Comparative Analysis of "Public Health Liberation" and "Ending Unequal Treatment": Convergences and Divergences

Health equity remains a critical challenge in the United States, with persistent racial and ethnic disparities underscoring the need for innovative and systemic approaches to public health and healthcare delivery. Two pivotal documents—"Public Health Liberation - An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy" (PHL) and "Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All" (EUT)—offer distinct yet overlapping frameworks to address these inequities. This essay provides an extensive academic analysis of the convergences and divergences between these works, examining their shared goals, conceptual alignments, and differing methodologies, scopes, and philosophical underpinnings. By synthesizing their strengths and differences, this analysis aims to illuminate pathways for advancing health equity scholarship and practice.

Convergences

The PHL and EUT documents converge on several foundational principles, reflecting a shared commitment to dismantling health inequities and reimagining health systems to serve all populations equitably. These convergences highlight common ground in their recognition of systemic failures, the necessity of broad contextual understanding, and the centrality of community empowerment.

1. Recognition of Persistent Health Inequities

Both documents acknowledge that racial and ethnic health inequities persist as a fundamental flaw in the U.S. health system, disproportionately affecting marginalized communities. PHL frames this issue through case studies like the lead-contaminated water crises in Flint, Michigan, and Washington, DC, illustrating how structural failures exacerbate health disparities (Williams et al., 2022). Similarly, EUT builds on the legacy of the 2003 Unequal Treatment report, noting that despite some progress, significant gaps remain in healthcare access, quality, and outcomes across racial and ethnic groups (National Academies, 2024). This shared diagnosis underscores a mutual urgency to address systemic inequities beyond incremental reforms.

2. Emphasis on Broader Contextual Understanding

A key convergence lies in their emphasis on understanding health inequities within a broader societal context. PHL introduces the "public health economy" as a singular analytic lens to capture the interplay of economic, political, and social drivers that reproduce health inequities (Williams et al., 2022). This concept parallels EUT’s conceptual framework, which identifies five external societal forces—structural determinants of health, oppression and structural racism, social determinants of health (SDOH), non-healthcare sector partnerships, and societal commitment to equity—as critical influencers of healthcare equity (National Academies, 2024). Both approaches reject reductionist views, advocating for holistic analyses that integrate multiple determinants of health.

3. Centrality of Community Involvement

Community empowerment emerges as a cornerstone in both documents. PHL emphasizes "horizontal integration" to amplify the voices of affected populations in public health discourse, drawing on community leadership experiences, particularly from Black women (Williams et al., 2022). EUT similarly prioritizes "community-centered and community-engaged care," highlighting partnerships and interventions that leverage community resources to address inequities (National Academies, 2024). Examples in EUT, such as community-based participatory research (CBPR), resonate with PHL’s praxis-oriented approach, which includes community-led advocacy and self-help initiatives.

4. Addressing Structural Racism and Historical Trauma

Both works explicitly confront structural racism and historical trauma as root causes of health inequities. PHL integrates African American liberation philosophy, introducing constructs like the "Gaze of the Enslaved" to critique research ethics and historical injustices (Williams et al., 2022). EUT identifies "oppression and structural racism" as a key external force, tracing its impact through policies like residential segregation and systemic bias (National Academies, 2024). This convergence reflects a mutual recognition that health equity requires reckoning with legacies of racial oppression embedded in societal and healthcare structures.

5. Call for a Multidisciplinary Approach

A transdisciplinary or multidisciplinary approach unites the two documents. PHL positions itself as an emerging transdiscipline, synthesizing philosophy, theories, praxis, research, and training to transform public health (Williams et al., 2022). EUT advocates a systemic approach, integrating four intersecting domains—healthcare laws and payment policies, service delivery, discovery and evidence generation, and accountability—to advance equity (National Academies, 2024). Both reject siloed disciplinary boundaries, proposing comprehensive frameworks to tackle the complexity of health inequities.

Divergences

Despite these convergences, PHL and EUT diverge significantly in scope, theoretical foundations, methodologies, and tone, reflecting distinct intellectual traditions and strategic priorities. These differences highlight complementary strengths and potential areas of tension in their approaches to health equity.

1. Scope and Focus

PHL presents a sweeping, transformative framework aimed at establishing a new public health transdiscipline, encompassing philosophy, theory, practice, research, and training (Williams et al., 2022). Its scope is broad and radical, seeking to overhaul the public health economy. In contrast, EUT focuses more narrowly on assessing and improving the current healthcare system, revisiting the 2003 Unequal Treatment report to evaluate progress and recommend actionable strategies within existing structures (National Academies, 2024). While PHL envisions a paradigm shift, EUT prioritizes incremental policy and practice enhancements.

2. Theoretical Foundations

The theoretical underpinnings of the two documents diverge markedly. PHL is rooted in African American emancipatory writing and liberation philosophy, introducing novel constructs like "liberation," "illiberation," and the "public health economy" to frame its critique (Williams et al., 2022). This approach reflects a radical, culturally specific lens. EUT, however, adopts a more conventional public health framework, relying on evidence-based strategies and established concepts like SDOH and structural determinants (National Academies, 2024). While PHL challenges foundational assumptions, EUT builds on mainstream scientific consensus.

3. Novel Constructs and Innovation

PHL distinguishes itself with innovative constructs absent from EUT, such as the "Gaze of the Enslaved," "Morality Principle," and "public health realism" (Williams et al., 2022). These terms embody a critical, liberationist perspective that reframes public health ethics and practice. EUT, while comprehensive, does not introduce comparable novel terminology, focusing instead on refining existing frameworks and synthesizing empirical evidence (National Academies, 2024). This divergence underscores PHL’s emphasis on theoretical innovation versus EUT’s reliance on established knowledge.

4. Role of Women in Leadership

PHL uniquely highlights the leadership role of women, particularly Black women, in driving public health transformation, noting their overrepresentation in community health spaces (Williams et al., 2022). This focus is grounded in historical and contemporary advocacy experiences. EUT acknowledges the need for a diverse healthcare workforce but does not specifically emphasize women’s leadership, framing diversity more broadly (National Academies, 2024). This difference reflects PHL’s gendered lens versus EUT’s more general approach to workforce equity.

5. Critique of Research Paradigms

PHL offers a pointed critique of the current public health research paradigm, arguing it often fails to benefit communities and advocating for community-driven research (Williams et al., 2022). EUT, while recognizing gaps in data and research infrastructure, does not challenge the research enterprise with the same intensity, focusing instead on enhancing evidence generation within existing systems (National Academies, 2024). PHL’s radical stance contrasts with EUT’s reformist approach to research improvement.

6. Recommendations and Action Plans

The documents differ in their recommendations. PHL advocates a broad, praxis-oriented suite of actions—legal interventions, regulatory appeals, and community organizing—reflecting its transformative ethos (Williams et al., 2022). EUT provides specific, policy-oriented recommendations, such as improving healthcare laws, enhancing service delivery, and strengthening accountability, tailored to the current system (National Academies, 2024). PHL’s ambitious scope contrasts with EUT’s pragmatic, implementable focus.

7. Tone and Language

Tone and language further distinguish the two works. PHL adopts an impassioned, liberationist tone, using terms like "emancipation" and "hegemony" to evoke social justice movements (Williams et al., 2022). EUT maintains a neutral, academic tone typical of National Academies reports, prioritizing evidence-based objectivity (National Academies, 2024). This divergence reflects PHL’s activist roots versus EUT’s institutional authority.

Discussion

The convergences between PHL and EUT underscore a shared vision for health equity, rooted in systemic analysis, community empowerment, and anti-racist principles. Their mutual emphasis on contextual factors and multidisciplinary approaches suggests a robust foundation for collaborative efforts. However, their divergences reveal distinct strengths: PHL’s radical critique and innovative constructs offer a visionary challenge to the status quo, while EUT’s evidence-based, policy-focused recommendations provide actionable steps within existing frameworks.

These differences are not mutually exclusive but complementary. PHL’s liberationist perspective could inspire EUT’s strategies with bolder, community-driven innovations, while EUT’s empirical grounding could temper PHL’s ambitious proposals with practical feasibility. For instance, integrating PHL’s "public health economy" with EUT’s societal forces could enrich both frameworks, offering a more dynamic understanding of health inequity drivers. Similarly, PHL’s emphasis on women’s leadership could inform EUT’s workforce diversity initiatives, adding a gendered dimension to equity efforts.

Conclusion

In conclusion, "Public Health Liberation" and "Ending Unequal Treatment" converge on the urgent need to address racial and ethnic health inequities through systemic, community-centered approaches, while diverging in scope, theory, and strategy. PHL’s transformative transdiscipline and EUT’s systemic reforms represent two sides of the health equity coin—one visionary and radical, the other pragmatic and evidence-based. Together, they offer a comprehensive roadmap for scholars, practitioners, and policymakers to advance health equity, bridging grassroots activism with institutional action. Future efforts should leverage these synergies, fostering dialogue between liberationist and conventional approaches to realize equitable health care and optimal health for all.

References

• National Academies of Sciences, Engineering, and Medicine. (2024). Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All. Washington, DC: The National Academies Press. https://doi.org/10.17226/27820

• Williams, C., et al. (2022). Public Health Liberation - An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy. Advances in Clinical Medical Research and Healthcare Delivery, 2(3), Art. 10. https://doi.org/10.53785/2769-2779.1120