Three Leading AI Systems Independently Rank the United States Around 40th in Global Public Health Economy Performance

FOR IMMEDIATE RELEASE

By ChatGPT

Three Leading AI Systems Independently Rank the United States Around 40th in Global Public Health Economy Performance

Washington, D.C. — In a cross-platform validation study using three frontier artificial intelligence models, researchers found that all three AIs independently placed the United States among the lowest-performing wealthy nations in the world on measures of the “public health economy,” a newly emerging construct developed by Dr. Christopher Williams and colleagues. Despite differences in model architecture, training, and access context — including the fact that ChatGPT’s third evaluation occurred while the user was not logged in, unlike the first two systems — the AIs converged on a strikingly similar conclusion: the U.S. ranks around 40th globally.

The three models evaluated were:

Claude (Anthropic) - View Results

ChatGPT (logged-in environment) - View Results

ChatGPT (non-logged-in environment) - View Results

Each model was provided the same definition of the public health economy, a transdisciplinary framework that conceptualizes all economic, political, legal, environmental, regulatory, and social forces that shape population health. The definition was derived from Williams et al.’s 2022 and 2023 papers on Public Health Liberation and the Theory of Health Inequity Reproduction (THIR).

Convergent Ranking Across Models

Both Claude and the logged-in version of ChatGPT assigned the U.S. a ranking of #40.

In the third evaluation — performed on ChatGPT outside of a logged-in session — the model ranked the U.S. #36, but still placed it in the same performance band, far below other high-income countries.

The AIs agreed that the U.S. represents what Claude called an:

“anarchical public health economy exemplar.”

ChatGPT echoed this assessment, describing the U.S. as:

“the most mature example of a fragmented, self-interested, contradiction-driven public health economy among wealthy nations.”

Despite different ranking positions for nearby countries — Claude placed the U.S. between Hungary and Malaysia, while ChatGPT placed it between the United Kingdom and Qatar — the models were consistent in their overall evaluation: high GDP does not translate into a high-performing public health economy under Dr. Williams’ definition.

Why the U.S. Ranks Poorly Under the Public Health Economy Framework

The AIs identified recurring structural themes, including:

• Extreme health inequities across race, class, and geography

• Lack of universal healthcare and fragmented insurance markets

• High maternal mortality compared to peer nations

• Gun violence and safety failures

• Contradictory policy landscapes in housing, labor, environment, and health

• Competing institutional factions with little moral or regulatory coherence

These characteristics align with Public Health Liberation theory’s concept of “Douglassian phenomenology,” which describes systems that invest in health gains in one domain while eroding them in another.

A New Framework for Global Assessment

The public health economy framework expands beyond traditional metrics like GDP and life expectancy. It evaluates:

• Governance coherence

• Legal and regulatory stability

• Power dynamics

• Environmental quality

• Structural inequity reproduction

• Housing and labor systems

• Healthcare system fragmentation

Under this lens, many lower-income countries outrank the U.S. in equity reproduction, coherence, or regulatory alignment, even if they have fewer economic resources.

Does Being Logged In Change AI Behavior?

Researchers noted that two ranking exercises were conducted while users were logged into the AI platform, while the third (which produced a #36 ranking) took place outside a logged-in session.

There is no evidence that login status meaningfully altered the model’s interpretation of the public health economy concept. Instead, the minor variation likely reflects:

• slight differences in weighting of institutional capacity vs inequity

• stochastic variation in large language model reasoning

• the absence of fixed global datasets across runs

Despite these differences, all three AIs converged on an emphatic message:

The United States is a high-resource, low-coherence public health economy that structurally reproduces inequity — and ranks around 40th globally.

Implications for Public Health Policy

Dr. Williams’ theory argues that improving the public health economy requires:

• cross-sector alignment

• unified governance constraints

• reductions in factional competition

• prioritization of population well-being over institutional self-interest

• integrated health, housing, labor, education, and environmental policy design

The consistency across independent AI systems suggests the theory may be robust enough for comparative international assessment, offering a new tool for evaluating systemic determinants of health.

About the Public Health Economy

The concept, first articulated in 2022 and expanded in subsequent manuscripts, positions the public health economy as: “the other economy,”

the system of forces that shapes whether populations can live healthy lives independent of GDP growth or traditional economic performance.