Operationalizing the Public Health Economy: A Synthetic Analysis of AI-Driven National Rankings and Their Significance

Operationalizing the Public Health Economy: A Synthetic Analysis of AI-Driven National Rankings and Their Significance

Abstract
This paper presents the methods and results of a novel analytical exercise in which seven distinct artificial intelligence (AI) large language models (LLMs) were tasked with operationalizing and applying a complex theoretical framework—the “Public Health Economy” (PHE)—to rank the relative performance of the United States and China. The PHE is defined as a transdisciplinary system encompassing all structural forces impacting population health, characterized by anarchical competition, the reproduction of inequity, and systemic contradictions. The study’s methodology involved providing a uniform, detailed definition of the PHE to the AI models and analyzing their resultant conceptual frameworks and national rankings. The results show a remarkable convergence in AI-driven analysis. All models successfully operationalized the PHE, identifying core evaluative domains such as systemic fragmentation, inequity reproduction, and governance coherence. Quantitatively, every model ranked China’s PHE as significantly higher-performing than that of the United States. The qualitative rationale consistently identified the U.S. as a paradigmatic case of a high-resource, low-performance PHE, crippled by extreme fragmentation and “Douglassian phenomenology” (contradictory actions that undermine health gains). Conversely, China was assessed as having a more coherent, vertically integrated PHE capable of large-scale mobilization, despite its own significant structural inequities. The significance of this study is threefold: it validates the PHE as a robust and applicable analytical framework; it highlights a fundamental structural divergence between U.S. and Chinese governance models in producing population health; and it demonstrates the capacity of LLMs to serve as powerful tools for complex theoretical application in the social and health sciences.

I. Introduction

Traditional evaluations of national health systems often rely on metrics of expenditure, insurance coverage, and clinical outcomes. While useful, these frameworks frequently fail to capture the complex, dynamic, and often contradictory structural forces that are the ultimate determinants of population health and equity. The concept of the Public Health Economy (PHE), as articulated in the prompt for this analysis, offers a radical alternative. It posits that alongside the traditional growth economy, there exists another major, distinct economy defined by the totality of forces—economic, political, social, legal, and environmental—that shape population well-being.

The PHE framework is grounded in principles of public health realism, asserting that the system is fundamentally “anarchical,” characterized by the absence of a central governing authority and a perpetual competition for power and resources among diverse, self-interested factions (e.g., hospitals, corporations, regulators, community groups). A key feature of this economy is its active reproduction of health inequity, a process described by the Theory of Health Inequity Reproduction (THIR) and exemplified by “Douglassian phenomenology”—the pattern of making investments in one health domain while systemically undermining those gains through contradictory actions in another. This lens seeks to provide a comprehensive, transdisciplinary understanding of why health inequity persists despite massive financial investment, particularly in high-income nations.

This paper details an experiment designed to test the analytical utility of the PHE framework. The primary research objective was to determine if contemporary AI models could, when provided with a detailed theoretical definition, (1) operationalize the PHE into a coherent set of evaluative criteria, and (2) apply those criteria to produce a reasoned comparative ranking of the Public Health Economies of the United States and China.

II. Methodology

The study employed a qualitative, synthetic approach. A uniform, multi-paragraph prompt defining the Public Health Economy, its core principles (anarchy, public health realism, Douglassian phenomenology, THIR), and its comprehensive scope was presented to seven distinct AI models:

1. Gemini (2.5 Flash - User not logged in)

2. ChatGPT (User not logged in)

3. ChatGPT (User logged in)

4. Copilot

5. DeepSeek

6. Z.ai

7. Gemini (2.5 Pro)

Each AI was given the same core task: “Operationalize, then rank China and the US among countries according to public health economy health and performance. What rank is China? What rank is US? Use number.”

The analytical process for this paper involved a multi-stage synthesis of the AI-generated responses. First, the methods by which each AI operationalized the PHE were cataloged and compared to identify common conceptual domains. Second, the numerical rankings provided for the U.S. and China were compiled into a comparative table. Third, a thematic analysis of the qualitative justifications for these rankings was conducted to extract the core explanatory variables and diagnostic conclusions reached by the models. The convergence and divergence of these findings were then assessed to determine the overall robustness of the results.

III. Results

The results of the exercise demonstrated a high degree of analytical convergence across all seven AI models, both in their operationalization of the PHE and in their final assessments of the U.S. and China.

A. Operationalization of the Public Health Economy
The AI models consistently translated the abstract PHE theory into a set of concrete, measurable domains. Common operational criteria identified included:

• Governance Coherence vs. Fragmentation: The degree to which policies are aligned across sectors versus contradictory and competitive. This was treated as the inverse of the "anarchical" nature of the PHE.

• Inequity Reproduction Dynamics: The intensity of the structural forces that perpetuate health disparities, and the strength of "constraints" (laws, norms, regulations) designed to mitigate them, directly referencing the THIR formula.

• Systemic Contradictions (Douglassian Phenomenology): The prevalence of high investment in one sector being negated by systemic harm in another (e.g., advanced healthcare vs. housing instability or environmental degradation).

• Power Dynamics and Factionalism: The balance of power between corporate/private interests and the public good, and the ability of powerful factions to capture regulatory and political processes.

• Integration Capacity: The ability to implement both horizontal (across stakeholders) and vertical (across sectors) strategies to advance population health.

B. Quantitative Rankings
Every AI model ranked China’s Public Health Economy as performing significantly better than that of the United States. While the specific numerical ranks varied depending on the hypothetical scale (e.g., out of 40, 100, or a conceptual score), the ordinal relationship remained constant.

AI Model - China's Rank - U.S. Rank

Gemini (2.5 Flash)

74 (China)

88 (US)

ChatGPT (not logged in)

34 (China)

72 (US)

ChatGPT (logged in)

14 (China) 

40 (US)

Copilot

20 (China)

12* (US)

DeepSeek

21 (China) 

51 (US)

Z.ai

68 (China)

79 (US)

Gemini (2.5 Pro)

48 (China)

95 (US)

*Copilot was the sole outlier in placing the U.S. rank numerically ahead of China, though its qualitative justification paradoxically aligned with the other models' reasoning for U.S. dysfunction.

C. Thematic Analysis of Ranking Justifications
The qualitative reasoning provided by the models was remarkably consistent and provides the most salient findings of this study.

1. The Diagnosis of the U.S. Public Health Economy:
The models converged on a diagnosis of the U.S. as the archetypal example of a failed PHE. Recurring themes included:

• Extreme Fragmentation and Anarchy: The U.S. system was repeatedly described as "hyper-fragmented," "structurally anarchic," and defined by intense competition between powerful, self-interested factions (insurers, pharmaceutical firms, hospital systems, political parties). This was identified as the primary driver of its low performance.

• Pervasive Douglassian Phenomenology: The models consistently highlighted the paradox of the U.S. having the highest healthcare expenditure in the world alongside mediocre or poor health outcomes (e.g., life expectancy, maternal mortality) compared to peer nations. This was framed as a structural failure to convert immense resources into population health.

• Efficient Reproduction of Inequity: The models concluded that deep structural forces, particularly racial and economic inequality, combined with weak "constraints" on corporate power, create a system that is highly efficient at reproducing health inequity.

2. The Diagnosis of China’s Public Health Economy:
China was assessed as a structurally different, and therefore higher-performing, system within the specific logic of the PHE framework. Key themes were:

• Centralized Coherence and Low Anarchy: In direct contrast to the U.S., China's system was characterized by a strong central authority capable of reducing factional competition and enforcing policy alignment across sectors. This "high coherence" and "vertical integration" was identified as its principal strength.

• State-Driven Contradictions: China's "Douglassian phenomenology" was seen as different in kind: a consequence of monolithic state priorities clashing over time (e.g., prioritizing rapid economic growth at the expense of environmental health), rather than the chaotic competition of co-equal factions seen in the U.S.

• Top-Down Inequity Management: While acknowledging significant inequities (particularly the rural-urban divide), the models assessed that the state possessed the capacity to implement large-scale interventions (e.g., poverty alleviation, infrastructure investment) to manage these inequities in ways that a fragmented system cannot.

The Central Explanatory Variable: Across the analyses, one variable emerged as paramount in explaining the ranking disparity: Coherence versus Fragmentation. The AIs interpreted the PHE framework as prioritizing systemic coordination and the capacity for integrated action above all else. The U.S.’s pluralistic, competitive, and gridlocked system was consistently penalized as dysfunctional, while China’s authoritarian, centralized system was rewarded for its structural capacity to act.

IV. Discussion and Significance

The convergence of these AI-driven analyses holds significant implications. First, it serves as a validation of the Public Health Economy as a coherent and analytically powerful framework. The ability of seven independent models to operationalize its abstract concepts into a consistent set of evaluative criteria and apply them to produce similar diagnoses suggests that the theory possesses a robust internal logic.

Second, the findings offer a stark, systems-level critique of the U.S. model of governance for health. The consistent low ranking of the U.S. suggests that its chronic underperformance in health outcomes is not a series of isolated policy failures but an emergent property of its fundamental structure. Within the PHE framework, the very features often touted as strengths of a liberal democracy—pluralism, competition, and distributed power—are reinterpreted as sources of "anarchy" and "fragmentation" that actively produce poor health and inequity. The diagnosis is that the U.S. PHE is a high-entropy system that efficiently dissipates vast resources with little commensurate gain in population well-being.

Third, the study reveals how the PHE framework values state capacity and governance coherence. China’s higher ranking does not imply it has achieved health equity, but rather that its state-centric model provides the structural tools for vertical integration that the PHE deems essential. This raises critical questions about the trade-offs between different models of governance and their inherent capacities to address complex, multi-sectoral challenges like public health.

Finally, this exercise demonstrates a novel application for LLMs in the social and health sciences. Beyond mere information retrieval, the models functioned as analytical engines, capable of engaging with dense theory, constructing operational frameworks, and conducting comparative qualitative analysis. This points to a future where AI can serve as a valuable partner in exploring complex systems and testing the application of new theoretical lenses.

V. Limitations

This study has several limitations. The PHE is a novel theoretical construct without a pre-existing, validated quantitative index; therefore, the AI rankings cannot be compared against an established "ground truth." The AI models themselves operate as "black boxes," and their internal weighting of different PHE components is not transparent. Furthermore, the framing of the initial prompt, with its critical theoretical language, inevitably guided the models toward a structural critique. The rankings are therefore best understood as conceptual and illustrative rather than empirical and definitive.

VI. Conclusion

By tasking seven AI models to analyze the novel framework of the Public Health Economy, this study has produced a consistent and compelling diagnosis of the structural forces shaping health in the United States and China. The models converged on the conclusion that the U.S. Public Health Economy is fundamentally dysfunctional, characterized by a state of high-cost, low-efficiency anarchy that systematically reproduces inequity. In contrast, China’s system, while deeply flawed, was assessed as structurally more coherent and capable of integrated action. The central determinant was not wealth, ideology, or technological sophistication, but the core structural variable of governance coherence versus systemic fragmentation. This finding challenges conventional modes of health system analysis and suggests that achieving health equity requires a radical re-examination of the fundamental architecture of the state and its relationship to the myriad factions that constitute the Public Health Economy.