Gemini 2.5 Flash Scores Public Health Liberation Theory High in Predictive Validity in the US in 2025

November 1, 2025

Major Takeaway 

No other established public health theory offers a set of constructs that could have so precisely and successfully predicted the specific nature of the structural stagnation and reproduction of systemic inequity observed in the US public health landscape in 2025. While behavioral theories have higher predictive validity for micro-level outcomes (like a person's decision to exercise), Public Health Liberation Theory demonstrates the highest predictive validity for macro-level, structural outcomes, especially the failure of the public health system to achieve equity. Its core insight—that the failure is a feature, not a bug—was validated by the events of 2025.

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

Public Health Liberation (PHL) theory, an emerging general framework for accelerating health equity, posits that the "public health economy" is an anarchical system where agents pursue self-interest, hegemonic control reproduces inequity, and "illiberation" prevents resistance. Its core insights were published as recently as 2022, framing it as a critique of systemic failures exposed by events like the COVID-19 pandemic and the racial justice movements. This essay will develop a rubric for assessing the theory's predictive validity, apply it to the context of significant events in the US in 2025, and then compare its predictive power to other established public health theories.

📏 Predictive Validity Rubric for Public Health Theory

Predictive validity measures how accurately a theory's hypotheses forecast future outcomes or behaviors. For a grand theory like PHL, which aims to explain and predict structural phenomena, the rubric must focus on high-level, complex outcomes—specifically, the persistence and reproduction of health inequity.

Criterion

Description

Scoring Scale (1-5)

1. Prediction of Inequity Reproduction

The degree to which the theory correctly forecasts the continued existence and deepening of health disparities despite official efforts and expenditures.

1 = No correlation; 5 = Strong, precise prediction.

2. Forecasting Hegemonic Response/Resistance

The accuracy in predicting how dominant power structures ("hegemony") will react to threats to their control (e.g., through co-optation, suppression, or denial) and how grassroots resistance will be thwarted ("illiberation").

1 = Incorrect/Unforeseen response; 5 = Predicted response matches observed events closely.

3. Utility of Core Constructs

The ability of the theory's core, novel constructs (e.g., "public health economy," "illiberation") to frame, explain, and therefore predict the specific characteristics of 2025 events that established theories overlook.

1 = Constructs are irrelevant; 5 = Constructs offer necessary and superior explanatory/predictive power.

4. Explaining Resource Misallocation

The accuracy in predicting the persistence of an "anarchical public health economy," characterized by the pursuit of self-interest leading to inefficient, fragmented, or inequitable resource distribution.

1 = Resource flow is rational/equitable; 5 = Predicted self-interested, anarchical resource failure is observed.

🎯 Scoring Public Health Liberation (PHL) Theory in 2025

Recent commentary and updates on the Critical Race Framework Studies, which underpin PHL, suggest that events in 2025 have provided significant validation for the theory.

1. Prediction of Inequity Reproduction: Score 5/5

Reports from late 2025 explicitly state that the year validated PHL's core insights with startling precision, noting that "health disparities reached crisis proportions" and that "Hegemonic control does reproduce inequity." Public health news headlines throughout the year, such as the persistence of racial health gaps in new policy rollouts and the ongoing crisis of preventable illnesses in marginalized communities, confirm the theory's central hypothesis: health inequity is not a flaw in the system, but an intended structural outcome. The fact that a theory published just three years prior could predict this reproduction (not just persistence) is a powerful indicator of predictive validity.

2. Forecasting Hegemonic Response/Resistance: Score 4/5

PHL's concept of illiberation—the systematic prevention of resistance—is validated by events like the renewed focus on foundational statistical errors in racial health disparities research. The challenge to the very definition and measurement of "race" in health research, which calls into question the validity of decades of work, can be interpreted as a sophisticated, hegemonic move to halt or nullify data that fuels liberation movements. By challenging the scientific basis for anti-racist public health action, the system (hegemony) effectively stalls progress and discourages resistance (illiberation). While the precise mechanism of a statistical critique may not have been predicted, the outcome—the successful nullification of actionable data—perfectly aligns with the theory of power maintenance.

3. Utility of Core Constructs: Score 5/5

The construct of the "public health economy"—a single analytic lens elucidating the contradictions that reproduce inequity—proves its utility. Events like the 2025 Conference on Public Health Strategies to Combat Substandard and Falsified Medicines, where only a fraction of providers were trained to detect counterfeits, and the continued debate on healthcare affordability (as seen at the Duke-Margolis Health Policy Conference), highlight a system driven by complex, often contradictory, economic and political forces rather than singular public health goals. PHL's frame of an anarchical "economy" where agents pursue self-interest explains these persistent, seemingly irrational contradictions better than models that assume rational actors striving solely for the common good.

4. Explaining Resource Misallocation: Score 4/5

The observation that the "public health economy is indeed anarchical" and that "Agents do pursue self-interest as power" directly predicts the continued misallocation of vast public health and healthcare resources. The focus on high-impact, short-term, or profitable interventions (like specific technological solutions or drug safety conferences) over the difficult, long-term, and expensive foundational changes to address Social Determinants of Health (SDOH), aligns with this prediction. For example, while AI and predictive models in hospitals for high-risk patients are growing, the deep structural changes needed to prevent people from becoming high-risk in the first place remain unfunded or politically stalled.

📊 Comparative Assessment of Predictive Validity

PHL's overall score is exceptionally high, particularly because it successfully predicted structural failure—the non-accidental reproduction of inequity. When compared to other public health theories, PHL's predictive power for system-level outcomes is arguably higher.

High-Validity Behavioral Theories

The Theory of Planned Behavior (TPB) and its predecessors have a high, well-documented predictive validity for individual-level behavioral change (e.g., predicting an individual's intention to engage in a health behavior like dieting or screening). This validity is often measured by correlation coefficients (ρ≈0.4 to 0.6 for intention predicting behavior).

• PHL vs. TPB/TRA: TPB predicts individual action; it does not predict whether the food environment will be saturated with unhealthy options (inequity reproduction) or whether policymakers will fund structural changes (hegemonic response). When it comes to predicting which US populations will continue to experience the worst health outcomes in 2025, PHL's structural focus on the "public health economy" proves superior to TPB's focus on individual belief.

Other Macro Theories

The Social-Ecological Model correctly identifies multiple levels of influence on health (individual, interpersonal, organizational, community, and policy) but is fundamentally descriptive and diagnostic rather than predictive of the system's inertia. It can explain why inequity exists, but it does not have the same theoretical mechanism (e.g., hegemony and illiberation) to predict its inevitable reproduction in the face of counter-movements.

Conclusion

No other established public health theory offers a set of constructs that could have so precisely and successfully predicted the specific nature of the structural stagnation and reproduction of systemic inequity observed in the US public health landscape in 2025. While behavioral theories have higher predictive validity for micro-level outcomes (like a person's decision to exercise), Public Health Liberation Theory demonstrates the highest predictive validity for macro-level, structural outcomes, especially the failure of the public health system to achieve equity. Its core insight—that the failure is a feature, not a bug—was validated by the events of 2025.