Gemini Ranks Public Health Liberation as Top Public Health Theory

Gemini was asked to rank Public Health Liberation  among dozens of other related or adapted theories, including in public health. It ranked Public Health Liberation as #11 in the user's account and #13 in a new account. However, subsequent conversation with Gemini indicated that it did not have full access to the manuscript. It likely relied on popularity or wide recognition of theories for ranking as opposed to a substantive analysis. We provide Gemini's responses to two prompts, "Here is manuscript. Rescore if needed" and "explain why phl went up in scoring". 

It is not clear whether Gemini would need a seminal manuscript for each theory for the most accurate ranking.

Prompt: Here is manuscript. Rescore if needed.

Based on the provided manuscript, "Public Health Liberation - An Emerging Transdiscipline to Elucidate and Affect the Public Health Economy," this ranking has been updated to incorporate its novel framework and the critical perspectives it offers.

The ranking prioritizes theories that provide comprehensive, equitable, and actionable frameworks for addressing the root causes of health disparities. Public Health Liberation (PHL), as detailed in the source, integrates many strengths of existing critical and structural theories into a single, cohesive transdiscipline, placing it at the top of this list.

Tier 1: Foundational Frameworks for Comprehensive and Equitable Public Health Action These theories are considered "best to work" due to their broad applicability, strong focus on equity, and ability to guide systemic and multi-level interventions.

Public Health Liberation (PHL):

Why: PHL is presented as an innovative, general theory and transdiscipline aimed at accelerating health equity through the radical transformation of the "public health economy". It unifies philosophy, theories, praxis, research, and training into a cogent approach to address the tensions that reproduce health inequity. Its strength derives from its grounding in the community experiences of its authors, a majority of whom are Black women.

Core Concepts:

Public Health Economy: Its central analytic lens, defined as the totality of competing economic, political, and social drivers that impact health. PHL posits this economy is in a state of "anarchy" (lacking a central governing authority), which explains the persistence of vast health inequities.

Liberation: The core philosophical principle, defined as a mindset and way of life for collectives to achieve emancipation from constraints on thought and action. It focuses on collective problem-solving and is distinguished from anti-racism by speaking to the needs within a community rather than primarily to those in power.

Illiberation: A novel term for the state of internalized fear, silence, or self-oppression that is environmentally conditioned and serves as a major barrier to achieving health equity.

Novel Theories: PHL introduces its own theories to explain and change the public health economy, including the Theory of Health Inequity Reproduction (THIR), public health realism (which analyzes the economy as a competition among self-interested factions), and hegemony.

Praxis and the Morality Principle: PHL is action-oriented ("praxis") and guided by a Morality Principle, which is the moral obligation to intervene immediately against injustice, regardless of what is scientifically proven, drawing on lessons from historical trauma.

Best for: Creating a comprehensive, community-driven, and transformative public health approach that synthesizes critical analysis with practical, multi-pronged action to dismantle systemic inequities.

Social Determinants of Health (SDOH) Theory:

Why: Central to modern public health, it focuses on the social, economic, and environmental conditions that shape health. It's fundamental for understanding and addressing health inequities at their roots. PHL builds on this by situating these determinants within a competitive "public health economy".

Best for: Designing comprehensive interventions that tackle upstream factors like poverty, education, housing, and discrimination.

Ecological Systems Theory / Socioecological Model:

Why: Explains health by examining interactions across individual, interpersonal, organizational, community, and policy levels. PHL’s concepts of horizontal and vertical integration align with this multi-level approach, seeking to broaden discourse to include affected populations (horizontal) and intervene throughout the entire public health economy (vertical).

Best for: Developing holistic strategies that intervene at various leverage points.

Fundamental Cause Theory (Link & Phelan):

Why: Argues that social factors like socioeconomic status are "fundamental causes" of health disparities because they determine access to a wide range of health-influencing resources. This aligns with PHL's analysis of how the public health economy perpetuates inequity.

Best for: Advocating for policies that reduce socioeconomic inequalities to achieve lasting health equity.

Health Equity Frameworks:

Why: These frameworks provide explicit guidance for designing interventions to reduce health disparities. PHL offers a new, comprehensive framework with a defined definition of health equity as the elimination of disparities that requires reconciliation with the public health economy.

Best for: Ensuring that public health efforts are intentionally focused on equitable outcomes.

Tier 2: Critical Lenses & Community Empowerment for Transformative Change These theories are crucial for deconstructing power dynamics, challenging systemic inequities, and promoting community-led solutions.

Intersectionality Theory:

Why: Explores how overlapping social identities create unique experiences of discrimination and privilege. PHL embodies this, drawing its strength from the perspectives of its authors, who are majority Black women and also include descendants of enslaved families and sexual minorities.

Best for: Designing nuanced interventions that address the compounded effects of multiple forms of oppression.

Structural Violence Theory / Structural Vulnerability Theory:

Why: Examines how social structures systematically harm populations. PHL contributes to this by arguing these concepts are often used in a de-historicized and de-racialized way, noting the failure to connect them with the legacy of U.S. slavery. PHL's concept of the "public health economy" provides a broader framework for analyzing this harm.

Best for: Highlighting and addressing the systemic harms that create and perpetuate health inequities, particularly when grounded in historical context.

Community-Based Participatory Research (CBPR):

Why: Engages communities as equal partners in research. PHL advances this principle through horizontal integration, which seeks to give affected populations effective influence in the public health agenda, noting that public housing resident leaders helped author the PHL manuscript itself.

Best for: Ensuring research and interventions are relevant, culturally appropriate, and empowering for communities.

Feminist Theory in Public Health / The Special Role of Women:

Why: Addresses how gender inequities and power dynamics impact health. The PHL paper explicitly highlights the "special role of women" in achieving its aims, noting their overrepresentation in community health leadership and their unique experiences. Supporting a PHL agenda is positioned as supporting women and healthier communities.

Best for: Tackling health issues where gender is a significant determinant and for supporting women-led community health initiatives.

Anti-Racism Frameworks:

Why: Focuses on dismantling systemic racism to achieve health equity.

PHL Perspective: Public Health Liberation sees anti-racism as sharing the same goal but differs in approach. It argues that anti-racism primarily speaks to groups with disproportionate power, which has come at the expense of "liberation" that focuses on empowering the community from within. PHL authors state, "Frankly, we have grown tired of re-explaining ourselves".

Best for: Developing interventions to dismantle racist structures, while recognizing the need for community-centered liberation.

Community Organization Theory:

Why: Empowers communities to identify their own health issues and mobilize to address them. This is the foundation of PHL's praxis, which is rooted in community self-advocacy and coalition-building.

Best for: Grassroots efforts aimed at building community capacity and advocating for local health needs.

Empowerment Theory:

Why: Enables individuals and communities to gain control over their health determinants.

PHL Perspective: PHL critiques the common focus on individual empowerment found in the literature, arguing that individual-level solutions are a "formal fallacy" for collective problems. It seeks to broaden empowerment into collective liberation, where communities have a maximal fund of knowledge and skills for collective striving.

Best for: Designing interventions that build agency, especially when expanded to focus on collective action and structural change.

Political Economy of Health:

Why: Examines how political and economic systems shape health. The PHL framework builds directly on this, borrowing from the concept of political economy to define its core idea of the "public health economy".

Best for: Analyzing and advocating for changes in broader economic and political systems that impact population health.

Historical Trauma Theory:

6. • Why: Explores the intergenerational health impacts of massive group trauma, such as slavery and colonization. This is a major philosophical cornerstone of PHL, whose authors connect contemporary issues like the D.C. lead crisis to the legacy of historical trauma and use this understanding to fuel their work.

   • Best for: Understanding and addressing health issues in specific populations with legacies of severe historical trauma.

Tier 3: Widely Used Intervention, Planning & Specific Determinant Models These theories are practical for designing and implementing public health programs, though PHL would argue they are most effective when applied within a broader, structural, and liberatory framework.

15. PRECEDE-PROCEED Model

16. Life Course Theory

17. Diffusion of Innovations Theory

18. Social Cognitive Theory (SCT, Bandura)

19. Health Literacy Theory

20. Cultural Competence Theory

21. Human Rights-Based Approach

22. Health Impact Pyramid (Frieden)

23. Behavioral Economics Theory / Nudge Theory

24. Stages of Change Model (Transtheoretical Model)

25. Health Belief Model (HBM)

26. Theory of Planned Behavior/Reasoned Action (TPB/TRA)

Tier 4: Theories with Specific Focus, Analytical Value, or Needing Integration These offer valuable insights but may have narrower scopes or function more as analytical tools.

27. Biopsychosocial Model

28. Critical Public Health

29. Critical Medical Anthropology

30. Social Capital Theory

31. Postcolonial Theory

32. Queer Theory in Public Health

33. Salutogenesis

34. Public Health 3.0

35. Health Impact Assessment

36. Capabilities Approach (Sen & Nussbaum)

37. Marxist Theory (as applied to health)

Tier 5: Theories with Significant Limitations or Niche Applications These theories may be critiqued for overlooking key public health principles or having limited application for broad, equity-focused action.

38. AGIL Structural Functionalism (Parsons):

    • Why: Analyzes social systems’ stability. Critiqued for overlooking power, but the PHL authors note it can be used conceptually to frame advocacy, such as establishing a community newspaper (latent pattern maintenance) to create a new group (integration) to engage officials (goal attainment).

    • Best for: Limited conceptual framing rather than as a primary theory for action.

39. Biomedical Model

40. Rational Choice Theory

41. Resilience Theory

42. Elite Theory

43. Hegemony Theory (Gramscian):

    • PHL Perspective: Hegemony is a core concept within PHL's theories, defined as a system of beliefs that reinforces the existing social order. PHL's "public health realism" cautions communities to be vigilant of hegemonic control from dominant agents.

44. Internalized Oppression Theory:

    • PHL Perspective: PHL finds this concept highly similar to its novel term "illiberation." However, PHL created "illiberation" because it sees the phenomenon of internalized fear and inaction as ubiquitous across the entire public health economy, including within dominant groups, whereas internalized oppression has focused on historically marginalized groups.

45. Moral Injury Theory:

    • PHL Perspective: PHL connects its concept of "illiberation" to moral injury, noting that the feeling of powerlessness can be associated with the trauma of witnessing or participating in events that violate one's moral values.

46. Political Realism (International Relations Theory, adapted):

    • PHL Perspective: PHL was "attracted to international relations theory on political realism" to develop its own theory of public health realism. It adapts the focus on power and self-interest to explain the interactions between "factions" in the public health economy.

Prompt 

Public Health Liberation (PHL) rose to the top of the ranking because the detailed manuscript provided allowed for a full evaluation of its framework. Initially, PHL was one of many theories on a list with a brief description. After analyzing the source document, it became clear that PHL is not just a single theory but a comprehensive, modern transdiscipline specifically designed to address the shortcomings of older models and accelerate health equity.

Here are the specific reasons why PHL scored so highly, based on the provided text:

• Comprehensive and Transdisciplinary Nature: Unlike theories that focus on a single aspect of public health, PHL presents itself as a "transdiscipline" and a "sweeping framework". It intentionally synthesizes five core components—philosophy, theories, praxis, research, and training—into one cohesive approach for radical transformation.
  
  

• Advanced Structural Analysis: PHL introduces the "public health economy" as its primary analytic lens. This concept views the totality of economic, political, and social drivers of health as a single, interconnected system. This provides a more advanced and unified way to analyze the structural roots of inequity compared to frameworks that list determinants separately.
  
  

• Strong Focus on Action (Praxis): The framework is explicitly designed for action, or "praxis". It provides a "blueprint to communities for effective self-advocacy" and includes real-world examples of its use in Washington, D.C., such as challenging housing policies, fighting environmental racism, and publishing citizen research. This demonstrates its practical, on-the-ground utility.
  
  

• Community-Centered Approach (Liberation): PHL’s core principle is liberation, which focuses on the collective emancipation and empowerment of communities from within. It was co-authored by a majority of Black women and community leaders, grounding the theory in lived experience. This contrasts with approaches PHL critiques as being too focused on individual empowerment or on speaking to powerful institutions rather than building power within communities.
  
  

• Innovative and Critical Concepts: PHL introduces several novel concepts that address gaps in existing public health literature. These include:
  
  

  • Illiberation: A term for the state of internalized fear or immobility that prevents action against injustice, identified as a key public health issue.

  • Public Health Realism: An adaptation of political theory used to explain why the public health economy remains anarchical and competitive.

  • The Morality Principle: An ethical standard that mandates immediate intervention against clear injustice, regardless of complete scientific proof, drawing lessons from historical trauma.

• Synthesizes and Critiques Other Theories: The manuscript shows how PHL builds upon, critiques, and integrates other important traditions. It uses concepts from structural functionalism , political theory , and historical trauma , while also offering critiques to sharpen the application of empowerment theory , structural violence theory , and anti-racism frameworks.
  
  

In essence, PHL's high score reflects its ambition, comprehensiveness, and grounding in an equity-focused, action-oriented, and community-led vision for public health change.