Meet Dr. Xuanyi (“Max”) Nie, Post-Doctoral Research Fellow
Part of an occasional series of windows
into the lives of researchers on the Harvard China Health Partnership.
How did you become interested in researching “medical cities”?
I’ve always been interested in how humans interact with complex things. Health care systems constantly pose challenges to us as humans and people respond differently to the constraints of the built environment, thus shaping behavior.
I first became interested in health care when I was preparing my master’s thesis at the Harvard Graduate School of Design. I took a class with Alex Krieger—who was also running a project in Nanjing, my hometown in China—and had a conversation with him about the built environment as it interacts with education and health care. I later learned more about the unique history of the hospitals in the Longwood Medical Area of Boston, where there is an incredibly high concentration of clinical health care services, biomedical research, and educational experiences, all linked around an anchor educational institution—Harvard Medical School.
I began to realize that healthcare interacts with the spatial system through, for example, hospital and biotech lab projects. Between healthcare and urban development, the government, payer, provider, and consumer interact in a complex network. The public and private spending on providing health care, and the knowledge-intensive industry based on life science research, are powerful engines for growth and strong hands in reshaping the urban environment. This inspired me to pursue a doctoral degree exploring primarily two questions: what are the roles of the state, market, and individuals in producing healthcare-driven urban developments, particularly the “medical cities” in the United States and China, and how do they interact in the processes through which these new spaces are produced and governed.
Under the guidance of Prof. Yip, I began to think deeper about the political economy of healthcare and its relationship with human health. Working with her has helped me develop an interest in understanding the dynamics of how policies developed to target population health have been translated differently at local levels, and how the variation in policies can lead to health outcomes that exceed, fail, or contradict expectations.
Can you describe one of your current research projects and how it contributes to improving population health?
I did a project about the geographical relationship between public tertiary hospitals and biotech startups in China and the extent to which tertiary hospitals drive entrepreneurship based on theories of alliance formation. Research on the value chain of biotechnology has suggested that biotech startups collaborate with upstream partners for knowledge generation and downstream partners for product development. However, much of the existing research tends to focus on the roles of universities, while hospitals—which are very important players in the biotech ecosystem—have not been given much attention. I am very excited to explore the relationship between hospitals and biotech innovations from a location analysis perspective.
We believe that hospitals in China have even more important roles. The hospital-centric healthcare system and university-hospital affiliation system make public tertiary hospitals in China critical upstream and downstream partners for biotech startups.
What is one of your key takeaways from comparing health systems in LMICs and HICs?
I have lived in both LMICs and HICs, so I will start with my most direct impression: infrastructure. Though I have to wait for a long time to see a doctor in the United States, I know that I will receive my results, and everything is retrievable online. I went to see some hospitals in Southeast Asia and also helped organize COVID-19 tests in Africa for chartered flights back to China. In Africa, providers could treat, provide necessary care, and run tests, but the process was not efficient and reliable. I also noticed that some professionals were performing tasks with outdated equipment, such as handwritten records and manual matching of test samples and names.
From a theoretical point of view, I think sustainability and accessibility are also major takeaways. For example, doing a COVID test in Nairobi was $90 in 2020, and many people could not afford this price.
What do you consider a key success factor for conducting research in China?
Knowing culture in China is so important. In my personal experiences, many things in China are left unspoken, rooted in the Confucian concept “the way of the mean.” Many times, the language used has connotations that cannot be voiced directly. This is cultural but is also utilitarian because people can avoid taking responsibility for the consequences of words. Experts who know about these “codes” are critical for conducting good research because their knowledge helps reconstruct meaning. This is also true in doing policy analysis. Sometimes even if a policy says something, there may have been different iterations over multiple years, and subtle changes in wording could reflect the state’s thoughts on the importance of the policy.
What can other countries learn from China’s health system? Conversely, where might China benefit from the experience of other countries?
I think one impressive achievement that other countries could learn from China is the universal health coverage built from a once-shattered healthcare system. It is a functional and effective system that accommodates the basic needs of the population. Catastrophic expenditures do exist, but most people are also able to get health care for basic illnesses at an affordable price. However, the population’s increasing demand for healthcare and the increasing inequality in incomes have created challenges to the current health system. China could learn from countries such as Germany for a public-private mixed system. One foreseeable challenge is patient perception towards the private sector because the best hospitals in China tend to be in the public system.
Do you have any advice for people considering a research career in global public health?
For doing research, curiosity is key. Healthcare is a cause, but also a result. Healthcare operates through political economy, through the market society, but its impacts are reflected through not only population health but also consumer satisfaction and risk prevention. I am referring to the input-performance measure-performance goals of the “control knob” framework. I also think being able to appreciate difference and embrace new things is important for working on a global scale. Particularly in healthcare, one needs to understand the socioeconomic differences and sometimes even the differences in the cultural and value systems.
Has anything about living in Boston surprised you?
The growth has surprised me the most. I came to Boston in 2012, and over the past decade, I have seen the growing number of Chinese students, the changing skyline, and of course the rising rent and housing prices. Gentrification has been significant. Biotech industries have brought fortunes to the city, but I also start to worry about rent sustainability. I still love this city.
What’s one positive life change you’ve made during the pandemic?
Before the pandemic I imagined myself working at an NGO or in the private sector. When the pandemic started, I had to dramatically reduce travel and spend more time alone. But that was not a bad experience because I significantly increased the time that I spent with my research projects, sometimes for a day without interruption. I began to realize that I love doing research, and this has settled my plan to stay in academia.