Addressing Inequalities in Health Care

Liang’s summer medical school project examined the prevalence of receiving annual eye screenings among South Korean adult patients with type 2 diabetes and how access to that care differed across demographic and socioeconomic groups over time. The goal was to investigate why screening rates for diabetic retinopathy, a complication of type 2 diabetes, remain low in South Korea, despite the country having universal health insurance coverage and guidelines that recommend annual eye screenings to prevent this leading cause of blindness.

He worked on this project with co-advisors Eggleston and Young Kyung Do, a professor in Seoul National University’s Department of Health Policy and Management and AHPP’s inaugural postdoctoral fellow. They found that lower-income patients with diabetes experienced barriers to quality diabetes care and had lower access to annual diabetes-related eye screenings.

For Liang, these results underscored a deeper lesson: even strong health systems with universal health insurance coverage have structural socioeconomic inequities that leave vulnerable groups behind. The findings helped solidify his conviction that improving health care requires more than clinical training alone. 

The project culminated in Liang’s presentation of the findings at the 2021 AcademyHealth Annual Research Meeting and spurred a new sense of purpose. ”It grew into a life-changing journey at Stanford,” Liang says.

That journey has led him to collaborate with researchers from around the world, particularly in Japan, Korea, and China, utilizing large-scale data to advance population health and applying population health methods to research topics ranging from maternal and child health to mental health, aging, and inflammatory skin diseases.

Image

Liang in South Korea. Photo courtesy of Richard Liang.

From Research to Health Policy Impact

Over the years, Liang evolved from a mentee of Eggleston into a collaborator on projects in Korea and elsewhere. As COVID-19 disrupted health services worldwide, he joined Eggleston and a team of researchers in studying the impact of the pandemic on chronic disease care in India, China, Hong Kong, Korea, and Vietnam. Their findings showed that marginalized and rural communities in those countries were hit especially hard, with negative consequences for population health that reached far beyond those directly infected with the virus.

He and Eggleston also co-authored a study on preferences for telemedicine services among patients with diabetes and hypertension in South Korea during the early COVID-19 pandemic. The research drew the attention of the Prime Minister’s Office in Korea, which used it to guide national policy on telemedicine, a field still lacking a formal legal framework in the country.

For Liang, it was proof of the available opportunities to make tangible improvements in population health by combining rigorous research with policy engagement and drawing on insights across medicine, public health, and the social sciences.

“As a medical student researcher with experiences across different East Asian countries, I witnessed firsthand many pressing challenges in health and society, from rapidly aging populations to rising rates of chronic diseases,” he says. “To tackle these issues holistically, there is a growing need to bring together diverse perspectives, but regional collaborations in medical and public health research have been scarce, and rarer still between the biomedical and social sciences.”

Image

Liang in China on a field visit during a 2025 summer seminar co-taught by Professors Eggleston and Williams. Photo courtesy of Richard Liang.

A Second Academic Home

Eggleston describes Liang as a model of interdisciplinary scholarship. In addition to medical school and doctoral research, he has carved out space to pursue his passion for East Asian studies. He has taken classes with APARC and affiliated faculty on topics ranging from health and politics in modern China to historical and cultural perspectives on North Korea, science and literature in East Asia, and tech policy, innovation, and startup ecosystems in Silicon Valley and Japan.

“The various classes and seminars I’ve attended through APARC, and subsequently as an East Asian Studies master’s student, have helped me think more critically about how the science and practice of medicine impact policy and society, and vice versa,” Liang says. Thanks to these experiences, he also found “a second academic home away from the medical school — a community that shares the recognition of the need to strengthen dialogue and cooperation across the Pacific and that actively encourages the interdisciplinary environment necessary to make my aspirations a reality.”

Most recently, he participated in a summer seminar on AI-enabled global public health and population health management, co-taught by Eggleston and Michelle Williams, a professor of epidemiology and population health at Stanford’s School of Medicine. Offered via the Stanford Center at Peking University, this three-week seminar focused on advancing global health through cross-cultural collaboration and the application of cutting-edge technology in population health and health policy decision-making. 

“During this program, I not only got to share my experiences from conducting population health research across East Asia, but also learn from and alongside fellow students across different disciplines, spanning from international relations to computer science,” Liang notes. He especially enjoyed meeting local Chinese graduate students and providing feedback and near-peer mentorship as an upper-year graduate student.

The seminar also led to exploring additional opportunities for research collaborations to study the implications of long-term annual health screenings across China. Liang, Eggleston, and Williams plan to expand this collaborative work.

Preparing to Become a Better Care Provider

Liang’s work across borders and disciplines not only advances research but also deepens the perspective of cultural humility he brings to his future role as a physician.

“The cross-cultural experiences and fruitful academic exchanges I’ve learned through as a Stanford graduate student not only inform my research in different countries, but also help prepare me to become a better care provider for my future patients,” he says.

For his achievements, Liang has earned multiple honors, including a Young Investigator Collegiality Award from the International and Japanese Societies for Investigative Dermatology, the Critical Language Scholarship in Korean from the U.S. Department of State, and the Stanford Center for Asian Health Research and Education Seed Grant.

He is looking forward to finishing medical school, attending a residency program, and continuing an interdisciplinary career that advances human health and well-being.

Reflecting on the fleeting nature of student life, his advice to fellow students is to remember that “Your time as a Stanford student can really fly by, so make sure to explore the opportunities that speak to you and offerings across the university, by organizations like APARC and the Freeman Spogli Institute for International Studies. The Bechtel International Center’s Office of Global Scholarships and the Hume Center for Writing and Speaking are also wonderful resources to get started.”

It is advice he has embodied himself, building a career at the intersection of medicine, public health, and East Asian studies, one project at a time.

Argument and Contribution

At the national level, the United States struggled to effectively respond to the COVID-19 pandemic: federal policy was delayed and inconsistent, supply shortages were widespread, and political pressure undermined accurate public health guidance. At the state and local levels, however, there was a great deal of variation in terms of the capacity to respond to COVID. While indicators of state capacity often focus on “formal” indicators like institutional resources, staffing, and finances, translating formal capacities into effectively implemented policies is neither a simple nor an automatic process. 

In “Building the Plane While Flying,” Didi Kuo and Andrew S. Kelly draw our attention to the importance of informal indicators of public health capacity. These include strong relationships within and across government agencies, the embeddedness of health officers in local communities, and prior experience with responding to disasters, among other factors. The authors argue that local governments with strong informal capacity were better able to communicate with and learn from one another, as well as to gain the trust of community members, during the pandemic. Conversely, localities with otherwise strong formal capacities often failed to respond to the challenges at hand. This is because they were unable to effectively leverage their relationships and organizational networks.
 

Kuo and Kelly’s paper is informed by qualitative analysis of California’s public health institutions as well as in-depth interviews with health officers across seventeen Northern, Central, and Southern California counties. The interviews illuminate the concrete processes by which local governments responded (or struggled to respond) to the COVID-19 pandemic. One of the paper’s key contributions is to push us to conceptualize state capacity more broadly and to focus on the factors that drive not just policy development, but policy implementation. 

The Importance of Informal Capacity

The bulk of the paper disaggregates informal capacity into its various mechanisms and processes. Each of these proves to be crucial in explaining different pandemic outcomes at the local level. One such mechanism is coordination within local governments. To illustrate this, consider public health officers, who enjoy broad legal powers to protect public health as well as financial resources and personnel at their disposal. By law, officers possess significant capacities to mitigate health crises. Yet across the interviews, health officers reported that effectively implementing COVID-19 policy required their cooperation and communication with a host of actors, including the County Counsel (the county’s top lawyer), Chief Administrative Officer, and Board of Supervisors, which is charged with appointing health officers.
 

Closely related to intra-governmental coordination is the importance of autonomy, particularly in the face of political pressure. For example, boards of supervisors sometimes undermined the public guidance provided by health officers. (This guidance could range from the need to close schools to officers simply communicating truthfully with localities about COVID-19 risks.) Overcoming efforts by board members to ignore or muzzle officers required coordination between those actors who were more insulated from political pressure.

Another key component of informal capacity was prior experience responding to emergencies and California’s myriad of natural disasters, such as fires, floods, or mudslides. Health officers from more experienced counties noted their ability to draw upon established emergency procedures and partnerships. For example, some counties had previously cooperated with each other, as well as with independent agencies like the Red Cross, to provide aid and shelter to those affected by wildfires. These experiences — for which no amount of financial resources or personnel can substitute — served as templates to help coordinate COVID-19 policy responses.

Informal capacity also depended upon health departments effectively communicating with the public. Many departments initially lacked the infrastructure to do this, and therefore relied on cooperation with other actors like school superintendents, sheriffs, and community leaders. Some counties created toolkits to improve their community’s understanding of personal protective equipment (PPE) or even produced local TV shows. Still others scheduled conference calls with local hospitals, faith leaders, and nursing homes. Given that many of these communication efforts were improvised, public health officers stressed the importance of formalizing coordination between state and nonstate actors so as to improve emergency preparedness in the future.
 

In addition to coordination within local governments, effective policy-making and communication required coordination across governments. One such institution was the Association of Bay Area Health Officers (ABAHO), founded in the 1980s during the HIV/AIDS epidemic. ABAHO members had also coordinated policy responses to the H1N1 outbreak. These cross-county partnerships enabled early, rapid, and unified responses to the COVID-19 pandemic. By contrast, the authors find that regions without such networks faced greater challenges in developing and implementing public policy.

A final aspect of informal capacity is the social embeddedness of health officials in their communities. This includes partnerships with leaders of businesses and faith groups, teachers, and restaurant owners. Not only did these partnerships increase the scope of outreach, but they also often established relationships that had not existed beforehand. Gaining a foothold in local communities thus increased the likelihood that community members would support policies and enabled local governments to access hard-to-reach populations.
 

Kuo and Kelly’s analysis of informal capacity should give us pause when considering existing indices of public health preparedness; some of these have ranked the United States quite high despite its often ineffective responses to the COVID-19 pandemic. That this mismatch occurs is arguably a function of observers prioritizing formal capacities. For federal, decentralized countries like the US, informal capacities and relationships are essential not only for delivering services but for generating legitimacy and trust among those receiving services.

*Research-in-Brief prepared by Adam Fefer.

The Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to invite applications for a suite of fellowships in contemporary Asia studies to begin in fall quarter 2026.

The Center offers postdoctoral fellowships that promote multidisciplinary research on Asia health policy, contemporary Japan, and contemporary Asia broadly defined, as well as postdoctoral fellowships and visiting scholar positions with the Stanford Next Asia Policy Lab and a visiting fellow position on contemporary Taiwan. Learn more about each opportunity and its specific application requirements:

2026-27 Asia Health Policy Program Postdoctoral Fellowship

Hosted by the Asia Health Policy Program at APARC, the fellowship is awarded to one recent PhD recipient undertaking original research on contemporary health or healthcare policy of high relevance to countries in the Asia-Pacific region, especially developing countries. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.

2026-27 Japan Program Postdoctoral Fellowship

Hosted by the Japan Program at APARC, the fellowship supports research on contemporary Japan in a broad range of disciplines, including political science, economics, sociology, law, policy studies, and international relations. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.  

2026-27 Shorenstein Postdoctoral Fellowship on Contemporary Asia

APARC offers two postdoctoral fellowship positions to junior scholars for research and writing on contemporary Asia. The primary research areas focus on political, economic, or social change in the Asia-Pacific region (including Northeast, Southeast, and South Asia), or international relations and international political economy in the region. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025. 
 

2026-27 Taiwan Program Visiting Fellowship

Hosted by the Taiwan Program at APARC, the fellowship is awarded to one mid-career to senior-level expert with extensive experience studying contemporary Taiwan. The fellowship research focus is on issues related to how Taiwan can meet the challenges and opportunities of economic, social, technological, environmental, and institutional adaptation in the coming decades, using a variety of disciplines, including the social sciences, public policy, and business. The application deadline is March 1, 2026.