Discussion Questions: Roger Thurow's The First 1,000 Days

Questions for Introduction and Part One, "Pregnancy," chapters 1 & 2:

1. What is resonating with you after reading the first 48 pages? What images, facts and stories are most sticking with you? Explain.
2. What did you find to be the most common factors leading to malnutrition in Uganda and India? What role did culture play in each country?
3. Which community program seems effective? Why?
4. On page 6, Thurow writes, “Every child deserves a chance to reach his or her full potential.” Do you agree? Does our society agree? Provide evidence to support your claim.
5. On page 7, Thurow writes, “…potential can be undermined by the perils of a mosquito bite or a sip of dirty water (malaria and diarrhea, along with malnutrition, being the greatest threats to child development); by the lack of something taken for granted in the wealthy world, like a toilet or electricity; by discrimination and ignorance.”  Let’s discuss.
6. On page 17, Thurow writes about Ireland’s commitment to reducing global hunger. What is it about Ireland’s history that makes this especially important?
7. On page 25, Thurow writes that in Uganda, “[i]mmediate causes of infant mortality were hypothermia (37%), premature birth and pneumonia and infections, with malnutrition being an underlying cause of 40% of all under-five deaths.” Why?
8. On page 29, a woman boasts that her youngest child “had reached the age of one without any illness.” This is a triumph in much of the developing world.  Let’s discuss.
9. On page 36, a mother describes her exhausting job picking peppermint. How does our consumption of goods affect working conditions in the developing world?
10. On page 37, Thurow writes that more than 65% of households in Uttar Pradesh have no toilet facilities.  This is “normal” for millions of people.  How would your life be different without toilet facilities?  What are the short-term and long-term effects of having a home without a toilet?
11. On page 39, Thurow writes, “Vishwajeet insisted that what needed to change were cultural attitudes and behaviors toward maternal and child health, particularly in the first 1,000 days.” What does he mean by this?
12. On page 47, Thurow writes, “(the) gender gap was particularly pronounced in some of the wealthier, more prosperous areas of the country, perhaps because there was greater access to ultrasounds and people who performed abortions. It seemed to matter little that the government had made it illegal in India for parents to even ask a doctor about the sex of a child after an ultrasound.” Why? What are the long term effects?

Questions for Part One, "Pregnancy," chapters 3 & 4:

1. What is resonating with you after reading these chapters? What images, facts and stories are most sticking with you? Explain.
2. On page 50, Thurow writes, “The moms here were also uniformly short, almost all of them less than five feet; as in India, it was difficult for local people to perceive a stunting problem when stunting was the norm, and to see malnutrition, not just ancestry, was a factor in children’s stature.” In your opinion, what are some “norms” in your family, community, country that shouldn’t be norms?
3. On page 52, Thurow points out that Guatemala has the worst malnutrition rate in the Americas with half of its under-five population malnourished. Why?
4. Also, on page 52, Thurow mentions that corn has been key to Guatemalans for thousands of years and that the ancient Maya believed they were descended from cornstalks. Shall we read their origin story? What other ancient societies had deities representing food or beverages that were important to their society? Why?
5. “The plastic snack-food wrappers littered the countryside. They were at Maria Pillar’s feet, modern-day junk-food tumbleweeds rolling through the rows of peas, broccoli, and carrots.” How do you visualize this?  How do you connect with this?
6. On page 54, Thurow points out that the new Guatemalan president sent members of his government to spend a night with a poor family. Why did President Otto Perez Molina do this? What were their findings? Could this project work in our society?
7. “The (Guatemalan) president declared that every investment in better nutrition was also an investment in better education and improved security for the country.” What does he mean by this? To what extent do you agree?
8. Describe Brent Savoie’s journey. How do you connect with him?
9. Describe Jessica’s experience being pregnant as a teenager in Chicago. How can you connect with her?
10. Jessica’s nutrition coach gives her a homework assignment to read labels. Why does she do this? How often do you read labels? Save labels of foods you consume over the next couple days. Bring them to class and let’s discuss.
11. Explain the role WIC plays in Jessica’s life. How would Jessica be affected if WIC did not exist?
12. Describe Quintana’s experience being pregnant in Chicago. How can you connect with her?
13. What is Scaling Up Nutrition? Let’s explore their website and discuss.
14. U.S. president Harry Truman signed the National School Lunch Act in 1946. Research this act and its effects.
15. Read Carl Sandburg’s poem, “Chicago.” How does Sandburg’s perception of 1914 Chicago compare with Chicago today? Create a poem that reflects the city today.
16. Research WIC and SNAP. Compare and contrast both programs.
17. What role does the Greater Chicago Food Depository play in combatting hunger?

Questions for Part Two, "Birth":

1. What is resonating with you after reading these chapters? What images, facts and stories are most sticking with you? Explain.
2. Thurow says, “The nutrients are the great equalizer. They are humanity’s common denominator.” Explain.
3. Chapter 5 mentions the Copenhagen Consensus. Research this and report back with an analysis and reflection.
4. Explain the nutritional importance of vitamin A, iron, iodine, and zinc during pregnancy.
5. What is developmental plasticity and why is it important to understand?
6. On page 79, Thurow writes, “Good nutrition…is the cornerstone of this cognitive foundation.” What evidence does he use to back up his claim?
7. What did you think when you read, “the moms would be last in line to eat, behind their husbands and children, as is the social custom” (page 83)?
8. The World Food Program is mentioned in this and other chapters. Research their funding, goals, and effects on society.
9. Page 85 references the caste system in India.  What does this mean? Research the caste system, if necessary. How does caste affect health?
10. “India accounted for 60% of the incidence of open defecation in the world” (page 86). What are the negative effects of this practice? What are the government and NGOs doing to combat this issue?
11. Thurow points out that 90% of Indian girls are anemic. What are the causes of this stat? What are effects of this stat?
12. “Malaria accounted for nearly 1/3 of all deaths of children under five in Uganda.” How did you connect with this?
13. What does Thurow mean when he says, “Poverty trumped knowledge in the wealthiest country in the world, too”?
14. “Uganda had its hunger season; Chicago had its season of violence…In 2012 Chicago endured more than 500 murders, 443 with a firearm, and 65 of those victims were children.” How do you connect with this? What are the 2016 and projected 2017 stats? How does violence affect health?
15. Chapter six articulates that Jessica hoped she was carrying a girl. How does her hope compare with those of mothers globally? Explain.
16. “Domestic and international organizations advocating access to safe abortions estimated that a woman died every two hours from an unsafe abortion in India.” What did you think about when you read this?
17. Jessica’s teacher wouldn’t allow her to bring a water bottle to class, so she battled dehydration. Imagine being pregnant while attending high school. What other obstacles would you face?
18. “Few moms in India and Uganda complied with the WHO recommendation of going to at least four prenatal care visits with trained health workers.” (p.101) Why? Explain the causes and effects.
19. “Even in the US, not all pregnant women met the WHO standards.” (p.101) Why? Explain.
20. In more than 66,000 health care facilities, 38% lacked access to improved water source and 35% didn’t have soap.” Explain your reaction to these statistics. What are the effects of these stats? How can they be improved?
21. How did you react to the signs posted around Shivgarh and Sahara Hospitals (p. 107-110)? Explain.

Questions for Part Three, "The First Year":

1. Why did Thurow choose the title “The Child Is No Longer Here” for chapter 9? If you were his editor, what other titles might you suggest? Why?
2. What factors led to Sarita’s death?
3. Why did Thurow choose the title “This Child Is Brilliant” for chapter 10? If you were his editor, what other titles might you suggest? Why?
4. Describe the water purification process that Brenda and her community in rural northern Uganda administer to filter the water (page 159). Do some research on our purification process. How does our water get “cleaned”? How does it get to our faucets?
5. How could you connect with the guilt that Brenda felt? Explain.
6. Over 500 million people in India engage in open defecation. Identify and explain the reasons why so many people prefer open defecation in India (pages 164-167).
7. Read, analyze, and discuss a related article from National Geographic, “Nearly a Billion People Still Defecate Outdoors. Here’s Why.”
8. As a class, let's analyze the photos from “Around the World in 12 Toilet Pictures.”
9. Why is ending open defecation such an important goal for the United Nations?
10. Why is biofortification such a game-changer in the global fight against hunger? How were Brenda, Esther, and their families affected by biofortification?
11. What role does Howdy’s perseverance play in the development of HarvestPlus?
12. On page 183, Harriet proudly says that she has become known as the “orange sweet-potato lady” and the “high iron bean lady.” Providing these nutrients to her community have become part of her identity. What is one aspect of you identity that makes you proud?
13. Let’s watch the fantastic YouTube music video of the “Better Nutrition from the High Iron Beans” that is mentioned on page 184. Evaluate the extent to which American musicians promote health and/or well-being.
14. What roles do GAIN, WFP and DSM play in the fight against hunger?
15. On page 192, Thurow points out that most children, regardless of geography or economics, don’t receive sufficient nutrient diversity. Consider everything you have consumed in the last 48 hours. Are you getting enough nutrients? How do you know? Why is nutrient diversity important? How can we improve our own nutrient diversity? How can we improve our the nutrient diversity of our family and community?

Questions for Part Four, "The Second Year":

1. What is resonating with you after reading these chapters? What images, facts and stories are most sticking with you? Explain.
2. On page 208, Thurow writes about how decreased rain weakened the corn crop and how it’s the worst drought Dianet’s family had every experienced.  What role does climate change play in Dianet’s hunger? To what extent does climate change play in global hunger today?
3. On page 209, Dianet explains that her husband was trying to immigrate to the US for a better job. Do some research. How many people immigrate to the US every year? What percent are seeking better jobs? How many people emigrate from their home country every year? What other factors lead to emigration? Why?
4. Some would say that Dianet’s family is seeking the “American Dream.” Does the “American Dream” still exist?  If yes, what does it look like?
5. Thurow mentions that 2014 saw a great wave of migrants from Central America. Why 2014? Do some research and explain.
6. Why did coyotes spread the rumor that President Obama had changed the law to allow children from Central America to come the US?
7. Do some research and report back on the Plan for the Alliance for Prosperity in the Northern Triangle of Central America. 
8. How did Jessica’s life change when she returned to school? How did it remain the same? Explain.
9. Jessica’s first period class is One Goal. Do some research on One Goal. What is their mission? How does the organization work? What are the effects of the program?
10. Rajender sums up a story by saying, “You can never satisfy the crowd…if you listen to them, you’ll be ruined.” How do you connect with that quote and story?
11. How did Esther’s life change when Rodgers learned to walk (page 220)?
12. How does the drought affect Harriet’s food supply? What role does climate change play in Harriet and her family’s hunger? 
13. What are the long term effects of the health post closings articulated on page 225?
14. Dr. Jorge Gramajo explains that the hospital’s budget had been slashed by 80%. Why did this happen? What are the long term effects?
15. Do some research on the history of Guatemala - specifically Guatemala as a Spanish colony, a banana republic, and a place of U.S. business interest. What role does this history play in Guatemala’s current state of poverty?
16. Rajender articulates the need to pay six dowries. Research the history and current state of dowries. Let’s discuss.
17. Let’s do some research on the amazing Thirty Million Words program developed by University of Chicago Dr. Dana Suskind. Why is this program so successful? Thinking back to your own childhood, do you remember being exposed to lots of words? Were you read to as a kid? Explain the effects.
18. What do you think is the most persuasive argument for eliminating childhood malnutrition and stunting: moral, security, or eonomic? (Source: First Thousand Days Reading Group Guide)
19. Is the development of healthy children solely the responsibility of parents and caregivers? What role does the larger society play? What can governments do to assure that their nation’s children get off to the best possible start in life? (Source: First Thousand Days Reading Group Guide)
20. What can we do to help make “the first 1,000 days” a household phrase in our community and world? (Source: First Thousand Days Reading Group Guide)