Liberatory Public Service (LPS) as a Framework for Transforming Health and Human Services

Abstract

This commentary introduces the Liberatory Public Service (LPS) framework as a transformative, trauma-informed, and equity-driven approach to reimagining health and human services administration. Focusing on the structural inequities revealed by the COVID-19 pandemic and the persistent barriers faced by LGBTQIA+ communities, it demonstrates how LPS can guide systemic change grounded in healing, justice, and inclusion. By centering those most marginalized, LPS offers a bold and practical path for advancing health equity in the United States.

Introduction

More than 72 million Americans across political and ideological lines rely on Medicaid as their main source of health coverage. The One Big Beautiful Bill Act proposes deep cuts to both Medicaid and Medicare, threatening access to care for those who need it most. Those most affected are people with the fewest financial resources, particularly Black, Brown, Indigenous, LGBTQIA+, and disabled individuals who already face significant barriers to care (Millett et al., 2020; Piepzna-Samarasinha, 2022).

Health and human services administration occupies a unique position at the intersection of healthcare, social policy, and public administration. The current crisis calls for a reimagination of the field through an equity-centered lens, one that not only addresses the symptoms of rising costs but also dismantles the structural inequities that produce them. This commentary argues that the Liberatory Public Service (LPS) framework offers a vision for path forward, grounding administrative practice in the values of equity, repair, compassion, and healing (Chordiya & Sabharwal, 2024).

Given the persistent challenges in ensuring equitable access to and delivery of public services, including in healthcare, Chordiya and Sabharwal (2024) propose the Liberatory Public Service (LPS) framework, which envisions a transformative approach to public service administration grounded in love, courage, repair, healing, solidarity, and transformation. The authors define LPS as “the vision and practice of eliminating systemic biases and barriers in public services while simultaneously advancing a proactive politics of equity, inclusion, belonging, and freedom” (p. 118). It demands that administrators move beyond compliance and efficiency toward compassion and justice.

LPS is inspired and shaped by key social justice movement frameworks, including transformative justice, restorative justice, trauma-informed approaches, healing justice, disability justice, and intersectionality. It emphasizes that public institutions must not only mitigate harm but also repair it and co-create supportive conditions for collective healing to emerge. The five guiding principles of LPS call on health and human service professionals to:

1. Integrate inner and collective transformation for social justice.

2. Be trauma-informed.

3. Prioritize repair and healing.

4. Compassionately center the margins.

5. Transform conditions of harm and co-create liberatory alternatives.

LPS invites health and human services administrators to consistently build and expand their individual and organizational capacities and competencies for transformation as the foundation for systemic change. Applying LPS in health and human services means reorienting institutional priorities. Administrators must move from demographic representation to systems designed to affirm the dignity, safety, and self-determination of all people. This requires transparent decision-making, equitable resource distribution, and the active inclusion of communities that are socio-economically left behind in shaping policy. Institutions can operationalize LPS by adopting trauma-informed, healing centered organizational policies that ensure physical and psychological safety, peer-support, collaboration, self-determination, and building trust across staff and clients. Culturally and historically responsive health and care practices must become standard, not optional in every aspect of care delivery. Empowered and collaborative partnerships with community-based organizations should replace top-down program design, ensuring that those most affected by inequities are empowered and resourced to lead in defining solutions. Creating the conditions not only for individual care and healing but collective care and healing becomes a matter of public health significance.

Application of LPS to Health Inequity Examples

Healthcare inequities in the United States are neither new nor accidental nor imaginary. They are embedded in the historical, institutional, and cultural fabric of public systems (Martin-Howard & Farmbry, 2020; Wright & Merritt, 2020; Wright et al., 2022). As outlined in Liberatory Public Service, “the patterns of structural oppression are reproduced and persist through unexamined and inequitable policies, procedures, structural and cultural factors” (Chordiya & Sabharwal, 2024, p. 25) that advantage dominant “in-groups” and disadvantage the marginalized “others.” From racialized zoning and environmental racism to inaccessible facilities, health inequities are sustained through policies that appear neutral but operate inequitably.

To illustrate how the Liberatory Public Service (LPS) framework can begin to disrupt these deeply rooted patterns of inequity, this commentary focuses on two urgent and emblematic cases: the COVID-19 pandemic and the systemic barriers faced by LGBTQIA+ communities in accessing care. These examples were chosen not only for their national relevance and broad impact, but also because they highlight the intersectional and compounding nature of structural harm. In doing so, they reveal how LPS can move beyond abstract ideals to offer a concrete, justice-centered approach to transforming health and human services systems.

The COVID-19 pandemic revealed how structural inequities magnify vulnerability across marginalized communities. Disabled people, particularly those who are also Black, Indigenous, and People of Color endure heightened exposure to harm, delayed diagnoses, and exclusion from equitable treatment options (Piepzna-Samarasinha, 2022). Black, Indigenous, and Latinx populations faced higher infection and mortality rates with causes rooted in systemic disparities rather than individual behavior. Millett et al. (2020) found that nearly 90% of predominantly Black counties reported COVID-19 cases early in the pandemic and nearly half reported deaths, even after adjusting for poverty, age, and comorbidities. These counties also had higher chronic disease burdens, greater air pollution, and less access to insurance and healthcare, conditions that compounded the pandemic’s toll and exposed deep racial inequities in health outcomes. Structural disinvestment in healthcare infrastructure, environmental safety, and education created conditions of vulnerability long before the virus arrived (Krieger, 2021).

Similarly, LGBTQIA+ individuals, people face ongoing medical discrimination and denial of care. Transgender and nonbinary youth face numerous policy, structural, and cultural barriers to accessing healthcare. In several states, laws banning gender-affirming care for youth under 18 have led to harmful health and legal consequences. Gender-affirming care includes both social support and medical interventions, which research consistently identifies as essential for mental health and overall well-being (Tordoff et al., 2022). These challenges are further exacerbated under the new executive order signed by President Trump, titled, Protecting Children From Chemical and Surgical Mutilation severely limits gender affirming care for children under 19 across the nation (Executive Order [EO], 2025). In contrast, while transgender youth are denied access to affirming care, intersex children and youth are often subjected to non-consensual and often unnecessary medical procedures, including in infancy to enforce binary gender norms—practices that can cause lifelong trauma (Intersex Justice Project, n.d.).

If we seek a society that is fair, just, and inclusive, where everyone can grow and contribute to the fabric of our nation, we must move beyond reform, act with imagination to co-create liberatory possibilities, and commit to true transformation. The Liberatory Public Service framework provides both hope and direction to guide that change. As a novel model, LPS shifts the focus from reactive policy fixes to proactive healing-centered governance, placing equity, repair, and community voice at the core of public administration. In doing so, it offers a transformative roadmap for health and human services leaders to not only recognize injustice but to systematically dismantle it and co-create structures that affirm dignity, belonging, and well-being for all.