About

Paul J Fleming, PhD, MPH, is an Associate Professor at the University of Michigan School of Public Health and a co-founder of the Collaborative for Transformative Public Health. His research and teaching focus on the root causes of racial health inequities and strategies to address them. He partners with community-based organizations and community organizers to bring equity and anti-racism principles into practice, aiming to advance health equity and create communities and organizations that enable all people to thrive. Dr. Fleming's work includes collaborations on projects funded by the Kellogg Foundation to improve maternal and child health outcomes for Latinx pregnant people, as well as efforts to integrate anti-racist principles into public health teaching and practice. He is a recognized thought leader on how to transform organizations and communities through prevention thinking and policy change. His latest book, 'Imagine Doing Better: Why policies backfire and how prevention thinking can change everything,' provides a hopeful roadmap for leaders and practitioners seeking to foster systemic change.

Research topics

• Political Science
• Nursing
• Law
• Medicine
• Business
• Clinical psychology
• Environmental health
• Public relations
• Psychology
• Social psychology
• Marketing
• Criminology
• Psychiatry

Selected publications

• A logic model for alternative response programs to guide public health research and practice

  Social Science & Medicine · 2026-04-15

  article1st authorCorresponding
  PublisherDOI

• Description and Evaluation of a Measurement Technique for Assessment of Performing Gender

  UNC Libraries · 2025-09-18

  articleOpen access
  PublisherDOI

• A Collaborative Approach to Enhance Capacity and Power for Community-driven Policy Change: Project HEARD

  Progress in community health partnerships · 2025-09-01 · 1 citations

  articleOpen accessSenior author

  BACKGROUND: A longstanding community-based participa-tory research center designed Project Health Equity via Advocacy for Resources in Detroit (HEARD) to enhance the capacity, collective power, and impact of community-based organizations-working in partnership with academics-to advance policy change for health equity in their communities. OBJECTIVES: We describe how Project HEARD supported community-academic teams to develop policy advocacy campaigns that included 1-year goals for equity-focused change. METHODS: Project HEARD had the following main components: a cohort of community-academic teams, policy change workshops, policy advocacy grant, mentoring by community-academic pairs, and online strategy sessions. LESSONS LEARNED: Supporting community-driven policy change requires recognizing and building on teams' contexts, history, and expertise; tailoring support for teams with diverse policy experiences; and identifying additional ways to support sustainability. CONCLUSIONS: Project HEARD's approach and initial lessons learned can inform projects in diverse contexts aiming to amplify community-led policy change to support health equity.

  PublisherOA PDFDOI

• Adherence to Gender-Typical Behavior and High-Frequency Substance Use From Adolescence Into Young Adulthood

  UNC Libraries · 2025-09-06

  articleOpen access1st authorCorresponding

  Substance use is prevalent among adolescents in the U.S., especially males. Understanding the cross-sectional and longitudinal associations between gender norms and substance use is necessary to tailor substance use prevention messages and efforts appropriately. This study investigates the relationship between adherence to gender-typical behavior (AGB) and substance use from adolescence into young adulthood. Participants in the National Longitudinal Study of Adolescent to Adult Health completed self-report measures on the frequency of binge drinking, cigarette smoking and marijuana use as well as various behaviors and emotional states that captured the latent construct of AGB. Sex-stratified logistic regression models revealed cross-sectional and longitudinal relationships between AGB and high frequency substance use. For example, an adolescent male who is more gender-adherent, compared to less adherent males, has 75% higher odds of high frequency binge drinking in adolescence and 22% higher odds of high frequency binge drinking in young adulthood. Sex-stratified multinomial logistic regression models also revealed cross-sectional and longitudinal relationships between AGB and patterns of use. For example, a more gender-adherent adolescent male, compared to one who is less adherent, is 256% more likely to use all three substances in adolescence and 66% more likely to use all three in young adulthood. Cross-sectional and longitudinal results for females indicate greater gender-adherence is associated with lower odds of high frequency substance use. These findings indicate adherence to gender norms may influence substance use behaviors across the developmental trajectory, and inform strategies for prevention efforts.

  PublisherDOI

• Care-Based Approaches for Responding to Emergencies: How Unarmed Non-Police Programs Address Inequities

  Health Education & Behavior · 2025-07-07 · 1 citations

  articleSenior authorCorresponding

  The American Public Health Association has identified police violence as a major public health concern and driver of inequities. Unarmed non-police response (UNPR) programs have emerged as significant interventions to promote community well-being and safety. The research presented in this article sheds light on how these programs impact community health, focusing on operational efficacy and the breadth of health benefits they offer communities. We conducted 11 semi-structured interviews with UNPR staff from six different programs across the country to examine the impact of programs on community health. Our findings reveal that UNPR programs serve as critical hubs for community safety, including chronic disease management, infectious disease prevention, violence reduction, and jail time reduction. We found that UNPR programs address health inequities through four key pathways: (a) referrals to health-promoting social services, (b) direct health care provision, (c) conflict de-escalation, and (d) reducing entry into the criminal legal system. Staffing these programs and building trust with communities are key to ensuring that historically marginalized communities, which often distrust police and experience poor health outcomes, view them as a valuable resource. Our findings provide important insights into the functioning and impact of UNPR programs, highlighting their value in promoting safety, public and community health, and equity, while also underscoring the importance of UNPR programs as health promotion interventions to build care and connection to community resources.

  PublisherDOI

• Why Building Power Is Key to Protecting Academic Public Health and Advancing Health Equity

  American Journal of Public Health · 2025-10-08 · 3 citations

  editorialOpen access
  PublisherOA PDFDOI

• Working Toward Structural Change: Visions and Tension Points for a City-Wide Unarmed Response Program to Enhance Health Equity

  Health Promotion Practice · 2025-03-26

  articleSenior authorCorresponding

  Amid growing evidence and high-profile incidents highlighting the dangers of current police practices, many are questioning the role of armed police in their communities. Police violence is a public health issue and unarmed nonpolice response programs represent one potential solution for addressing this issue. In this article, we describe local visions and key tension points for an unarmed public safety program to reduce police violence and improve the health and well-being of its residents. We report on interviews ( n = 15) conducted with local leaders, activists, and social service providers in a small-sized Midwestern city that had allocated funding to pilot an unarmed response program. To supplement the interviews, we also systematically followed local news stories and city council meetings and participated as members of a coalition working toward implementing an unarmed response program. Our analysis focused on participants’ visions and expectations for an unarmed safety program and identified several key concerns related to program logistics, including program reach, response time, funding, impact, and staffing. We found that key concerns raised by activists and leaders—including the scope of the program, the satisfaction the community has with the program, how it will be evaluated, and how community members will be involved—are similar to concerns raised in a typical health promotion program planning process. The visions and tensions detailed in this article can inform organizing efforts in other municipalities and suggest a role for public health practitioners in developing and implementing these programs.

  PublisherDOI

• Converging crises and maternal and child health: colonialism, extreme weather, and COVID-19

  Reproductive Health · 2025-11-05

  articleOpen access

  BACKGROUND: Climate change is a growing threat to human health, particularly in regions facing overlapping environmental hazards and social inequities. Puerto Rico-a U.S. territory with a colonial history-offers a unique case for examining how multiple disasters, including Hurricane Maria, ongoing earthquakes, and the COVID-19 pandemic, interact with structural vulnerabilities to affect maternal and child health. Despite increasing attention to climate-related health outcomes, little is known about the reproductive health impacts of cumulative disaster exposure in colonial contexts. METHODS: We used U.S. National Vital Statistics System data (2017-2021) to assess associations between disaster exposure and six maternal and newborn outcomes: preterm birth, low birthweight, term low birthweight, gestational hypertension, gestational diabetes, and excessive weight gain. Disaster exposure was defined based on the timing of hurricanes and the pandemic, using a three-month lag period. We analyzed data from Puerto Rico and used Florida and Texas as comparison sites. Multivariable log-binomial regression models estimated adjusted prevalence ratios. Effect modification was tested for (1) region within Puerto Rico and (2) colonial status, comparing Puerto Rico (territory) to Florida and Texas (states). Simulations were conducted to account for potential live-birth bias. RESULTS: Across 104,560 births in Puerto Rico, disaster periods were consistently associated with worse maternal health outcomes. For example, during the late post-hurricane period, gestational diabetes increased (RR = 1.19, 95% CI: 1.08, 1.31), while term low birthweight surprisingly appeared to decline (RR = 0.90, 95% CI: 0.83, 0.98). Associations with newborn health were mixed and may have been underestimated due to sharp declines in live births after disasters. Simulations suggested stronger disaster-related risks than observed in primary analyses. Effect modification by region and colonial status showed inconsistent but notable differences, particularly elevated maternal health risks in certain regions of Puerto Rico and compared to U.S. states. CONCLUSIONS: Our findings suggest that multiple disasters negatively affect reproductive health in Puerto Rico and that structural factors, including colonialism, may exacerbate these impacts. Public health responses must account for cumulative disaster exposure and systemic inequities to better support maternal and child health in marginalized settings, especially as climate change continues to intensify.

  PublisherOA PDFDOI

• Wellness Coaching in a Summer Internship Program to Address the Mental Health Pandemic Among College Students, 2022–2023

  American Journal of Public Health · 2025-04-17

  articleOpen accessSenior author

  In this article, we describe and present evaluation data for an innovative initiative and approach that integrate a wellness program into a summer pathway program for underrepresented undergraduate students in public health to address the students’ mental health needs. This collaborative partnership and integrated wellness approach provide opportunities for summer programs at academic institutions to creatively address the needs of the students they serve. ( Am J Public Health. 2025;115(9):1379–1382. https://doi.org/10.2105/AJPH.2025.308014 )

  PublisherOA PDFDOI

• The Association Between Men’s Concern About Demonstrating Masculine Characteristics and Their Sexual Risk Behaviors: Findings from the Dominican Republic

  UNC Libraries · 2024-07-26

  articleOpen access
  PublisherDOI

Frequent coauthors

• William D. Lopez

  32 shared

• S. Fornasier

  32 shared

• M. A. Barucci

  Sorbonne Paris Cité

  32 shared

• Clare Barrington

  University of North Carolina at Chapel Hill

  26 shared

• J. D. P. Deshapriya

  24 shared

• Shari L. Dworkin

  University of Washington Bothell

  21 shared

• Yeycy Donastorg

  Instituto Dermatológico y Cirugía de Piel "Dr. Huberto Bogaert Díaz"

  20 shared

• P. H. Hasselmann

  Astronomical Observatory of Rome

  16 shared

Education

• PhD, Health Behavior

  University of North Carolina at Chapel Hill

  2015

• MPH, Behavioral Sciences and Health Education

  Emory University

  2011

• BA, Political Science, Spanish

  University of Illinois at Urbana-Champaign

  2006