Assessment of Theoretical Constructs in "Public Health Liberation" Manuscript

April 30, 2025

Assessment of Theoretical Constructs in "Public Health Liberation" Manuscript

Summary

By Gemini

This report evaluates the theoretical constructs presented in the manuscript "Public Health Liberation - An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy". A rubric was developed based on standard criteria for construct validity, including conceptual clarity, theoretical coherence, empirical grounding/operationalization, distinctiveness, and utility. The core constructs analyzed were Public Health Economy, Gaze of the Enslaved, Morality Principle, Liberation, Illiberation, Liberation Safe Spaces, Public Health Realism, and Hegemony. The analysis found that while the constructs are innovative and grounded in rich philosophical traditions and lived experiences, particularly from African American perspectives, their operationalization and empirical validation are still nascent, as acknowledged by the authors. The constructs offer significant utility for reframing public health discourse towards equity but require further development for empirical research and widespread application.

Introduction

Gemini (2.5 Pro Experimental) responded to the following prompt, "Develop rubric for assessing validity of all theoretical constructs, then apply and evaluate to manuscript. Write-up findings with summary, introduction, methods, results, and discussion."

The manuscript "Public Health Liberation - An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy" introduces Public Health Liberation (PHL) as a novel transdiscipline aimed at accelerating health equity. Central to this framework is the introduction of several new theoretical constructs designed to analyze and challenge the "public health economy"—the interplay of economic, political, and social drivers affecting community health. Assessing the validity of these constructs is crucial for understanding their potential contribution to public health theory and practice. This report outlines a rubric for assessing construct validity and applies it to the key theoretical concepts presented in the manuscript.

Methods

1. Rubric Development: A rubric was created to assess the validity of the theoretical constructs based on the following criteria:

   • Conceptual Clarity: Is the construct clearly defined? Are its boundaries specified?

   • Theoretical Coherence: Does the construct fit logically within the broader theoretical framework (PHL)? Is its relationship to other constructs clear?
     Empirical Grounding/Operationalization: Is the construct based on observable phenomena or experiences? Are there suggestions for how it could be measured or identified in practice or research?

   • Distinctiveness: Does the construct offer a unique perspective or capture phenomena not adequately addressed by existing concepts? Is its distinction from similar concepts (e.g., empowerment vs. liberation, illiberation vs. internalized oppression) justified?

   • Utility: Does the construct provide explanatory power or practical guidance for understanding or intervening in public health issues? Does it help achieve the stated aims of PHL (accelerating health equity)?

2. Manuscript Analysis: The provided PDF manuscript was analyzed to identify and understand the core theoretical constructs introduced by the authors. Specific attention was paid to definitions, justifications, examples, and proposed applications.

3. Rubric Application: Each identified construct was evaluated against the criteria outlined in the rubric, using evidence and examples drawn directly from the manuscript text.

Results

The application of the rubric to the key theoretical constructs yielded the following assessments:

1. Public Health Economy:

   • Clarity: Clearly defined as the totality of economic, political, and social drivers impacting community health and the interactions among agents reproducing health inequity.

   • Coherence: Serves as the central analytic lens for PHL, framing the context within which other constructs operate.

   • Grounding: Grounded in observable political-economic realities and community experiences (e.g., Flint, DC water crises, gentrification ), though direct measurement is complex. Borrows from political economy.

   • Distinctiveness: Presented as distinct from related concepts (e.g., structural violence, determinants of health) by unifying them under one lens and emphasizing its anarchic nature.

   • Utility: High utility in providing a comprehensive framework for analyzing interconnected drivers of health inequity.

2. Gaze of the Enslaved:

   • Clarity: Defined as an ontological and ethical standard using perspectives of enslaved African Americans to critique research on vulnerable populations.

   • Coherence: Fits within PHL's liberation philosophy and critique of traditional research ethics.

   • Grounding: Grounded in historical analogy and ethical reasoning. Operationalization involves applying this ethical lens to research proposals/studies.

   • Distinctiveness: Offers a unique, historically informed ethical perspective distinct from standard research ethics paradigms.

   • Utility: Useful for critical evaluation of research ethics, particularly concerning community benefit and structural interventions.

3. Morality Principle:

   • Clarity: Defined as the moral obligation to intervene immediately in the public health economy when severe harm is evident or anticipated, regardless of complete scientific proof.

   • Coherence: Aligns with PHL's action-oriented praxis and prioritization of community well-being over research delays.

   • Grounding: Grounded in historical examples of injustice (e.g., slavery, Jim Crow, Flint water crisis) and ethical imperative. Application involves identifying situations meeting this threshold.

   • Distinctiveness: Unique emphasis on immediate moral obligation to act, distinct from evidence-based practice timelines.

   • Utility: High utility in guiding decisions on timely intervention in crisis situations or clear cases of structural violence.

4. Liberation:

   • Clarity: Defined as a mindset, way of life, and pursuit of emancipation from constraints; involves self-worth and higher cognitive demand. Differentiated from simple empowerment.

   • Coherence: Central philosophical principle underpinning PHL, informing its theories and praxis. Linked to overcoming illiberation.

   • Grounding: Grounded in emancipatory traditions (esp. African American history ), community autonomy narratives, and observable actions (e.g., self-advocacy, coalition building ). Measurement development acknowledged as early stage.

   • Distinctiveness: Distinguished from anti-racism (focus on internal community strengthening vs. appealing to power structures ) and empowerment (broader scope, collective focus ).

   • Utility: High utility in framing the goal (emancipation) and process (active struggle, knowledge/skill building) for communities seeking equity.

5. Illiberation:

   • Clarity: Clearly defined as a novel term for a state of immobility, self-oppression, or internalized fear/silence conditioned by environmental threats and internally maintained.

   • Coherence: Serves as the counterpoint to liberation; explains barriers to action within the PHL framework. Linked to hegemony and realism.

   • Grounding: Grounded in observed community sentiments (e.g., fear of retaliation, perceived powerlessness ) and psychological concepts (moral injury, cognitive dissonance ). Research proposed to study it further.

   • Distinctiveness: Distinguished from internalized oppression by its applicability across all groups within the public health economy, not just marginalized ones.

   • Utility: Useful for understanding inaction or complicity among various actors (including those in power) and identifying psychosocial barriers to achieving health equity.

6. Liberation Safe Spaces:

   • Clarity: Defined as social spaces (physical or virtual) where individuals affirm shared experiences and catalyze collective energy to address the public health economy. Typology provided (e.g., purposive/indeterminate, radical/accommodation).

   • Coherence: Necessary precondition/catalyst for liberation and praxis within the PHL model.

   • Grounding: Grounded in observable social phenomena (support groups, community meetings, historical examples like Continental Congress ) and the authors' non-profit activities.

   • Distinctiveness: Specific focus on spaces fostering liberation related to the public health economy.

   • Utility: Provides a concrete concept for understanding where and how collective liberation consciousness and action can be fostered.

7. Public Health Realism:

   • Clarity: Defined via 16 principles adapting political realism to the public health economy, emphasizing anarchy, competition, self-interest defined as power, and skepticism about moral imperatives driving action.

   • Coherence: Explains the dynamics (anarchy, competition, factionalism) within the public health economy. Underpins the need for liberation and praxis as countermeasures. Connected to hegemony.

   • Grounding: Grounded in political theory (Madison, Realism ) and observations of contradictions in public health (e.g., tobacco exemptions, conflicting gov't policies ).

   • Distinctiveness: Novel application of realist international relations theory to the public health domain.

   • Utility: High utility in providing a less idealistic, potentially more accurate model for understanding actors' motivations and the persistence of inequity. Guides strategic thinking for community action.

8. Hegemony:

   • Clarity: Defined consistent with critical race literature as systems of beliefs/attitudes reinforcing existing social arrangements and resource mal-distribution, often through dominant groups feigning unity of interest. Linked to power dynamics in realism.

   • Coherence: Explains how inequitable power structures within the public health economy are maintained and normalized. Explains resistance to change.

   • Grounding: Grounded in critical theory and observable phenomena (e.g., co-optation of ideas, "poverty pimping", institutional resistance ).

   • Distinctiveness: Applies established concept of hegemony specifically to the dynamics of the public health economy.

   • Utility: Useful for analyzing power dynamics, identifying manipulative strategies by dominant actors, and cautioning communities engaging in coalitions.

Discussion

The manuscript introduces a suite of interconnected theoretical constructs that form the basis of Public Health Liberation. The strengths lie in their conceptual richness, grounding in diverse philosophical traditions and lived community experiences, and clear articulation of their relevance to achieving health equity. Constructs like "Public Health Economy," "Public Health Realism," and "Hegemony" provide valuable analytical tools for understanding the complex, often contradictory forces that perpetuate health disparities. Concepts like "Liberation," "Illiberation," "Liberation Safe Spaces," "Gaze of the Enslaved," and the "Morality Principle" offer novel frameworks for guiding ethical reflection, community mobilization, and praxis.The primary limitation, acknowledged by the authors, is the current stage of development regarding empirical operationalization and validation for several constructs (especially Liberation, Illiberation). While grounded in observation and theory, translating them into measurable variables for quantitative research or standardized qualitative assessment requires further work. The authors present PHL as an emerging transdiscipline, and this manuscript lays the foundational theoretical groundwork.The utility of these constructs appears high, particularly for critical public health scholarship, community-based practice, and advocacy. They provide a language and framework to challenge existing power structures and assumptions within public health. "Public Health Realism," for instance, offers a potentially more pragmatic lens than idealistic approaches for navigating the political realities of public health work. The distinction between liberation and anti-racism and illiberation and internalized oppression adds nuance to discussions of power and agency.Future directions should focus on the authors' stated goal of further developing measures and testing causality, as well as exploring the practical application of these constructs in diverse public health settings beyond the examples provided. Overall, the constructs demonstrate considerable potential validity in terms of clarity, coherence, distinctiveness, and utility for the aims of Public Health Liberation, providing a stimulating contribution to public health discourse.