The imaginary intervention: a conceptual framework for applied imagination in public health

This conceptual framework article explores how public health might extend its focus beyond structural conditions like income, housing, and access to care to also consider the cultural norms that shape how people see themselves, their choices, and their futures. These internalized norms can erode well-being by narrowing perceived possibilities, suppressing vitality, and increasing stress. We propose two complementary capacities for addressing these normative harms: cultural reflexivity and applied imagination. Cultural reflexivity enables people to recognize and question the cultural logics that guide assumptions about health, personhood, and worth. Applied imagination allows them to suspend default interpretations and explore alternative ways of living. Together, these capacities may foster more adaptive norms that support measurable outcomes including greater vitality, flourishing, and reduced allostatic load, which in turn modulate chronic inflammation, cardiovascular dysfunction, and metabolic risk. We conclude with a call for research about how cultivating and measuring reflexivity and imagination might strengthen resilience, reduce inequities, and enhance population well-being.