Julian Xie MPP’20: Sanford Fed His Passion For Equity in Food Systems and Health

Image

Sanford provides fertile soil for many students to develop ideas that will blossom into careers. This is quite literal for Julian Xie, a Sanford graduate who planted a lasting legacy of health advocacy at Duke and continues to foster healthy communities today.

During his years on campus, Julian's agricultural (and entrepreneurial) spirit was evident in his co-founding of Root Causes, a student organization at Duke University School of Medicine dedicated to addressing the social drivers of health.

Under his leadership, Root Causes became a vibrant platform engaging medical students in advocacy, education, and community service. Julian created the Fresh Produce Program, which delivers local produce, nonperishable foods, and health education resources to food-insecure patients, illustrating his commitment to marginalized communities in Durham.

Today, Julian is a dynamic figure at the intersection of healthcare innovation, public policy, and food systems advocacy. He completed a Duke trifecta, starting with economics and music for his Duke undergraduate degree in 2015, followed by a Master of Public Policy (MPP) in 2020, and finished with a medical degree (MD) from Duke in 2021. His academic journey reflects his deep-"seeded" interest in sustainable food systems and health policy.

Currently serving as the Senior Health Innovation and Evaluation Manager at Benefits Data Trust (BDT), Julian spearheads partnerships with healthcare organizations to enhance the well-being of low-income people.

His role involves leveraging data-driven strategies to enhance people’s access to public benefits to improve their food and nutrition security, improve health outcomes, and reduce preventable healthcare costs.

Image

As he continues to leave (in his words) an “inedible” mark at Duke and beyond, he exemplifies the transformative potential of interdisciplinary collaboration and purpose-driven leadership in shaping a healthier, more just society.

We asked Julian for his perspective on his time at Sanford and how it shaped his career.

What impact has Sanford had on your professional and/or personal journey?

Image

Sanford has had a huge impact on crafting my professional identity and becoming someone who can speak the languages of healthcare delivery, health policy, and food systems. A few key things:

Becoming more confident and self-directed as a leader and consultant: the 804 course and Masters Project (MP) demystified the consulting field. I learned how to establish a client-organization relationship, identify a policy problem, conduct research, and communicate the results in a digestible way.

The Global Alliance for Improved Nutrition, my MP client, brought me back to do more with them even after I graduated from Sanford. This led to an academic publication and virtual presentations like those with the Hidden Hunger Congress in Stuttgart.

Sanford also helped me develop both quantitative and qualitative research skills. Using my strong econometrics training, I led a quantitative analysis of a Produce Prescription Program I helped implement as a medical student called EatWell (formerly Bull City Bucks). I got my hands dirty cleaning data, doing regression analyses, and lead-authoring a paper published in the journal Public Health Nutrition. Sanford’s data training, plus the clinical informatics training I got at Duke Med, has made me highly conversant in working with data teams, a critical part of my BDT job.

I’m grateful for the Margolis scholarship because the Margolis Institute taught me about the policies affecting my patients in the Duke Health system. Understanding North Carolina’s Medicaid transformation has also been an asset in my work to get more North Carolinians onto SNAP (the Supplemental Nutrition Assistance Program).

Similarly, the Margolis Institute is focused on value-based care, the idea that healthcare should pay for and deliver improved outcomes and reduced avoidable costs. The movement towards value-based care puts us at a specific moment when US healthcare organizations are far more willing and incentivized to invest in the social drivers of health, including food security, housing security, and closing disparities in care based on race, ethnicity, and gender. Working at BDT has been cool because we’re at the forefront of these healthcare-social policy partnerships.

The Geneva Program was also essential, linking me to the perfect internship that involved building food-healthcare bridges. The program rounded out my Sanford International Development classes and global health training. I contributed to important collaborations - particularly the Global Action Plan for Healthy Lives and Well Being - between the UN World Food Programme, the WHO, and other global health agencies.

Why does public policy matter in 2024 and beyond? 

Public policy matters because the field gives us the tools to develop an inspirational vision and then act on it. We know the world’s problems, but we still have much work to do to create solutions.

The food system always interested me because everybody interacts with food because we eat - and what we eat has everything to do with how it’s made and gets to us – and therefore, labor rights, gender rights, racial equity, animal welfare, climate change, and global health. I’m working on one slice - “food is medicine.”

At Duke Med, my clinical training got me thinking beyond diabetes medications we could prescribe from the doctor’s office and asking what community and national resources we could develop to make nutritious food more accessible.

Working at BDT has been extremely rewarding because our mission encapsulates how Sanford taught me to think - “helping people today and designing a better system for tomorrow.” BDT exists to close the $80 billion benefits gap, in which significant barriers have caused people not to access social safety net programs they’re eligible for. As Sanford’s Human Centered Design course taught, define the problem and consider all possible solutions - focusing on giving clients/users/patients (i.e., people most impacted by policy change) ownership in designing solutions.

Through BDT’s contact centers, we assist people in applying for public benefits daily. In doing that, we collect quantitative data and client insights to advocate for state and federal governments to streamline their public benefits systems.

Public policy teaches us exactly this - listen to people who have experienced the most historical marginalization and ensure they have a seat at the table in governing and improving the systems that affect their lives.

What is the most interesting highlight so far in your career?

Founding the Root Causes Fresh Produce Program: during clinical rotations, my patients expressed how food assistance resources were insufficient to afford nutritious foods. In response, my Duke Med classmates and I established the Root Causes Fresh Produce Program (FPP) at Duke Health.

We secured grant funding and partnered with Farmer Foodshare, a local food hub, and built relationships with Duke Campus Farm, Interfaith Food Shuttle, and Serenity Community Garden. We formed relationships with social workers, dietitians, and physicians to establish referral pathways and strategic scheduling, such as food distribution at group diabetes classes.

As COVID-19 began, we converted to home delivery, growing from 50 to 340 households served. We fundraised to procure food, masks, and medical equipment and to compensate our delivery driver volunteers. Getting my MPP by spring 2020 prepared me to be a more decisive leader in the craziness of early COVID-19.

At Benefits Data Trust, I lead relationships with 12 healthcare partners – to provide public benefit outreach and application assistance, resulting in BDT submitting 20,000 benefit applications and referrals on behalf of 12,000 households in the last three years.

By enrolling low-income patient populations in public benefits, we’re improving food security, improving health outcomes, and reducing healthcare costs. I’ve also been applying my dual degree training to help healthcare organizations expand their own public benefits access programming and expand cross-sectoral data-sharing to support focused outreach and higher quality social drivers of health programming evaluation.

Playing music alongside Ozaguin, a musician from the Central African Republic, in the Geneva train station, whom the World Food Programme had brought to Geneva for a special interview.

Image

Terry Sanford implored students to 'stand for something.'  What do you stand for?

I stand for justice, equity, and returning power to people who’ve had it taken away from them because of poverty and oppression.

Medical school imprinted on me the importance of open-ended questions. We’re trained to ask patients, “How do you feel?” “What brings you here today?” and “How confident are you about changing how you eat?” That mindset has extended into my journey towards building justice. We need to ask our teammates, the clients we serve, and everyone else - why is this happening, what do we want our world to look like, and how will we get there?