Lessons from the First 1,000 Days
Roger Thurow sheds light on malnutrition, integration and the role we all have in making change
In his latest book, The First 1,000 Days: A Crucial Time for Mothers and Children — And the World, Roger Thurow, senior fellow at the Chicago Council on Global Affairs and former reporter for the Wall Street Journal, wants us to be outraged by the persistence of global hunger and maternal and child malnutrition into the 21st century. But Thurow also wants us to walk away inspired to do something about it. When I spoke with him recently, his message for all of us is that it is high time to make it a scourge of the past.
The first 1,000 days of a child’s life — from conception through two years of age — constitute a critical window of opportunity for physical and cognitive development. If a child emerges from this period without having reached her growth potential (a result of not receiving the right nutrients at the right time, combined with bouts of illness or infection, which impede the absorption of nutrients), she will be considered stunted, a condition that is largely irreversible beyond this developmental stage. This, in turn, will negatively affect her future health outcomes, educational attainment, job prospects, and economic achievement. In the aggregate, this is cause for great concern for the health and wealth of entire nations. While it’s true that rates have fallen over time, it’s widely agreed that this progress has not occurred quickly enough, with 159 million children under the age of 5 still stunted globally.
Much has now been published on the research surrounding these 1,000 days, most often in academic journals and policy papers. The evidence and positions being crafted around it have been vital for better understanding early childhood development and its effect on later life stages, as well as for advancing the agenda with regard to integrated action on nutrition. (The 1,000 Days and Scaling Up Nutrition movements in particular have led the charge.) Harder to find, however, are tools that connect with a broader audience through narratives that are at once enlightening, engaging, and accessible. With his latest work, Thurow helps to bridge this gap.
The First 1,000 Days follows mothers and their families — in Lira, Uganda, Uttar Pradesh, India, the western highlands of Guatemala, as well as on the south side of Chicago — who face a number of diverse challenges. What these deeply personal stories convey is that life for these women, their children, and their families is complex. The well being of children is dependent upon a number of interrelated factors including diet, water and sanitation, hygiene, health care, infrastructure, education, employment, security, and socioeconomic status. These mothers inherently know that among these, there’s not one “silver bullet,” as Thurow puts it, “that’s going to make [a] child develop properly and robustly and be really smart and achieve all these things in life.” Rather, these multiple factors impact a child’s nutritional status and development concurrently, and that foundation is what really sets the stage for the child’s future.
The book also closely follows those working tirelessly to ensure a healthy pregnancy for mothers and a healthy start for our world’s youngest citizens. These local change makers are social workers, nutrition counselors, community health workers, and doulas, to name but a few. It’s Thurow’s hope that readers will not only grow to care about the women, children, and families through their stories, but will also be galvanized by those who are at the front lines providing essential information and care. In many places, they continue to do so even amidst shortfalls in both resources and leadership, despite government commitments enshrined in “glossy brochures” or “flowery speeches.”
For those of us in this field who have struggled to make the scientific or policy discussions relevant to those around us, The First 1,000 Days serves as an invaluable tool to navigate discussions that can easily devolve into technical jargon by illuminating the lived experience of those facing formidable choices and trade-offs daily.
At the heart of this movement is the fundamental importance of integration. Thurow’s take is that “this era of pet causes needs to give way to common cause. The 1,000 days provides a new paradigm of looking at development — that we need to do all these things simultaneously. That’s a great challenge for people on the ground and for development philosophers and academics. Stunting is a new measurement of the importance of this coordination.”
To illustrate: much like the mothers in The First 1,000 Days understand, growing a nutritionally rich sweet potato to support the healthy development of an infant son can all too easily be thwarted by diarrhea resulting from an unsafe water source. Such examples shed light on barriers to change that stubbornly persist despite interventions with the best of intentions. The First 1,000 Days provides significant motivation to work across sectors in order to bring about meaningful, transformative change.
“This is the great argument to make for the development agencies, for the foundations, and donor governments — this precise argument — that everyone understands that you need all of this. We can’t just celebrate the achievement of this goal and scratch our heads; what happened on this one?”
Thurow’s analysis that “success is dependent on the success of everybody else and what they’re doing,” rings true. However, this type of collaboration is still very difficult to achieve. While “reach out to the other [technical] silos — demolish the silos,” is excellent advice, the reality is that the system presently in place does not readily facilitate efforts to do so. Programming often follows funding streams instead of the other way around and the current financing system, typically led by large donors, has historically lagged in flexibility and integration. This point is central to any progress that can be made on this front. For me, this is imperative — to remind myself daily what is at stake and to commit myself daily to actively pursuing this shift.
Whether you work in the field of global nutrition (or global health, more broadly) or have no experience of the sort, The First 1,000 Days has you covered. Maternal and child nutrition is a matter of urgent importance the world over and The First 1,000 Days presents a convincing case for deeply caring about this — whether you’re an expecting mom or dad, grandparent, teacher, public servant, business owner, and the list goes on.
Children are not only precious new humans deserving of love, dignity, and care, they are future farmers, future corporate executives, future poets, future presidents. Their successes, or missed opportunities, are highly dependent on their earliest stages and this is something that frankly affects all of us. As Thurow is quick to note, “a stunted child anywhere is a stunted child everywhere.” Guaranteeing an excellent start to their lives is “not only the right thing to do, it’s the smart thing to do.”
As our conversation came to a close, Thurow left me with the following rallying cry: “This is a really exciting time — for you, for your colleagues — whether it’s health care work or social development, the classical development issues or the social entrepreneurs, business students, finance students. No matter what your expertise, there is something that you can do, and your knowledge and expertise can apply to these issues. That is something that is now more evident and possible than ever before.”
“Go to it, go forward. Outrage and inspire. Accomplish what previous generations have not been able to do.”