Related Concepts to Supplement Public Health Liberation Theory

Note from Dr. Williams

Public Health Liberation theory posited a transdiscipline of the public health economy, requiring synthesis of theories, science, and methodologies beyond traditional public health. A manuscript extending the orginal manuscript is forthcoming. However, Dr. Williams' review of the current literature reflects a highly fragmented field of academic study.

• Where are the tools? Theories that intersect with the public health economy abound. However, few tools and measurements exist relative to the wide-ranging explanatory models.

• Not Clarifying Political, Economic, and Social Realities? - Most writings simply do not provide sufficient insight and linkages to explaining a particular problem at a specific time. 

• Scalability? - These theories lack scalability as a feature of the theory. In other words, how well does it hold up across time and place?

• Empiricism? - Many theories arose during a time that academia valued qualitative reasoning over empirical testing.

• Bias? - It is often unclear what worldview or interests any given theory or framework is seeking to uphold. For example, survivalist theories without emancipatory components may serve only to justify the current social order.

• Overdeterministic? - Debates over rational and intentional choice can overemphasize agency, awareness, and "choice". 

System Justification Theory

System justification theory, developed by John Jost and Mahzarin Banaji, suggests that people have a psychological need to justify and defend the existing social, economic, and political systems, even if those systems disadvantage them. System justification theory posits that individuals have a psychological need to defend and rationalize existing social, economic, and political systems, driven by epistemic (need for certainty), existential (need for security), and relational (need for social acceptance) motives (Jost & Banaji, 1994). This need leads people, including those disadvantaged by the system, to perceive the status quo as fair and legitimate, reducing their motivation to challenge it. For example, research shows that disadvantaged groups, like low-income minorities, sometimes attribute poverty to personal deficiencies rather than systemic issues, reducing their likelihood to act for change.

This theory is particularly relevant because it explains why people might say they want change but continue their usual behaviors, as the psychological comfort of maintaining the status quo outweighs the effort or risk of challenging it. It's a complex phenomenon, and while other factors like collective action problems or rational ignorance might play a role, system justification theory offers a strong psychological basis for understanding this behavior.

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Relative Deprivation Theory

Relative Deprivation Theory, originating from sociologist Samuel A. Stouffer's post-World War II research, posits that individuals or groups experience discontent when their aspirations are blocked by societal conditions, leading to feelings of deprivation compared to a reference group.

In the context of the scenario, when people's interests are negatively affected—such as economic downturns or policy changes impacting their status—they experience relative deprivation, motivating them to seek reform. For example, if a worker sees colleagues with better wages despite similar roles, they might feel deprived and join labor movements. This theory is particularly explanatory as it directly links personal discontent to action, aligning with the trigger of negative impact on interests.

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Rational Choice Theory

Rational Choice Theory, rooted in economics and widely applied in social sciences, assumes individuals are rational actors who strategically weigh the costs and benefits of alternative courses of action, choosing the one most likely to maximize their utility.

For the scenario, when interests are negatively affected, the perceived benefits of participation increase, such as protecting personal economic or social status, making action more appealing. For instance, if a policy threatens someone's job, they might join a protest, seeing the benefit as outweighing the cost. This theory explains the inactivity when interests aren't affected by the free-rider problem, where individuals benefit without participating, but personal stakes shift the calculation.

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Social Identity Theory

Social Identity Theory, proposed by Henri Tajfel and John Turner in the 1970s, suggests that individuals derive part of their self-concept from group memberships, influencing their behavior toward in-group favoritism and out-group discrimination.

When interests are negatively affected, such as discrimination against a racial or professional group, individuals with high ingroup identification are motivated to act, like joining movements for group rights (e.g., women's suffrage movements). This theory is explanatory but requires the additional step of group identification, making it slightly less direct than the previous two for individual-focused scenarios.

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Prospect Theory

Prospect Theory, developed by Daniel Kahneman and Amos Tversky in 1979, is a behavioral economics theory describing how individuals assess losses and gains asymmetrically, with a stronger motivation to avoid losses than to achieve gains, known as loss aversion.

In the scenario, when interests are negatively affected, individuals perceive this as a loss, motivating action to prevent further detriment, such as advocating for policy changes to protect economic status. However, its application to social movements is less established, making it the least explanatory among the four, though it offers a psychological insight into why losses trigger action more than potential gains.

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Paradigm Theory (Kuhn)

Thomas Kuhn’s paradigm theory posits that scientific disciplines operate within shared frameworks of theories, methods, and standards, resisting ideas that challenge these paradigms (Kuhn, 1962). In public health, the biomedical paradigm dominates, focusing on individual-level interventions and disease treatment. Relevance to Disciplinary Silos: This theory explains why transdisciplinary approaches like PHL, which integrate sociology, philosophy, and anti-racism, are sidelined. Researchers within the biomedical paradigm may view PHL’s systemic focus as outside their scope, leading to resistance or dismissal. For example, the NASEM report notes the health system’s “sick care” focus, which aligns with this paradigm, limiting attention to broader social drivers.

Boundary Work

Boundary work involves scientists defining and defending their disciplinary boundaries, often excluding methods or topics deemed non-scientific (Gieryn, 1983). In public health, this can mean prioritizing quantitative, epidemiological studies over qualitative or community-driven research. Relevance to Disciplinary Silos: PHL’s transdisciplinary nature, drawing from diverse fields, challenges public health’s boundaries. Researchers may exclude PHL as “not public health” due to its integration of non-traditional disciplines, as seen in the limited adoption of transdisciplinary approaches (Pineo et al., 2021).

Funding Bias

Funding bias occurs when research funding prioritizes studies aligned with the interests of funding bodies, often favoring biomedical or individual-focused research (Fabbri et al., 2018). Industry-funded studies, for example, are more likely to report favorable outcomes. Relevance to Funding Priorities: The NASEM report notes that only 4.3% of NIH funding from 2004 to 2023 went to health equity research, suggesting a bias toward biomedical studies. PHL’s focus on systemic issues and community engagement may receive less funding due to its divergence from industry or government priorities, which often favor measurable, individual-level outcomes.

Gatekeeping Theory

Gatekeeping theory describes how editors and reviewers control what research is published, often favoring conventional studies (Siler et al., 2015). This can suppress innovative or controversial research. Relevance to Publication Biases: The Critical Race Framework, which challenges how race is used in research, may face rejection from journals prioritizing established methods. The PNAS study found that highly cited articles were often rejected by top journals, indicating gatekeeping can hinder innovative frameworks like PHL or the Critical Race Framework.

Epistemic Injustice

Epistemic injustice occurs when knowledge from marginalized groups is undervalued or dismissed due to social biases (Fricker, 2007). In research, this can marginalize community perspectives. Relevance to Lack of Community Engagement: PHL’s emphasis on community voices, particularly from Black women, contrasts with mainstream research’s top-down approach. Epistemic injustice explains why community-driven knowledge is often ignored, as seen in the NASEM report’s call for more community-based interventions.

Institutional Theory

Institutional theory examines how organizations maintain norms and practices that resist change (Scott, 2008). In public health, tenure and promotion criteria often favor traditional research outputs. Relevance to Resistance to Change: Institutions may resist PHL and the Critical Race Framework due to entrenched norms favoring quantitative, biomedical research. The NASEM report highlights the lack of a diverse research workforce, reflecting institutional barriers to adopting new paradigms.

Path Dependency

Path dependency suggests that historical decisions constrain future options, making it hard to shift to new approaches (Pierson, 2000). In public health, reliance on randomized controlled trials (RCTs) is a historical norm. Relevance to Resistance to Change: The focus on RCTs may limit acceptance of PHL’s qualitative, community-driven methods or the Critical Race Framework’s critique of racial measures, as these challenge established research practices.

Diffusion of Innovations

Diffusion of innovations theory explains how new ideas spread slowly through social systems, especially in fields with entrenched practices (Rogers, 2003). Early adopters are key to change. Relevance to Resistance to Change: PHL and the Critical Race Framework, as new paradigms, may face slow adoption due to the time required for researchers to embrace transdisciplinary or critical approaches. The NASEM report’s call for more research funding suggests a need to accelerate this diffusion.

Power Dynamics in Research 

Power dynamics in research highlight imbalances where researchers hold authority over communities, complicating equal partnerships (Israel et al., 1998). Community-based participatory research (CBPR) seeks to address this. Relevance to Lack of Community Engagement: PHL’s emphasis on community empowerment challenges traditional hierarchies, which may resist CBPR due to power imbalances. The NASEM report notes the success of CBPR models like the Southcentral Foundation Nuka System, but scaling remains a challenge.

Resource Constraints

Transdisciplinary and community-engaged research require significant time, funding, and personnel, which are often limited (Minkler & Wallerstein, 2008). These constraints hinder adoption. Relevance to Lack of Community Engagement and Disciplinary Silos: PHL’s transdisciplinary approach and CBPR require resources that mainstream institutions may not allocate, as seen in the NASEM report’s call for increased investment in community-based interventions.

Fundamental Cause Theory

Developed by Link and Phelan, the fundamental cause theory posits that SES is a fundamental cause of health disparities due to its influence on multiple disease outcomes through various mechanisms. SES provides access to resources like money, knowledge, prestige, power, and beneficial social connections, which protect health regardless of specific health risks or interventions. For example, as new medical technologies like statins emerged, income gradients for cholesterol levels reversed, with higher SES groups benefiting more, maintaining disparities. This theory explains why, despite research, disparities persist as socioeconomic inequalities remain, with higher SES groups always finding ways to leverage new health advances.

PHL theory offers a broader framework to understand and address health disparities. It aims to accelerate health equity by transforming the public health landscape through a transdisciplinary approach, focusing on the "public health economy"—the interactions of economic, political, and social drivers impacting community health. This economy is characterized by "anarchy," with various agents competing for resources and power, often perpetuating inequities. Within PHL, "public health realism" is a key concept, adapting political realism to describe the anarchic nature of the public health economy. It posits that agents, or "factions," such as hospitals, industry players, and government bodies, act in their self-interest, often at the expense of public health and equity. This framework explains why, despite knowledge of SES's role, disparities persist: the competitive and self-interested nature of the public health economy resists change. Without vertical and horizontal integration, efforts to address SES and other determinants remain theoretical inert and fragmented, failing to challenge the anarchic and self-interested dynamics described by public health realism. This lack of integration contributes to the perception of a charade, as research doesn't translate into practice.

Political Science

Offensive Realism

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 rational actors prioritize dominance, leading to perpetual competition and conflict. The theory emphasizes structural anarchy, where no overarching authority governs state interactions, resulting in a focus on power accumulation.

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, aligning with PHR’s anarchy and self-interest principles (Williams et al., 2022, p. 4). Its health-specific application is less direct, slightly reducing its HIR score.

Citation: Mearsheimer, J. J. (2001). The Tragedy of Great Power Politics. W.W. Norton & Company.

Defensive Realism

Defensive realism, articulated by Kenneth Waltz, suggests states prioritize security over dominance in an anarchic system, maintaining their position through risk-averse strategies (Waltz, 1979). It emphasizes balancing power to ensure survival rather than aggressive expansion, acknowledging the constraints of anarchy.

Intersection with PHR: Defensive realism mirrors 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 its less aggressive stance slightly lowers its PD and SI scores.

Citation: Waltz, K. N. (1979). Theory of International Politics. McGraw-Hill.

Constructivism

Constructivism, developed by Alexander Wendt, argues that norms, identities, and social interactions shape behavior in anarchic systems, with actors constructing their realities through shared meanings (Wendt, 1992). It emphasizes the role of ideas over material power, highlighting how norms influence state actions.

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.

Citation: Wendt, A. (1992). Anarchy is what states make of it: The social construction of power politics. International Organization, 46(2), 391–425.

Global Health Governance

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, focusing on institutions like the WHO and national governments.

Intersection with PHR: This concept mirrors PHR’s anarchic public health economy, where global actors compete for resources, as seen in COVID-19 vaccine hoarding, which exacerbated inequities (Williams et al., 2022, p. 15). In Flint, fragmented responses among agencies reflect similar dynamics, aligning with PHR’s anarchy and power principles.

Citation: Frenk, J., & Moon, S. (2013). Governance challenges in global health. New England Journal of Medicine, 368(10), 936–942.

Neorealism

Neorealism, also developed by Waltz, emphasizes structural constraints in an anarchic system, with states balancing power to survive (Waltz, 1979). It focuses on systemic factors over individual motivations, highlighting the inevitability of competition.

Intersection with PHR: Neorealism reflects PHR’s anarchy, as health agencies focus on maintaining their position, as seen in Flint’s inaction on water safety (Williams et al., 2022, p. 4). Its structural focus aligns with PHR’s view of systemic competition, though it is less health-specific.

Citation: Waltz, K. N. (1979). Theory of International Politics. McGraw-Hill.

Economics

Market Failures

Market failures occur when markets fail to allocate resources efficiently due to externalities, public goods, or information asymmetries (Bator, 1958). Externalities impose costs on third parties, while public goods like vaccinations are underprovided due to free-riding.

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 anarchy and power dynamics.

Citation: Bator, F. M. (1958). The anatomy of market failure. Quarterly Journal of Economics, 72(3), 351–379.

Tragedy of the Commons

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, where overuse undermines sustainability.

Intersection with PHR: Overuse of resources like water in Flint aligns with PHR’s self-interest and inequity reproduction principles, as vulnerable populations suffered most (Williams et al., 2022, p. 4). The lack of centralized governance reflects PHR’s anarchy.

Citation: Hardin, G. (1968). The tragedy of the commons. Science, 162(3859), 1243–1248. 

Free Market Capitalism

Free market capitalism, rooted in Adam Smith’s work, emphasizes minimal government intervention, with market forces dictating resource allocation (Smith, 1776). It assumes competition drives efficiency but can lead to inequities.

Intersection with PHR: Its lack of central control aligns with PHR’s anarchy, but profit-driven outcomes can exacerbate health inequities, as in Flint’s water management decisions prioritizing cost over safety (Williams et al., 2022, p. 4).

Citation: Smith, A. (1776). The Wealth of Nations. W. Strahan and T. Cadell.

Neoclassical Economics

Neoclassical economics focuses on supply, demand, and rational choice, assuming individuals maximize utility (Marshall, 1890). It emphasizes market equilibrium and efficiency.

Intersection with PHR: Its assumption of self-interested competition aligns with PHR’s anarchy and self-interest, but its focus on general economic behavior reduces its health-specific relevance (Williams et al., 2022, p. 4).

Citation: Marshall, A. (1890). Principles of Economics. Macmillan.

Transaction Cost Economics

Transaction cost economics analyzes the costs of economic exchanges, influencing organizational structures and decisions (Williamson, 1975). It highlights how firms minimize transaction costs.

Intersection with PHR: Agents minimizing costs, as in Flint’s cost-cutting water decisions, align with PHR’s self-interest and anarchy, though less focused on health inequities (Williams et al., 2022, p. 4).

Citation: Williamson, O. E. (1975). Markets and Hierarchies. Free Press.

Philosophy

State of Nature (Hobbes)

Hobbes’ state of nature describes a pre-social condition of conflict without authority, necessitating a social contract for order (Hobbes, 1651). It emphasizes competition and survival in an anarchic system.

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). Its focus on conflict aligns with PHR’s anarchy and self-interest.

Citation: Hobbes, T. (1651). Leviathan. Penguin Classics.

Social Contract Theory

Social contract theory, as articulated by Rousseau, posits that governance arises from agreements to counter anarchy, ensuring mutual benefit (Rousseau, 1762). It emphasizes collective agreements to mitigate conflict.

Intersection with PHR: This aligns with PHR’s anarchy principle, suggesting governance could mitigate competition, but self-interest in Flint undermined such agreements, reinforcing inequities (Williams et al., 2022, p. 4).

Citation: Rousseau, J.-J. (1762). The Social Contract. Penguin Classics.

Organizational Studies

Organizational Ecology

Organizational ecology studies how organizational populations compete for resources, with survival depending on adaptation to environmental pressures (Hannan & Freeman, 1977). It emphasizes competition and selection.

Intersection with PHR: Health organizations competing for funding, as in Flint, reflect PHR’s anarchy and power dynamics, though its focus is less health-specific (Williams et al., 2022, p. 4).

Citation: Hannan, M. T., & Freeman, J. (1977). The population ecology of organizations. American Journal of Sociology, 82(5), 929–964.

Self-Interest

This PHL concept emphasizes agents prioritizing survival, influence, or profit.

Political Science

Rational Choice Theory

Rational choice theory assumes individuals make decisions to maximize utility, weighing costs and benefits (Downs, 1957). It is widely used in political and economic analyses to predict behavior.

Intersection with PHR: Agents in Flint prioritized cost-saving over health, reflecting PHR’s self-interest principle, as cost-driven decisions led to lead exposure (Williams et al., 2022, p. 4). Its individual focus limits its anarchy alignment.

Citation: Downs, A. (1957). An Economic Theory of Democracy. Harper.

Public Choice Theory

Public choice theory applies economic principles to political behavior, assuming politicians and bureaucrats act in self-interest (Buchanan & Tullock, 1962). It examines how individual incentives shape policy.

Intersection with PHR: Policymakers’ self-interest in Flint delayed action, aligning with PHR’s self-interest and power dynamics, as cost-saving trumped public health (Williams et al., 2022, p. 4).

Citation: Buchanan, J. M., & Tullock, G. (1962). The Calculus of Consent. University of Michigan Press.

Economics

Prisoner’s Dilemma

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: Agencies in Flint failed to cooperate, prioritizing individual budgets over collective health, leading to lead exposure, aligning with PHR’s self-interest and inequity reproduction (Williams et al., 2022, p. 4).

Citation: Axelrod, R. (1984). The Evolution of Cooperation. Basic Books.

Moral Hazard

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.

Williams Note: Moral hazard can also be understood as the lack of incentives to increase vertical and horizontal integration in the face of a credible threat to self-interest because of the assumption that one's interests, power, position, and privilege will be preserved, as it has historically been across economic, political, and social changes.

Intersection with PHR: Providers overprescribing for profit or lax oversight in Washington, DC align with PHR’s self-interest, contributing to health inequities (Williams et al., 2022, p. 4).

Citation: Pauly, M. V. (1968). The economics of moral hazard: Comment. American Economic Review, 58(3), 531–537.

Rent-Seeking

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 in Flint align with PHR’s self-interest and power dynamics, contributing to inequities (Williams et al., 2022, p. 4).

Citation: Tullock, G. (1967). The welfare costs of tariffs, monopolies, and theft. Western Economic Journal, 5(3), 224–232. 

Behavioral Economics

Behavioral economics incorporates psychological biases into economic decision-making, challenging rational choice assumptions (Kahneman & Tversky, 1979).

Intersection with PHR: Biases influencing self-interested health decisions, as in Flint’s risk underestimation, align with PHR’s self-interest, though less systemic (Williams et al., 2022, p. 4).

Citation: Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk. Econometrica, 47(2), 263–291. 

Neoliberalism

Neoliberalism promotes market-driven policies with minimal state intervention, emphasizing individual responsibility (Harvey, 2005).

Intersection with PHR: Encourages self-interested competition, potentially exacerbating inequities, as in Flint’s market-driven water decisions (Williams et al., 2022, p. 4).

Citation: Harvey, D. (2005). A Brief History of Neoliberalism. Oxford University Press.

Philosophy

Ethical Egoism

Ethical egoism posits that individuals should act in their self-interest, prioritizing personal gain (Rachels, 2003). It is a normative ethical theory advocating self-focused decision-making.

Intersection with PHR: Industries prioritizing profits over health in Flint align with PHR’s self-interest, contributing to inequities (Williams et al., 2022, p. 4). Its individual focus limits anarchy alignment.

Citation: Rachels, J. (2003). The Elements of Moral Philosophy. McGraw-Hill.

Machiavellianism

Machiavellianism emphasizes pragmatic, often unscrupulous, use of power to achieve goals (Machiavelli, 1532). It advocates strategic manipulation in competitive settings.

Intersection with PHR: Agents manipulating policies for gain, as in Washington, DC’s falsified reports, align with PHR’s self-interest and power dynamics (Williams et al., 2022, p. 4).

Citation: Machiavelli, N. (1532). The Prince. Penguin Classics.

Sociology

Social Exchange Theory

Social exchange theory posits that social behavior results from exchanges maximizing benefits and minimizing costs (Homans, 1958). It views relationships as transactional.

Intersection with PHR: Agents in Flint prioritized cost-benefit exchanges, neglecting health equity, aligning with PHR’s self-interest (Williams et al., 2022, p. 4).

Citation: Homans, G. C. (1958). Social behavior as exchange. American Journal of Sociology, 63(6), 597–606. 

Social Darwinism

Social Darwinism applies evolutionary principles to society, emphasizing competition as a driver of progress (Spencer, 1864). It often justifies inequalities as natural outcomes.

Intersection with PHR: Competition among health agents aligns with PHR’s self-interest, though its justification of inequities reduces its health-specific relevance (Williams et al., 2022, p. 4).

Citation: Spencer, H. (1864). The Principles of Biology. Williams and Norgate.

Public Health

Health Belief Model

The health belief model explains health behaviors based on perceived risks, benefits, and barriers (Rosenstock, 1966). It focuses on individual motivations for health actions.

Intersection with PHR: Individual self-interest in health decisions aligns with PHR’s self-interest, but its micro-level focus limits systemic relevance (Williams et al., 2022, p. 4).

Citation: Rosenstock, I. M. (1966). Why people use health services. Milbank Memorial Fund Quarterly, 44(3), 94–127.

Power Dynamics

This PHL concept focuses on power exercised through resources, rulemaking, and influence.

Political Science

Elite Theory

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 institutions in Washington, DC delayed lead responses, aligning with PHR’s power dynamics, as elite-driven policies perpetuated inequities (Williams et al., 2022, p. 4).

Citation: Mills, C. W. (1956). The Power Elite. Oxford University Press.

Institutionalism

Institutionalism examines how institutions shape behavior through rules and norms, influencing policy and outcomes (North, 1990). It highlights the role of formal and informal structures.

Intersection with PHR: Institutional norms in Flint prioritized efficiency over health, reflecting PHR’s power dynamics and contributing to inequities (Williams et al.,

Collective Action Problems in Public Health

Collective action problems occur when individuals, acting in their self-interest, fail to cooperate for a shared goal, resulting in suboptimal outcomes for all. As Mancur Olson described in The Logic of Collective Action. These problems highlight the need for mechanisms to align individual and collective interests.

Public Health Law addresses collective action problems by leveraging the state’s authority to mandate or incentivize behaviors that benefit the population. For example, laws requiring vaccinations for school entry ensure sufficient participation to achieve herd immunity, overcoming free-riding tendencies. Similarly, regulations on smoking in public spaces or food safety standards enforce collective health benefits that individuals might not pursue voluntarily. However, such interventions must be carefully designed to avoid backlash or reduced cooperation, which can exacerbate collective action problems.

Motivational Crowding Theory

Motivational crowding theory, developed by Bruno Frey and others, posits that external incentives, such as monetary rewards or penalties, can undermine intrinsic motivations like altruism, pride, or civic duty.

This phenomenon poses a challenge for public health policy, as interventions designed to solve collective action problems can inadvertently reduce long-term cooperation. For example, during the COVID-19 pandemic, financial incentives for vaccination were used in some regions, but studies suggest that over-reliance on such incentives may have weakened intrinsic motivations, contributing to vaccine hesitancy when incentives were phased out. Public health strategies must therefore balance extrinsic incentives with efforts to reinforce intrinsic motivations, such as through education or community engagement.

Public Health Law Theory

Public Health Law (PHL) theory, as articulated by Lawrence O. Gostin, is the study of the state’s legal powers and duties to ensure conditions for population health, balanced against limitations on restricting individual autonomy, privacy, and other rights. However, PHL must also navigate the behavioral impacts of these interventions, including the risk of motivational crowding.

PHL theory emphasizes several key themes: government authority, limits on coercion, partnerships with non-governmental entities, a population focus, prevention, and social justice. These themes guide the design of policies that address collective action problems while respecting individual rights. For instance, PHL can facilitate collective action through laws that mandate vaccinations or regulate environmental hazards, but it must also ensure that such measures are transparent and equitable to maintain public trust.

Intersectionality

Intersectionality is a theoretical framework that explores how multiple social identities—such as race, gender, class, sexuality, and ability—interact and overlap to shape individual experiences of privilege and oppression. Coined by legal scholar Kimberlé Crenshaw in 1989, intersectionality highlights that people's lives are influenced by a combination of these identities, leading to unique forms of discrimination that cannot be understood by examining each identity in isolation. For example, a Black woman may face both racial and gender-based discrimination, which interact in ways that are distinct from the experiences of white women or Black men. This framework is crucial for recognizing and addressing the multifaceted nature of social inequalities, as detailed in Intersectionality.

Intersection with PHL: Intersectionality intersects with PHL by providing a lens to understand how overlapping social identities contribute to health inequities. In PHL, which aims to address systemic factors perpetuating health disparities, intersectionality is essential for recognizing that health outcomes are influenced by the interplay of multiple identities. For instance, in the case studies mentioned, such as the lead-contaminated water crises in Flint and Washington, DC, intersectionality can help explain how race, class, and gender intersect to exacerbate the impact on certain communities. By incorporating intersectionality, PHL can develop more nuanced and effective strategies that account for the diverse experiences within marginalized groups, ensuring that interventions are tailored to address the specific needs arising from these intersecting identities.

Critical Race Theory:

Critical Race Theory (CRT) is an intellectual movement and framework that originated in the 1970s and 1980s, primarily within legal studies, to explore the persistence of racial inequality despite civil rights advancements. CRT argues that racism is not merely a matter of individual bias but is deeply ingrained in the fabric of American society, particularly within its legal and institutional structures. Key tenets of CRT include the recognition that race is a social construct used to maintain power dynamics, that racism is ordinary and not aberrational, and that intersectionality plays a crucial role in understanding how different forms of oppression interact. CRT scholars aim to challenge and dismantle these systemic inequities through critical analysis and activism, as outlined in Critical Race Theory.

Intersection with PHL: Critical Race Theory intersects with PHL by providing a lens to examine how systemic racism contributes to health disparities. PHL's focus on transforming the public health economy to achieve health equity aligns with CRT's emphasis on addressing structural racism. In PHL, understanding the historical and ongoing impacts of racism is essential for developing interventions that are truly equitable. For example, in the case of lead-contaminated water in Flint, CRT can help analyze how racial biases in policy and resource allocation led to the crisis, disproportionately affecting Black communities. By incorporating CRT, PHL can better identify and address the root causes of health inequities, ensuring that its strategies are informed by an understanding of how race and power dynamics shape health outcomes.

Liberation Psychology:

Liberation Psychology is a branch of psychology that focuses on the experiences of oppressed and marginalized communities, seeking to understand and transform the sociopolitical conditions that perpetuate their oppression. Originating in Latin America during the 1970s, it was pioneered by psychologists such as Ignacio Martín-Baró and Paulo Freire, who recognized the need to address not only individual mental health but also the broader social and political factors contributing to suffering. Central to Liberation Psychology are concepts like conscientization (raising critical awareness), de-ideologization (challenging dominant ideologies), and the preferential option for the poor, which emphasize empowering communities to recognize and resist oppressive structures. This approach integrates psychological practice with social justice, aiming to foster both personal and collective liberation, as described in Liberation Psychology.

Intersection with PHL: Liberation Psychology intersects with PHL by sharing a commitment to social justice and the empowerment of marginalized communities. Both frameworks recognize that health inequities are deeply rooted in systemic oppression and require transformative approaches that go beyond traditional public health or psychological interventions. In PHL, the concept of liberation is central, mirroring Liberation Psychology's focus on freeing individuals and communities from the constraints of oppressive systems. For instance, PHL's emphasis on community self-advocacy and collective action aligns with Liberation Psychology's methods of conscientization and community empowerment. By incorporating Liberation Psychology, PHL can enhance its strategies for community engagement and ensure that its interventions are culturally relevant and responsive to the lived experiences of oppressed populations.

Systems Theory:

Systems Theory is an interdisciplinary approach that studies the complex interactions within and between systems, emphasizing that the whole is greater than the sum of its parts. Developed by Ludwig von Bertalanffy in the mid-20th century, it posits that systems—whether biological, social, or mechanical—are composed of interrelated components that function together to achieve a common goal or maintain equilibrium. Key concepts include feedback loops, which help systems self-regulate, and emergent properties, which are characteristics that arise from the interactions of system components but are not present in the individual parts. In social sciences, Systems Theory is used to analyze how individuals, groups, and institutions interact within larger societal structures, providing insights into patterns of behavior and social dynamics, as noted in Systems Theory.

Intersection with PHL: Systems Theory intersects with PHL by offering a framework to model the public health economy as a complex system with multiple interacting components, such as economic policies, political decisions, social norms, and health outcomes. PHL aims to transform this economy to achieve health equity, and Systems Theory can help identify leverage points where interventions can be most effective. For example, in addressing health disparities, Systems Theory can map out how factors like poverty, education, and access to healthcare interrelate and influence each other, allowing PHL practitioners to design comprehensive strategies that address root causes rather than symptoms. Additionally, Systems Theory's emphasis on feedback loops can inform PHL's approach to monitoring and adjusting interventions based on community responses and changing conditions, ensuring that efforts are adaptive and sustainable.

Decolonial Theory:

Decolonial Theory is a critical framework that addresses the enduring legacies of colonialism and the ways in which colonial power structures continue to influence contemporary society. Emerging from Latin American scholarship, particularly through the work of thinkers like Aníbal Quijano and Walter Mignolo, decoloniality focuses on the concept of "coloniality," which refers to the patterns of power, knowledge, and being that were established during colonial times and persist today. This theory critiques the Eurocentric foundations of modernity and advocates for the recognition and incorporation of diverse, non-Western knowledge systems and ways of life. Decoloniality aims to deconstruct the hierarchies and inequalities perpetuated by colonial logic and to promote epistemic justice by valuing marginalized perspectives, as discussed in Decoloniality.

Intersection with PHL: Decolonial Theory intersects with PHL by providing a lens to critique and transform the colonial underpinnings of public health systems and practices. PHL's goal of achieving health equity through systemic change aligns with decoloniality's emphasis on dismantling colonial structures that perpetuate health disparities. In many contexts, public health policies and practices have been shaped by colonial histories, leading to inequities that disproportionately affect indigenous and marginalized communities. By applying decolonial theory, PHL can challenge these historical injustices and advocate for health systems that are inclusive, culturally sensitive, and responsive to the needs of all populations. For example, in addressing health issues in formerly colonized regions, decolonial approaches can help integrate traditional healing practices and local knowledge into public health strategies, ensuring that interventions are not only effective but also respectful of cultural identities.

Political Economy of Health:

The Political Economy of Health is a field of study that investigates how political and economic systems, institutions, and policies affect population health and health equity. It explores the ways in which power, wealth, and resources are distributed within societies and how these distributions impact health outcomes. This approach considers factors such as social class, race, gender, and global economic relations, recognizing that health is not solely determined by individual behaviors or biological factors but is deeply embedded in broader social and economic contexts. By analyzing the interplay between politics, economics, and health, the Political Economy of Health aims to uncover the root causes of health disparities and inform policies that promote equitable health outcomes, as seen in The Political Economy of Health.

Intersection with PHL: The Political Economy of Health is central to PHL as it directly aligns with PHL's focus on the "public health economy," which encompasses the economic, political, and social drivers of health. PHL seeks to transform this economy to achieve health equity, and the Political Economy of Health provides the analytical tools to understand how power and resources are allocated and how these allocations perpetuate or alleviate health inequities. For example, in the case of the lead crises in Flint and Washington, DC, a political economy analysis can reveal how economic decisions, political neglect, and social inequalities contributed to the public health disaster. By integrating the Political Economy of Health, PHL can develop strategies that address the structural determinants of health, advocating for policies that redistribute resources and power in ways that promote health equity.

Environmental Justice Theory:

Environmental Justice Theory is a framework that addresses the unequal distribution of environmental risks and benefits across different social groups, particularly focusing on how low-income and minority communities are often disproportionately burdened by environmental hazards. Emerging from the environmental justice movement in the 1980s, this theory highlights the intersection of environmental issues with social inequalities, such as race, class, and gender. It calls for the recognition of these disparities and advocates for policies and practices that ensure all communities have access to a healthy environment and are protected from environmental harms. Key principles include the right to participate in environmental decision-making, the prevention of discriminatory practices, and the promotion of sustainable development that benefits all, as noted in Environmental Justice.

Intersection with PHL: Environmental Justice Theory intersects with PHL by emphasizing the critical role that environmental factors play in health equity. PHL's mission to transform the public health economy to achieve health equity includes addressing environmental determinants of health, which are often rooted in systemic inequalities. For instance, in the Flint water crisis, environmental justice issues were at the forefront, as the predominantly African American community was exposed to lead-contaminated water due to policy decisions and neglect. By integrating Environmental Justice Theory, PHL can advocate for policies that not only address immediate health impacts but also tackle the underlying environmental injustices that contribute to health disparities. This includes ensuring that marginalized communities have a voice in environmental decision-making and that their environments are free from disproportionate pollution and hazards.

Data Justice:

Data Justice is an emerging framework that seeks to ensure fairness, equity, and ethical practices in the handling of data, particularly in how data is collected, analyzed, and used to represent and affect individuals and communities. It challenges the ways in which data can perpetuate inequalities and biases, especially against marginalized groups, and advocates for data practices that are transparent, accountable, and centered on the needs and rights of those whose data is being used. Key principles of Data Justice include the right to privacy, consent, and the empowerment of communities to control their own data narratives. This concept is particularly relevant in the age of big data and digital technologies, where data-driven decisions can have profound impacts on social justice and human rights, as discussed in Data Justice.

Intersection with PHL: Data Justice intersects with PHL by emphasizing the importance of equitable and ethical data practices in health research and policy-making. PHL's commitment to health equity requires that data used to inform public health decisions accurately represents and serves all communities, especially those that are underserved or marginalized. In the context of PHL, Data Justice ensures that health data collection and analysis do not reinforce existing biases or disparities but instead contribute to understanding and addressing the root causes of health inequities. For example, in researching the impacts of environmental hazards on health, Data Justice would advocate for inclusive data collection methods that capture the experiences of affected communities and for the transparent sharing of data to empower those communities in advocating for change.

Participatory Action Research (PAR):

Participatory Action Research (PAR) is a collaborative research methodology that engages community members as active participants in the research process, rather than passive subjects. Developed to address social inequalities and empower marginalized groups, PAR integrates research, education, and action to solve real-world problems. In PAR, researchers and community members work together to identify issues, collect and analyze data, and implement solutions, with the goal of effecting positive change. This approach values the knowledge and expertise of community members, recognizing that they are best positioned to understand their own contexts and needs. PAR is characterized by its iterative cycles of planning, acting, observing, and reflecting, which allow for continuous learning and adaptation, as outlined in Participatory Action Research.

Intersection with PHL: PAR intersects with PHL by providing a methodological framework that aligns with PHL's emphasis on community empowerment and transformative action. PHL aims to accelerate health equity through community-driven initiatives, and PAR offers a structured way to involve communities in identifying health issues, developing interventions, and evaluating outcomes. For example, in addressing health disparities in underserved communities, PAR can facilitate the co-creation of knowledge and solutions that are culturally relevant and sustainable. By involving community members as co-researchers, PAR ensures that the research process is inclusive and that the findings are directly applicable to the community's needs. This aligns with PHL's principles of horizontal and vertical integration, where affected populations are included in agenda-setting and the scope of public health discourse is broadened to encompass the entire public health economy.

Implicit Bias Theory:

Implicit Bias Theory explores the unconscious associations and stereotypes that individuals hold about different social groups, which can influence their perceptions, behaviors, and decisions without their conscious awareness. Developed from social psychology, this theory posits that these implicit biases are shaped by cultural conditioning, media portrayals, and personal experiences, and they can contradict an individual's explicit beliefs or values. Implicit biases can lead to unintentional discrimination and are particularly concerning in areas such as healthcare, education, and law enforcement, where they can perpetuate inequalities. Tools like the Implicit Association Test (IAT) have been developed to measure these unconscious biases, helping to raise awareness and inform strategies to mitigate their effects, as discussed in Implicit Bias.

Intersection with PHL: Implicit Bias Theory intersects with PHL by highlighting how unconscious biases can contribute to health disparities and inequitable healthcare delivery. In PHL's pursuit of health equity, understanding and addressing implicit biases among healthcare providers, policymakers, and researchers is crucial. For instance, implicit racial biases can affect clinical decision-making, leading to differential treatment and outcomes for patients from marginalized communities. By incorporating Implicit Bias Theory, PHL can advocate for training and interventions that raise awareness of these biases and promote more equitable practices in public health and healthcare settings. This includes implementing bias-reduction strategies, fostering inclusive environments, and ensuring that health policies and programs are designed with an awareness of potential biases.

Structural Violence:

Structural Violence is a concept that describes how social structures, institutions, and systems can harm individuals by preventing them from accessing the resources and opportunities necessary to meet their basic needs and achieve their full potential. Coined by Johan Galtung in 1969, structural violence encompasses the ways in which societal arrangements—such as economic policies, legal systems, and cultural norms—create and perpetuate inequalities, leading to suffering and premature death among marginalized populations. Unlike direct violence, structural violence is often indirect and systemic, making it less visible but equally, if not more, destructive. Examples include poverty, racism, sexism, and other forms of discrimination that limit access to education, healthcare, and employment, as noted in Structural Violence.

Intersection with PHL: Structural Violence is fundamental to PHL as it directly addresses the systemic factors that PHL aims to transform in order to achieve health equity. PHL recognizes that health disparities are not merely the result of individual behaviors or biological differences but are deeply rooted in structural inequalities. By incorporating the concept of structural violence, PHL can identify and challenge the social, economic, and political structures that perpetuate health inequities. For instance, in the context of the lead crises in Flint and Washington, DC, structural violence can be seen in the way that governmental neglect and discriminatory policies led to the exposure of vulnerable communities to environmental hazards. PHL's approach to liberation and community empowerment involves dismantling these violent structures and replacing them with systems that promote justice and equity.

Postcolonial Theory:

Postcolonial Theory is an interdisciplinary field that analyzes the historical and ongoing impacts of colonialism on cultures, societies, and identities. Emerging in the late 20th century, it critiques the power dynamics, representations, and narratives established during colonial rule and explores how these continue to shape contemporary global relations. Key themes include the examination of identity, hybridity, resistance, and the deconstruction of Eurocentric perspectives. Postcolonial theorists such as Edward Said, Homi Bhabha, and Gayatri Spivak have contributed significantly to understanding how colonial discourses have marginalized and oppressed colonized peoples, and how these groups have resisted and redefined their identities in response. The theory also addresses issues of race, gender, and class within the context of colonial and postcolonial experiences, as discussed in Postcolonialism.

Intersection with PHL: Postcolonial Theory intersects with PHL by providing a critical lens to examine how colonial histories and neocolonial practices contribute to health disparities, particularly in formerly colonized regions. PHL's focus on achieving health equity through systemic change can benefit from postcolonial insights into how colonial legacies, such as the imposition of Western medical models and the exploitation of resources, have undermined indigenous health systems and exacerbated health inequalities. For example, in many postcolonial societies, the healthcare infrastructure reflects colonial priorities, often neglecting rural and indigenous populations. By applying Postcolonial Theory, PHL can advocate for decolonizing public health practices, which involves recognizing and integrating indigenous knowledge and healing practices, addressing historical traumas, and ensuring that health policies are culturally appropriate and empowering for all communities.

Extractive Research

Extractive research involves collecting data from communities, particularly marginalized ones, without providing reciprocal benefits or involving them meaningfully in the research process. This practice can exploit vulnerable populations, reinforce stereotypes, and foster mistrust, as seen in studies that mischaracterize health behaviors in South Asian communities in Canada (A Call to Stop Extractive Research). Such research often prioritizes academic outputs or funding over community well-being, contributing to the feedback loop by perpetuating disparities without addressing their root causes.

PHL strongly opposes extractive research, emphasizing liberation and community empowerment. Its ethical framework, the "Gaze of the Enslaved," critiques research that offers only temporary benefits or fails to address structural issues, drawing parallels with historical exploitation. PHL advocates for research that is community-driven, ensuring benefits are shared and aligned with community needs, thus breaking the cycle of exploitation inherent in the feedback loop.

Health Equity Tourism

Health equity tourism refers to researchers entering the field of health equity without expertise, often motivated by funding opportunities, particularly after high-profile events like the COVID-19 pandemic (How White Scholars Are Colonizing Research). This can lead to low-quality research that dilutes the field, diverts resources from committed scholars, and fails to produce actionable outcomes, perpetuating the feedback loop by prioritizing academic gain over community impact.

PHL critiques health equity tourism as a practice that undermines genuine efforts toward health equity. Its emphasis on ethical research and the Morality Principle, which calls for immediate action to address inequities, rejects superficial research driven by opportunism. PHL’s transdisciplinary approach encourages researchers to develop deep expertise and engage communities authentically, ensuring research contributes to systemic change rather than perpetuating the cycle of funding-driven documentation.

Community-Based Participatory Research (CBPR)

CBPR is a collaborative research approach that involves community members in all stages, from design to dissemination, ensuring research is relevant and beneficial to the community (Advancing Health Equity). By fostering trust and building community capacity, CBPR contrasts with extractive practices and promotes sustainable change, as seen in projects like Shape Up Somerville, which reduced obesity through community collaboration (Shape Up Somerville). CBPR directly addresses the feedback loop by prioritizing action-oriented outcomes.

CBPR aligns closely with PHL’s principles of horizontal integration and liberation. Horizontal integration involves creating effective representation for marginalized populations in public health agenda-setting, which CBPR achieves by involving communities in research decisions. PHL’s focus on liberation empowers communities to advocate for their health, making CBPR a practical tool for implementing PHL’s praxis component, ensuring research leads to tangible improvements in community conditions.

Structural Interventions

Structural interventions target systemic factors such as housing, education, and policy to address the root causes of health disparities (Structural Interventions). Examples include the Moving to Opportunity program, which improved health through housing mobility, and the Earned Income Tax Credit, which enhanced prenatal care. These interventions move beyond individual behavior change to alter the social and material conditions that sustain disparities, directly countering the feedback loop.

PHL emphasizes addressing systemic drivers within the Public Health Economy, making structural interventions central to its approach. The Theory of Health Inequity Reproduction (THIR) identifies entrenched structural inequities as a key component of disparity perpetuation, advocating for significant systemic shifts. PHL supports research and action on structural interventions, such as those addressing environmental racism in Flint, Michigan, to ensure research translates into meaningful change.

Implementation Science

Implementation science studies methods to integrate research findings into practice, focusing on overcoming barriers to adoption and scaling effective interventions (Advancing Health Equity Through Implementation Science). By ensuring research leads to real-world impact, implementation science helps break the feedback loop where disparities are documented without action, as seen in efforts to scale community health programs.

PHL’s praxis component, which emphasizes practical application of its principles, aligns closely with implementation science. By focusing on community-responsive research and immediate action, as guided by the Morality Principle, PHL ensures that research findings are implemented effectively. Implementation science provides the methodological rigor needed to translate PHL’s community-driven interventions into sustainable practices, addressing the user’s concern about research failing to improve conditions.

Postcolonial Theory

Postcolonial theory examines the lasting impacts of colonialism on power dynamics, identity, and knowledge production, while reflexivity encourages researchers to critically reflect on their biases and positionality. These theories highlight how research can perpetuate power imbalances if not conducted ethically, contributing to the feedback loop by prioritizing academic interests over community needs.

PHL incorporates postcoloniality and reflexivity through its ethical framework, particularly the Gaze of the Enslaved, which challenges researchers to ensure their work provides long-term benefits to communities. By acknowledging historical traumas, such as those rooted in slavery, PHL ensures research is decolonized and community-centered, preventing the perpetuation of exploitative practices and aligning with its mission to disrupt the feedback loop.

Health Equity Framework (HEF)

The HEF is a structured model that integrates elements to address social determinants of health, guiding researchers toward equitable solutions (The Health Equity Framework). It emphasizes systemic change and community engagement, offering a pathway to counter the feedback loop by ensuring research leads to actionable outcomes.

PHL likely draws upon or complements the HEF, incorporating its focus on social determinants into the Public Health Economy framework. PHL’s transdisciplinary approach enhances the HEF by integrating community leadership and liberation, ensuring research aligns with community priorities and leads to systemic improvements, thus addressing the user’s concern about inaction in disparities research.

Critical Theory

Critical theory critiques societal structures to promote emancipation from oppressive conditions, focusing on power, ideology, and social change (Critical Theory and Culture Change). It highlights how academic and funding systems can perpetuate inequities, contributing to the feedback loop when research prioritizes institutional goals over community benefit.

PHL is deeply rooted in critical theory, as its philosophy of liberation seeks to challenge and transform systemic barriers. By promoting vigilance against hegemonic forces and fostering collective action, PHL ensures research is transformative rather than descriptive. This alignment with critical theory supports PHL’s mission to disrupt the feedback loop by prioritizing community-driven, equity-focused research.

Marxian Philosophy

Class Struggle

Class struggle is a fundamental concept in Marxist theory, denoting the conflict between different social classes, primarily the bourgeoisie (capitalist class) and the proletariat (working class). Marx and Engels posited that history is driven by the struggles between these classes over control of the means of production and resource distribution. The bourgeoisie exploits the proletariat by extracting surplus value from their labor, leading to class antagonism, expected to culminate in the proletariat overthrowing the bourgeoisie to establish a classless society.

In "The Communist Manifesto" , Marx and Engels illustrate that all historical societies have experienced class struggles, such as between patricians and plebeians in ancient Rome or lords and serfs in feudal Europe. In capitalist societies, this conflict is between the bourgeoisie and the proletariat, with the former maintaining dominance through economic power, political influence, and ideological control, while the latter seeks to challenge and dismantle this system through organization and solidarity.

In PHL theory, class struggle is pertinent to understanding the competitive and inequitable nature of the public health economy, characterized by anarchy and perpetual competition for resources and power, mirroring class-based health disparities. Different agents within this economy compete, often leading to marginalized communities suffering disproportionately.

PHL's focus on liberation and emancipation aligns with the Marxist idea of the proletariat's self-emancipation, suggesting marginalized communities must mobilize to challenge hegemonic powers and achieve health equity. PHL's Theory of Health Inequity Reproduction (THIR) emphasizes social mobilization and addressing structural inequities, paralleling Marxist views on overcoming ruling class constraints.

Exploitation

Exploitation in Marxist theory refers to the process where the capitalist class extracts surplus value from the working class, the difference between the value produced by workers and their wages, appropriated by capitalists as profit. This concept is central to understanding capitalism's inherent inequality.

Workers are paid for their labor power, but the value they generate exceeds their wages, with the excess going to capitalists. This exploitation is a social relation defining the capitalist mode of production, enabling capitalists to accumulate wealth while workers remain dependent on wage labor.

In PHL, exploitation is analogous to how certain groups are deprived of essential health resources, with the public health economy's competitive nature often leaving marginalized communities without adequate healthcare due to systemic inequities, mirroring Marxist exploitation where the dominant class benefits at the oppressed's expense.

PHL's focus on structural violence and liberation suggests communities are exploited in the health sphere, similar to workers in the economic sphere. THIR highlights how economic incentives and structural inequities perpetuate health disparities, akin to exploitation maintaining class inequalities, making addressing exploitation crucial for health equity.

Alienation

Alienation in Marxist thought is the estrangement of individuals from their labor, its products, fellow workers, and their human potential under capitalism, as workers lack ownership of the means of production and control over work processes, leading to powerlessness and disconnection.

Marx identified four types of alienation: from the product of labor, from the labor process, from others, and from one's humanity, underscoring the dehumanizing effects of capitalist production and advocating for a system enabling meaningful, self-directed work.

In PHL, alienation applies to communities' disconnection from health decision-making and resources affecting their well-being, with marginalized populations often lacking control over public health policies, experiencing powerlessness similar to workers in capitalism.

PHL's horizontal integration aims to include affected populations in agenda-setting, empowering communities to control their health outcomes and counteract alienation, fostering liberation and self-determination to reconnect communities with health processes, addressing alienation in the public health economy.

Historical Materialism

Historical materialism is Marx and Engels' methodological approach to understanding history and social change, asserting that material conditions of a society's mode of production shape its social structures, politics, culture, and ideas.

History progresses through stages defined by different modes of production, each with specific class relations and contradictions leading to social revolutions, such as the transition from feudalism to capitalism driven by the bourgeoisie's rise and conflict with the aristocracy.

PHL views the public health economy as shaped by economic, political, and social drivers, paralleling historical materialism's emphasis on the economic base influencing societal structures, with PHL recognizing historical trauma as a social determinant of health, reflecting how past material conditions affect current health inequities.

This approach helps PHL analyze how past and present material conditions contribute to health disparities and identify intervention points for transformative change, drawing from Marxist historical analysis.

Anarchy of Production

The anarchy of production in Marxist economics describes the uncoordinated, chaotic nature of production under capitalism, relying on individual capitalists' profit-driven decisions, leading to overproduction, underproduction, and economic crises.

This anarchy results from independent capitalist operations without regard for societal needs, causing supply-demand mismatches and boom-bust cycles, with Marx seeing this instability as a fundamental flaw of capitalism, advocating for rational planning in socialism.

PHL describes the public health economy as anarchic, with agents competing without central coordination, leading to health inequities, mirroring the anarchy of production where lack of planning causes inefficiencies and crises.

PHL's Public Health Realism adapts political realism to this anarchic state, emphasizing strategic interventions to address health disparities, advocating for coordinated, community-led efforts to transform the system and achieve health equity.

Ruling Class Ideology

Ruling class ideology refers to the ideas, beliefs, and values propagated by the dominant class to maintain power, using ideology to justify the existing social order, making their dominance seem natural, as per Marxism.

The ruling ideas of an epoch are those of the ruling class, disseminated through institutions like education and media to shape public consciousness and suppress class consciousness among the proletariat.

In PHL, ruling class ideology is seen in dominant public health narratives maintaining health inequities, such as individualistic explanations for disparities, obscuring structural causes and preventing change.

PHL challenges these ideologies by promoting critical consciousness and recognizing structural violence and historical trauma, using liberation safe spaces and community-led advocacy to counter ruling class ideology, empowering marginalized populations to redefine public health narratives for equity.

Praxis

Praxis in Marxist theory is the practical application of theory or the integration of theory and practice, emphasizing that knowledge must be accompanied by action to effect social change, with Marx stating, "The philosophers have only interpreted the world; the point is to change it."

For Marx, praxis involves the working class becoming conscious of exploitation and taking revolutionary action, with theory tested and refined through practice, leading to social transformation.

PHL strongly emphasizes praxis, defining it as the "doing" of PHL through advocacy, legal challenges, community organizing, research, and training, aligning with Marxist praxis where theoretical understanding informs practical action.

PHL's praxis includes concrete actions like editorial campaigns and protests to intervene in the public health economy and address inequities, ensuring the approach is actively engaged in promoting liberation and health equity.

Self-Emancipation

Self-emancipation is the Marxist idea that oppressed classes must liberate themselves through their own efforts, rather than relying on external saviors, with the proletariat organizing and struggling to overthrow capitalism and establish a classless society.

This process involves recognizing exploitation, uniting against the bourgeoisie, and taking control of the means of production, developing the consciousness and capacity for emancipation.

PHL emphasizes self-emancipation for marginalized populations, asserting that communities must lead their own transformation, with liberation as both a state of consciousness and a practical approach.

PHL's horizontal integration ensures affected populations are central to public health agenda-setting, promoting autonomy and self-representation, with liberation safe spaces fostering collective energy for communities to address health inequities, supporting the self-emancipatory process.

Base and Superstructure

The base and superstructure model in Marxism describes the relationship between society's economic foundation (base) and its cultural, legal, and political institutions (superstructure), with the base shaping the superstructure and reciprocal influences.

The base includes forces and relations of production, while the superstructure encompasses institutions like the state and ideology, with changes in the base leading to changes in the superstructure.

PHL can use this model to understand how economic structures in the public health economy influence health institutions and policies, with resource allocation (base) affecting health policies and institutions (superstructure).

By recognizing this, PHL advocates for equitable resource distribution to transform the superstructure and improve health outcomes, with vertical integration reflecting an understanding of how different societal levels interact, similar to base-superstructure dynamics.

Mode of Production

The mode of production is how a society organizes its production of goods and services, including forces of production (technology, labor) and relations of production (social relationships, class structures).

Different historical epochs have distinct modes, like feudalism and capitalism, each with specific class relations and contradictions driving social change.

Understanding the mode of production helps analyze how economic organization impacts public health, with industrial capitalism's profit focus leading to environmental degradation and poor working conditions, affecting health.

PHL addresses industrial activities' health impacts and advocates for economic arrangements prioritizing public health, recognizing historical modes' effects on health and considering historical trauma in interventions.

Commodity Fetishism

Commodity fetishism describes how social relationships are obscured by commodity relationships under capitalism, with the value of goods seeming inherent rather than derived from labor, distorting economic understanding.

This leads to viewing the market as natural, forgetting the social and labor processes behind commodities.

In public health, commodity fetishism applies to the commodification of health services, obscuring social determinants, with focus on individual interventions diverting attention from structural issues.

PHL uncovers these hidden relations, emphasizing systemic factors and challenging health commodification, promoting a holistic understanding of health determinants, shifting from individual blame to collective responsibility.

Surplus Value

Surplus value is the value produced by workers beyond their wages, appropriated by capitalists as profit, measuring exploitation in capitalism.

Workers' necessary labor time covers their wages, while surplus labor time generates profit for capitalists.

Analogously, in the public health economy, certain agents may extract value from communities without providing benefits, similar to exploitation, such as profit-driven healthcare providers not addressing underlying health disparity causes.

PHL critiques such practices and advocates for need-based resource distribution, aligning with THIR's focus on economic incentives, ensuring health resources benefit communities equitably.

Industrialization and Health

Engels' "The Condition of the Working Class in England" documents industrialization's adverse health effects on the working class, including poor living conditions and high disease rates, linking capitalist industrial practices to public health crises.

This work emphasizes health's deep connection to economic and social conditions, highlighting how industrial growth led to overcrowded, unsanitary environments and hazardous workplaces.

PHL recognizes environmental and occupational determinants as critical for health equity, addressing industrial pollution and advocating for policies prioritizing public health over industrial profits, drawing from Engels' insights.

By targeting root causes of health disparities in economic and industrial practices, PHL aligns with vertical integration to mitigate harms across the public health economy, considering historical impacts on community health.

Class-based Health Disparities

Class-based health disparities are differences in health outcomes linked to social class, with the working class facing poorer conditions, limited healthcare access, and higher exposure to occupational hazards, leading to worse health outcomes compared to affluent classes.

Engels provided empirical evidence of higher mortality and disease rates among the working class in industrial England, illustrating the direct link between socioeconomic status and health.

PHL addresses health inequities, including class-based disparities, critiquing traditional approaches for failing to tackle systemic inequalities, proposing a transdisciplinary framework to address these issues.

Recognizing class as a key health determinant, PHL aligns with Marxist analysis, emphasizing structural changes for health equity, with THIR identifying structural inequity as requiring major social reform, echoing Marxist revolutionary change.

Environmental Determinants of Health

Environmental determinants include physical, chemical, biological, and social factors affecting health, with Engels highlighting how poor housing, sanitation, and industrial pollutants disproportionately impacted the working class, influenced by economic and class structures.

These determinants, such as lack of clean water and exposure to pollutants, lead to higher illness and death rates, underscoring the need to address environmental conditions in public health.

PHL incorporates environmental determinants in understanding health inequities, discussing community efforts against pollution and advocating for protective policies, recognizing economic activities' impact on health.

By taking a holistic approach, PHL aligns with Marxist critiques of capitalism's environmental disregard, with vertical integration aiming to address these determinants at multiple levels of the public health economy.

Social Movement Theory:

Social Movement Theory is a sociological framework that examines how social movements form, develop, and achieve their objectives through collective action. Key perspectives include resource mobilization, which focuses on acquiring resources like money and organizational skills; political process theory, which looks at political opportunities influencing success; and framing theory, which explores how movements communicate to gain support.

In PHL, Social Movement Theory is relevant as it emphasizes community mobilization, aligning with PHL’s praxis through advocacy and protests. The manuscript highlights community-led initiatives, like editorial campaigns, which can use social movement strategies to demand health equity, enhancing PHL’s transformative efforts.

Empowerment Theory:

Empowerment Theory focuses on processes enabling individuals and communities to gain control over their lives and environments, enhancing self-efficacy and critical awareness. It involves building skills, accessing resources, and fostering participation in decision-making at individual, organizational, and community levels.

Within PHL, empowerment is central to liberation, as the manuscript describes communities pursuing health equity actively. Empowerment Theory supports PHL’s liberation safe spaces, where communities collaborate, ensuring interventions build local capacity and leadership for sustainable change.

Critical Pedagogy:

Critical Pedagogy is an educational philosophy promoting learning as a tool for liberation and social change, developed by Paulo Freire. It encourages critical thinking, dialogue, and reflection on societal structures to empower learners to challenge oppression and pursue transformative action.

In PHL, Critical Pedagogy is integral to training, fostering critical consciousness among community members, as noted in the manuscript. It enables educational programs that analyze the public health economy, cultivating leaders committed to equity and aligning with PHL’s transformative agenda.

Complexity Theory:

Complexity Theory studies systems with many interacting components, where interactions lead to emergent behaviors unpredictable from individual parts. It involves concepts like feedback loops and self-organization, applicable to modeling complex social systems like public health.

PHL views the public health economy as complex; Complexity Theory helps understand how interactions perpetuate inequities and identify intervention points. By mapping feedback loops, PHL can design adaptive strategies, aligning with its call for responsive action to disrupt negative cycles.

Historical Trauma Theory:

Historical Trauma Theory examines cumulative emotional and psychological wounding across generations from massive group trauma, like colonization or slavery, impacting descendant communities’ health and well-being.

PHL acknowledges historical trauma as a social determinant, especially for Black Americans. Historical Trauma Theory deepens understanding of past injustices’ effects, informing culturally sensitive interventions like community healing, aligning with PHL’s focus on historical context and equity.

Built Environment Theory:

Built Environment Theory explores how physical spaces, like buildings and streets, affect health, focusing on factors like walkability, access to green spaces, and housing quality, encompassing urban planning and environmental design.

In PHL, the built environment influences health outcomes, as the manuscript likely discusses environmental determinants. Built Environment Theory supports advocating for urban policies improving living conditions, aligning with PHL’s vertical integration to address structural barriers to equity.

Change Management Theory:

Change Management Theory provides frameworks for managing organizational and systemic change, like Kotter’s 8-Step Process, outlining steps such as creating urgency and building coalitions to anchor new approaches in culture.

For PHL, seeking to transform public health, Change Management Theory is invaluable, as the manuscript emphasizes radical change. It helps navigate implementing new policies and shifting norms, ensuring sustainable embedding of equity-focused practices within institutions.

Leadership Theories:

Leadership Theories describe how leaders influence others, including transformational leadership inspiring commitment and servant leadership emphasizing service. They include models adapting styles based on context, focusing on empowering followers.

In PHL, effective leadership, especially by women and Black women, is crucial, as highlighted in the manuscript. Leadership Theories provide insights for developing skills aligning with PHL’s values, enhancing community mobilization and systemic change through inspired leadership.

Distributive Justice:

Distributive Justice deals with fair allocation of resources and benefits, including principles like equality, equity, and need-based distribution, as proposed by John Rawls, where inequalities benefit the least advantaged.

In PHL, Distributive Justice is fundamental to addressing inequities, as the public health economy involves resource competition. It supports advocating for need-based policies, aligning with PHL’s moral obligation to intervene in evident harm and promote equitable resource distribution.

Human Rights Theory:

Human Rights Theory posits all individuals are entitled to fundamental rights, like life and health, universal and indivisible, forming the basis for international law.

PHL’s ethical framework is rooted in human rights, particularly the right to health, as likely referenced in the manuscript. Human Rights Theory leverages standards to hold institutions accountable, supporting PHL’s advocacy for policies ensuring health access and equity.

Legal Epidemiology:

Legal Epidemiology studies how laws and legal practices influence health outcomes, analyzing legislation’s impact using law and epidemiology methods.

For PHL, Legal Epidemiology assesses legal frameworks contributing to inequities, as the manuscript mentions legal interventions. It informs advocacy for reformed laws promoting equity, aligning with PHL’s praxis through evidence-based policy recommendations.

Health Economics:

Health Economics applies economic principles to health, examining resource allocation, provider behavior, and policy evaluation from an economic perspective.

In PHL, understanding economic drivers in the public health economy is crucial, as described. Health Economics analyzes incentives affecting outcomes, supporting equity-focused policies, like assessing intervention cost-effectiveness to reduce disparities.

Feminist Theory:

Feminist Theory examines gender inequalities and their intersections with race and class, critiquing patriarchal structures and advocating for gender equity across domains, including health.

PHL’s intersectional approach recognizes gender’s role in inequities. Feminist Theory deepens understanding of gender-based health issues, ensuring strategies address women’s specific needs, aligning with PHL’s inclusive equity efforts.

Queer Theory:

Queer Theory challenges normative assumptions about sexuality and gender, focusing on LGBTQ+ experiences, critiquing heteronormativity, and exploring social constructions of identity.

In PHL, Queer Theory ensures inclusivity, addressing LGBTQ+ health challenges like mental health disparities. It supports advocating for inclusive policies, aligning with PHL’s liberation efforts for all marginalized groups, enhancing equity.

Conflict Theory:

Conflict Theory posits society is characterized by conflicts due to power and resource inequalities, examining how dominant groups maintain power and subordinate groups resist, rooted in Marxist and Weberian thought.

In PHL, Conflict Theory analyzes power dynamics in the anarchic public health economy, as described. It identifies conflict sources perpetuating inequities, guiding strategies to challenge hegemonic powers and promote equitable resource distribution.

Social Capital Theory:

Social Capital Theory explores how social networks and norms facilitate cooperation, suggesting strong ties lead to better health outcomes through support and information sharing.

PHL emphasizes community empowerment; Social Capital Theory supports building networks for collective action, as seen in liberation safe spaces. It guides leveraging community resources for advocacy, enhancing PHL’s capacity for equity.

Life Course Theory:

Life Course Theory examines how experiences across the lifespan, from prenatal to old age, shape health, considering cumulative effects of social, economic, and environmental factors.

In PHL, Life Course Theory addresses inequities rooted in early life, likely discussed in the manuscript. It informs interventions targeting critical periods, preventing cumulative disadvantages, aligning with PHL’s long-term equity focus.

Resilience Theory:

Resilience Theory studies how individuals and communities adapt to adversity, identifying factors like social support and coping strategies promoting recovery.

For PHL, Resilience Theory understands how communities cope with inequities, aligning with liberation. It identifies factors strengthening community capacity, supporting PHL’s efforts to foster thriving despite adversities through community-led initiatives.

Asset-Based Community Development (ABCD):

ABCD focuses on identifying and leveraging community strengths, like local knowledge and networks, rather than deficits, emphasizing community-driven development.

In PHL, ABCD aligns with community empowerment, as the manuscript advocates for community-led interventions. It ensures strategies are grounded in local capacities, fostering sustainable change and avoiding paternalistic approaches, enhancing equity.

Collective Impact Theory:

Collective Impact Theory describes structured cross-sector collaboration for social issues, involving a common agenda, shared measurement, and continuous communication, with backbone support.

For PHL, seeking integration across domains, Collective Impact Theory supports coordinating stakeholders, as mentioned in partnerships. It enhances effectiveness of interventions for systemic change, aligning with PHL’s horizontal and vertical integration strategies.

Additional Political Theory 

Agonistic Pluralism

Description: Agonistic pluralism, developed by political theorist Chantal Mouffe, posits that conflict and contestation are inherent to democratic societies due to irreconcilable differences in values and interests. Unlike deliberative democracy, which seeks consensus, agonism embraces adversarial yet respectful engagement between competing groups, transforming antagonism into productive agonism (Mouffe, 2000). It emphasizes the need for spaces where marginalized voices can challenge hegemonic power structures.

Relevance to PHL: Agonistic pluralism complements PHL’s depiction of the public health economy as anarchic and competitive, where agents pursue self-interest (Williams et al., 2022, p. 15). PHL’s liberation safe spaces (p. 12) align with agonistic spaces for contestation, but the manuscript lacks a framework to structure these conflicts constructively. Agonistic pluralism could guide PHL’s praxis by ensuring marginalized communities’ challenges to hegemonic powers (e.g., industrial polluters or policymakers) are channeled into legitimate, transformative dialogue rather than suppressed or co-opted. For example, in Flint’s water crisis, agonistic pluralism could frame community protests as legitimate contestation against state inaction, fostering policy change without requiring consensus.

Citation: Mouffe, C. (2000). The Democratic Paradox. Verso.

Deliberative Democracy

Description: Deliberative democracy, as articulated by Jürgen Habermas and others, emphasizes rational discourse and inclusive participation in decision-making to achieve legitimate outcomes. It prioritizes open dialogue, mutual respect, and reason-giving among stakeholders to resolve conflicts and shape policies (Habermas, 1996). It assumes that inclusive deliberation can reduce power imbalances and enhance democratic legitimacy.

Relevance to PHL: PHL’s horizontal integration seeks to include marginalized populations in public health agenda-setting (p. 5), but the manuscript does not explicitly address how these voices are integrated into decision-making processes. Deliberative democracy offers a normative framework for structuring PHL’s community engagement, ensuring that liberation safe spaces (p. 12) facilitate reasoned dialogue rather than unstructured conflict. In Washington, DC’s lead crisis, deliberative forums could have amplified community voices to hold agencies accountable, countering the anarchy of the public health economy (p. 4). This theory could also mitigate illiberation (p. 13) by empowering communities through inclusive participation.

Citation: Habermas, J. (1996). Between Facts and Norms: Contributions to a Discourse Theory of Law and Democracy. MIT Press.

Polyarchy

Description: Polyarchy, developed by Robert Dahl, describes a form of democracy characterized by widespread participation and contestation, with multiple centers of power and checks on elite dominance (Dahl, 1971). It emphasizes the diffusion of power through competitive elections, free speech, and associational autonomy, ensuring no single group monopolizes decision-making.

Relevance to PHL: PHL’s public health realism highlights the anarchic competition among factions (p. 15), but it lacks a framework for how power can be diffused to prevent hegemonic dominance. Polyarchy could inform PHL’s vertical integration (p. 6) by advocating for decentralized power structures in the public health economy, such as community-led health boards or participatory budgeting, to counter elite-driven policies (e.g., those in Flint, p. 4). By fostering multiple loci of influence, polyarchy supports PHL’s goal of empowering marginalized communities to challenge structural inequities, enhancing the Theory of Health Inequity Reproduction (THIR) (p. 14).

Citation: Dahl, R. A. (1971). Polyarchy: Participation and Opposition. Yale University Press.

Legitimation Crisis

Description: Jürgen Habermas’ concept of a legitimation crisis occurs when a political system fails to maintain public trust and legitimacy due to contradictions between its stated goals (e.g., equity) and actual outcomes (e.g., persistent inequities) (Habermas, 1975). This crisis arises when systemic failures erode citizens’ confidence, prompting demands for reform or revolution.

Relevance to PHL: PHL’s analysis of the Flint and Washington, DC lead crises (p. 4) illustrates a legitimation crisis, where government failures undermined trust, yet the manuscript does not frame these as such. This concept could strengthen PHL’s explanation of why communities mobilize (e.g., through liberation safe spaces, p. 12) when public health institutions fail to deliver equity. By identifying legitimation crises in the public health economy, PHL could target interventions to restore trust, such as transparent policy reforms or community-led oversight, aligning with its praxis and THIR’s call for social mobilization (p. 14).

Citation: Habermas, J. (1975). Legitimation Crisis. Beacon Press.

Subaltern Counterpublics

Description: Nancy Fraser’s concept of subaltern counterpublics refers to parallel discursive arenas where marginalized groups develop alternative narratives and strategies to challenge dominant public spheres (Fraser, 1990). These counterpublics enable oppressed communities to articulate their needs and resist hegemonic discourses.

Relevance to PHL: PHL’s liberation safe spaces (p. 12) function as counterpublics, but the manuscript does not explicitly theorize them as such. Subaltern counterpublics could enhance PHL’s horizontal integration (p. 5) by providing a framework for how marginalized communities, like those in Flint, create alternative discourses to challenge hegemonic narratives (e.g., falsified CDC reports, p. 4). This concept supports PHL’s focus on community autonomy and liberation, offering a political theory lens to legitimize and amplify marginalized voices within the anarchic public health economy.

Citation: Fraser, N. (1990). Rethinking the public sphere: A contribution to the critique of actually existing democracy. Social Text, (25/26), 56–80.

Governmentality

Description: Michel Foucault’s concept of governmentality describes how power is exercised through techniques and rationalities that shape individual and collective behavior, often through institutions and discourses (Foucault, 1991). It examines how populations are governed via subtle, diffuse mechanisms beyond overt coercion.

Relevance to PHL: PHL’s public health realism notes how agents exercise power through rulemaking and issue framing (p. 16), but it lacks a nuanced analysis of how power operates discursively. Governmentality could deepen PHL’s understanding of how public health policies (e.g., in Flint, p. 4) normalize inequities through technocratic discourses or surveillance (e.g., health data collection). By analyzing governmentality, PHL could develop strategies to resist these subtle power mechanisms, supporting its liberation philosophy (p. 11) and praxis to disrupt hegemonic control in the public health economy.

Citation: Foucault, M. (1991). Governmentality. In G. Burchell, C. Gordon, & P. Miller (Eds.), The Foucault Effect: Studies in Governmentality (pp. 87–104). University of Chicago Press.

Political Opportunity Structure

Description: Political opportunity structure, a concept from social movement theory adapted to political theory, refers to the external conditions (e.g., elite divisions, policy windows, or repression levels) that facilitate or constrain collective action (Tarrow, 1994). It explains when and why movements emerge or succeed.

Relevance to PHL: PHL’s praxis emphasizes community mobilization (p. 18), but the manuscript does not analyze how external political conditions enable or hinder these efforts. Political opportunity structure could guide PHL’s strategies by identifying moments when the public health economy’s anarchy (p. 4) creates openings for intervention, such as during Flint’s crisis when public outrage forced policy shifts. This concept would enhance THIR’s focus on social mobilization (p. 14) by providing a framework to exploit political opportunities for health equity.

Citation: Tarrow, S. (1994). Power in Movement: Social Movements, Collective Action and Politics. Cambridge University Press.

Hegemonic Stability Theory

Description: Hegemonic stability theory, developed in international relations by Robert Gilpin, posits that a dominant power (hegemon) creates and maintains order in an anarchic system by providing public goods and enforcing rules, benefiting itself and others (Gilpin, 1981). Stability depends on the hegemon’s strength and willingness.

Relevance to PHL: PHL’s public health realism identifies hegemonic powers in the public health economy (p. 16), but it does not explore how a dominant agent could stabilize or disrupt inequities. This theory could analyze whether a hegemonic health institution (e.g., CDC) could enforce equity-focused rules or, conversely, perpetuate inequities (e.g., falsified reports in Washington, DC, p. 4). It would enhance PHL’s understanding of power dynamics and guide strategies to either leverage or challenge hegemonic influence for health equity.

Citation: Gilpin, R. (1981). War and Change in World Politics. Cambridge University Press.

Civic Republicanism

Description: Civic republicanism, rooted in the works of thinkers like Hannah Arendt and Philip Pettit, emphasizes active citizenship, civic virtue, and participation in public life to sustain a free and equitable society (Pettit, 1997). It advocates for non-domination, where individuals are free from arbitrary power.

Relevance to PHL: PHL’s liberation philosophy calls for communities to actively shape the public health agenda (p. 11), but it lacks a political theory grounding active citizenship. Civic republicanism could frame PHL’s horizontal integration (p. 5) as a form of civic virtue, encouraging communities to resist domination by hegemonic agents (e.g., polluters in Flint, p. 4). It would also support PHL’s praxis by promoting collective action and accountability, countering illiberation (p. 13) through empowered citizenship.

Citation: Pettit, P. (1997). Republicanism: A Theory of Freedom and Government. Oxford University Press.

Discursive Institutionalism

Description: Discursive institutionalism, developed by Vivien Schmidt, examines how ideas and discourses shape institutional change and policy outcomes within political systems (Schmidt, 2008). It emphasizes the role of communicative and coordinative discourses in legitimizing or challenging power structures.

Relevance to PHL: PHL’s focus on challenging hegemonic narratives (p. 17) aligns with discursive institutionalism, but the manuscript does not explicitly analyze how discourses shape public health policies. This theory could enhance PHL’s praxis by guiding how communities frame health equity demands to influence policy (e.g., countering narratives that blamed Flint residents for water issues, p. 4). It would also support PHL’s liberation safe spaces (p. 12) as sites for developing counter-discourses, strengthening efforts to transform the public health economy.

Citation: Schmidt, V. A. (2008). Discursive institutionalism: The explanatory power of ideas and discourse. Annual Review of Political Science, 11, 303–326.

Legal Theories

Precautionary Principle

Precautionary Principle: Originating in environmental law, this principle justifies interventions to prevent harm under uncertainty, as noted in research on public health law The legal determinants of health. For PHL, it is essential for proactive measures, especially in environmental health crises like Flint’s lead contamination.

Natural Law Theory

Natural Law Theory: Originating from philosophers like Thomas Aquinas, this theory suggests that laws should reflect universal moral truths. For PHL, it provides a philosophical basis for advocating health as a fundamental right, supporting legal arguments for universal healthcare access and equity. This aligns with the manuscript’s mention of constitutional liberties and rights, enhancing PHL’s ethical framework.

Legal Realism

Legal Realism: Developed in the early 20th century, Legal Realism emphasizes that law is shaped by social interests and judicial discretion, not just formal rules. This theory is relevant to PHL as it focuses on how laws are applied in practice, crucial for understanding their real-world impact on health outcomes, especially in marginalized communities.

Additional Economic Theory

Opportunity Cost

Opportunity cost is the value of the next best alternative foregone when a decision is made, representing the trade-offs involved in resource allocation, especially in resource-scarce settings. For example, if a government allocates funds to build a hospital, the opportunity cost might be the schools or roads that could have been built instead, highlighting the need to evaluate the benefits lost from not choosing other options.

In the PHL framework, opportunity cost is vital for prioritizing health interventions to maximize health equity. The manuscript discusses the competitive nature of the public health economy, where resources are often misallocated. By considering opportunity costs, PHL advocates for directing resources towards interventions that offer the greatest benefit to marginalized communities, ensuring efficient use of limited funds to address structural inequities.

Public Goods in Health

Public goods in health, such as vaccinations and clean air, are non-excludable and non-rivalrous, meaning they benefit all without diminishing availability to others. These goods are essential for population health but often require collective action and government intervention due to the free-rider problem, where individuals benefit without contributing.

PHL emphasizes community-wide benefits and collective action. The manuscript highlights the need for interventions that provide broad health benefits, which are public goods. In an anarchic public health economy, self-interested agents may neglect these goods. PHL calls for structural changes to ensure their provision, particularly for marginalized groups, aligning with its equity goals.

Externalities in Health

Externalities in health are unintended effects of actions on others, such as pollution impacting community health, which are not reflected in market prices. Negative externalities, like industrial emissions, can lead to market failures, requiring government intervention to align social and private costs and protect public health.

The manuscript discusses environmental determinants and cases like Flint's water crisis, where negative externalities disproportionately affect marginalized communities. PHL's Theory of Health Inequity Reproduction identifies such structural issues as drivers of disparities, advocating for regulations to mitigate these externalities and protect vulnerable populations.

Information Asymmetry in Healthcare

Information asymmetry in healthcare occurs when providers have more information than patients, leading to potential market failures like overtreatment or undertreatment. This imbalance can result in suboptimal health outcomes and higher costs, particularly affecting those with less access to information, such as low-income patients.

PHL focuses on empowering communities and reducing power imbalances. By addressing information asymmetry through education and community involvement, PHL aims to enable informed decision-making and advocacy, reducing exploitation and improving health outcomes for marginalized groups.

Cost-Effectiveness Analysis

Cost-effectiveness analysis compares the costs and outcomes of health interventions to determine the best value for money, such as cost per life-year saved. It is crucial for prioritizing interventions in resource-limited settings, ensuring that health benefits are maximized for the resources invested.

PHL uses cost-effectiveness analysis to prioritize interventions that maximize health equity. The manuscript advocates aligning economic incentives with equity goals, ensuring resources are used efficiently to address root causes of disparities and provide sustainable benefits to underserved populations.

Adverse Selection in Health Insurance

Adverse selection in health insurance occurs when high-risk individuals are more likely to purchase insurance, leading to higher premiums and potential market failure. This can make insurance unaffordable for many, exacerbating health inequities by limiting access to care for those who need it most.

PHL addresses barriers to healthcare access, including insurance issues. By understanding adverse selection, PHL can advocate for policies like universal coverage to ensure equitable access to healthcare, reducing disparities exacerbated by market failures in insurance.

Human Capital Theory

Human capital theory posits that investments in health and education enhance productivity and economic value, linking better health to increased workforce participation and higher earnings. This theory underscores the economic benefits of health investments for both individuals and society.

PHL frames health equity as an investment in human capital, arguing that improving health in marginalized communities enhances their economic participation and societal development. This perspective supports PHL's call for systemic changes to prioritize health investments in underserved areas.

Income Inequality and Health Disparities

Income inequality refers to the unequal distribution of income, linked to poorer health outcomes due to limited access to resources, increased stress, and reduced social cohesion. Higher inequality is associated with higher rates of chronic diseases and lower life expectancy, particularly affecting low-income populations.

The manuscript identifies economic drivers as key to health inequities. PHL advocates for policies reducing income inequality to improve health outcomes, aligning with its focus on structural determinants and the need for comprehensive strategies to achieve equity.

Labor Market Discrimination and Health

Labor market discrimination involves treating individuals differently in employment based on characteristics like race or gender, leading to lower wages and job insecurity, which negatively impact health through chronic stress and reduced access to resources.

PHL's intersectional approach recognizes how labor market discrimination affects health. The framework supports policies promoting fair employment practices to improve economic stability and health for marginalized populations, addressing both economic and health disparities.

Market Power in Healthcare

Market power in healthcare refers to the ability of entities like pharmaceutical companies to influence prices and supply due to their dominant market position, often leading to higher costs and reduced access, particularly for low-income and uninsured individuals.

In the competitive public health economy, market power can exacerbate inequities. PHL calls for regulatory interventions to curb such power, ensuring healthcare markets prioritize public health over profit, thereby promoting equitable access to services.

Social Theory

Ecosocial Theory

Ecosocial Theory, proposed by Nancy Krieger, offers a multilevel framework integrating biological, ecological, and social factors. It emphasizes how social inequalities, such as racial and economic disparities, interact with environmental conditions to produce health outcomes. This aligns with PHL’s transdisciplinary approach, supporting interventions that address both social and environmental determinants, such as community-led efforts against industrial pollution.

Allostatic Load Theory

Allostatic Load Theory, by McEwen, explains how chronic stress from social inequalities leads to physiological wear and tear, increasing disease risk. This is particularly relevant for PHL’s focus on structural violence, as it highlights how marginalized communities, like those in Flint, Michigan, face cumulative stress from environmental hazards and economic disadvantage, necessitating trauma-informed interventions.

The Weathering Hypothesis

The Weathering Hypothesis, by Geronimus, specifically addresses racial health disparities, suggesting that Black Americans experience accelerated health deterioration due to cumulative stress from racism. This theory is vital for PHL, given its emphasis on historical trauma and the leadership of Black women, providing a lens to design culturally sensitive strategies that address these unique burdens.

Syndemics Theory

Syndemics Theory, by Singer, examines how multiple epidemics, such as HIV and substance abuse, interact in socially disadvantaged communities, often exacerbated by poverty and discrimination. This theory supports PHL’s approach to addressing overlapping health issues, ensuring interventions are comprehensive and community-driven, such as in areas with high rates of both mental health challenges and environmental exposures.

Biopower

Biopower, from Foucault, explores how power is exercised over populations through health policies and practices, such as mandatory vaccinations or surveillance. This concept is relevant for PHL’s critique of power dynamics, informing strategies to challenge oppressive public health structures and promote community self-determination, aligning with PHL’s liberation safe spaces.

Social Network Theory

Social Network Theory, through Berkman and Glass’s model, highlights how social ties influence health behaviors and access to resources. This is crucial for PHL’s community empowerment, supporting interventions that leverage social networks for advocacy, such as community organizing against health inequities, enhancing collective action and resilience.

Embodiment Theory

Embodiment Theory, by Krieger, explores how social experiences, like discrimination, become biologically embedded, affecting health across the lifespan. This theory complements PHL’s focus on historical trauma, showing how past social conditions, such as slavery’s legacy, shape current health outcomes, informing long-term equity strategies.

Public Health Critical Race Praxis

Public Health Critical Race Praxis (PHCRP), by Ford and Airhihenbuwa, adapts Critical Race Theory for public health, focusing on racism’s structural impact on health disparities. It provides a framework for research and action, aligning with PHL’s emphasis on racial equity, particularly in cases like Flint’s lead crisis, where racial biases in policy contributed to disparities.

Minority Stress Theory

Minority Stress Theory, by Meyer, explains how stigma and discrimination create health challenges for minorities, such as increased mental health issues among LGBTQ+ populations. This theory aligns with PHL’s liberation goals, informing strategies to mitigate discrimination’s health impacts, ensuring inclusive and equitable public health practices.

Religious Theory 

Liberation Theology

Liberation Theology is a theological movement that emerged in the late 20th century, primarily within the Catholic Church in Latin America, though it has spread to other regions and denominations. It emphasizes the liberation of oppressed peoples from social, economic, and political injustices, interpreting Jesus Christ’s teachings as a call to action against poverty and inequality. Central to this theology is the "preferential option for the poor," asserting God’s special concern for the marginalized and the church’s duty to prioritize their needs. Liberation theologians argue that faith must be expressed through concrete actions to transform unjust structures and promote human dignity, often drawing on biblical narratives like the Exodus to inspire social change.

In PHL, Liberation Theology provides a powerful framework for understanding and addressing health inequities, aligning with its goal to transform the public health economy for marginalized communities. The manuscript highlights PHL’s focus on liberation as both a mindset and practical approach, resonating with Liberation Theology’s call for systemic change. It can inspire community mobilization against environmental racism, such as in the Flint water crisis, by legitimizing advocacy through a spiritual lens. By integrating this theology, PHL can enhance its appeal among faith-based communities, reinforcing its moral and ethical dimensions to address disparities.

Black Liberation Theology

Black Liberation Theology, developed in the 1960s and 1970s by theologians like James Cone, is a strand of Liberation Theology focusing on African Americans’ experiences. It interprets Christianity through the lens of Black oppression and liberation, positing that God sides with the oppressed and Jesus’ message is one of freedom from racial injustice. It challenges the church to confront racism and work towards emancipating Black people from systemic discrimination, drawing on biblical figures like Moses to symbolize liberation. This theology emphasizes the intersection of faith and social justice, advocating for collective action to dismantle racial barriers.

Given PHL’s emphasis on African American emancipatory writing and Black women’s leadership, Black Liberation Theology is highly relevant. The manuscript underscores addressing historical trauma and systemic racism in public health, and this theology provides a theological foundation for viewing health disparities as racial oppression. It can inform PHL’s praxis by encouraging community-led initiatives, leveraging spiritual resources to demand better healthcare access. For example, faith-based organizations can mobilize Black communities to challenge policies perpetuating inequities, aligning with PHL’s focus on liberation safe spaces and collective action.

Womanist Theology

Womanist Theology, coined by Alice Walker, centers Black women’s experiences, referring to a Black feminist committed to the survival and wholeness of entire communities. Developed by theologians like Delores Williams and Katie Cannon, it explores the intersections of race, gender, and class, critiquing racism within feminist movements and sexism within Black liberation efforts. It advocates for a holistic approach to liberation, emphasizing Black women’s unique challenges and contributions, often drawing on biblical stories like Hagar to highlight resilience and agency. This theology seeks to empower Black women as leaders in social justice movements.

Womanist Theology is crucial for PHL’s intersectional approach to health equity, as the manuscript highlights Black women’s leadership in driving change. It ensures PHL’s strategies address the specific needs of Black women, who face compounded health disparities due to intersecting oppressions. For instance, in addressing maternal mortality, Womanist Theology can guide culturally competent interventions, resonating with PHL’s emphasis on community empowerment. It aligns with the manuscript’s call for inclusive, community-driven research, ensuring health programs reflect Black women’s lived realities and foster equitable outcomes.

Social Gospel

The Social Gospel, a Protestant movement from the late 19th and early 20th centuries led by figures like Walter Rauschenbusch, applies Christian ethics to social problems like poverty and inequality. It views the kingdom of God as a present reality achievable through social justice, advocating for reforms in public health, education, and labor rights. It emphasizes collective action to address societal ills, drawing on biblical teachings like the Sermon on the Mount to inspire compassion and reform. This movement historically supported initiatives like sanitation improvements and workers’ rights, seeing them as Christian duties.

The Social Gospel’s focus on applying religious principles to social issues parallels PHL’s aim to transform societal structures for health equity. The manuscript presents PHL as integrating disciplines to address root causes, and the Social Gospel’s historical advocacy for public health reforms can model contemporary efforts. It supports PHL’s call for policies improving housing and education, key health determinants, and aligns with horizontal integration by emphasizing community welfare. This concept can inspire PHL’s praxis, mobilizing faith communities to advocate for systemic changes that reduce disparities.

Preferential Option for the Poor

The Preferential Option for the Poor, from Catholic social teaching, asserts that the needs of the poor and vulnerable should be prioritized in policy and action. It calls for justice and solidarity with marginalized groups, ensuring their voices are heard and rights protected. This principle encourages evaluating decisions based on their impact on the least advantaged, drawing on biblical calls to care for the widow, orphan, and stranger. It is a cornerstone of Catholic social thought, emphasizing that societal progress is measured by how the poorest are treated.

In PHL, achieving health equity requires focusing on marginalized communities, and the Preferential Option for the Poor provides an ethical mandate. The manuscript emphasizes PHL’s moral obligation to intervene in evident harm, aligning with this principle. It guides resource allocation to target low-income and minority populations, ensuring equitable interventions. By adopting this option, PHL can ensure strategies are just, addressing the needs of those most in need, and reinforcing its commitment to transformative change within the public health economy.

Prophetic Tradition

The Prophetic Tradition involves religious leaders or prophets speaking out against injustice, a practice seen in Abrahamic faiths with figures like Isaiah and Amos denouncing corruption and neglect of the poor. It calls for moral and social reform, urging societies to align with divine justice. This tradition continues through modern figures like Martin Luther King Jr., using prophetic rhetoric to advocate for civil rights, drawing on biblical imagery to inspire action. It emphasizes speaking truth to power and mobilizing communities for change.

The Prophetic Tradition can inspire PHL’s advocacy efforts, as the manuscript describes praxis through advocacy and community organizing. It provides a model for public health leaders to challenge hegemonic powers, demanding accountability for health inequities like environmental racism. For example, prophetic voices can mobilize communities to address crises like Flint’s water contamination, aligning with PHL’s commitment to speaking truth to power. This tradition reinforces PHL’s transformative agenda, encouraging collective action to achieve systemic change.

Stewardship

Stewardship is a theological concept emphasizing responsible management of resources, including the environment, as a duty entrusted by God. It involves caring for creation sustainably and equitably, seen across religions as a moral obligation to protect the earth for future generations. It draws on biblical mandates like Genesis 2:15, where humans are called to tend and keep the garden, and extends to human resources, ensuring they benefit all. Stewardship is central to religious environmental ethics, advocating for justice in resource use.

In PHL, addressing environmental determinants is crucial, as discussed in the manuscript regarding industrial pollution and housing. Stewardship provides a religious framework for advocating environmental justice, engaging faith communities in efforts to reduce pollution and improve living conditions. It supports PHL’s vertical integration by linking environmental sustainability with public health, ensuring policies protect vulnerable populations from hazards. This concept can mobilize religious support for PHL’s initiatives, framing environmental health within a moral context.

Common Good

The Common Good, from Catholic social teaching, refers to social conditions allowing people to reach fulfillment more fully, emphasizing community well-being, especially for the vulnerable. It involves ensuring access to basic needs like food, shelter, and healthcare, drawing on biblical calls for communal care, such as Acts 2:44-45, where early Christians shared resources. It prioritizes collective welfare, viewing societal progress as dependent on the flourishing of all members, particularly the marginalized.

The Common Good is foundational to PHL’s ethical framework, as the manuscript aims to transform the public health economy for all. It supports advocating for universal healthcare access and reducing disparities, aligning with PHL’s horizontal integration by involving marginalized communities in decision-making. By prioritizing the common good, PHL can ensure policies foster social conditions conducive to health, reinforcing its commitment to equity and justice within the public health landscape.

Eco-Theology

Eco-Theology explores the relationship between religion and nature, emphasizing spiritual dimensions of environmental stewardship. It draws on religious texts to advocate for protecting the environment, addressing ecological crises through themes of interconnectedness and justice. It argues that caring for the earth is a moral and religious imperative, often citing biblical passages like Psalm 24:1, where the earth is the Lord’s. Eco-theologians call for sustainable practices to ensure environmental and human health, linking faith with ecological responsibility.

Given PHL’s focus on environmental justice, as seen in the Flint crisis, Eco-Theology offers insights for addressing disparities. It can mobilize religious communities for advocacy, promoting policies ensuring clean water and air, aligning with PHL’s vertical integration. By framing environmental health within a moral context, Eco-Theology can galvanize support for PHL’s initiatives, ensuring interventions are sustainable and just, addressing the manuscript’s call for transformative environmental strategies.

Faith-Based Community Organizing

Faith-Based Community Organizing involves religious congregations working together for social change, leveraging moral authority and networks. Rooted in social justice, it mobilizes faith communities for issues like housing, immigrant rights, and healthcare, drawing on religious teachings like Micah 6:8 to do justice. It emphasizes collective action, using religious gatherings to build coalitions and advocate for reform, often through campaigns and protests, ensuring community voices are heard in policy decisions.

Faith-Based Community Organizing is directly applicable to PHL’s praxis, as the manuscript emphasizes community-led initiatives. It can tap into faith networks to build coalitions pushing for health equity, such as demanding safe drinking water or challenging discriminatory policies. This approach aligns with PHL’s liberation safe spaces, fostering collaboration for change, and supports the manuscript’s focus on community empowerment, ensuring research and action are grounded in community needs and resources.

Cultural Capital

Cultural Capital, as conceptualized by Pierre Bourdieu, refers to non-financial social assets, such as knowledge and skills, that promote social mobility. In social justice advocacy, speakers may accumulate cultural capital by demonstrating expertise on issues like racial and ethnic disparities, which they can then convert into economic or social benefits through paid speaking engagements, media appearances, or book deals. This can lead to careerism, where the primary motivation is personal gain rather than effecting genuine change, aligning with the user's concern about using the "poor lot in life" of others for career advancement.

PHL theory directly addresses this issue by emphasizing liberation and genuine community benefit. One of PHL's key constructs, the Gaze of the Enslaved, serves as an ethical standard and ontology for evaluating research and interventions, drawing from the perspectives of enslaved African Americans to critique studies that fail to provide sustainable benefits to communities. This construct challenges practices that prioritize individual career advancement over collective well-being, such as speakers leveraging cultural capital for personal gain. Additionally, PHL advocates for horizontal integration, which enhances the representation and influence of affected populations in setting public health agendas, ensuring their voices are central and that initiatives are driven by community needs rather than individual ambitions. By prioritizing community-led liberation and accountability, PHL theory seeks to mitigate the risks associated with cultural capital being used for careerism at the expense of real progress in health equity.

Moral Grandstanding

Moral Grandstanding, as developed by Justin Tosi and Brandon Warmke in their book Grandstanding: The Use and Abuse of Moral Talk (2020), describes the use of moral discourse primarily to enhance one's own status or reputation. In social justice contexts, this can manifest as speakers publicly lamenting disparities to appear morally superior, thereby gaining social approval and advancing their careers, potentially without contributing to actual change. This behavior is problematic as it can divert attention and resources from effective solutions to superficial displays of concern, aligning with critiques of TED talks for prioritizing entertainment over substance, as noted in Benjamin Bratton's article in The Guardian ("We need to talk about TED").

Connection to PHL Theory: PHL theory counters moral grandstanding through its emphasis on praxis and immediate intervention. The Morality Principle within PHL asserts a moral obligation to act swiftly when harm is evident, even without complete scientific evidence, as seen in environmental crises like the lead-contaminated water crises in Flint, Michigan, and Washington, DC, which highlight institutional failures and environmental racism. This principle demands tangible action over mere rhetoric, thereby discouraging grandstanding by focusing on real outcomes. Furthermore, PHL's focus on liberation safe spaces—social spaces where individuals with shared experiences gather to affirm and address health inequities—fosters environments for authentic dialogue and collective action, reducing the incentive for grandstanding by prioritizing community empowerment and real outcomes over individual recognition. This aligns with PHL's goal of transforming the public health economy to prioritize health equity.

Moral Entrepreneurship

Moral Entrepreneurship, a sociological concept, involves individuals promoting certain moral issues to gain influence or authority. In public health, speakers might advocate for social justice causes to position themselves as thought leaders, leading to career benefits like speaking fees, consulting roles, or media exposure, without necessarily effecting meaningful change. This aligns with the user's observation that some speakers use the "poor lot in life" of others for careerism, as promoting awareness can enhance their professional standing without contributing to tangible outcomes, potentially widening the gap between advocacy and impact.

Connection to PHL Theory: PHL theory challenges moral entrepreneurship by advocating for vertical integration, which expands the scope of public health to monitor and respond proactively to the entire public health economy, requiring expertise, community involvement, and strong social bonds to effect systemic change. This approach demands a deep understanding of systemic issues and a commitment to transformative change, rather than superficial engagement driven by personal branding. Additionally, PHL's Theory of Health Inequity Reproduction (THIR) posits that health inequity reproduction results from a complex interplay of social mobilization, constraints on harmful conduct, economic incentives/punishments, and structural inequity, emphasizing the need for comprehensive strategies that go beyond individual efforts. By promoting a transdisciplinary approach that integrates philosophy, theory, and practice, PHL encourages advocates to engage deeply with communities and systems, reducing the likelihood of moral entrepreneurship driven by self-interest and fostering a culture of accountability and collective action.

Public Choice Theory

Originating from economics, Public Choice Theory posits that individuals, including those in public roles, act to maximize their own utility, similar to how they would in private roles. Applied to social justice advocacy, this suggests that speakers may choose topics like racial and ethnic disparities and presentation styles that optimize personal gains, such as fame, money, or career opportunities, rather than focusing on effecting real change. This theory is reflected in critiques of professionalization, where incentives like funding can shift focus from impact to self-interest, as noted in Sunil Babu Pant's article in The Guardian ("Why grassroots activists should resist being ‘professionalised’ into an NGO"), which warns that professionalization can reduce effectiveness by prioritizing maintaining funding over real change.

Connection to PHL Theory: PHL theory addresses this through its concept of Public Health Realism and Hegemony, which describe the anarchic nature of the public health economy, where agents (or "factions") pursue self-interest and power, often at the expense of health equity. Hegemony refers to dominant powers maintaining control through misleading actions or resource mal-distribution, aligning with the self-interested behaviors predicted by public choice theory. However, PHL aims to transform this economy by fostering a unified discipline that prioritizes health equity over individual gains. By promoting liberation as a mindset and way of life, PHL encourages individuals to transcend self-oppression and fear (illiberation) and to act collectively for the common good, as seen in its emphasis on community-led initiatives and accountability mechanisms. This helps to align individual actions with broader societal goals, counteracting the tendencies predicted by public choice theory and fostering a more equitable public health economy.

Health Energy Theory

The Health Energy Theory (HET) is a novel approach that uses quantum mechanics to address public health inequities, viewing health as a dynamic, probabilistic state within a health energy field. This field is influenced by various energies, aiming to shift public health paradigms by considering health as part of a complex, interconnected system. PHL, as a transdisciplinary framework, seeks to accelerate health equity by transforming the public health economy, which encompasses systemic factors like income inequality and racial disparities, as noted in the position statement from PublicHealthLiberation.com.

Both HET and PHL share a revolutionary approach to public health, challenging traditional models. HET’s concepts, such as vital and destructive energies, can be seen as analogous to the positive and negative forces affecting health in PHL’s public health economy. For instance, vital energy, such as community solidarity, aligns with PHL’s emphasis on community empowerment and liberation, while destructive energy, like structural racism, corresponds to the systemic barriers PHL aims to dismantle. This integration could help develop strategies that are both theoretically grounded and practically effective, enhancing public health outcomes, as seen in PHL’s case studies like the lead-contaminated water crises in Flint, Michigan.

Autonomy Theory

This theory, as discussed in Jane Wright's 1999 paper "Minority groups, autonomy, and self-determination" . In the context of the Public Health Economy framework, autonomy theory plays a crucial role in empowering minority communities to manage their own health affairs. By granting self-governance, either territorially or through cultural institutions, minority leaders can tailor health services and policies to better suit the specific needs and cultural contexts of their populations. This localized control can lead to more effective health interventions and improved health outcomes, addressing the health disparities that are central to the Public Health Economy's mission. For instance, indigenous communities with self-governance agreements often have health programs that integrate traditional healing practices with modern medicine, which can be more acceptable and effective for their members.

Consociationalism

Originating from Arend Lijphart's work, this theory, detailed in "Consociationalism" , involves grand coalitions, segmental autonomy, proportionality, and minority veto. It is evident in countries like Belgium and Lebanon, ensuring minority leaders have a say in national governance, stabilizing deeply divided societies. In the PHL framework, consociationalism ensures that minority groups have a voice in health policy-making, leading to more inclusive and equitable health systems. By incorporating minority perspectives, health policies can better address the unique challenges faced by these groups, such as higher rates of certain diseases or barriers to accessing care, aligning with the goal of achieving health equity.

Federalism

This system, as seen in Canada with Quebec's autonomy, divides power to allow regional governance . It supports minority groups in specific regions, enabling leaders to govern locally, reflecting their cultural and political needs. Within the PHL, federalism enables minority groups in specific regions to have greater control over their health policies, facilitating region-specific health initiatives tailored to local needs, potentially reducing health disparities. Decentralized governance allows for more responsive and culturally sensitive public health interventions.

Cultural Autonomy

Non-territorial autonomy, discussed in "Non-territorial autonomy" , allows minority groups to manage cultural and educational matters. This is crucial for dispersed communities, empowering leaders to preserve identity without territorial control, as seen in Hungary's minority self-governments. In the PHL context, cultural autonomy supports minority groups in managing aspects that influence health, such as education and language, leading to culturally appropriate health education and promotion, improving health literacy and behaviors among minority populations, thereby contributing to better health outcomes.

Multiculturalism: 

Will Kymlicka's "Multicultural Citizenship" highlights state policies supporting cultural diversity. This framework allows minority leaders to advocate for rights, as seen in Canada's multicultural policies, fostering community governance. In the PHL, multiculturalism provides a framework for advocating for minority health needs, encouraging inclusive health policies and practices that are accessible to all cultural groups, involving measures like multilingual health materials and cultural competence training for providers, addressing social determinants of health.

International Human Rights Law: 

The UN Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities provides legal protections, empowering leaders to use international norms for advocacy, enhancing their governance role. In the PHL, international human rights law supports the right to health for minorities, empowering leaders to advocate for better health services and hold governments accountable, guiding the development of equitable health policies that prioritize non-discrimination.

Indigenous Governance Theories: 

These theories, explored in "Indigenous governance" , focus on traditional structures like tribal councils and modern adaptations. They show how indigenous leaders govern within larger states, often through treaties and self-government agreements, as in Canada. In the PHL, indigenous governance often includes holistic health approaches, and supporting these structures can lead to effective health interventions that respect traditional knowledge, improving health service utilization and outcomes for indigenous communities.

Social Capital Theory

Robert Putnam's "Bowling Alone" explains how networks and trust facilitate cooperation. In minority communities, high social capital, like in tight-knit ethnic enclaves, supports self-governance, enhancing leadership effectiveness. In the PHL, high social capital within minority communities enhances their ability to self-govern and manage health issues effectively, supporting better dissemination of health information and community resilience, crucial for addressing health challenges and achieving equity.

Social Movement Theory:

Detailed in "Comparative Perspectives on Social Movements" , this theory describes how leaders mobilize for change, as seen in civil rights movements. It enables minority leaders to advocate for governance improvements and rights. In the PHL, social movements can advocate for health equity, with minority leaders using mobilization to raise awareness, demand policy changes, and secure resources, driving systemic improvements in health outcomes.

Legal Pluralism

John Griffiths' work "What is Legal Pluralism?" discusses multiple legal systems, allowing minority groups to have customary or religious laws. This empowers leaders to govern internal matters, like Sharia courts in Muslim communities. In the PHL, legal pluralism enables minority groups to govern health matters through their own frameworks, such as integrating traditional health practices, improving service acceptability and effectiveness, and respecting cultural diversity in health beliefs.

Black Urban Regime Theory:

This theory, detailed in sources like [Black Urban Regime], focuses on cities with majority Black populations led by Black mayors and city councils. It posits that these regimes form governing coalitions comprising Black leaders, middle-class professionals, and white corporate elites, alongside an electoral base of Black working-class voters. A key question is why these regimes often pursue pro-corporate development policies that may not align with the material interests of their electoral base. The theory highlights structural constraints, such as deindustrialization and fiscal challenges, which push leaders toward business-friendly agendas, potentially at the expense of social equity. This theory is particularly relevant for understanding leadership in cities like Detroit or Atlanta, where economic revitalization often takes precedence over redistributive policies.

Relation to PHL: Through the lens of PHL's public health economy, this theory highlights how economic interests can influence health outcomes. Pro-corporate policies may prioritize economic growth over community health needs, potentially exacerbating health disparities. For example, in Washington, DC, the mention of 200 million square feet of real estate given for redevelopment in 2021, as noted on Dr. Christopher Williams' Website, has led to displacement, impacting the health of African American residents, aligning with PHL's focus on structural determinants like housing and environmental racism.

Electoral Competition Theory:

Derived from Richard A. Keiser's work, [Subordination or Empowerment? African-American Leadership and the Struggle for Urban Political Power], this theory argues that electoral competition among white factions can create opportunities for Black political empowerment. In cities where white political groups are divided, Black leaders can leverage their voting bloc to gain office and influence, as seen in historical analyses of Chicago and Philadelphia. However, the theory also notes that without such competition, Black votes may lose leverage, leading to extra-electoral strategies like protest movements, which can shape governance approaches.

Relation to PHL: PHL emphasizes addressing structural determinants of health. Black leaders empowered through electoral competition may have the opportunity to implement policies that tackle these determinants, such as improving healthcare access. However, their dependence on white faction support might limit their ability to fully address health inequities, resonating with PHL's call for vertical integration to address issues at all levels.

Deracialization Theory:

This theory examines how Black politicians may downplay racial issues to appeal to a broader, often white, electorate, influencing their governance style once in office. While not a formal theory in all contexts, it is widely discussed in political science literature, such as in urban politics texts. It suggests that leaders like mayors might focus on universal policies (e.g., economic development) rather than race-specific ones, with debates over whether this dilutes racial advocacy.

Relation to PHL: PHL stresses the importance of addressing racial health disparities, as seen in case studies like the lead crisis in DC, discussed on PublicHealthLiberation.com. Leaders who deracialize their approach might implement universal policies that do not specifically target these disparities, potentially hindering efforts to achieve health equity, which PHL seeks to accelerate through community-centered approaches.

Linked Fate Theory:

Originating from Michael Dawson's [Behind the Mule: Race and Class in African-American Politics], this theory posits that Black leaders' political behavior is influenced by their sense of linked fate with the Black community. This connection can lead to policies prioritizing community uplift, such as investments in education or housing, but its impact varies by leader and context, with some leaders balancing broader city needs against community expectations.

Relation to PHL: This theory aligns with PHL's emphasis on community empowerment and liberation, as outlined on PublicHealthLiberation.com. Leaders with a strong sense of linked fate are likely to advocate for policies that directly benefit the community, such as improving healthcare access and addressing environmental racism, resonating with PHL's practice of community action.

Structural Dependence Theory:

This theory, rooted in political economy, highlights how local governments' dependence on private investment constrains policy choices. For Black leaders, this means navigating fiscal pressures that often push toward pro-business policies, limiting their ability to implement progressive agendas like affordable housing or social services. It is a broader framework, applicable to urban politics, and underscores the economic constraints faced by Black-led cities.

Relation to PHL: The public health economy in PHL includes economic structures that reproduce inequity, as discussed in the PHL manuscript. Structural dependence may limit Black leaders' ability to implement progressive public health policies due to economic pressures, thereby perpetuating health disparities, aligning with PHL's Theory of Health Inequity Reproduction.

Minority Incorporation Theory:

Based on works like [Racial Politics in American Cities] by Browning, Marshall, and Tabb, this theory examines how minority groups, including Blacks, are integrated into political systems and their influence on policy. In urban settings, it explores how Black leaders build coalitions and negotiate power, particularly in majority-minority cities, affecting governance through representation and policy outcomes.

Relation to PHL: PHL advocates for horizontal integration, including affected populations in decision-making, as seen in PHL's community action examples on PublicHealthLiberation.com. Effective minority incorporation can lead to better representation and policies that address health equity by ensuring marginalized voices are heard, aligning with PHL's focus on liberation.

Politics of Recognition:

Drawing from Charles Taylor's [The Politics of Recognition], this theory focuses on symbolic politics and cultural recognition as part of governance. For Black leaders, this might involve renaming streets, promoting Black history, or cultural events, which can be seen as complementary to material policy changes, though some argue it may substitute for substantive action, sparking debate.

Relation to PHL: While PHL primarily focuses on material conditions, recognition can foster community empowerment and address illiberation, as defined on PublicHealthLiberation.com, by boosting community pride and agency, which are crucial for collective action in public health, aligning with PHL's emphasis on liberation safe spaces.

Transformational Leadership Theory:

A general leadership theory, it suggests leaders inspire and motivate followers to achieve extraordinary outcomes. Applied to Black leaders, as seen in urban politics literature, it examines whether they adopt styles that mobilize community support for change, such as through visionary policies or community engagement, though empirical evidence varies.

Relation to PHL: PHL's practice involves community action and advocacy, which transformational leaders can facilitate by inspiring and mobilizing communities to achieve significant changes in public health, as exemplified by PHL's COVID-19 vaccine registration efforts on PublicHealthLiberation.com.

Critical Race Theory in Urban Politics:

This approach applies critical race theory to analyze how systemic racism impacts urban governance, even under Black leadership. It highlights how historical and structural inequalities shape policy options, with implications for addressing racial disparities, and is a lens found in urban studies texts, acknowledging ongoing debates over its practical application.

Relation to PHL: Both frameworks recognize systemic racism as a key factor in shaping policy and health outcomes. PHL's focus on structural determinants aligns with critical race theory's emphasis on addressing racism to achieve health equity, as discussed in PHL's case studies like Flint and DC on PublicHealthLiberation.com.

Intergovernmental Relations Theory:

This theory explores how interactions between local, state, and federal governments affect urban governance. For Black-led cities, state preemption or federal funding cuts can limit policy implementation, influencing how leaders govern, as discussed in urban politics literature, with variations based on regional political climates.

Relation to PHL: PHL's vertical integration involves addressing health issues at all levels of government. Understanding intergovernmental relations is crucial for implementing comprehensive public health policies that effectively tackle health disparities across different jurisdictions, aligning with PHL's approach to systemic change.

Iron Law of Oligarchy

Proposed by Robert Michels, this theory suggests that all organizations, regardless of democratic intentions, develop into oligarchies ruled by a small elite due to structural needs for efficiency and expertise.

How Leaders Contribute: Leaders within minority groups form a small elite, consolidating power and resources, which marginalizes other members and creates political and social stratification.

Relation to PHL Manuscript: In the public health economy, health organizations within minority communities may be controlled by a small elite, leading to unequal distribution of health resources and services, such as access to clinics or health education programs. This creates health stratification, where certain members receive better care due to their proximity to power. The PHL framework, as described in Public Health Economy, emphasizes structural determinants of health inequity, highlighting how such oligarchic structures within community health initiatives can perpetuate disparities. PHL advocates for governance reforms to ensure equitable resource allocation.

Internalized Oppression

This occurs when minority group members internalize negative stereotypes and beliefs imposed by the dominant society, leading to self-devaluation and perpetuation of oppressive behaviors within the group.

How Leaders Contribute: Leaders who internalize these biases may favor certain members perceived as aligning with dominant norms, creating disparities in access to resources or opportunities.

Relation to PHL Manuscript: Internalized oppression among minority group leaders can manifest in public health by prioritizing certain community members for health services based on biased criteria, such as skin color or socioeconomic status. This contributes to health disparities within the group. The PHL framework, with its integration of Critical Race Theory as noted in Public Health Critical Race Praxis, addresses how internalized biases reproduce health inequity. It calls for critical self-reflection and anti-oppression training to ensure leaders advocate equitably for all community members’ health needs.

Clientelism

Clientelism involves leaders (patrons) providing resources or benefits to followers (clients) in exchange for loyalty or political support, resulting in unequal resource distribution.

How Leaders Contribute: Leaders favor loyal supporters, distributing resources like jobs or opportunities unequally, fostering hierarchies within the group.

Relation to PHL Manuscript: In the public health economy, clientelism can lead to health resources, such as access to vaccinations or community health programs, being allocated based on loyalty rather than need, undermining health equity. The PHL framework critiques such political practices, as seen in its analysis of political influences on resource allocation . By examining how patronage systems exacerbate health disparities, PHL advocates for transparent and need-based distribution of health resources to achieve equitable outcomes.

Social Closure

Social closure refers to the process by which groups restrict access to resources and opportunities to a select few to maintain their advantages, often based on criteria like education or social networks.

How Leaders Contribute: Leaders limit access to opportunities, creating an elite class within the group that excludes others, thus fostering stratification.

Relation to PHL Manuscript: In public health, social closure can occur when leaders restrict access to health programs or leadership roles to a select group, such as those with specific connections or backgrounds, creating health inequalities. The PHL framework promotes inclusive health policies to counter such exclusionary practices, aligning with its goal of dismantling structural barriers to health equity. By addressing how social closure limits access to health resources, PHL seeks to ensure that all community members benefit from health initiatives.

Social Dominance Theory

Developed by Sidanius and Pratto, this theory explains how societies maintain group-based hierarchies through legitimizing myths and discrimination, even within subordinate groups.

How Leaders Contribute: Leaders may endorse myths that justify the dominance of certain subgroups, reinforcing internal hierarchies based on attributes like gender or class.

Relation to PHL Manuscript: Within minority groups, leaders may perpetuate internal hierarchies that affect health access, such as prioritizing certain demographic groups for healthcare based on perceived superiority. The PHL framework, incorporating Critical Race Theory , challenges these hierarchies by examining how racial and social myths sustain health disparities. PHL’s transdisciplinary approach seeks to dismantle such legitimizing narratives to promote equitable health resource distribution.

Rent-Seeking

Rent-seeking involves seeking economic gain without contributing to productivity, often by manipulating social or political environments to control resources.

How Leaders Contribute: Leaders control and distribute resources for personal gain, creating economic inequalities within the group.

Relation to PHL Manuscript: Rent-seeking by leaders can misallocate health resources, exacerbating health inequities. A pertinent example from the PHL manuscript is the DC Housing Authority, criticized for decades of neglect, leading to substandard living conditions that adversely affect residents’ health . PHL highlights how such mismanagement, driven by leaders’ self-interest, contributes to health disparities, advocating for government intervention and accountable resource management to ensure health equity.

Caste System

A hereditary social hierarchy, prevalent in some South Asian communities, that determines status, occupation, and resource access.

How Leaders Contribute: Leaders from higher castes maintain traditional hierarchies, limiting opportunities for lower-caste members, thus creating stratification.

Relation to PHL Manuscript: In minority communities with caste systems, health stratification can occur along caste lines, with higher-caste leaders prioritizing health services for their own group. The PHL framework addresses such structural discriminations by advocating for policies that ensure equal access to health services, regardless of caste. By recognizing caste as a determinant of health inequity, PHL seeks to dismantle these traditional hierarchies to promote equitable health outcomes.

Patriarchy

A social system where men hold primary power, dominating leadership roles and resource control.

How Leaders Contribute: Male leaders prioritize men’s needs, marginalizing women and non-binary individuals, leading to gender-based stratification.

Relation to PHL Manuscript: Patriarchal leadership can lead to gender-based health stratification, as illustrated in the PHL manuscript’s example of biased medical education practices, where inappropriate interview questions about family planning disproportionately affect women . PHL incorporates feminist perspectives to address gender biases in health leadership, advocating for inclusive policies that ensure equitable access to health services and opportunities for all genders.

Gerontocracy

A system where older individuals hold power, often due to cultural respect for elders.

How Leaders Contribute: Older leaders enforce norms that privilege their authority, limiting opportunities for younger members and creating age-based stratification.

Relation to PHL Manuscript: In communities with gerontocratic structures, health policies may favor the elderly, potentially neglecting the health needs of younger generations, such as pediatric or adolescent healthcare. The PHL framework encourages a balanced approach to health priorities, ensuring that resources address the needs of all age groups to mitigate generational health disparities. This aligns with PHL’s holistic view of community well-being.

Credentialism

An overemphasis on formal credentials as indicators of ability or worth, restricting access to power and resources.

How Leaders Contribute: Leaders gatekeep opportunities with credential requirements, favoring an educated elite and excluding others.

Relation to PHL Manuscript: In public health, credentialism can exclude individuals without formal qualifications from contributing to health initiatives, even if they possess valuable community knowledge. The PHL framework promotes inclusive leadership models that value diverse forms of expertise, such as community-based participatory research, to enhance health initiatives. By challenging credential-based barriers, PHL aims to ensure that all community members can contribute to achieving health equity.

Lateral Violence

Lateral violence involves harmful behaviors like bullying or exclusion among members of an oppressed group, often due to internalized oppression from historical trauma.

Relation to PHL: Lateral violence aligns with PHL’s concept of "illiberation," where internalized fear or oppression leads to intra-community conflict, hindering collective action. PHL counters this through its liberation philosophy, promoting self-worth and "liberation safe spaces" to heal historical trauma and foster unity. By encouraging collective problem-solving, PHL reduces lateral violence, enabling communities to address health disparities collaboratively.

Elite Capture

Elite capture occurs when a small group within a community controls resources or decision-making, often prioritizing their own interests over the broader group’s needs.

Relation to PHL: In the public health economy, as described by PHL’s Public Health Realism, elite capture can manifest when community leaders or organizations monopolize resources, creating stratification. PHL’s horizontal integration ensures affected populations participate in decision-making, preventing elites from dominating. The liberation focus empowers communities to demand transparency, countering elite capture and promoting equitable resource distribution.

Authoritarian Leadership

Authoritarian leadership involves leaders exerting absolute control, making decisions without input, and demanding obedience, which can suppress dissent.

Relation to PHL: Authoritarian leaders in minority communities can create hierarchies by silencing diverse voices. PHL promotes community autonomy and inclusive leadership, emphasizing participatory decision-making. By advocating for horizontal integration, PHL ensures leadership reflects community needs, countering authoritarian tendencies and fostering equitable power structures.

Power Distance

Power distance reflects the extent to which less powerful community members accept unequal power distribution, often enabling hierarchical structures.

Relation to PHL: High power distance in minority communities can allow leaders to maintain control, perpetuating stratification. PHL’s liberation philosophy challenges these hierarchies by empowering individuals to question authority and demand equity. Through community education and engagement, PHL reduces power distance, fostering a culture of equality and mutual respect.

Clientelism

Clientelism occurs when leaders provide benefits like jobs or resources in exchange for loyalty, creating dependency and exclusion.

Relation to PHL: In the public health economy, clientelism can lead to political and economic stratification by favoring loyal supporters. PHL’s vertical integration monitors resource allocation across all levels, promoting transparency and fairness. By encouraging community-led initiatives, PHL dismantles clientelistic networks, ensuring benefits are distributed based on need.

Rent-Seeking

Rent-seeking involves individuals or groups increasing wealth by manipulating systems without creating new value, often at others’ expense.

Relation to PHL: Leaders engaging in rent-seeking within minority communities can exacerbate economic inequalities. PHL’s Theory of Health Inequity Reproduction (THIR) advocates for constraints on harmful conduct and economic incentives to discourage such behaviors. Community oversight and systemic changes promoted by PHL help reduce rent-seeking, ensuring equitable resource allocation.

Social Closure

Social closure is when groups restrict access to resources or opportunities to maintain their advantages, creating internal divisions.

Relation to PHL: Social closure in minority communities can exclude certain members from opportunities, leading to stratification. PHL’s horizontal integration breaks these barriers by including marginalized voices in public health decisions. The liberation philosophy fosters solidarity, encouraging collective action to ensure all community members access resources equitably.

Kinship-Based Stratification

Kinship-based stratification occurs when power and resources are tied to family or clan affiliations, creating hierarchies.

Relation to PHL: In some minority cultures, kinship ties can concentrate influence, marginalizing others. PHL respects cultural traditions but promotes inclusivity through community education, broadening leadership beyond kinship networks. This ensures leadership is merit-based and representative, reducing stratification and enhancing equity.

Charismatic Leadership

Charismatic leadership relies on a leader’s personal charm to inspire followers, but it can centralize power and marginalize dissent.

Relation to PHL: While charismatic leaders can drive change, they may create dependencies. PHL advocates for inspirational yet inclusive leadership, ensuring community input in decisions. By fostering shared leadership and accountability, PHL mitigates risks of charismatic authority, promoting equitable governance.

Paternalistic Leadership

Paternalistic leadership involves leaders acting as parental figures, making decisions for the group while expecting loyalty.

Relation to PHL: Paternalistic leadership can limit community autonomy, fostering dependency. PHL’s liberation philosophy emphasizes self-determination, encouraging communities to take charge of their health. Through education and capacity-building, PHL shifts communities toward democratic governance, countering paternalistic models.

Black Conservatism

Emphasizes personal responsibility over systemic issues. In the context of Public Health Liberation (PHL), Black Conservatism represents a perspective that may conflict with PHL's emphasis on structural determinants of health. PHL posits that health inequities are deeply rooted in systemic issues within the Public Health Economy, requiring collective action and systemic change. Black Conservatism, with its focus on personal responsibility and individual agency, might downplay these structural factors, potentially aligning with what PHL terms 'illiberation'—a state where individuals are constrained by internalized beliefs that hinder recognition of systemic barriers. PHL's approach would involve challenging such perspectives through education and liberation practices to foster a collective understanding of health equity.

Neoliberalism

Focuses on market solutions, minimizing structural racism focus. Neoliberalism, with its emphasis on market solutions and individual success, often overlooks the structural barriers that perpetuate health inequities. In the framework of Public Health Liberation (PHL), neoliberal policies are critiqued for their role in the Public Health Economy, where economic drivers can exacerbate disparities if not aligned with equity goals. PHL's concept of 'public health realism' describes the anarchic nature of the Public Health Economy, where agents act out of self-interest, often reproducing inequities—a dynamic that neoliberalism may fuel by prioritizing market competition over collective well-being. PHL advocates for interventions that constrain harmful conduct and promote equity within this economy.

Interest Convergence

Racial progress aligns with dominant interests, avoiding systemic challenges. Interest Convergence, as theorized by Derrick Bell, posits that advancements in racial equity occur only when they align with the interests of the dominant white group. This concept resonates with Public Health Liberation's (PHL) notion of 'public health realism,' which views the Public Health Economy as an anarchic system where agents act primarily out of self-interest. In this context, PHL recognizes that achieving health equity may require strategic alignments where the interests of marginalized communities converge with those of powerful stakeholders, thereby facilitating systemic changes that benefit all parties involved.

Tokenism

Symbolic inclusion without power, expecting conformity. Tokenism, where Black leaders are placed in visible but powerless positions, undermines genuine efforts toward health equity by maintaining the status quo. Public Health Liberation (PHL) advocates for 'horizontal integration,' which seeks to enhance the representation and influence of affected populations in setting public health agendas. Tokenism contradicts this principle by offering symbolic inclusion without substantive power, thereby perpetuating structural racism. PHL's approach involves creating 'liberation safe spaces' where marginalized communities can affirm their experiences and catalyze collective action, countering the isolating effects of tokenism.

Respectability Politics

Promotes assimilation to reduce racism, downplaying systemic issues. Respectability Politics encourage conformity to dominant societal norms as a strategy to mitigate racism, often at the expense of acknowledging structural barriers. In contrast, Public Health Liberation (PHL) promotes 'liberation' as a mindset that embraces cultural regeneration and community autonomy, rejecting the need to conform to external standards. PHL's focus on 'personhood restoration' underscores the importance of affirming one's identity and experiences without succumbing to respectability norms, thereby fostering a more authentic and empowered approach to achieving health equity.

Deracialization

Downplays race in politics to appeal to white voters. Deracialization, a strategy employed by some Black leaders to minimize racial discourse in order to appeal to wider audiences, can inadvertently contribute to the erasure of racial identities and experiences. Public Health Liberation (PHL) staunchly opposes such erasure, emphasizing the critical importance of recognizing and studying race and ethnicity to address health disparities accurately. By advocating for culturally sensitive research and the preservation of racial data, PHL ensures that the unique challenges faced by marginalized communities are not overlooked in the pursuit of health equity.

Class Divide

Successful leaders disconnected from lower-income struggles. The Class Divide among Black Americans can result in affluent individuals being less attuned to the systemic barriers faced by lower-income community members. Public Health Liberation (PHL) addresses this by prioritizing the experiences and leadership of those most affected by health inequities, particularly focusing on Black women and drawing from African American emancipatory traditions. Through 'horizontal integration,' PHL ensures that community voices from all socioeconomic backgrounds are represented and influential in shaping public health agendas, thereby mitigating the disconnect caused by class differences.

Internalized Racism

Accepting negative racial beliefs, downplaying systemic issues. Internalized Racism, where individuals accept and perpetuate negative stereotypes about their own racial group, can hinder efforts to address structural racism by fostering a sense of resignation or blame towards the community itself. In Public Health Liberation (PHL), this phenomenon is akin to 'illiberation,' a state where individuals are constrained by internalized oppression, preventing them from recognizing and challenging systemic inequities. PHL's emphasis on 'liberation' as a mindset and way of life aims to counteract internalized racism by promoting self-affirmation, collective identity, and empowerment to achieve health equity.

Strategic Moderation 

Adjusting stances for political expediency, downplaying racism. Strategic Moderation, where Black leaders temper their advocacy on racial issues to maintain political viability, may fall short of the transformative change required to dismantle structural racism. Public Health Liberation (PHL) champions a radical reconceptualization of public health, advocating for comprehensive systemic reforms through its transdisciplinary approach. By integrating philosophy, theory, praxis, research, and training, PHL pushes for unapologetic and direct confrontation of health inequities, rejecting moderated strategies that may perpetuate the status quo.

Post-racial Narrative 

Promoting society as beyond race, minimizing structural racism focus. The Post-racial Narrative, which posits that racial barriers have been largely overcome, directly contradicts the foundational premises of Public Health Liberation (PHL). PHL asserts that structural racism remains a pervasive force in the Public Health Economy, necessitating explicit recognition and targeted interventions to achieve health equity. By advocating for the preservation of racial data and culturally sensitive research, PHL counters post-racial myths and ensures that public health efforts are informed by the lived realities of marginalized communities.

Postmodern Theory of Public Health

The Postmodern Theory of Public Health, a component of HET, posits that health exists in a superposition of states until observed, embracing a non-deterministic view that challenges conventional deterministic models of health and disease. This theory suggests that health is influenced by a multitude of factors across different dimensions, aligning with PHL’s rejection of simplistic explanations for health inequities, as advocated in the paper from Rochester Regional Health Advances. PHL emphasizes a comprehensive understanding of the public health economy, recognizing the complexity of health outcomes shaped by structural determinants.

PHL’s focus on empowering communities to overcome barriers resonates with the Postmodern Theory’s emphasis on the multiplicity of health states and the importance of context. By viewing health through a postmodern lens, public health practitioners can develop nuanced strategies that consider cultural and historical factors, supporting PHL’s transformative goals. This connection could enhance PHL’s efforts to foster collective action and accelerate health equity, ensuring interventions are contextually relevant and effective, as seen in PHL’s advocacy for horizontal integration to include marginalized populations.

Quantum Health Energy Model (QHEM)

The Quantum Health Energy Model (QHEM) within HET integrates quantum mechanics, systems theory, and ethical philosophy to quantify health coherence, using parameters like vital and destructive energies. It provides a mathematical model, to assess the resilience of health systems, as detailed in the previous analysis. While PHL is more qualitative, focusing on transforming the public health economy, QHEM offers a potential tool to measure the impact of PHL’s interventions, aligning with its call for new analytical approaches.

For instance, QHEM’s focus on ethical philosophy complements PHL’s moral imperative to address disparities, ensuring interventions are just and equitable. By applying QHEM, PHL practitioners could evaluate changes in health coherence before and after implementing strategies, enhancing accountability and effectiveness. This integration could strengthen PHL’s efforts to create a more coherent and equitable public health system, supporting community empowerment and systemic change, as seen in PHL’s recent successes like influencing Washington, DC’s Comprehensive Plan for racial equity.

Vital and Destructive Energy

In HET, vital energy (VE) promotes health, exemplified by factors like maternal love and community faith, while destructive energy (DE) undermines it, such as structural racism and profit-driven harm, with indices like Vital Energy Index (VEI) and Destructive Energy Index (DEI) being qualitative. PHL identifies similar forces within the public health economy, where systemic factors like structural racism (DE) perpetuate disparities, and community solidarity (VE) can enhance equity, as highlighted in the position statement from PublicHealthLiberation.com. This alignment allows PHL to leverage HET’s framework to develop targeted interventions, addressing both positive and negative influences on health.

By mapping VE and DE to PHL’s strategies, practitioners can focus on enhancing VE through community empowerment and mitigating DE through policy changes. For example, fostering VE like community cohesion aligns with PHL’s liberation safe spaces, while tackling DE like tobacco exemptions (linked to 80-90% of lung cancer deaths) supports PHL’s critique of hegemonic systems. This connection could strengthen PHL’s efforts to create a more equitable public health landscape, addressing systemic barriers effectively, as seen in PHL’s case studies of fighting displacement and mobilizing vaccination efforts.

Infinite Health Continuum (IHC)

The Infinite Health Continuum (IHC) in HET models health as evolving from chaos (0) to infinite coherence, capturing its dynamic nature across multiple dimensions, with formulas reflecting vitality and connection. This aligns with PHL’s view of health equity as an ongoing process requiring continuous effort, recognizing that achieving coherence is a journey, as noted in the paper from Rochester Regional Health Advances. The IHC provides a conceptual tool for PHL to visualize and track progress, identifying areas for improvement and tailoring interventions accordingly.

For PHL, the IHC’s notion of infinite coherence suggests there is always room for enhancement, supporting its commitment to accelerating health equity. By understanding where communities lie on the continuum, PHL can develop strategies that foster resilience and connection, aligning with its focus on liberation and community action. This integration could enhance PHL’s ability to address complex health disparities, ensuring a holistic and adaptive approach to public health, as seen in PHL’s emphasis on praxis and community-responsive research.

Theory of Health Inequity Reproduction (THIR)

Developed by PHL, this theory explains how health inequities are reproduced within the public health economy through mechanisms like social mobilization, regulatory changes, and economic interventions. It identifies structural factors such as income inequality, racial disparities, and judicial decisions as key drivers.

Implication: THIR highlights why research often fails to affect social lives by showing how systemic inequities are perpetuated without collective action. PHL uses THIR to guide interventions, aligning with its call for transformative actions like community mobilization, as seen in its critique of judicial decisions exacerbating health disparities.

Relation to PHL: THIR is central to PHL's framework, providing a structured approach to disrupting cycles of inequity, directly addressing the critique of research inaction.

Public Health Realism

Also developed by PHL, this theory draws from political realism to describe the public health economy as a competitive, anarchical system where agents act in their self-interest, often at the expense of health equity. It outlines 16 principles, such as self-serving egoism and lack of central authority.

Implication: This theory explains why research may not lead to structural change due to the self-interested behavior of agents, such as hospitals or government agencies, prioritizing their own interests over collective health goals.

Relation to PHL: PHL uses Public Health Realism to guide communities in building power and influence, challenging dominant forces, as seen in its examples like the Washington, DC DCHA neglect requiring federal intervention, highlighting system failures.

Hegemonic Theory

Rooted in critical race theory and political economy, this theory examines how dominant powers maintain control over the public health economy, reinforcing social arrangements and resource distribution that favor the powerful, often through hegemonic practices.

Implication: Hegemonic Theory explains why research often serves elite interests, perpetuating inequities rather than challenging them, aligning with PHL's critique of traditional research practices.

Relation to PHL: PHL leverages this theory to advocate for horizontal and vertical integration, redistributing power and resources, as seen in its focus on addressing environmental racism and educational disparities.

Two-Communities Theory (Caplan, 1979)

This theory posits that researchers and policymakers operate in different "communities" with distinct cultures, values, and reward systems, making it difficult for research to influence policy or social change.

Implication: This cultural divide explains why research remains academic and theoretical, disconnected from practical application, especially in policy-making contexts.

Relation to PHL: PHL's transdisciplinary approach, involving communities and stakeholders, seeks to bridge this gap, ensuring research is relevant and impactful, as seen in its call for integrating political theory into public health research.

Mode 1 and Mode 2 Knowledge Production (Gibbons et al., 1994)

This framework distinguishes between "Mode 1" (traditional, discipline-based research) and "Mode 2" (transdisciplinary, application-oriented research involving stakeholders). The dominance of Mode 1 in academia explains why much research remains theoretical and disconnected from societal needs.

Implication: Academic incentives prioritize publications over societal impact, limiting structural change.

Relation to PHL: PHL calls for a shift to Mode 2, promoting collaborative, practical research to address complex structural determinants, as seen in its advocacy for the Public Health Economy framework.

Bourdieu's Theory of Cultural Reproduction

Pierre Bourdieu argues that education and research systems reproduce social inequalities by maintaining class-based disparities through cultural capital. Research often serves elite interests, reinforcing the status quo rather than challenging it.

Implication: Research fails to address structural inequalities, as it is embedded in systems that perpetuate them.

Relation to PHL: PHL critiques current research for perpetuating inequalities, and Bourdieu's theory explains how this happens, aligning with PHL's focus on disrupting cycles of inequality through the Public Health Economy.

Freire's Critical Pedagogy

Paulo Freire's theory critiques traditional research and education as "banking" models, where knowledge is deposited without fostering dialogue or action. It emphasizes the need for research to be transformative and engage with oppressed groups to effect social change.

Implication: Traditional research practices maintain the status quo, failing to empower or benefit marginalized communities.

Relation to PHL: PHL's emphasis on community involvement and cultural sensitivity resonates with Freire's principles, ensuring research is empowering, as seen in its dialogical approach to health equity.

Dependency Theory

In development studies, this theory explains how global economic structures maintain inequalities between core (wealthy) and peripheral (poor) nations. Research conducted in or about peripheral regions often fails to address structural issues, as it may serve the interests of the core.

Implication: Research can perpetuate global inequalities, especially in contexts like developing countries, limiting its impact on structural change.

Relation to PHL: PHL's focus on structural determinants like income inequality relates to Dependency Theory, highlighting the need to address global economic structures, as seen in its critique of judicial decisions affecting marginalized communities.

Postcolonial Theory

This theory critiques research practices rooted in colonial legacies, where knowledge production often serves dominant groups (e.g., Global North) rather than benefiting marginalized communities (e.g., Global South). It highlights how research can perpetuate rather than challenge structural inequalities.

Implication: Research may extract knowledge without giving back, failing to improve the lives of studied communities.

Relation to PHL: PHL's focus on racial disparities and health equity in marginalized communities is informed by Postcolonial Theory, aiming to decolonize research, as seen in its emphasis on culturally sensitive practices.

Slacktivism

Slacktivism, a blend of "slacker" and "activism," refers to low-effort, low-risk actions to support a cause, such as liking, sharing, or tweeting on social media, signing online petitions, or changing profile pictures to show solidarity. Critics argue it creates an illusion of impact by satisfying individuals’ desire to contribute without requiring significant effort, potentially deterring more substantive activism. However, some studies, like one from ScienceDirect, suggest mixed evidence, noting that slacktivism can raise awareness but often lacks tangible outcomes.

Connection to PHL: PHL emphasizes activism as praxis, defined as human activity aimed at radical transformation, involving actions like public testimony, legal challenges, and community organizing to address structural determinants of health, such as income inequality and environmental racism. Slacktivism’s superficial nature contrasts with PHL’s call for sustained, high-effort engagement within the Public Health Economy. For example, the white paper describes PHL’s efforts in challenging industrial polluters, which require deep commitment far beyond sharing a post about environmental health.

Clicktivism

Clicktivism, a term often used interchangeably with slacktivism, specifically refers to minimal online actions like signing petitions or sending form letter emails to support a cause. It is criticized for its ease and lack of real-world impact, as noted in Wikipedia, though some argue it can amplify awareness when part of broader campaigns, such as the Human Rights Campaign’s marriage equality initiative.

Connection to PHL: PHL’s approach to engagement, particularly through liberation safe spaces and community-led initiatives, requires active participation, which clicktivism cannot provide. The white paper critiques traditional public health for superficially engaging communities during research phases, a practice mirrored by clicktivism’s minimal actions. Addressing issues like the lead-contaminated water crisis in Flint, Michigan, as discussed in the white paper, demands sustained advocacy and policy change, not just online clicks.

Performative Activism

Performative activism involves actions taken primarily to enhance one’s social image or reputation rather than to effect change, such as posting on social media to appear socially conscious. It is often criticized for prioritizing optics over impact, as seen in examples like the widespread sharing of the “All Eyes on Rafah” image, which raised awareness but lacked follow-through action.

Connection to PHL: PHL warns against hegemonic control and “poverty pimping,” where agents feign unity with communities for self-interest, akin to performative activism. The white paper’s concept of liberation safe spaces emphasizes authentic community engagement to catalyze collective action, contrasting with performative gestures that lack substance. PHL’s focus on genuine liberation ensures actions lead to systemic change, not just appearances.

Virtue Signaling

Virtue signaling is the public expression of opinions or sentiments to demonstrate moral correctness, often without accompanying action, creating a false sense of impact. It is seen as a way to signal moral superiority rather than contribute meaningfully, as discussed in social media studies.

Connection to PHL: PHL’s Morality Principle demands immediate, actionable intervention in public health issues, contrasting with virtue signaling’s focus on moral posturing. The white paper highlights the need for proactive responses, such as during the Flint and Washington, D.C., lead crises, where inaction exacerbated harm. Virtue signaling, such as posting about health disparities without action, fails to meet PHL’s call for tangible outcomes.

Illusion of Transparency

The illusion of transparency is a psychological tendency to overestimate how much others understand or are influenced by one’s actions, leading to a false sense of impact. In online activism, individuals may believe their posts are highly influential, despite limited reach or effect, as noted in psychological literature.

Connection to PHL: PHL’s Gaze of the Enslaved emphasizes accountability, ensuring actions genuinely benefit communities. This counters the illusion of transparency by requiring deep community engagement to understand and meet needs, as seen in PHL’s community-led initiatives. For example, addressing judicial determinants of health, as discussed in the position statement, requires informed, accountable action beyond superficial online advocacy.

Echo Chambers

Echo chambers are online environments where individuals are exposed only to agreeing opinions, reinforcing existing views and creating a false sense of widespread support. This can inflate perceptions of impact, as discussed in social media polarization studies.

Connection to PHL: PHL’s horizontal integration seeks to include diverse community voices in decision-making, countering the narrowing effect of echo chambers. The white paper notes that traditional public health often excludes marginalized communities, engaging them superficially, which echo chambers can exacerbate by limiting exposure to diverse perspectives on issues like environmental racism.

Filter Bubbles

Filter bubbles are personalized information environments created by algorithms that tailor content to user preferences, limiting exposure to diverse viewpoints and inflating the perceived impact of online actions within curated spaces, as noted in social media research.

Connection to PHL: PHL’s vertical integration requires a comprehensive understanding of the Public Health Economy across various levels, which filter bubbles hinder by restricting information. The white paper’s focus on systemic issues like lax regulations demands a broad perspective, countering the narrowing effects of filter bubbles to ensure informed interventions.

Digital Dualism

Digital dualism is the belief that online and offline worlds are separate, leading to misjudgments about the impact of online actions. Research, such as from ScienceDirect, suggests online and offline activism are often positively correlated, challenging this notion.

Connection to PHL: PHL integrates digital and physical activism, using social media for advocacy alongside on-the-ground action like liberation safe spaces. The position statement’s discussion of judicial determinants of health illustrates how PHL bridges online awareness with real-world advocacy, aligning with the interconnected nature of activism.

Network Society Theory

Definition: Network Society Theory, developed by Manuel Castells, describes society as structured around digital networks, where social interactions and power dynamics are shaped by information technologies. It can lead to superficial engagement if online actions do not translate into real-world change, as noted in ResearchGate.

Connection to PHL: PHL’s Public Health Economy aligns with this theory, viewing health as a network of interdependent agents. PHL’s public health realism and hegemony concepts address power imbalances within these networks, advocating for liberation to ensure engagement leads to systemic change, countering superficial participation.

Social Media Engagement Theory

Definition: Social Media Engagement Theory explains how users interact with social media content through likes, shares, and comments, creating a sense of social presence and impact, even if minimal. While useful for awareness, these actions often lack the depth needed for systemic change, as discussed in social media studies.

Connection to PHL: PHL strategically uses social media for awareness but emphasizes integration with community organizing and policy advocacy, as seen in its influence on Washington, D.C.’s Comprehensive Plan. PHL’s praxis ensures online engagement translates into tangible outcomes, aligning with the theory’s focus on social presence but prioritizing real-world impact.

Selective Enforcement Theory

This theory posits that government officials, such as police officers, prosecutors, or regulators, exercise discretion in choosing whether or how to punish violations, leading to uneven enforcement. It can result from bias (e.g., racial prejudice, corruption) and is considered a threat to the rule of law.

Examples: The 2011 "Morton Memo" prioritized immigration enforcement on criminals, effectively waiving prosecution for non-criminal illegal aliens, illustrating discretionary enforcement (Selective Enforcement - Wikipedia). In Richmond, Virginia, Black drivers were stopped at over five times the rate of white drivers, showing selective targeting (Inferable Discrimination: A Landmark Decision Addresses Selective Law Enforcement).

Relation to PHL: The Public Health Liberation (PHL) position statement highlights the uneven enforcement of laws as a critical barrier within the Public Health Economy. Specifically, it points out that communities most disadvantaged by health disparities face a "concomitant 'equal protection problem'" where governmental bodies fail to enforce laws equally, particularly in areas like fair housing and environmental justice. This selective enforcement exacerbates health inequities by allowing discriminatory practices to persist, directly impacting the structural determinants of health—such as education, income inequality, and racial disparities—that PHL aims to address. The PHL's emphasis on the Public Health Economy as anarchic and lacking central authority further aligns with this theory, as it highlights how decentralized enforcement can lead to inconsistent application of laws across jurisdictions, perpetuating health disparities.

Economic Theory of Optimal Enactment and Enforcement

This economic theory, rooted in cost-benefit analysis, suggests that laws may be enacted without enforcement if some individuals reflexively comply due to moral beliefs or civic virtue. It posits that enforcement is optimal only when harm is high, and non-enforcement is preferable when harm is low and compliance is high.

Examples: Laws against minor offenses, like outdated bicycle bell requirements, may be enacted for symbolic value but rarely enforced, serving an expressive function (An Economic Theory of Optimal Enactment and Enforcement of Laws - ScienceDirect).

Relation to PHL: PHL's advocacy for a new field of study focused on the Public Health Economy resonates with this theory. In public health, laws intended to protect health equity—such as those addressing environmental regulations or housing standards—might not be enforced due to resource constraints or political priorities, leading to inefficiencies in addressing structural determinants of health. The PHL position statement highlights economic failures in areas like housing, food access, and environmental regulation, which require government intervention but often lack consistent enforcement. For instance, the failure to enforce laws against slum lording or environmental racism contributes to health inequities, particularly in marginalized communities. This aligns with the economic theory's focus on the cost-benefit analysis of enforcement, where non-enforcement can exacerbate public health challenges.

Marxist Theory of Law Enforcement

Description: From a Marxist perspective, laws are tools of the ruling class to maintain power and control. Enforcement is selective, targeting those who threaten the economic or political status quo while protecting the interests of the elite.

Examples: Marxist theory suggests that laws against labor strikes or protests may be enforced more strictly against working-class groups, reflecting class-based power dynamics (Selective Law Enforcement - Marxist Theories of Crime and Deviance - tutor2u).

Relation to PHL: The Marxist perspective on law enforcement as a tool of the ruling class to maintain power aligns closely with PHL's critique of how laws and policies often serve to perpetuate existing power structures. PHL argues that recent Supreme Court decisions—such as those overturning reproductive rights and affirmative action—have deepened income and racial disparities, which can be seen as a form of social control that benefits the dominant class. The PHL's focus on structural determinants of health, including education, income inequality, and racial disparities, reflects the Marxist view that laws are used to maintain class-based power dynamics. Furthermore, the PHL's call for a transdisciplinary approach to study the Public Health Economy includes examining how political determinants of health, such as judicial decisions, reinforce systemic inequities, supporting the Marxist theory's emphasis on class conflict and power dynamics.

Discrimination and Bias Theories

These theories encompass various forms of bias, including racial profiling, gender-based discrimination, and targeting specific groups (e.g., LGBTQ+, homeless). They suggest that enforcement disparities arise from implicit or explicit biases within law enforcement practices.

Examples: Racial profiling leads to disproportionate stops and frisks of Black individuals, as seen in Baltimore, where young Black men are targeted more than white individuals (Different Types Of Selective Enforcement - Iamele & Iamele, LLP). Gender-based discrimination may result in men being charged more often for domestic violence, while women receive leniency.

Relation to PHL: PHL explicitly addresses racial and ethnic disparities in health outcomes, which are often exacerbated by discriminatory law enforcement practices. The position statement notes that government inaction in enforcing laws against discriminatory practices—such as fair housing laws—contributes to health inequities. For example, the failure to enforce laws against redlining or gentrification allows for practices that disproportionately harm minority communities, directly impacting their health. Additionally, the PHL's discussion of case studies, such as DC housing policies, highlights how certain groups are disproportionately affected by uneven enforcement of laws. This aligns with discrimination and bias theories, as it underscores how systemic biases in law enforcement contribute to structural determinants of health, perpetuating disparities in education, income, and environmental justice.

Prosecutorial Discretion Theory

This theory focuses on the wide discretion prosecutors have in deciding which cases to pursue, influenced by resource constraints, political pressures, or personal biases. This discretion can lead to uneven enforcement across jurisdictions or demographics.

Examples: Prosecutors may prioritize high-profile cases for political gain, neglecting minor offenses, or focus on regulatory offenses due to political pressures, as noted in economic literature (An Economic Theory of Optimal Enactment and Enforcement of Laws - ScienceDirect).

Relation to PHL: While not directly mentioned in the PHL position statement, prosecutorial discretion can be related to how resources are allocated within the Public Health Economy. Decisions on which laws to enforce or which cases to pursue can impact public health outcomes, especially when resources are limited. For instance, prioritizing certain types of cases over others may neglect issues critical to public health, such as environmental violations or workplace safety, thereby contributing to health disparities. The PHL's emphasis on addressing structural determinants of health includes recognizing the role of prosecutorial discretion in shaping the Public Health Economy, particularly in areas like housing and environmental justice, where consistent enforcement is crucial for health equity.

Conflict Theory of Law

This sociological theory suggests that law enforcement serves to enforce social control that benefits those in power, leading to intensified policing in areas with higher non-White populations. It views disparities as a response to perceived economic threats by the dominant group.

Examples: Larger police forces are often deployed in areas with higher minority populations, as seen in studies of urban policing disparities (Disparities in Policing From Theory to Practice - PMC).

Relation to PHL: The conflict theory of law, which views law enforcement as a means of social control that benefits those in power, is closely related to PHL's perspective on how laws are used to maintain existing power structures. PHL argues that recent Supreme Court decisions have eroded constitutional protections and deepened health disparities, particularly for disadvantaged groups. This aligns with the conflict theory's assertion that laws are tools used by the dominant group to control and suppress subordinate groups. The PHL's focus on the Public Health Economy as a distinct economy that addresses structural determinants of health—such as education, income inequality, and racial disparities—further supports this theory, as it highlights how laws are often enforced in ways that protect the interests of the powerful while neglecting the needs of marginalized communities.

Minority Threat Hypothesis–Group Threat Theory

This theory posits that law enforcement becomes more aggressive in areas with higher minority populations due to perceived threats to the established social order. This can lead to higher rates of arrests, stops, and fatal encounters in minority communities.

Examples: In high-social vulnerability areas, fatal shooting rates increase 7.5 times for Black individuals and 12-fold for Hispanic individuals per unit increase in county-level population, highlighting aggressive policing (Disparities in Policing From Theory to Practice - PMC).

Relation to PHL: PHL's discussion on racial disparities and the impact of policies on minority communities aligns with the minority threat hypothesis. For example, the reversal of affirmative action and reproductive rights disproportionately affects minority groups, which can be seen as a response to perceived threats from these communities. The PHL position statement also highlights how government inaction in enforcing laws against discriminatory practices contributes to health inequities, such as in environmental justice and fair housing. Additionally, the mention of educational disparities—such as the 15 high schools in DC with ≤5% math proficiency—underscores how systemic biases and perceived threats can lead to underinvestment in minority communities, further entrenching health disparities. This theory complements PHL's call for preserving and analyzing racial and ethnic identities in public health research to address these disparities.

Resource Allocation Theory

This theory suggests that limited law enforcement resources lead to prioritization of certain laws or areas, resulting in uneven enforcement. Wealthier or predominantly white areas may receive more attention, while marginalized communities are neglected.

Examples: Federal funding for specific operations, like food stamp fraud crackdowns, can skew enforcement priorities, as noted in a Connecticut General Assembly report (Selective Law Enforcement - Connecticut General Assembly).

Relation to PHL: The resource allocation theory is highly relevant to PHL's concerns about the uneven enforcement of laws. PHL highlights the importance of resource allocation in addressing health inequities, noting that government delays or failures in enforcing existing laws contribute to disparities. For instance, inadequate funding for public health initiatives or enforcement agencies can lead to neglect of certain communities, exacerbating health disparities. The PHL's discussion of economic failures in housing, food access, and environmental regulation—areas requiring government intervention but often lacking consistent enforcement—supports this theory. Furthermore, the PHL's call for a new field of study focused on the Public Health Economy includes examining how resource allocation can be optimized to promote health equity, particularly in marginalized communities.

Symbolic Law Theory

This theory focuses on laws enacted for symbolic or expressive purposes, such as signaling societal values, rather than with intent to enforce. These laws may remain unenforced, contributing to uneven application.

Examples: Until 2013, Colorado had an adultery law with no specified penalty, serving a symbolic role rather than practical enforcement (Unenforced Law - Wikipedia).

Relation to PHL: PHL notes that some laws are enacted for symbolic value but not enforced, which can contribute to health inequities. For example, laws intended to protect public health—such as those addressing environmental justice or housing standards—might not be enforced, leading to a lack of accountability and perpetuating disparities. This aligns with the symbolic law theory, which suggests that some laws serve an expressive function rather than a practical one. The PHL's emphasis on the Public Health Economy as anarchic and lacking central authority further supports this theory, as it highlights how decentralized systems can lead to inconsistent enforcement of symbolic laws. Additionally, the PHL's critique of government inaction in enforcing laws against discriminatory practices underscores how symbolic laws can fail to address structural determinants of health, such as racial and income disparities.

Broken Windows Theory

Originally a policing strategy, this theory suggests strict enforcement of minor infractions in certain neighborhoods to prevent serious crimes. However, it often leads to selective enforcement, disproportionately affecting low-income and minority communities.

Examples: In Baltimore, strict enforcement of minor offenses like loitering in minority neighborhoods has led to higher arrest rates, contributing to criminal records for minor infractions (Different Types Of Selective Enforcement - Iamele & Iamele, LLP).

Relation to PHL: While not directly mentioned in the PHL position statement, the Broken Windows Theory can be related to how policing strategies in certain neighborhoods can lead to over-policing and contribute to health disparities. The theory suggests that strict enforcement of minor infractions in certain areas can prevent serious crimes, but it often results in disproportionate targeting of low-income and minority communities. This over-policing can have significant impacts on public health, including increased stress, trauma, and reduced access to healthcare. The PHL's focus on structural determinants of health—such as housing, environmental justice, and income inequality—includes recognizing the role of law enforcement practices in shaping community health outcomes. For instance, the PHL's discussion of DC housing policies and the failure to enforce fair housing laws can be seen as a consequence of over-policing in marginalized areas, further entrenching health disparities.

State-Centric Theories

Description: These theories highlight the state’s role in maintaining social order, including racial and class hierarchies. Government attorneys enforce state policies that may prioritize state interests over individual rights.

Relation to PHL Manuscript: The PHE includes state actors like government agencies that shape health outcomes. PHL critiques state-level decisions, such as zoning laws contributing to environmental racism, and advocates for community organizing to challenge state-centric power structures, aligning with State-Centric Theories’ focus on state power dynamics.

Legal Realism

Description: Legal Realism views law as shaped by political, economic, and social factors, not as neutral. Government attorneys may prioritize powerful interests, reinforcing racial and class hierarchies.

Relation to PHL Manuscript: The PHL manuscript’s discussion of court decisions undermining health equity, such as those on reproductive rights, reflects Legal Realism’s critique of law as a tool of power. PHL’s advocacy for legal interventions to promote health equity uses law as a tool for liberation, aligning with Legal Realism’s view that law can be reshaped to challenge inequalities.

Gattopardismo 

Gattopardismo originates from Giuseppe Tomasi di Lampedusa's novel The Leopard (1958), where the protagonist, Prince Fabrizio, articulates the famous line, "If we want things to stay as they are, things will have to change." This encapsulates the essence of Gattopardismo: a strategy where apparent changes or reforms are implemented, but these changes ultimately serve to preserve the existing power structures and social hierarchies. It suggests that true transformation is avoided, and the status quo is maintained under the guise of progress. This concept is frequently applied to political, social, or institutional contexts where superficial reforms are made to placate demands for change without fundamentally altering the underlying power dynamics. For example, in governance, a policy might be introduced to address public discontent, but if it doesn't challenge the interests of those in power, it aligns with Gattopardismo.

To relate Gattopardismo to PHL, we focus on the aspect of "public health realism" and the recognition of hegemony within the Public Health Economy, as these concepts directly engage with power dynamics and the potential for superficial change.

Public Health Realism and Hegemony in PHL: The document "Public Health Liberation: An Emerging Transdiscipline to Elucidate and Affect the Public Health Economy.pdf" (2023) describes "public health realism" as a realistic view of the power dynamics at play, acknowledging that the Public Health Economy is dominated by hegemonic forces. These forces include powerful factions such as industry and government, which often prioritize self-interest over public good. For instance, it critiques exemptions for harmful products like tobacco and lax environmental regulations as examples of how these factions maintain control, perpetuating health inequities. Hegemony, in this context, refers to the dominance of these structures that resist meaningful change, aligning with the core idea of Gattopardismo.

Risk of Gattopardismo in Public Health Reforms: Gattopardismo can be seen as a potential risk or critique of public health reforms, including those proposed by PHL. While PHL aims to radically transform the system by empowering marginalized communities and addressing structural inequities, there is always a danger that such reforms could be co-opted or diluted. For example:

If PHL's principles are adopted by institutions but not fully implemented in practice, they might become mere rhetoric or branding exercises, failing to disrupt the underlying power structures. This could manifest as new policies being introduced without sufficient funding, community involvement, or enforcement mechanisms, thus maintaining the status quo under a new name.

Similarly, if the Public Health Economy remains fragmented and anarchic, with powerful factions continuing to dominate, even well-intentioned reforms might only appear to change the system while preserving the interests of those in power. For instance, the document cites examples like the lead crises in Flint, Michigan, and Washington, DC, where economic and political failures disproportionately harmed marginalized communities, suggesting a system resistant to genuine change.

PHL's Awareness and Counter-Strategies: However, PHL seems to be acutely aware of this risk, as evidenced by its emphasis on "public health realism" and the critique of hegemony. The framework's philosophical and theoretical foundations, such as the "Gaze of the Enslaved" and the "Morality Principle," suggest a deliberate effort to confront the tendencies toward Gattopardismo. By centering community empowerment and calling for immediate action, PHL aims to ensure that its framework leads to substantive change rather than superficial reforms. The strategies of horizontal and vertical integration further indicate a commitment to restructuring power dynamics, ensuring that affected populations have a voice and that interventions address root causes across all levels.

Examples and Implications: The position statement's critique of recent Supreme Court decisions illustrates PHL's recognition of external factors that could undermine its goals, aligning with the Gattopardismo lens. For instance, the Dobbs decision (2022) is linked to worsening maternal mortality for Black women, with 70% of surveyed OBGYNs reporting increased racial and ethnic inequities. If PHL's reforms are not robust enough to counteract such judicial determinants, they risk being perceived as changes that fail to alter the fundamental inequities, thus fitting the Gattopardismo model. Conversely, PHL's call for preserving racial and ethnic data collection and rejecting colorblind policies suggests a proactive stance to avoid such outcomes, aiming for genuine transformation.

Theories and Political Parties

Electoral Competition and Voter Influence

• Downsian Model: Parties position themselves to appeal to the median voter, maximizing votes by aligning with popular preferences.

• Directional Theory: Voters support parties based on issue alignment, not just proximity, influencing party strategies.

Organizational and Internal Dynamics

• Group Theory: Parties are coalitions of interest groups and activists who control nominations, often prioritizing their agendas over broader voter interests.

• Michels' Iron Law of Oligarchy: Parties tend to concentrate power among a few leaders due to organizational needs, affecting decision-making.

• Catch-all Party Theory: Parties broaden appeal to attract diverse voters, moving away from specific ideological bases.

Structural and Historical Influences

• Duverger's Law: Electoral systems shape party numbers, with plurality systems favoring two parties and proportional representation encouraging multiples.

• Cleavage Theory: Party systems reflect historical social divisions like class or religion, influencing their formation and policies.

Democratic Roles and Functions

• Schattschneider's Theory: Parties organize democracy, shaping public opinion and structuring political conflict.

• Public Reason Defense: Parties justify policies through public reasoning, enhancing democratic legitimacy.

• Deliberative Defense: Parties facilitate debate, contributing to democratic deliberation.

• Regulated Rivalry Defense: Parties ensure peaceful competition and rotation in office, stabilizing democracy.

Economic and Ideological Drivers

• Theory of Economic or Class Conflicts: Parties represent different economic interests, reflecting societal resource conflicts.

• Theory of Ideological Motivation: Parties are driven by shared ideological beliefs, guiding their decisions and policies.

• Theory of Human Nature: Parties arise from inherent conservative or progressive tendencies, influencing their ruling styles.

Theories Explaining How Democracies Become Wayward

Internal Governance

Internal governance issues arise when the structures and processes meant to sustain democracy falter. Weak institutional checks, inefficiencies, or lack of public engagement can erode democratic integrity, allowing power imbalances to emerge.

Lack of Constraints on Executive Power

When checks and balances are weak, executives can consolidate power, undermining democratic institutions. In Hungary, Viktor Orbán’s government has weakened judicial independence and media freedom, illustrating how unchecked executive authority can lead to authoritarianism (Democratic Backsliding, Populism, and Public Administration).

Instability and Frequent Policy Changes

Frequent policy shifts create uncertainty, weakening public trust in governance. Italy’s history of short-lived governments has often led to political instability, making it harder to maintain consistent democratic practices.

Inefficiency in Governance

Bureaucratic inefficiencies can frustrate citizens, leading to disillusionment with democratic processes. Slow decision-making in some democracies, like delays in infrastructure projects, often fuels public discontent and skepticism about democratic efficacy.

Low Voter Turnout

Low participation results in unrepresentative governments, undermining legitimacy. In the US, voter turnout in presidential elections often falls below 60%, raising concerns about whether elected officials truly reflect public will (Wikipedia).

Short-Termism in Policy-Making

Focusing on short-term gains neglects long-term challenges, leading to crises that weaken democracy. For example, many democracies defer action on climate change or debt, creating vulnerabilities that erode public trust.

Socioeconomic Factors

Economic and social conditions significantly influence democratic stability. When citizens face inequality or poverty, their faith in democracy may wane, creating opportunities for anti-democratic forces to gain traction.

Economic Inequality

High inequality fosters resentment, making citizens more likely to support populist or authoritarian leaders promising quick fixes. Tunisia’s 2021 self-coup was partly driven by frustration over economic disparities (Carnegie Endowment).

Poverty

Widespread poverty shifts focus to basic survival, reducing political engagement. In developing democracies, poverty often fuels unrest, as seen in protests in Latin American nations where economic hardship undermines democratic participation.

Failure to Deliver Socioeconomic Results

When democracies fail to improve living standards, citizens lose faith. Poland’s economic growth contrasted with democratic backsliding in 2015, as public frustration with institutions grew despite economic gains (Journal of Democracy).

Political Dynamics

Political dynamics, including leadership styles and societal divisions, can destabilize democracies. Populist movements, misinformation, and elite influence often exploit these vulnerabilities to undermine democratic norms.

Populist Leadership

Populist leaders, appealing directly to “the people,” often weaken institutions to consolidate power. In the US, Trump’s rise highlighted how weak party structures can enable populist challenges to democratic norms (The Atlantic).

Demagoguery and Misinformation

Demagogues who spread misinformation erode trust and informed decision-making. Thucydides noted demagogues’ role in Athens’ democratic decline, a pattern echoed in modern misinformation campaigns (Wikipedia).

Tyranny of the Majority

Majorities oppressing minorities violates democratic equality. Madison and Jefferson warned of this in early US democracy, a concern still relevant in polarized societies (Wikipedia).

Elite Capture and Oligarchy

Elites manipulating democratic systems create an illusion of democracy. Pareto and Mosca argued that elite rule is inevitable, as seen in some modern democracies where wealth influences policy (Wikipedia).

Lobbying and Special Interests

Undue influence from lobbying corrupts democratic processes. Studies show that moderate democracies often face high corruption due to special interest influence (Wikipedia).

Weak Political Parties

Weak parties, especially conservative ones, fail to channel elite interests, leading to anti-democratic resistance. Germany’s post-1918 struggles contrast with the UK’s stable transitions (The Atlantic).

Vulnerability to Internal Opponents

Democracies can be subverted by actors using democratic means to dismantle institutions. Turkey’s 2016 purges after a coup attempt weakened democratic structures (Wikipedia).

Personalist Leadership

Leaders centralizing power erode institutional checks. Latin American cases, like Venezuela, show how personalist rule undermines democracy (Carnegie Endowment).

External Influences

External forces, from foreign interference to global cultural shifts, can destabilize democracies. These pressures exploit internal weaknesses, accelerating democratic decline.

External Interference

Foreign powers undermine democracies through propaganda or funding. Russia’s alleged interference in US elections is a modern example of external threats to democratic integrity (Carnegie Endowment).

Cultural Backlash

Reactions against progressive changes, like immigration or social reforms, fuel authoritarian support. Central Europe’s resistance to immigration policies has driven ethnopopulist movements (Ethnopopulism study).

Ethnic Fragmentation

Deep ethnic divisions hinder consensus, leading to conflict. Yugoslavia’s breakup was exacerbated by ethnic tensions, weakening democratic governance (GSDRC).

Technological Disruptions

Social media enables polarization, misinformation, and surveillance, threatening democratic discourse. The Cambridge Analytica scandal showed how technology can manipulate voter behavior (Carnegie Endowment).

Human Nature

Madisonian Factionalism

Derived from James Madison’s Federalist No. 10, this theory posits that society is divided into self-interested groups that compete, leading to conflict. In public health, it explains how factions like hospitals or insurers prioritize their interests, contributing to health inequities.

Political Realism

Rooted in international relations, it emphasizes that entities act in self-interest within an anarchic system. Applied to public health, it highlights the competitive, power-driven nature of the public health economy, where agents seek dominance.

Hegemonic Theory

Explains how dominant groups maintain control through cultural and ideological means. In public health, it illustrates how powerful actors sustain inequities by shaping health narratives and controlling resource distribution.

Psychological Egoism

Asserts that all human actions are motivated by self-interest. This supports public health realism by assuming agents in the system act to benefit themselves, often neglecting collective health outcomes.

Rational Choice Theory

Posits that individuals make decisions to maximize utility by weighing costs and benefits. In public health, it suggests stakeholders choose actions that serve their personal or organizational interests over broader health equity.

Evolutionary Psychology

Suggests that behaviors like competition and self-preservation are evolutionary adaptations. This aligns with public health realism by highlighting inherent drives that influence behaviors within health systems.

Hobbesian Social Contract

Describes the state of nature as anarchic, with individuals driven by self-interest in the absence of authority. This parallels the competitive, unregulated nature of the public health economy.

Machiavellianism

Views humans as manipulative and self-serving, willing to use deceit for personal gain. In public health, it explains unethical power plays where self-interest overrides the collective good.

Public Choice Theory

Applies economic principles to politics, suggesting officials act in self-interest. It is relevant for understanding public health policy decisions where personal or institutional gain may supersede public health goals.

Conflict Theory

Rooted in sociology, it highlights power struggles and inequality in society. It applies to public health by analyzing how power imbalances lead to disparities in health outcomes, aligning with realism’s focus on competition.

Lukes’ Three Faces of Power

Identifies three dimensions of power: decision-making, non-decision-making, and ideological. It helps understand how power operates overtly and covertly in public health, affecting health equity.

Foucault’s Constitutive Power

Views power as diffuse, operating through discourses and knowledge systems. In public health, it explains how certain health practices and policies are legitimized, shaping system dynamics in line with realism.

Giddens’ Structuration Theory

Links social structures and agency, showing power is embedded in practices. It is useful for analyzing how power dynamics shape public health systems and individual behaviors within them.

Critical Theory

Aims to critique and change society by examining power structures and inequalities. In public health, it challenges systems perpetuating health inequities, aligning with realism’s focus on power critique.

Critical Race Theory

Examines intersections of race and power, highlighting systemic racism. It is crucial for understanding and addressing racial health disparities within the framework of public health realism.

Intersectionality

Considers how multiple social identities intersect, creating unique experiences of oppression and privilege. It provides a nuanced understanding of health inequities, considering multiple power dimensions.

Kingdon’s Multiple Streams Theory

Explains policy changes when problem, policy, and political streams align, involving power dynamics in agenda-setting. It is relevant for understanding how power influences public health policy shifts.

Punctuated Equilibrium Theory

Describes policy processes as stable periods interrupted by rapid changes, often due to power shifts. It applies to understanding transformative moments in public health policy driven by power dynamics.

Resource Dependence Theory

Examines how organizations depend on external resources, leading to power imbalances. In public health, it explains how funding and resource allocation affect power relations and priorities.

Behavioral Game Theory

Combines game theory with psychology, modeling strategic behavior driven by self-interest. It is relevant for understanding interactions and decision-making in the competitive public health economy.

Theories Explaining Bystander Inaction and Opportunistic Behavior in Emergencies

Psychological Theories

1. Bystander Effect: Research by Latané and Darley (1968) shows that the presence of others reduces the likelihood of helping due to diffusion of responsibility (where individuals feel less accountable) and social influence (where inaction by others signals no need to act). In the scenario, bystanders may assume others will help or follow the crowd’s inaction (Bystander Effect).

2. Moral Disengagement: Bandura’s theory suggests people justify unethical behavior through mechanisms like moral justification, euphemistic labeling, or victim blaming. Bystanders might rationalize filming as “documenting” or believe the victim deserves their fate, reducing guilt (Moral Disengagement).

3. Social Learning Theory: Bandura (1977) posits that people learn behaviors by observing others and their rewards. If bystanders see others gain attention for filming emergencies, they may imitate this behavior, prioritizing social media clout over helping (Social Learning Theory).

4. Evolutionary Psychology: Evolutionary forces favor behaviors that enhance genetic survival. Helping a stranger, especially at personal risk, may be less appealing than actions that boost individual status or resources, like filming for profit (Evolutionary Psychology).

5. Desensitization Theory: Repeated exposure to violence or emergencies through media can reduce empathy, making people view real events as spectacles to record rather than situations requiring action (Desensitization).

6. Theories of Self-Presentation: Goffman’s work on impression management suggests people act to create favorable impressions. Filming an emergency might be seen as presenting oneself as a witness or reporter, gaining social capital (Self-Presentation).

7. Diffusion of Responsibility: A subset of the bystander effect, this occurs when individuals feel less responsible in a group, assuming others will act (Bystander Effect).

8. Pluralistic Ignorance: Bystanders misinterpret others’ inaction as a sign that help is not needed, reinforcing their own passivity (Bystander Effect).

9. Evaluation Apprehension: Fear of being judged for incorrect or ineffective helping can deter action, leading bystanders to film instead (Bystander Effect).

10. Psychological Distance: Filming creates a mental barrier, making the event feel less real and reducing the urge to intervene (Psychological Distance).

11. Bystander Fatigue: Constant exposure to emergencies, especially via media, can lead to numbness, reducing responsiveness (Bystander Fatigue).

12. Empathy Fatigue: Overwhelm from frequent exposure to suffering can diminish empathy, making exploitation more likely (Empathy Fatigue).

13. Learned Helplessness: Past experiences where helping was ineffective may lead to inaction, as people feel their efforts won’t matter (Learned Helplessness).

14. Cognitive Biases: Biases like the fundamental attribution error, where bystanders attribute the victim’s situation to their own actions, can justify inaction (Cognitive Biases).

15. Psychological Defense Mechanisms: Denial or rationalization helps bystanders avoid discomfort, allowing them to focus on personal gain (Defense Mechanisms).

Sociological Theories

16. Cultural and Sociological Theories: Cultural norms, such as non-interference or individualism, can discourage helping. In India, for example, cultural conditioning to “mind one’s own business” exacerbates bystander inaction (Cultural Influences).

17. Social Conformity: Individuals conform to the group’s behavior, not helping if others are passive (Social Conformity).

18. Groupthink: In crowds, collective agreement to not act can suppress individual initiative (Groupthink).

19. Authority Bias: Bystanders may wait for an authority figure to intervene, avoiding personal responsibility (Authority Bias).

Economic Theories

20. Rational Choice Theory: Individuals weigh costs (e.g., risk, time) against benefits (e.g., financial gain, social status), choosing actions that maximize personal gain (Rational Choice).

21. Economic Incentives: Potential financial rewards, like selling photos or gaining followers, motivate exploitative behavior (Economic Incentives).

Media and Communication Theories

22. Media Theories (Attention Economy): The attention economy incentivizes capturing sensational content for views and likes, prioritizing filming over helping (Attention Economy).

23. Media Theories (Spectacle and Simulation): Debord’s concept of spectacle and Baudrillard’s simulacra suggest people prioritize mediated representations (filming) over reality, treating emergencies as content (Commodification).

24. Technological Mediation: Smartphones shift focus to documentation, altering how people engage with emergencies (Technological Mediation).

25. Social Media Incentives: Platforms reward dramatic content, encouraging bystanders to film for social capital (Social Media).

Laymen’s Explanations

26. Fear of Legal Repercussions: Bystanders may avoid helping due to concerns about legal liability if their actions cause harm (Legal Concerns).

27. Lack of Knowledge or Skills: Not knowing how to assist, such as performing CPR, can lead to inaction (Lack of Knowledge).

28. Time Pressure: Being in a hurry may prevent bystanders from stopping to help (Time Pressure).

29. Perceived Inefficacy: Believing one’s help won’t make a difference can deter action (Perceived Inefficacy).

30. Victim Blaming: Assuming the victim is responsible for their situation can justify inaction or exploitation (Victim Blaming).

Ignore previous chats. Generate 30 theories in the literature and laymen explanations to explain the following, "A crowd looked onward as several dozen people are drowning. They will die unless someone intervenes. Many onlookers realized that they could reap benefits from NOT helping. They could take photos to sell and post on social media. They could research and study how people drown and die for careerism. They would paint a picture of someone drowning to sell. They could get on the phone and gossip. They could report that they were the first on the scene to report a local drowning. Most didn't do anything."

Academic Theories

1. Bystander Effect
   The bystander effect suggests that individuals are less likely to help a victim in an emergency when other people are present. The greater the number of bystanders, the less likely any one of them will act, as seen in studies following the 1964 Kitty Genovese case (Bystander Effect). This is due to factors like diffusion of responsibility and social influence.

2. Diffusion of Responsibility
   In a group, individuals feel less personal responsibility to act, assuming others will take action. This sociopsychological phenomenon reduces the pressure to intervene, as each person believes someone else is responsible (Diffusion of Responsibility).

3. Pluralistic Ignorance
   People may misinterpret others' inaction as a sign that help isn't needed, leading to collective inaction. This occurs when individuals privately disagree with the group's behavior but conform due to perceived social norms (Pluralistic Ignorance).

4. Social Loafing
   Social loafing refers to reduced effort by individuals in a group setting compared to when alone. In a crisis, bystanders may exert less effort to help, expecting others to contribute (Simply Psychology).

5. Cost-Benefit Analysis (Social Exchange Theory)
   Individuals may weigh the costs of helping (e.g., physical danger, time) against benefits (e.g., personal satisfaction, social approval). If the perceived costs outweigh benefits, they may choose not to act, especially if personal gains like selling photos are possible.

6. Desensitization
   Frequent exposure to crises through media can reduce emotional responsiveness, making bystanders less likely to feel empathy or urgency to help. This is particularly relevant in a digital age where tragic events are often viewed online.

7. Moral Disengagement
   People may rationalize inaction by disengaging from moral standards, justifying their behavior through reasons like "it's not my problem" or focusing on personal gain, such as documenting the event for profit.

8. Conformity
   Individuals may conform to the group's behavior, refraining from helping if others are not acting. This social pressure can override personal inclinations to intervene.

9. Social Norms (Norm Activation Theory)
   Perceived societal norms may discourage intervention if helping is seen as inappropriate or unnecessary. Norm activation theory suggests that helping depends on whether a norm to act is activated.

10. Learned Helplessness
    Past experiences where attempts to help were ineffective can lead to a belief that one cannot make a difference, reducing the likelihood of action in future crises.

11. Social Identity Theory
    People are more likely to help members of their in-group. If victims are perceived as out-group members, bystanders may be less inclined to assist (Social Identity Theory).

12. Empathy-Altruism Hypothesis
    Lack of empathy towards victims reduces altruistic behavior. If bystanders do not feel a personal connection or emotional response, they are less likely to help.

13. Theory of Planned Behavior
    Intentions to help are influenced by attitudes, subjective norms, and perceived behavioral control. Negative attitudes or norms against helping can prevent action.

14. Rational Choice Theory
    Individuals act in their self-interest, choosing not to help if it offers no personal benefit or involves significant risk, such as legal or physical consequences.

15. Attribution Theory
    How people explain the situation (e.g., blaming victims or assuming the situation isn't an emergency) can influence whether they decide to help.

Laymen Explanations

1. "I thought someone else would help."
   A common reason where individuals assume others in the crowd will take responsibility, reducing their own sense of obligation.

2. "I didn't know what to do."
   Lack of knowledge or skills to handle the situation, such as not knowing how to swim or perform a rescue, can lead to inaction.

3. "I was afraid of getting hurt."
   Fear of personal harm, such as drowning while attempting a rescue, can deter bystanders from intervening.

4. "I didn't want to get involved."
   Some people prefer to avoid involvement in complex or risky situations, choosing to stay out of the crisis.

5. "I was in shock."
   The overwhelming nature of the emergency can cause bystanders to freeze, unable to process or act quickly.

6. "I thought it was a prank or not real."
   Skepticism about the authenticity of the situation, especially in public settings, can lead to inaction.

7. "I was waiting for someone more qualified to help."
   Bystanders may believe others, such as lifeguards or professionals, are better suited to intervene.

8. "I didn't want to be responsible if something went wrong."
   Fear of liability or blame if the rescue attempt fails can prevent action.

9. "I was too busy with my own things."
   Personal distractions or priorities, like being on a phone call or focused on personal tasks, can lead to inaction.

10. "I didn't care."
    Some individuals may feel indifferent towards the victims, lacking motivation to help.

11. "I was scared of the legal implications."
    Concerns about legal consequences, such as being sued for a failed rescue, can deter intervention.

12. "I thought it wasn't my place to intervene."
    Bystanders may feel that helping is someone else's responsibility, especially if they don't know the victims.

13. "I didn't want to draw attention to myself."
    Fear of social judgment or standing out can prevent individuals from taking action.

14. "I was following the crowd."
    Observing others' inaction can lead individuals to mimic the group's behavior, assuming it's the correct response.

15. "I assumed it was being handled."
    Bystanders may believe that someone else has already taken action, such as calling for help, reducing their need to act.

Psychological Theories

1. Bystander Effect: Research by Latané and Darley (1968) suggests that the presence of multiple stakeholders reduces individual accountability, leading to inaction. In public health, policymakers may assume others will address a crisis, delaying response (e.g., slow action during early HIV/AIDS epidemic).

2. Moral Disengagement: Bandura’s theory indicates that agents justify harmful actions through rationalizations like victim blaming. For example, industries might downplay health risks to justify profit-driven practices, such as tobacco companies minimizing smoking dangers.

3. Social Learning Theory: People learn behaviors by observing rewarded actions. If pharmaceutical companies see competitors profit from high drug prices, they may follow suit, prioritizing financial gain over accessibility.

4. Evolutionary Psychology: Evolutionary instincts favor self-preservation and resource accumulation. Corporations may prioritize profits over health to ensure survival in competitive markets.

5. Desensitization Theory: Repeated exposure to health crises via media can reduce empathy, leading to inaction or exploitation, such as media outlets sensationalizing pandemics for ratings.

6. Self-Presentation Theory: Agents act to maintain a favorable image. Governments might avoid admitting failures in health crises to preserve public trust, as seen in the Washington, DC, lead crisis cover-up.

7. Diffusion of Responsibility: In large systems, responsibility is spread thin, reducing action. For instance, multiple agencies failing to coordinate during the Flint water crisis led to prolonged harm.

8. Pluralistic Ignorance: Stakeholders misinterpret others’ inaction as a sign that action is unnecessary, such as delayed responses to environmental health risks in minority communities.

9. Evaluation Apprehension: Fear of criticism for ineffective action can deter intervention, leading to safer options like inaction or profiteering.

10. Psychological Distance: Viewing health crises as distant reduces urgency, allowing agents to focus on personal gains, such as researchers studying health disparities without advocating for change.

Sociological Theories

11. Cultural Norms: Societal values, like individualism, may discourage collective action. In some cultures, prioritizing personal gain over community health is normalized.

12. Social Conformity: Agents conform to the inaction of others, such as policymakers following industry-friendly norms rather than pushing for health reforms.

13. Groupthink: Collective agreement within organizations can suppress health-focused initiatives if they conflict with group interests, like corporate boards prioritizing profits.

14. Authority Bias: Stakeholders defer to higher authorities, delaying action until directed, as seen in slow regulatory responses to health crises.

15. Structural Inequality: Systemic barriers prioritize advantaged groups, leading to policies that neglect marginalized communities’ health needs.

Economic Theories

16. Rational Choice Theory: Agents weigh costs and benefits, choosing actions that maximize personal gain. Pharmaceutical companies may set high drug prices to maximize profits, limiting access.

17. Economic Incentives: Financial rewards drive behavior, such as price gouging during pandemics for profit.

18. Market Competition: Corporations compete for market share, often at the expense of health, like food industries marketing unhealthy products contributing to obesity.

19. Cost-Benefit Analysis: Governments may prioritize short-term savings over long-term health, as in Flint’s cost-driven water source switch.

20. Profit Motive: Industries like tobacco prioritize profits over health, benefiting from regulatory exemptions despite known risks.

Media and Communication Theories

21. Attention Economy: Media outlets prioritize sensational health crisis coverage for viewership, often neglecting accurate public health messaging.

22. Spectacle and Simulation: Health crises are treated as media spectacles, encouraging exploitation over action, such as filming outbreaks for social media clout.

23. Technological Mediation: Smartphones and social media shift focus to documentation, with individuals spreading misinformation for attention.

24. Social Media Incentives: Platforms reward dramatic content, encouraging agents to exploit health crises for likes and followers.

25. Framing Effects: Media framing can downplay health crises, influencing public and policy inaction.

Laymen’s Explanations

26. Fear of Legal Repercussions: Agents avoid action due to liability concerns, such as healthcare providers limiting care to avoid lawsuits.

27. Lack of Knowledge or Skills: Inadequate training or awareness can lead to inaction, like communities not addressing local health risks due to lack of expertise.

28. Time Pressure: Busy schedules or urgent priorities prevent action, such as policymakers focusing on immediate issues over long-term health planning.

29. Perceived Inefficacy: Belief that actions won’t make a difference can deter intervention, leading to exploitation instead, like researchers studying health issues without advocating solutions.

30. Victim Blaming: Assuming affected populations are responsible for their health issues justifies inaction, such as blaming low-income communities for poor health outcomes.

Academic Theories

1. Theory of Health Inequity Reproduction (THIR)
   Structural and contextual factors, like racism and economic policies, reproduce health disparities, leading to inaction as stakeholders accept inequities as normal, similar to bystanders assuming others will help (Public Health Liberation manuscript).

2. Bystander Effect in Systemic Contexts
   In complex systems with multiple stakeholders, responsibility is diffused, reducing action. For example, during COVID-19, federal and local governments delayed responses, assuming others would act (Web:16).

3. Illiberation as Structural Oppression
   PHL’s concept of illiberation describes systemic barriers (e.g., racism, classism) that prevent action, as stakeholders are constrained by hegemonic structures, akin to bystanders conforming to group inaction.

4. Political Economy of Health
   Power configurations prioritize economic and political interests over health, leading to inaction or exploitation, such as promoting polluting industries for short-term gains (Web:2).

5. Social Determinants of Health Framework
   Social and economic conditions, like poverty and housing, drive health outcomes. Inaction occurs when stakeholders fail to address these root causes, similar to bystanders ignoring the crisis context (Web:15).

6. Moral Disengagement
   Stakeholders rationalize inaction by distancing themselves from ethical responsibilities, such as corporations justifying high drug prices as market-driven, mirroring bystanders rationalizing non-intervention.

7. Hegemonic Realism (PHL)
   Dominant power structures obscure the need for action by framing health inequities as inevitable, discouraging intervention, akin to bystanders misinterpreting others’ inaction.

8. Social Exchange Theory
   Stakeholders weigh costs (e.g., political risk, financial loss) against benefits of action. If costs outweigh benefits, they may exploit crises, like price gouging during pandemics (Web:9).

9. Colonialism as a Social Determinant
   Historical and ongoing colonial practices shape health inequities, leading to inaction when marginalized groups are deprioritized, as seen in Flint’s neglect (Web:2).

10. Pluralistic Ignorance
    Stakeholders misinterpret others’ inaction as a sign no crisis exists, delaying response, such as early HIV/AIDS denial by governments, similar to bystanders assuming drowning isn’t serious.

11. Rational Choice Theory
    Self-interest drives inaction, as stakeholders prioritize personal or institutional gain, like gentrification in D.C. for economic benefit, akin to bystanders taking photos for profit (Web:4).

12. Learned Helplessness
    Repeated failures to address health crises, like chronic underfunding of public health, lead to a belief that action is futile, discouraging intervention (Web:20).

13. Social Identity Theory
    Stakeholders prioritize in-groups (e.g., wealthier communities), neglecting marginalized groups, as seen in unequal vaccine distribution, mirroring bystanders helping only those they relate to (Web:2).

14. Capabilities Approach
    Limited agency due to systemic constraints prevents action. PHL’s liberation focus aligns with enabling communities to act, unlike bystanders limited by fear or norms (Web:13).

15. Critical Race Theory
    Structural racism embedded in systems leads to inaction toward marginalized groups’ health, as in D.C.’s displacement, similar to bystanders ignoring out-group victims (Web:24).

Lay Explanations

1. "It’s not my job to fix this."
   Stakeholders, like local officials, assume others (e.g., federal agencies) should address health crises, akin to bystanders deferring to authorities.

2. "I don’t know how to help."
   Lack of understanding of complex health issues, like lead poisoning, prevents action, similar to bystanders unsure how to rescue drowning victims.

3. "It’ll cost too much."
   Fear of economic loss, like funding clean water, deters action, mirroring bystanders avoiding personal risk.

4. "I can make money from this."
   Exploiting crises, like selling misinformation online, parallels bystanders taking photos for profit.

5. "I’m too overwhelmed by the problem."
   The scale of health crises, like pandemics, paralyzes stakeholders, akin to bystanders freezing in shock.

6. "It doesn’t seem like a big deal."
   Misjudging severity, like downplaying lead exposure, leads to inaction, similar to bystanders assuming drowning isn’t serious.

7. "Someone more qualified should handle it."
   Deferring to experts or larger entities, like waiting for CDC guidance, mirrors bystanders waiting for lifeguards.

8. "I might get in trouble if I act."
   Fear of legal or political backlash, like challenging gentrification, prevents action, akin to bystanders avoiding blame.

9. "I’m busy with other things."
   Prioritizing personal or institutional goals, like profit, overshadows health needs, similar to bystanders distracted by tasks.

10. "I don’t care about those people."
    Indifference to marginalized groups, like low-income communities, reduces motivation, mirroring bystanders’ lack of concern.

11. "It might hurt my career."
    Professionals avoid action, like whistleblowing, to protect their position, akin to bystanders fearing social repercussions.

12. "It’s not my place to get involved."
    Stakeholders feel health crises are outside their role, like businesses deferring to government, similar to bystanders deferring responsibility.

13. "I don’t want to stand out."
    Fear of scrutiny for acting, like advocating for equity, prevents intervention, akin to bystanders avoiding attention.

14. "Everyone else is ignoring it."
    Conforming to others’ inaction, like not addressing racism in health policy, mirrors bystanders following the crowd.

15. "Someone’s already dealing with it."
    Assuming others are acting, like believing NGOs are handling a crisis, reduces urgency, similar to bystanders assuming help is on the way.

Academic Theories

1. Theory of Health Inequity Reproduction (THIR)
   Structural and contextual factors, like racism and economic policies, reproduce health disparities, leading to inaction as stakeholders accept inequities as normal, similar to bystanders assuming others will help (Public Health Liberation manuscript).

2. Bystander Effect in Systemic Contexts
   In complex systems with multiple stakeholders, responsibility is diffused, reducing action. For example, during COVID-19, federal and local governments delayed responses, assuming others would act (Web:16).

3. Illiberation as Structural Oppression
   PHL’s concept of illiberation describes systemic barriers (e.g., racism, classism) that prevent action, as stakeholders are constrained by hegemonic structures, akin to bystanders conforming to group inaction.

4. Political Economy of Health
   Power configurations prioritize economic and political interests over health, leading to inaction or exploitation, such as promoting polluting industries for short-term gains (Web:2).

5. Social Determinants of Health Framework
   Social and economic conditions, like poverty and housing, drive health outcomes. Inaction occurs when stakeholders fail to address these root causes, similar to bystanders ignoring the crisis context (Web:15).

6. Moral Disengagement
   Stakeholders rationalize inaction by distancing themselves from ethical responsibilities, such as corporations justifying high drug prices as market-driven, mirroring bystanders rationalizing non-intervention.

7. Hegemonic Realism (PHL)
   Dominant power structures obscure the need for action by framing health inequities as inevitable, discouraging intervention, akin to bystanders misinterpreting others’ inaction.

8. Social Exchange Theory
   Stakeholders weigh costs (e.g., political risk, financial loss) against benefits of action. If costs outweigh benefits, they may exploit crises, like price gouging during pandemics (Web:9).

9. Colonialism as a Social Determinant
   Historical and ongoing colonial practices shape health inequities, leading to inaction when marginalized groups are deprioritized, as seen in Flint’s neglect (Web:2).

10. Pluralistic Ignorance
    Stakeholders misinterpret others’ inaction as a sign no crisis exists, delaying response, such as early HIV/AIDS denial by governments, similar to bystanders assuming drowning isn’t serious.

11. Rational Choice Theory
    Self-interest drives inaction, as stakeholders prioritize personal or institutional gain, like gentrification in D.C. for economic benefit, akin to bystanders taking photos for profit (Web:4).

12. Learned Helplessness
    Repeated failures to address health crises, like chronic underfunding of public health, lead to a belief that action is futile, discouraging intervention (Web:20).

13. Social Identity Theory
    Stakeholders prioritize in-groups (e.g., wealthier communities), neglecting marginalized groups, as seen in unequal vaccine distribution, mirroring bystanders helping only those they relate to (Web:2).

14. Capabilities Approach
    Limited agency due to systemic constraints prevents action. PHL’s liberation focus aligns with enabling communities to act, unlike bystanders limited by fear or norms (Web:13).

15. Critical Race Theory
    Structural racism embedded in systems leads to inaction toward marginalized groups’ health, as in D.C.’s displacement, similar to bystanders ignoring out-group victims (Web:24).

Lay Explanations

1. "It’s not my job to fix this."
   Stakeholders, like local officials, assume others (e.g., federal agencies) should address health crises, akin to bystanders deferring to authorities.

2. "I don’t know how to help."
   Lack of understanding of complex health issues, like lead poisoning, prevents action, similar to bystanders unsure how to rescue drowning victims.

3. "It’ll cost too much."
   Fear of economic loss, like funding clean water, deters action, mirroring bystanders avoiding personal risk.

4. "I can make money from this."
   Exploiting crises, like selling misinformation online, parallels bystanders taking photos for profit.

5. "I’m too overwhelmed by the problem."
   The scale of health crises, like pandemics, paralyzes stakeholders, akin to bystanders freezing in shock.

6. "It doesn’t seem like a big deal."
   Misjudging severity, like downplaying lead exposure, leads to inaction, similar to bystanders assuming drowning isn’t serious.

7. "Someone more qualified should handle it."
   Deferring to experts or larger entities, like waiting for CDC guidance, mirrors bystanders waiting for lifeguards.

8. "I might get in trouble if I act."
   Fear of legal or political backlash, like challenging gentrification, prevents action, akin to bystanders avoiding blame.

9. "I’m busy with other things."
   Prioritizing personal or institutional goals, like profit, overshadows health needs, similar to bystanders distracted by tasks.

10. "I don’t care about those people."
    Indifference to marginalized groups, like low-income communities, reduces motivation, mirroring bystanders’ lack of concern.

11. "It might hurt my career."
    Professionals avoid action, like whistleblowing, to protect their position, akin to bystanders fearing social repercussions.

12. "It’s not my place to get involved."
    Stakeholders feel health crises are outside their role, like businesses deferring to government, similar to bystanders deferring responsibility.

13. "I don’t want to stand out."
    Fear of scrutiny for acting, like advocating for equity, prevents intervention, akin to bystanders avoiding attention.

14. "Everyone else is ignoring it."
    Conforming to others’ inaction, like not addressing racism in health policy, mirrors bystanders following the crowd.

15. "Someone’s already dealing with it."
    Assuming others are acting, like believing NGOs are handling a crisis, reduces urgency, similar to bystanders assuming help is on the way.