: In Flint, community coalitions competed with government agencies over water policy, reflecting PHR’s power dynamics (Williams