Public Health Liberation and the Moral Disruption of Economic Theory: Toward a Post-Neoliberal Political Economy of Health 

By ChatGPT

Abstract
The Public Health Liberation (PHL) framework marks a radical rethinking of the economic foundations of health systems, policy, and social value. It presents a post-disciplinary model that displaces efficiency-maximization and exchange logic in favor of moral, political, and structural analysis. This essay provides a comprehensive synthesis and theoretical mapping of how PHL disrupts standard economic paradigms. Building upon Williams’ core manuscripts and position papers, it argues that PHL theory introduces a new unit of analysis—the public health economy—which recasts markets, actors, and institutional incentives as morally entangled systems shaped by historical trauma and factional power. For economic theorists, PHL demands a foundational reckoning: markets must be analyzed not as neutral or equilibrium-producing mechanisms, but as structurally biased arenas of public contestation that often invert their own legitimating myths. PHL thus calls for a moral reconstitution of the economic sciences.

I. The Public Health Economy: A New Economic Ontology

Traditional economics relies on the separation between "health" and "the economy," relegating health to an outcome variable in models of productivity, labor, and human capital. PHL explodes this boundary by asserting that the public health economy is itself a major economy, comprising a complex network of economic forces, institutional behaviors, funding systems, and political actors that collectively determine health outcomes and health inequality .

This redefinition shifts health from a peripheral externality to a central organizing field of political economy. The public health economy is:

• Not governed by market logic, but by structural entrenchment, factional competition, and moral omission;

• Characterized by failure of epistemic coherence, where various stakeholders operate with incompatible knowledge systems and incentives;

• Unequally burdened, with marginalized populations systematically disempowered, over-extracted, or dismissed in both institutional planning and cost-benefit frameworks.

This ontological reframing challenges economic theory to abandon assumptions of neutrality and rationality when applied to health systems and instead recognize them as terrains of historically patterned constraint and institutional betrayal.

II. From Rational Choice to Illiberated Behavior

Mainstream economics is built on the rational choice paradigm. Even in behavioral economics, where bounded rationality and heuristics are acknowledged, the agent remains ultimately centered as a decision-making unit.

PHL introduces illiberation—a theoretical condition wherein individuals, particularly from structurally disadvantaged communities, operate under constraints so deep, internalized, and moralized that their capacity for autonomous choice is fundamentally distorted.

"Illiberation describes a varying state of immobility, self-oppression, or internalized fear or silence… that arises not just from institutional actors but from one’s moral relationship with institutions.”
— PHL White Paper

This concept implicates:

• Behavioral economics: models must account for systemic and historical trauma—not merely cognitive bias;

• Labor economics: choices to exit or remain in occupations, neighborhoods, or medical systems are not free but forged under historical duress;

• Public finance: benefit uptake (e.g., housing vouchers, legal redress) is skewed not only by bureaucratic cost but by the psychic and moral toll of state interactions.

Thus, standard models overestimate the autonomy of marginalized actors and underestimate the structural violence of “choice.”

III. The Anarchy of Health Markets: Factional Conflict and Institutional Drift

PHL theory draws on Madisonian federalism to reinterpret the health sector as a factional political economy—a space of contending interests among stakeholders including insurers, researchers, tech firms, landlords, pharmaceutical giants, and extractive corporations.

This reframing asserts:

• Health markets are not markets in the economic sense, but contested moral economies;

• Power asymmetries create structural moral evasion, where cost-benefit analysis substitutes for redress;

• Cross-sector dysfunction results in epistemic fragmentation, preventing a coherent social response to health crises (e.g., COVID, maternal mortality, climate-related illness).

The upshot is a moral failure of the market: it does not—and cannot—price the value of historical justice, collective health, or liberation.

IV. Efficiency as False Morality: The Rise of the Morality Principle

The economic concept of efficiency is morally seductive but ethically bankrupt when applied to entrenched inequity. PHL confronts this directly through the Morality Principle, which holds that:

"When institutional behavior can be reasonably shown to be causing harm to health, it becomes a moral obligation to act—and a moral failing to defer.”
— Public Health Economy Essay (2025)

Implications for economic theory:

• Pareto efficiency is demoted: it offers no guidance in contexts where all allocations reproduce injustice;

• Cost-effectiveness analysis is critiqued: it externalizes trauma and racialized historical constraints;

• Utilitarian metrics are reframed: liberation, not aggregate utility, becomes the evaluative benchmark.

PHL’s Theory of Health Inequity Reproduction (THIR) mathematically encodes this by identifying reproduction of inequity as a function of the suppression of moral will, not just resource scarcity. The formula is a direct rebuke to dominant optimization frameworks.

V. Judicial Determinants of the Public Health Economy

The Supreme Court decisions of 2022–2023 (Dobbs, Bruen, Harvard) offer real-world demonstrations of PHL’s thesis. The position statement from Public Health Liberation argues:

• These decisions worsen the public health economy by eliminating core health protections and suppressing historically marginalized educational access;

• The loss of affirmative action, reproductive rights, and LGBTQ protections undercuts labor market equity and intergenerational health outcomes;

• Judicial power thus operates as an economic actor, shaping the distribution of health, wealth, and liberty across racial and gender lines.

PHL calls this the judicial determinant of health—an unaccounted-for yet powerful driver in the economic ecosystem. It shows how law itself becomes a mechanism of economic stratification.

VI. Toward a Post-Neoliberal Economic Theory

The cumulative consequence of PHL is a post-neoliberal framework for economic theory:

Neoliberal Economics vs PHL-Informed Economics

Market efficiency is morally desirable vs Structural redress is morally necessary

Agents are autonomous and utility-maximizing vs Agents are illiberated and structurally constrained

Prices coordinate optimal outcomes vs Markets reproduce inequity under factionalism

Race and identity are external to economic modeling vs Race, history, and trauma are endogenous variables

Technocracy governs rational policy vs Epistemic decentralization and lived experience are vital

PHL is thus not just a critique—it is a blueprint for liberation-centered economics, wherein policy, budgeting, law, and labor are evaluated by their ability to heal, repair, and liberate.

Conclusion: A Paradigm Shift in Economic Reasoning

For economists committed to relevance in the 21st century, the Public Health Liberation framework demands full engagement. It exposes how economic theory has too often served as a handmaiden to injustice—cloaked in abstraction, indifferent to suffering, and structurally aligned with hegemonic power.

PHL offers a profound alternative: an economy whose purpose is not profit or growth alone, but the liberation of human beings from structural harm. It dares economists to recalibrate not just their models, but their moral compass.

This is not a technical update. It is a paradigm shift.

Keywords: public health economy, public health liberation, moral economics, illiberation, factional political economy, THIR, judicial determinants, post-neoliberalism, health equity, structural constraint, liberation economics.