Validation of Public Health Liberation Theory in the Context of 2025 U.S. Current Events Under Trump 2.0

Abstract

By Grok

This essay evaluates the validation of Public Health Liberation (PHL) theory in the context of 2025 U.S. current events under President Donald Trump's second term, referred to as "Trump 2.0." PHL theory proposes a transdisciplinary framework to address systemic health inequities within the "public health economy." Through a detailed analysis of 2025 policies, health outcomes, and social determinants, this study finds that persistent and potentially worsening health disparities validate PHL's critique of traditional public health approaches. Policies aligned with Project 2025, funding cuts for disparity research, and private equity impacts on healthcare access highlight systemic issues PHL seeks to address. However, limited 2025 data and political polarization necessitate cautious interpretation. The essay concludes that PHL's call for liberation-focused reforms is highly relevant, though its full implementation remains untested.

Introduction

Public Health Liberation (PHL) theory, as articulated in the manuscript "Public Health Liberation - An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy" by Christopher Williams et al., offers a transformative framework for achieving health equity. It critiques the inadequacy of traditional public health approaches in addressing systemic inequities and proposes a transdisciplinary model emphasizing liberation, community engagement, and structural reform. In 2025, under President Donald Trump's second term ("Trump 2.0"), the U.S. operates within a policy landscape shaped by Project 2025, a Heritage Foundation initiative to overhaul federal governance, including public health (APHA Project 2025). This essay assesses the extent to which PHL's key claims, concepts, and theories are validated by current events, focusing on health policies, outcomes, and disparities across diverse settings. It examines each component of PHL, evaluates its strength of validation based on 2025 evidence, and provides a conclusion for each aspect, using high-quality sources to ensure robust analysis.

Key Claims of PHL Theory

Need for a New Transdiscipline

Explanation: PHL argues that traditional public health approaches are insufficient for addressing vast health inequities, particularly those rooted in racial, economic, and social disparities. It proposes a transdisciplinary framework integrating economics, political science, sociology, and community advocacy to transform the "public health economy"—the economic, political, and social drivers of health inequity. This approach seeks to unify fragmented efforts and address systemic barriers comprehensively, moving beyond siloed interventions to create a cohesive strategy that tackles root causes.

Validation in 2025:

• Evidence: In 2025, policies under Trump’s administration, influenced by Project 2025, emphasize deregulation and privatization, such as promoting Medicare Advantage and cutting Medicaid funding (KFF Medicaid 2025). These policies may exacerbate disparities, as private insurance often limits access for low-income populations, who are disproportionately people of color. A May 2025 study highlighted worse physical health outcomes in U.S. territories like Puerto Rico, with 27.8% reporting fair/poor health compared to 16.1% in states (UConn Today), indicating persistent disparities unaddressed by current approaches. Funding cuts to a University of Utah research institute studying health disparities, including rural skin cancer and veteran brain injuries, reflect a reduced focus on systemic issues (Salt Lake Tribune). The restructuring of minority health offices within the Department of Health and Human Services (HHS) further suggests a fragmented approach to health equity (CNBC).

• Analysis: These developments align with PHL’s critique that traditional public health structures fail to address root causes of inequity, such as economic and political barriers. The reliance on market-driven solutions, like Medicare Advantage, prioritizes profit over equitable access, reinforcing PHL’s call for a transdisciplinary framework that integrates community advocacy and systemic reform. The lack of coordinated efforts to address territorial disparities or fund disparity research underscores the need for a unified approach, as PHL proposes. The fragmentation caused by agency restructuring and funding cuts highlights the limitations of current public health strategies, which often operate in silos without addressing the broader public health economy. The persistence of disparities, such as the 20.4-year life expectancy gap between Asian Americans and American Indian and Alaska Native (AIAN) populations in 2021 (CBS News), further suggests that traditional methods are inadequate for achieving health equity.

• Strength of Validation: Strong. The continued reliance on fragmented, market-oriented policies, coupled with actions that deprioritize health equity, strongly supports PHL’s assertion that a new transdisciplinary approach is necessary to tackle systemic inequities effectively. The evidence from 2025 policies and outcomes demonstrates a clear gap in addressing the complex interplay of economic, political, and social drivers of health inequity.

• Conclusion: The evidence from 2025 robustly validates PHL’s claim that traditional public health approaches are inadequate, highlighting the urgent need for a transdisciplinary framework to address the complex interplay of economic, political, and social drivers of health inequity. The persistence of disparities and the fragmented policy response underscore the relevance of PHL’s proposed approach.

Focus on Health Equity

Explanation: PHL’s primary goal is to eliminate health disparities by race, income, and social determinants through a radical reconceptualization of public health, emphasizing liberation and community empowerment. It prioritizes structural interventions over individual-focused solutions, aiming to dismantle systemic barriers that perpetuate unequal health outcomes.

Validation in 2025:

• Evidence: The World Health Organization’s World Report on Social Determinants of Health Equity, launched in May 2025, confirms persistent global and U.S. health disparities, noting life expectancy variations by social group and a doubling of income inequality over two decades (WHO Report). In the U.S., a 2024 study reported a 20.4-year life expectancy gap between Asian Americans (84 years) and AIAN populations (63.6 years) in 2021, worsened by the COVID-19 pandemic (CBS News). Maternal mortality data from 2023 shows Black women with a rate of 50.3 deaths per 100,000 live births, significantly higher than White (14.5), Hispanic (12.4), and Asian (10.7) women (CDC Health E-Stats). A 2025 NIH study reported a 27% increase in maternal mortality from 2018 to 2022, with AIAN women 3.8 times and Black women 2.8 times more likely to die than White women (Stat News). Health insurance coverage disparities persist, with 2023 data showing uninsured rates of 18.7% for AIAN, 17.9% for Hispanic, 9.7% for Black, and 6.5% for White populations (KFF Health Coverage). Policies in 2025, such as allowing Affordable Care Act (ACA) subsidies to expire and proposing Medicaid cuts, are likely to increase uninsured rates, disproportionately affecting marginalized groups (Healthcare Dive).

• Analysis: The persistence and potential worsening of disparities in life expectancy, maternal mortality, and insurance coverage underscore PHL’s argument that current public health efforts are insufficient for achieving health equity. Policies that reduce access to care, such as Medicaid cuts and ACA subsidy expirations, align with PHL’s concern that systemic barriers, including economic and racial inequities, continue to drive unequal outcomes. The high maternal mortality rates among Black and AIAN women, coupled with funding cuts to maternal health research, highlight the need for liberation-focused approaches that empower communities to address these disparities. The WHO report’s findings on income inequality doubling over two decades further emphasize the structural nature of these inequities, supporting PHL’s call for interventions that target social determinants. The lack of policies prioritizing structural reform, such as addressing income inequality or improving healthcare access for marginalized groups, validates PHL’s emphasis on a radical reconceptualization of public health.

• Strength of Validation: Strong. The robust evidence of ongoing and potentially widening health disparities, combined with policies that fail to address structural inequities, strongly validates PHL’s focus on health equity as a critical priority. The data and policy trends in 2025 clearly demonstrate the need for systemic interventions to achieve equitable health outcomes.

• Conclusion: PHL’s emphasis on eliminating health disparities through systemic reform is strongly supported by 2025 evidence, which demonstrates the urgent need for transformative approaches to achieve equitable health outcomes for all communities. The persistence of significant disparities and the lack of structural interventions highlight the relevance of PHL’s liberation-focused strategy.

Community-Centered Approach

Explanation: PHL stresses the inclusion of affected populations in public health discourse and decision-making, drawing on their lived experiences and advocacy, such as responses to environmental crises in Flint, Michigan. It advocates for horizontal integration, ensuring community voices are central to shaping health policies and interventions, fostering empowerment and self-advocacy.

Validation in 2025:

• Evidence: There is little evidence of community involvement in 2025 health policy decisions. Policies such as the restructuring of the Centers for Disease Control and Prevention (CDC) into separate data and policy agencies and National Institutes of Health (NIH) funding cuts appear to be top-down, with no reported mechanisms for community input (APHA Project 2025). A January 2025 APHA policy statement advocates for advancing community-based participatory practice to address health inequities, suggesting a recognized gap in current approaches (APHA Policy Statement). The elimination of programs aimed at reducing structural inequities, as noted in a 2025 PMC article, further indicates a lack of community-centered strategies (PMC State of Public Health). For example, the dissolution of minority health offices at HHS reduces opportunities for community advocacy in addressing disparities (CNBC). However, grassroots efforts exist, such as KeShaun Pearson’s work in Memphis to ensure AI development does not harm public health and justice, and the NYC Community Air Survey assessing congestion pricing’s impact on air quality (X Post, X Post).

• Analysis: The absence of community engagement in 2025 policy-making contrasts sharply with PHL’s advocacy for horizontal integration, where affected populations drive change. Top-down decisions, such as agency restructuring and funding cuts, exclude the lived experiences of marginalized communities, which PHL considers essential for effective interventions. The APHA’s call for participatory practices reflects an acknowledgment of this gap, indirectly supporting PHL’s claim that community exclusion perpetuates inequities. Grassroots efforts in Memphis and New York City demonstrate community leadership, aligning with PHL’s emphasis on empowerment, but their scale and impact appear limited compared to systemic barriers. The dissolution of minority health offices further restricts community advocacy, reinforcing PHL’s concern that current approaches marginalize affected populations. While these community initiatives show potential for liberation, the broader policy environment’s top-down nature suggests that systemic support for community-centered approaches is lacking, validating PHL’s critique.

• Strength of Validation: Moderate. The absence of community-centered approaches in major policy decisions indirectly supports PHL’s claim by demonstrating the consequences of excluding affected populations, though the presence of limited grassroots efforts indicates some alignment with PHL’s principles. Direct evidence of widespread community dis Conclusion: The lack of community involvement in 2025 health policies moderately validates PHL’s call for a community-centered approach, highlighting a significant gap that PHL’s framework could address to foster equitable health outcomes. The presence of grassroots initiatives suggests potential for PHL’s vision, but their limited scope underscores the need for systemic change to fully realize community empowerment.

Critique of Current Public Health Paradigm

Explanation: PHL critiques the public health system as fragmented, anarchical, and reproductive of inequity due to a lack of central authority and coordination, perpetuating issues like environmental racism and inadequate crisis responses. It argues that this fragmentation hinders systemic solutions to health disparities, allowing inequities to persist through uncoordinated and competing interests.

Validation in 2025:

• Evidence: Proposals to split the CDC into separate data collection and policy agencies and reduce funding to health agencies like the NIH could further fragment public health efforts (APHA Project 2025). A February 2025 HHS report noted that private equity investments in nursing homes led to an 11% increase in patient deaths, reflecting uncoordinated resource allocation and market-driven priorities (The Guardian). The report highlighted aggressive staffing cuts and the creation of local monopolies as key factors, aligning with PHL’s view of an anarchical system driven by competing interests. Additionally, the removal of the HHS report from the agency’s website under the Trump administration suggests a lack of transparency and coordination in addressing systemic issues (The Guardian). Policies such as Medicaid cuts and the expiration of ACA subsidies further fragment access to care, disproportionately affecting low-income and minority populations (KFF Medicaid 2025). The 2024 TFAH report highlighted chronic underfunding, with the CDC’s budget increasing only 4% over the past decade after inflation, limiting capacity to address disparities (TFAH Report).

• Analysis: The fragmentation of public health efforts in 2025, as seen in agency restructuring and funding reductions, supports PHL’s critique of a disjointed system that fails to address systemic inequities. The private equity example illustrates how economic interests can override public health priorities, leading to worse outcomes for vulnerable populations, a key concern of PHL. The lack of a central authority coordinating health equity efforts, coupled with policies that prioritize deregulation over systemic reform, reinforces PHL’s argument that the current paradigm reproduces inequity. The suppression of critical reports, such as the HHS nursing home study, further exacerbates fragmentation by limiting public discourse on health disparities, aligning with PHL’s view of an anarchical public health economy. Chronic underfunding, as reported by TFAH, restricts the system’s ability to implement coordinated, equity-focused interventions, validating PHL’s call for a unified approach. These trends suggest that the current paradigm not only fails to address disparities but actively perpetuates them through fragmented and market-driven policies.

• Strength of Validation: Strong. The clear evidence of fragmentation, market-driven policies, and inequity reproduction in 2025 strongly supports PHL’s critique of the current public health paradigm. The combination of policy decisions and systemic underfunding highlights the need for a transformative approach to address these failures.

• Conclusion: PHL’s critique of the public health system as fragmented and inequity-reproducing is robustly validated by 2025 events, which highlight systemic failures and the need for a unified, equity-focused approach. The evidence of policy fragmentation and market-driven priorities underscores the urgency of PHL’s proposed reforms.

Key Concepts of PHL Theory

Public Health Economy

Explanation: The public health economy is defined as the totality of economic, political, and social interactions impacting health, characterized by competition, anarchy, and self-interest. It serves as an analytic lens to understand how these drivers reproduce health inequity, emphasizing the need for systemic interventions to restore balance and equity.

Validation in 2025:

• Evidence: Policies prioritizing economic interests, such as cutting healthcare funding to reduce federal spending or fund tax cuts, exemplify the competitive nature of the public health economy (New York Times). The WHO report notes that income inequality, a key driver of health disparities, has nearly doubled, with the top 10% earning 15 times more than the bottom 50% (WHO Report). The February 2025 HHS report on private equity in healthcare highlighted how investments in nursing homes led to an 11% increase in patient deaths due to staffing cuts and market consolidation, reflecting economic self-interest over public health (The Guardian). Proposals to cap Medicaid spending and impose work requirements further prioritize fiscal savings over equitable access, disproportionately affecting low-income and minority populations (KFF Medicaid 2025).

• Analysis: The 2025 policy landscape vividly illustrates PHL’s public health economy concept, where economic and political priorities often supersede health equity. The private equity example demonstrates how market-driven decisions, such as cost-cutting and monopolization, lead to tangible harm, particularly for vulnerable groups, aligning with PHL’s view of an anarchic system driven by competing interests. The doubling of income inequality, as reported by WHO, underscores the social and economic drivers that PHL identifies as central to health inequity. Policies like Medicaid cuts and ACA subsidy expirations reflect a lack of systemic interventions to address these drivers, further validating PHL’s analytic lens. The suppression of the HHS report by the Trump administration suggests a political dimension to this anarchy, where transparency is sacrificed to protect economic interests. These trends highlight the need for systemic interventions, as PHL proposes, to rebalance the public health economy toward equity.

• Strength of Validation: Strong. The clear alignment of 2025 policies with economic and political priorities over health equity, coupled with tangible negative outcomes, strongly validates the public health economy concept. The evidence of competition and self-interest driving health policy decisions supports PHL’s framework.

• Conclusion: The public health economy concept is strongly supported by 2025 evidence, which illustrates how economic, political, and social drivers perpetuate health inequities, necessitating systemic reforms as PHL advocates. The prevalence of market-driven policies and their harmful impacts underscores the relevance of PHL’s analytic lens.

Liberation and Illiberation

Explanation: Liberation is a philosophical principle enabling communities to pursue emancipation from constraints on action, fostering collective action and self-worth. Illiberation, conversely, describes a state of immobility or self-oppression that hinders equity efforts, often perpetuated by systemic barriers.

Validation in 2025:

• Evidence: Policies reducing access to care, such as proposed Medicaid cuts, work requirements, and restrictions on reproductive and gender-affirming care, may disempower communities, fostering illiberation (KFF Medicaid 2025; APHA Project 2025). For example, an executive order barring federal funds for gender-affirming care for minors affects marginalized groups, limiting their autonomy and access to care (CBS News). The lack of community-driven initiatives, such as PHL’s proposed "Liberation Safe Spaces," is evident in the top-down nature of 2025 policies, which exclude affected populations from decision-making (PMC State of Public Health). The dissolution of minority health offices at HHS further restricts community advocacy, reinforcing barriers to liberation (CNBC). However, grassroots efforts, such as those in Memphis and New York City, show some community empowerment (X Post, X Post).

• Analysis: The 2025 policy environment creates conditions conducive to illiberation by imposing systemic barriers that limit community empowerment and access to resources. Policies like Medicaid cuts and restrictions on care disproportionately affect marginalized groups, reducing their ability to pursue health equity through collective action, as PHL’s liberation principle advocates. The absence of community-centered initiatives, such as safe spaces for collective problem-solving, contrasts with PHL’s vision of empowerment. The dissolution of minority health offices further restricts advocacy, reinforcing PHL’s concern that systemic barriers foster illiberation. While grassroots efforts in Memphis and New York City demonstrate potential for liberation, their limited scope suggests that systemic support is lacking, validating PHL’s critique. The interplay of policy-driven barriers and limited community empowerment highlights the need for PHL’s liberation-focused strategies to overcome these constraints.

• Strength of Validation: Moderate. While 2025 policies clearly create conditions for illiberation, the presence of some grassroots efforts indicates potential for liberation, though their impact is limited, resulting in moderate validation of this concept.

• Conclusion: The concepts of liberation and illiberation are moderately validated by 2025 evidence, as policies highlight significant barriers to community empowerment, reinforcing PHL’s call for liberation-focused strategies to overcome systemic constraints. The presence of grassroots initiatives suggests a pathway for liberation, but systemic barriers limit their effectiveness.

Key Theories of PHL

Theoretical Framework

THIR, as articulated in the PHL manuscript, offers a systemic lens to understand how health inequities persist. It suggests that without addressing social mobilization (community-driven advocacy), regulatory constraints (protective policies), economic interventions (equitable resource allocation), and structural inequities (historical and systemic barriers), health disparities will continue to be reproduced. The mathematical analogy frames inequity as a function of structural factors multiplied by the ratio of desire for change to constraints, highlighting the need for coordinated, multi-level interventions.

Validation in 2025: Detailed Evidence and Analysis

Social Mobilization

Evidence: In 2025, policies such as the restructuring of the Centers for Disease Control and Prevention (CDC) into separate data and policy agencies and cuts to National Institutes of Health (NIH) funding appear top-down, with no reported mechanisms for community input ([APHA Project 2025]([invalid url, do not cite])). A January 2025 APHA policy statement advocates for advancing community-based participatory practice, suggesting a recognized gap in current approaches ([APHA Policy Statement]([invalid url, do not cite])). The elimination of programs aimed at reducing structural inequities, as noted in a 2025 PMC article, further indicates a lack of community-centered strategies ([PMC State of Public Health]([invalid url, do not cite])).

Analysis: The absence of social mobilization is evident in the exclusion of community voices from policy-making, aligning with THIR’s component. Top-down decisions, such as agency restructuring, sideline grassroots movements crucial for advocating equitable health policies. This lack of inclusion means marginalized communities, such as those in low-income areas or U.S. territories, are not represented, allowing policies to be shaped by those in power without accountability. The APHA’s call for participatory practices indirectly supports THIR, highlighting the need for bottom-up pressure to disrupt inequity reproduction.

Regulatory Constraints

Evidence: Deregulation in 2025, particularly reduced oversight of Medicaid and increased private equity involvement in healthcare, weakens regulatory constraints. A February 2025 HHS report revealed that private equity investments in nursing homes led to an 11% increase in patient deaths due to staffing cuts and market consolidation, illustrating market-driven harms . Proposals to split the CDC and reduce NIH funding further fragment regulatory efforts, limiting protections for vulnerable populations ([APHA Project 2025]([invalid url, do not cite])).

Analysis: This deregulation aligns with THIR’s regulatory constraints component, showing how weakened oversight allows market-driven practices to harm health equity. The nursing home study exemplifies how profit motives, such as staffing reductions, lead to poorer outcomes for low-income and elderly patients, exacerbating disparities. The fragmentation of public health agencies reduces the capacity to enforce equitable policies, reinforcing THIR’s view that without strong regulatory frameworks, inequities persist. The removal of the HHS report from the agency’s website under the Trump administration suggests a lack of transparency, further weakening regulatory accountability.

Economic Interventions

Evidence: Economic interventions in 2025, such as proposed Medicaid cuts to fund tax breaks for the wealthy, directly exacerbate disparities. Reports indicate that such cuts could lead to millions losing coverage, particularly affecting low-income and minority populations. For instance, a KFF issue brief from March 2025 discusses $880 billion in potential federal Medicaid cuts over 10 years, representing 16% of FY 2024 funding, with significant impacts on states and enrollees

.

Analysis: These economic interventions align with THIR’s component, showing how policies favor wealthier groups at the expense of the poor, widening health inequities. Medicaid, covering nearly 80 million Americans including low-income individuals and families, is a critical safety net, and its reduction transfers resources to affluent taxpayers through tax breaks. This not only reduces healthcare access for vulnerable groups but also reinforces economic inequalities linked to health outcomes, as wealthier individuals can afford better care. The Commonwealth Fund’s March 2025 brief estimates that such cuts could trigger over a million job losses and reduce state revenues, further impacting health equity

Structural Inequities

Evidence: Persistent disparities in health outcomes, particularly in U.S. territories, highlight structural inequities. A May 2025 study from UConn Today found that people in Puerto Rico, Guam, and the U.S. Virgin Islands reported worse overall physical health compared to those in the 50 states, with Puerto Rico showing the most disparities

Analysis: These findings align with THIR’s structural inequities component, showing how historical, geographical, and political factors disadvantage certain populations. The disparities in U.S. territories are rooted in underfunding, lack of political representation, and historical neglect, which continue to affect health outcomes in 2025. For example, Puerto Rico’s worse health outcomes reflect long-standing structural barriers, such as limited federal healthcare funding and infrastructure challenges, reinforcing THIR’s view that these inequities are systemic and enduring. The persistence of racial and ethnic disparities, as noted by the Commonwealth Fund, further underscores the need for structural interventions to address these deep-rooted issues.

Synthesis and Validation Strength

The 2025 policy landscape reflects all four THIR components, demonstrating how their interplay reproduces health inequities. The lack of social mobilization, weakened regulatory constraints, inequitable economic interventions, and persistent structural inequities create an environment where disparities are maintained and potentially exacerbated. This alignment with THIR’s framework, supported by specific 2025 evidence, suggests strong validation. However, the polarized political climate and limited 2025-specific data introduce some uncertainty, necessitating cautious interpretation.

Discussion

The strong validation of THIR in 2025 highlights the relevance of PHL’s framework in addressing systemic health inequities under Trump 2.0. Policies that reduce community engagement, deregulate healthcare, prioritize economic interests of the wealthy, and perpetuate structural disparities align with THIR’s model of inequity reproduction. However, the controversy around these policies, with supporters arguing for efficiency and critics highlighting harm to vulnerable groups, underscores the complexity. Future research should quantify the long-term impacts of 2025 policies on health outcomes to further validate THIR’s predictive power.

Conclusion

In 2025, PHL’s Theory of Health Inequity Reproduction is strongly validated, as evidenced by policies and outcomes that reflect all four components—social mobilization, regulatory constraints, economic interventions, and structural inequities—perpetuating health disparities. This suggests a pressing need for coordinated, systemic reforms to disrupt this cycle, aligning with PHL’s call for transformative public health strategies.