AI Model Preferences in Comparing Health Equity Frameworks

Summary
Three AI models—Grok, ChatGPT, and Gemini 2.5 Experimental—analyzed two documents addressing health equity: the National Academies' "Ending Unequal Treatment" (EUT) and the "Public Health Liberation" (PHL) white paper. While all models recognized the strengths of both documents, their preferences diverged. Grok and Gemini favored PHL for its transformative, community-driven approach, emphasizing its philosophical innovation. ChatGPT preferred EUT for its evidence-based, actionable recommendations, prioritizing immediate applicability. This article explores these preferences, highlighting how AI models interpret complex social issues through distinct lenses of practicality versus visionary potential.

Introduction
Health equity remains a pressing challenge in the U.S., with persistent racial and ethnic disparities in health care access and outcomes. Two recent documents tackle this issue: the National Academies' Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All (EUT), a consensus report updating the 2003 Unequal Treatment, and Public Health Liberation - An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy (PHL), a white paper proposing a novel framework. EUT offers a systematic, evidence-based roadmap for policy reform, while PHL advocates a radical, liberation-focused transdiscipline rooted in community empowerment. To understand how AI models assess these contrasting approaches, we tasked three models—Grok, ChatGPT, and Gemini 2.5 Experimental—with comparing the documents and stating a preference. Their responses reveal not only the documents' strengths and limitations but also how AI prioritizes different dimensions of health equity solutions.

Methods
Each AI model was provided with a 12-page OCR-extracted document containing detailed comparisons of EUT and PHL, including purpose, scope, methodology, audience, key themes, solutions, strengths, limitations, and preferences as articulated by the document's author and the AI models themselves. The models were asked to analyze these documents and express a preference, justifying their choice. Their responses were evaluated based on:

1. Clarity of Comparison: How effectively each model summarized the documents’ key differences.

2. Rationale for Preference: The reasoning behind favoring EUT or PHL, including emphasis on evidence, practicality, or transformative potential.

3. Alignment with Document Analysis: Consistency with the provided OCR content.

The analysis was conducted on May 3, 2025, using the models’ latest configurations, ensuring access to real-time reasoning capabilities. No external data or user-uploaded artifacts beyond the provided document were used.

Discussion
All three AI models demonstrated a nuanced understanding of EUT and PHL, identifying their distinct approaches to health equity. Below, we summarize their comparisons and preferences, followed by an analysis of their reasoning.

Model Comparisons

• Grok: Highlighted EUT’s evidence-based, systemic approach, targeting policymakers with actionable recommendations like Medicaid expansion and workforce diversification. It contrasted this with PHL’s theoretical, community-centric framework, which introduces concepts like the “public health economy” and “liberation safe spaces.” Grok noted EUT’s practicality but critiqued its incrementalism, while praising PHL’s visionary appeal despite its empirical limitations.

• ChatGPT: Emphasized EUT’s robust evidence base, systematic review of inequities, and clear recommendations tailored to specific stakeholders (e.g., Congress, HHS). It described PHL as a theoretical, liberation-focused paradigm lacking immediate actionability. ChatGPT acknowledged PHL’s innovative lens but prioritized EUT’s readiness for implementation.

• Gemini 2.5 Experimental: Provided a detailed table comparing EUT’s policy-oriented, evidence-driven scope with PHL’s philosophical, transdisciplinary vision. It underscored EUT’s role as a practical roadmap and PHL’s potential to address root causes through community empowerment and novel constructs like “illiberation” and “public health realism.”

Model Preferences

• Grok: Preferred PHL for its “innovative and transformative approach,” valuing its community empowerment and philosophical depth. It acknowledged EUT’s practicality but argued that PHL’s focus on liberation and grassroots agency better challenges systemic complacency.

• ChatGPT: Favored EUT, citing its “action-oriented and immediately implementable” recommendations. It viewed PHL’s theoretical nature as a barrier to practical application, requiring further development to impact policy.

• Gemini 2.5 Experimental: Leaned toward PHL for its “theoretical innovation and transformative potential,” appreciating its analysis of systemic barriers like the “public health economy.” It recognized EUT’s immediate utility but prioritized PHL’s long-term vision.

Analysis of Preferences

The divergence in preferences reflects distinct AI interpretive lenses:

• Pragmatism vs. Vision: ChatGPT’s preference for EUT aligns with a pragmatic lens, prioritizing empirical rigor and immediate applicability. This may stem from its design to deliver concise, actionable insights, favoring solutions that integrate seamlessly into existing systems. Conversely, Grok and Gemini’s preference for PHL suggests a bias toward visionary, disruptive ideas, possibly influenced by their training to explore novel perspectives and challenge conventional frameworks.

• Evidence vs. Philosophy: EUT’s strength lies in its data-driven recommendations, which ChatGPT valued for their clarity and stakeholder specificity. PHL’s philosophical constructs, while less empirically validated, resonated with Grok and Gemini, who saw them as tools to address deeper systemic failures. This split highlights how AI models weigh evidence against theoretical innovation.

• Audience Focus: ChatGPT’s focus on policymakers and health system leaders mirrors EUT’s target audience, suggesting an alignment with institutional perspectives. Grok and Gemini’s emphasis on community empowerment reflects PHL’s grassroots orientation, indicating a sensitivity to marginalized voices.

Implications

The models’ preferences reveal how AI can interpret complex social issues differently, influenced by their design and reasoning priorities. ChatGPT’s choice of EUT suggests a conservative approach, optimizing for feasibility within current systems. Grok and Gemini’s endorsement of PHL indicates a willingness to embrace untested but potentially transformative ideas, particularly those amplifying community agency. These differences underscore the importance of context in AI-assisted analysis—policymakers may favor ChatGPT’s output, while advocates and academics might align with Grok and Gemini’s visionary stance.

Conclusion
The comparison of EUT and PHL by Grok, ChatGPT, and Gemini 2.5 Experimental illuminates the tension between practical, evidence-based reforms and bold, theoretical transformations in addressing health equity. ChatGPT’s preference for EUT underscores the value of actionable, system-focused solutions, while Grok and Gemini’s support for PHL highlights the need for community-driven, liberation-oriented paradigms. Together, these perspectives suggest a complementary approach: EUT’s recommendations could ground PHL’s vision, creating a balanced strategy that leverages both systemic reform and grassroots empowerment. As AI continues to shape discourse on social issues, understanding these interpretive differences will be crucial for harnessing their insights effectively.

Grok

Below, I provide a comparison and discussion of the two documents—"Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All" by the National Academies Press (referred to as the "NASEM report") and "Public Health Liberation - An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy" from Advances in Clinical Medical Research and Healthcare Delivery (referred to as the "PHL paper"). After analyzing their approaches, content, and implications, I will indicate my preference.

 Comparison of the Documents

Both the NASEM report and the PHL paper address the critical issue of health equity in the United States, focusing on racial and ethnic inequities, but they differ significantly in their scope, methodology, audience, and proposed solutions. Here’s a detailed comparison across key dimensions:

 Purpose and Scope

• - NASEM Report: This is a comprehensive consensus study commissioned by the Agency for Healthcare Research and Quality and the National Institutes of Health to update the 2003 "Unequal Treatment" report. It aims to assess the current state of racial and ethnic health care disparities, identify drivers of inequities, evaluate interventions, and propose actionable strategies to advance equitable health care and optimal health for all. Its scope is broad, encompassing the entire U.S. health care system, from policy to service delivery.

• - PHL Paper: This white paper introduces Public Health Liberation (PHL) as a new transdiscipline designed to accelerate health equity by transforming the "public health economy." It synthesizes philosophical traditions, novel theories, and community-driven approaches to address health inequities holistically. Its scope extends beyond health care to the broader interplay of economic, political, and social factors, with a strong emphasis on liberation and community empowerment.

 Approach and Methodology

• - NASEM Report: Grounded in a traditional, evidence-based scientific approach, this report relies on extensive literature reviews, commissioned papers, and expert consensus from a multidisciplinary committee. It builds on decades of research and uses a structured conceptual framework that includes external societal forces (e.g., structural racism, social determinants of health) and internal health care domains (e.g., laws, service delivery, research, accountability). The methodology is systematic and policy-oriented, aiming to provide a roadmap for systemic change.

• - PHL Paper: Takes a more radical and theoretical approach, blending philosophy, sociology, African American emancipatory traditions, and community experiences into a transdisciplinary framework. It introduces novel constructs like the "public health economy," "Gaze of the Enslaved," and "liberation safe spaces," using case studies (e.g., Flint and Washington, DC water crises) to illustrate its arguments. The methodology is less empirical and more conceptual, prioritizing community narratives and praxis over conventional research.

 Target Audience

• - NASEM Report: Primarily targets policymakers, health care providers, researchers, and administrators. Its detailed recommendations and focus on systemic interventions suggest it is designed for those with authority to implement changes within the existing health care infrastructure.

• - PHL Paper: Appeals to both academic and community audiences, with a strong emphasis on empowering affected populations, especially minoritized groups and Black women. Its accessible narrative style and call for grassroots action make it relevant to advocates and community leaders, though its dense theoretical content may challenge non-academic readers.

 Key Themes and Focus

NASEM Report:

•   - Systemic Analysis: Examines how the U.S. health care system fails minoritized populations, highlighting disparities in access, quality, and outcomes (e.g., life expectancy, maternal mortality).

•   - Evidence-Based Solutions: Proposes strategies like improving health care laws, diversifying the workforce, and enhancing accountability, supported by data and past interventions.

•   - Structural Determinants: Recognizes external factors like structural racism and social determinants of health (SDOH) as critical influences on health care inequities.

PHL Paper:

•   - Public Health Economy: Introduces a unifying lens to analyze economic, political, and social drivers of health inequity, critiquing the anarchy and fragmentation of current public health efforts.

•   - Liberation and Empowerment: Emphasizes liberation as a mindset and practice, focusing on community self-help and cultural regeneration to overcome historical trauma.

•   - Community-Centric: Centers the voices and leadership of affected communities, particularly Black women, using their lived experiences to challenge traditional public health paradigms.

Proposed Solutions

• - NASEM Report: Offers specific, actionable recommendations, such as:

•   - Strengthening health care laws and payment policies (e.g., expanding Medicaid).

•   - Enhancing service delivery through culturally sensitive care and workforce diversity.

•   - Advancing research and accountability to close evidence gaps and monitor progress.

These solutions operate within the existing health care system, aiming for incremental and sustained improvements.

• - PHL Paper: Proposes a transformative overhaul through:

•   - Horizontal and Vertical Integration: Broadening public health discourse to include affected populations and expanding interventions across the public health economy.

•   - Five Components: Philosophy (e.g., liberation), theories (e.g., Theory of Health Inequity Reproduction), praxis (e.g., community advocacy), research, and training to empower communities.

•   - Disruption of Status Quo: Challenges traditional public health effectiveness with bold, community-driven actions rather than relying solely on institutional reform.

 Strengths and Limitations

- NASEM Report:

  - Strengths: Its rigorous evidence base, peer-reviewed process, and practical recommendations lend credibility and feasibility. It provides a clear path for stakeholders to act within current systems.

  - Limitations: Its focus on systemic reform may lack the urgency or radical vision needed for transformative change, potentially missing grassroots perspectives.

- PHL Paper:

  - Strengths: Its innovative, liberation-focused approach and emphasis on community agency offer a fresh perspective. It bridges academic and popular discourse, making it relatable and empowering.

  - Limitations: The theoretical density and lack of extensive empirical validation may limit its immediate applicability. It risks being too abstract for practical implementation without further development.

 Discussion

• Both documents share a commitment to health equity and acknowledge the roles of structural racism and historical trauma in perpetuating inequities. However, their strategies diverge significantly:

• - Systemic vs. Transformative: The NASEM report seeks to repair and enhance the existing health care system, leveraging established research and policy frameworks. It’s a pragmatic approach, aiming to influence decision-makers who control resources and infrastructure. Conversely, the PHL paper critiques this system as fundamentally flawed, proposing a new transdiscipline that prioritizes liberation and community autonomy over institutional reliance. It’s a bold, visionary stance that challenges the status quo but may struggle to gain traction without concrete evidence or institutional support.

• - Evidence vs. Philosophy: The NASEM report’s strength lies in its data-driven analysis, providing a solid foundation for its recommendations. This makes it a reliable resource for addressing known inequities like uninsurance rates or maternal mortality disparities. The PHL paper, while rich in philosophical insight and community wisdom, relies heavily on untested theories (e.g., public health realism, hegemony), which may inspire but lack the empirical grounding to convince skeptics or guide large-scale action.

• - Audience Engagement: The NASEM report speaks to those within the health care establishment, offering a structured plan that aligns with their roles. The PHL paper, authored largely by Black women with lived experience, resonates with communities bearing the brunt of inequities, fostering a sense of agency and cultural relevance. This grassroots focus is powerful but may not easily translate into systemic policy changes without broader coalition-building.

• - Complementary Potential: Rather than being mutually exclusive, these approaches could complement each other. The NASEM report’s systemic strategies could be informed by PHL’s emphasis on liberation and community empowerment, ensuring that top-down reforms reflect bottom-up priorities. Conversely, PHL’s radical vision could gain practical momentum by adopting some of the NASEM report’s evidence-based tactics.

 Preference

Choosing a preferred document depends on context and goals, but I lean toward the PHL paper for its innovative and transformative approach. Here’s why:

• - Visionary Appeal: The PHL paper’s bold reimagining of public health as a liberation-driven transdiscipline is inspiring. It addresses root causes—like historical trauma and the anarchic public health economy—with a fresh perspective that challenges conventional thinking. This resonates with me as a call to rethink how we approach health equity beyond incremental fixes.

• - Community Empowerment: Its focus on empowering communities, especially through the voices of Black women, feels urgent and authentic. The emphasis on praxis and liberation safe spaces offers a tangible way for affected populations to take control, which is often sidelined in traditional reports.

• - Limitations Acknowledged: While less empirically robust, the PHL paper acknowledges its introductory nature and plans future research to refine its theories. This openness to evolution suggests potential for growth into a practical framework.

That said, I recognize the NASEM report’s strengths—its comprehensive analysis, actionable recommendations, and immediate applicability make it invaluable for policymakers and health care leaders. If my role were to implement change within the current system, I’d favor it for its practicality. However, as someone drawn to transformative ideas that prioritize community agency and challenge systemic complacency, the PHL paper stands out

Ultimately, I believe the ideal path forward lies in integrating both: using the NASEM report’s evidence and structure to ground PHL’s visionary liberation efforts. For now, my preference for the PHL paper reflects a hope for a future where health equity is driven as much by empowered communities as by reformed systems.

CHATGPT

Here’s a comparative overview of the two manuscripts you provided—the National Academies report Ending Unequal Treatment (2024) and the Public Health Liberation white paper—followed by a brief discussion of their relative strengths and my view on which better meets the goal of advancing health equity in practice.

1. Purpose and Scope

• Ending Unequal Treatment
  A consensus-study report commissioned by AHRQ and NIH, it reviews two decades of evidence on racial and ethnic inequities in U.S. health care, identifies barriers across four system domains (laws & payment, service delivery, evidence generation, accountability), and issues detailed, phased implementation recommendations for federal, state, and local actors .

• Public Health Liberation (PHL)
  A “white paper” proposing a new transdiscipline, centered on a general theory of the “public health economy,” with liberation as its core philosophical principle. It synthesizes political theory, African American emancipatory thought, and community psychology to reframe health equity as an emancipatory struggle .

2. Conceptual Frameworks

• Ending Unequal Treatment
  Uses a systems framework (Figure S-1) situating 4 health-system domains within 5 external societal forces, emphasizing the interplay of structural racism, social determinants, financing, community engagement, and accountability .

• PHL
  Centers on the “public health economy” concept—anarchical, fragmentary competition among agents—arguing that only through horizontal (across sectors) and vertical (across levels of power) integration, underpinned by a philosophy of liberation, can health inequities be uprooted .

3. Methodology and Evidence

• Ending Unequal Treatment
  Draws on a systematic review of published data (e.g., trends in insurance coverage, life expectancy gaps, disease-specific inequities), legal and policy analyses (ACA impacts, court rulings), and expert workshop testimony to grade past progress and identify evidence-based interventions .

• PHL
  Primarily theoretical, weaving historical case studies (Flint and DC water crises), emancipatory philosophy, and novel constructs (e.g., “Gaze of the Enslaved,” “Morality Principle,” “public health realism”) into a cohesive but as-yet-untested framework. It invites future measurement development and praxis but does not itself present empirical evaluation .

4. Recommendations and Actionability

• Ending Unequal Treatment
  Offers concrete “Goals and Recommended Implementation Actions,” ranging from immediate data-standard reforms and Medicaid expansion strategies to longer-term workforce diversification and community-engaged care models . Its recommendations are tailored to specific actors (Congress, HHS, payers, health systems) with clear priority areas.

• PHL
  Proposes a paradigm shift—adopting liberation philosophy, reconstituting public health through transdisciplinary integration, and cultivating “liberation safe spaces.” While rich in guiding principles, it stops short of detailed policy prescriptions or step-by-step implementation roadmaps .

5. Audience and Readiness for Uptake

• Ending Unequal Treatment targets policy makers, federal and state agencies, payers, and health system leaders prepared to act on consensus recommendations that build on decades of research.

• PHL speaks to scholars, activists, and community leaders seeking a new theoretical lingua franca—a foundation for future research, training, and long-term movement-building.

Preferred Manuscript

Ending Unequal Treatment is, in my view, the more action-oriented and immediately implementable document for advancing health care equity. It synthesizes a robust evidence base into sector-specific recommendations that can be adopted or piloted today by agencies and health systems. While Public Health Liberation offers a provocative and potentially transformative lens, it remains primarily conceptual and will require significant further development—measurement tools, pilot studies, and long-term evaluation—to inform policy and practice at scale.

—
I hope this comparison helps clarify the distinct contributions of each work and why the National Academies’ consensus report may be the most practical roadmap right now for driving systemic change in U.S. health care.

Gemini 2.5 Experimental

Okay, I have read and analyzed both documents: "Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All" and "Public Health Liberation: An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy". Here's a comparison, discussion, and my preferred document:

Discussion

Ending Unequal Treatment (EUT): This report serves as a critical, evidence-based assessment of the state of racial and ethnic health care disparities in the U.S., 20 years after the landmark 2003 report. It concludes soberingly that little progress has been made overall, with inequities persisting across the care continuum, driven by complex interactions between the health care system and broader societal factors like structural racism. The report meticulously documents these persistent inequities and provides a structured framework for understanding the problem, encompassing societal forces and health system domains (laws/payment, service delivery, research, accountability). Its major contribution is a set of concrete, actionable recommendations for various stakeholders (Congress, HHS, CMS, OMB, researchers, health systems) aimed at improving data collection, strengthening service delivery, funding research, enhancing accountability, and closing coverage gaps. It operates within the existing public health and policy framework, seeking evidence-informed, incremental improvements.Public Health Liberation (PHL): This white paper argues for a more radical transformation, proposing a new transdiscipline called Public Health Liberation. It posits that current public health paradigms are insufficient because they fail to grapple with the underlying "public health economy"—the dynamic interplay of economic, political, and social forces that actively reproduces health inequity through competition, fragmentation, and power imbalances. PHL draws heavily on diverse emancipatory philosophies, particularly African American liberation thought and the authors' lived experiences, to offer a new lens. It introduces novel concepts like "illiberation" (internalized powerlessness that hinders change), the "Morality Principle" (the duty to intervene immediately against profound injustice, regardless of complete scientific proof), and "public health realism" (acknowledging self-interest and power dynamics). It advocates for community empowerment ("liberation"), integration across disciplines and communities ("horizontal and vertical integration" ), and transformative action ("praxis").

Synthesis: While EUT provides a detailed status report and a practical policy roadmap for improving the current system, PHL offers a deeper theoretical critique, arguing that the system's fundamental dynamics ("public health economy") inherently resist equity. EUT seeks to fix the system; PHL seeks to transform the underlying philosophy and practice of public health itself. EUT's strength is its actionable recommendations for current stakeholders; PHL's strength is its novel theoretical framework for understanding why progress identified as lacking in EUT has been so elusive, and its call for a more fundamental, community-driven, liberation-focused approach.

Preferred Document

Both documents offer significant value. "Ending Unequal Treatment" is indispensable for policy makers and health system leaders seeking concrete, evidence-based steps to improve health care equity within the current framework. Its recommendations are clear and targeted.

However, I find "Public Health Liberation" conceptually more compelling and potentially more impactful in the long run. Its analysis of the "public health economy" and introduction of concepts like "illiberation," the "Morality Principle," and "public health realism" provide powerful tools for understanding the deep-rooted persistence of health inequities that EUT documents. While its call for a new transdiscipline is ambitious and less immediately actionable than EUT's policy points, its emphasis on liberation philosophy and community-driven praxis offers a more fundamental challenge to the status quo. It better addresses the "why" behind the lack of progress and proposes a pathway, rooted in community empowerment and a transformed worldview, that feels necessary for achieving true, sustainable health equity. Therefore, while recognizing EUT's practical importance, my preference leans towards Public Health Liberation for its theoretical innovation and transformative potential.