Unlikely path led economist to a life of global public health
He didn’t know that within a decade he would be back to stay, building a career as an expert on nutrition trends around the world.
“It’s all been serendipity,” he said. “I grew up in small-town America, in Superior, Wisconsin, and had written only one essay in my life before I got to college.”
He attended the University of Wisconsin in Madison on a scholarship and was shocked by the level of education his classmates had. His parents hadn’t gone to college, and everyone around him seemed better prepared.
“It was a whole new world,” he said. “I had no sense of what I would be, and as you go along, you try to think of how to build a career. I thought I’d go on to be a teacher or researcher of some sort, but I had no idea in what.”
In 1965 his scholarship allowed him to travel to India, though he’d never been farther than Chicago. For a year he lived in Old Delhi, splitting time between a student hostel and a squatter space packed with people.
A student of economics, he was profoundly affected by the density of the population and developed an interest in the human side.
“I started to think about the health, education and welfare of individuals,” he said. “When I came back to the U.S., I got involved in civil rights work, especially hunger. I had to do a senior honors thesis, and because no one else had touched it in the economics world, I chose nutrition.”
The paper led to summer work for the Office of Economic Opportunity during a time when the nation was beginning to engage in the war on hunger.
“It was a very unusual path for an economist,” Popkin said. “I was the only one looking at nutrition in that way, and that’s what led me to public health.”
Starting a global conversation
Popkin received a master’s degree at the University of Wisconsin, left for several years to become a fulltime political activist, and later received a Ph.D. from Cornell University, which led to work with the Rockefeller Foundation in Southeast Asia.
He was considering a job at Columbia University when he received a letter inviting him to join the faculty of the nutrition department at Carolina, a place he had not been since the ‘60’s.
In 1977, he started working at UNC where his research interests in, and his impact on, the health of developing countries accelerated. He designed a study evaluating the nutritional and breastfeeding habits of pregnant women in the Philippines and began exploring a similar study in China.
“The Philippines were small, and there were so many economic and social factors outside the scope of our study that were affecting nutrition,” he said. “I needed something bigger.”
He worked with the Chinese government to develop the China Health and Nutrition Survey, which continues today, and expanded that work for the Russian government as a member of the G7 Economic Reform Team. He has since helped Brazil, Mexico, the United Kingdom and many other countries monitor and collect data on health and nutrition behaviors.
Back in the U.S., he continued to focus on hunger, school lunch, food stamps and nutrition for women, infants and children, and was asked to head a nutrition panel that was part of a Presidential Commission on Child Health for President Jimmy Carter.
“I saw that all our food programs in the schools were based around hunger, but obesity was emerging in the schools and growing in adults,” Popkin said. “There was a mismatch.”
Nutrition transition theory
What had been happening slowly over time with obesity in the U.S. and Europe would actually begin happening at a much faster rate in low-income countries.
In closely observing the health patterns of countries all over the world, Popkin noticed a disturbing trend: “After pure poverty, the next issue for these people was obesity.”
He developed a theory called nutrition transition to explain what quickly happens across the globe to shift the way people eat, drink and move in conjunction with various technological and societal changes.
“You’d be poor one day, but then you could get a cheap TV, and then soft drinks and vegetable oils became cheap, then food systems drastically shifted as did food marketing,” Popkin said. “People who had daily physical activity that was so intense and diets that were so basic suddenly had sweet and fatty stuff along with work-saving technology thrown at them at cheap prices.”
The transition in a low-income country can be rapid, Popkin said, and there isn’t enough money to treat the diseases obesity can lead to.
“The most complex health issue we face is getting the correct diet and activity pattern. These countries can’t cope. If they don’t prevent it, they’re going to have a catastrophe,” he said.
Prevention as activism
“The 1960s activist part of me is coming back,” Popkin said.
Public service and policy work to help countries face nutrition-based health challenges has become a bigger part of his mission.
As with rules on seatbelts, bicycle helmets, fluoridated water or indoor smoking bans, government regulation on foods and beverages is met with great resistance. Food and beverage industries are very powerful, Popkin said, and they fight every step of the way to keep customers buying products that aren’t helping them get healthy.
Mayor Michael Bloomberg’s initiative to ban the sale of large sugary drinks in New York City restaurants and other venues is a prime example.
“We’re a nation of individualists who don’t always connect with the welfare side of things, and so we fight it,” he said. “But what this initiative has done that’s good is create a national dialogue in a huge way.”
Though much of his career has been spent on foreign soil, Popkin said he would never have been able to make this kind of impact without Carolina as home base.
“The Gillings School of Global Public Health and the Carolina Population Center have allowed me to continue this work for so long, and it’s why I’ve been able to collaborate the way I do,” he said. “It’s been a marvelous way to have a career.”