UND Master of Public Health students get a different point of view on health systems through Norway exchange.
Standing at the tip of Trolltunga—“Troll’s tongue”—nearly a mile above Lake Ringedalsvatnet, Abby Bachman resists the urge to pinch herself.
“The edge of the precipice was incredible,” Bachman said. “I have never seen anything like it before. We were above the clouds, which was an amazing experience. My parents saw the picture and were blown away, but at the same time they weren’t surprised. I’ve always sought out adventure.”
A UND Master of Public Health Program student who spent her fall 2017 semester at the University of Bergen in Norway, Bachman not only hiked some of the most scenic and untrammeled terrain in the world; she had the good fortune of also learning about the American health system by comparing it with health systems abroad—sometimes by experiencing them first-hand.
“I ended up breaking a finger during one of my volleyball practices,” said the second-year graduate student studying population health analytics at UND.
Although she got the finger splinted, Bachman lamented the amount of time she had to wait for an X-Ray in the Norwegian emergency room and the quality of care she received. When the finger continued to swell, she ended up visiting an emergency room in Germany on a weekend excursion for a follow-up X-Ray that she could take back to the States (which Norway wouldn’t allow her to do).
“The service was much quicker in Germany,” she noted.
Calling Norway “one of the most beautiful places I’ve been to,” Bachman’s MPH Program colleague and fellow hiker Natalie Scherr agreed: despite their flaws, health systems like those in Norway and Germany—which achieved universal coverage for their citizens in different ways in the last century—have these Americans thinking differently about their homelands’ systems.
“I’ve definitely noticed and been told about the perks of the Norwegian health system,” said Scherr, who spent the fall 2018 semester in Norway. “The fact that having health insurance is just a given here is pretty cool. I think the system does have some downfalls but, overall, it has me wondering why America doesn’t do the same.”
Different systems, different outcomes
After all, even slight differences between health systems can affect populations in major ways. Compared to the United States, Norway boasts lower costs and often better outcomes, including higher life expectancy, lower infant mortality, and less chronic disease overall.
This is why the World Health Organization, in its controversial World Health Report 2000, “Health Systems: Improving Performance,” listed Norway’s health system as eleventh best in the world in terms of outcomes, access, fairness, and cost efficiency. The United States infamously came in at 37 overall—above places like Slovenia and Cuba, but below most every other industrialized democracy in the world.
But such reports should be interpreted with caution, advised Arielle Seyla, PhD, assistant professor in UND’s Department of Population Health and coordinator of the MPH Program’s Norway exchange.
“Yes, Norway’s healthcare system shows success on objective outcomes, but there are also important pre-existing differences in things like population and lifestyle behaviors between countries that confound the relationship between systems and outcomes,” she said. “I can almost guarantee that most estimates of the healthcare systems’ impact are statistically overestimated.”
Despite such differences, or maybe because of them, faculty in the Master of Public Health Program at the UND School of Medicine & Health Sciences thought Norway would make for a great point of comparison for American students wanting to study public health systems and global health outcomes abroad.
“Bergen has an internationally-recognized graduate program in system dynamics modeling, and already partners with UND’s College of Engineering & Mines,” continued Selya, noting how system dynamics helps students and scholars understand health policy in new ways. “There are only a couple dozen public health researchers in the U.S. who are proficient in system dynamics, meaning MPH students of ours who study in Bergen will be highly marketable when they graduate.”
System dynamics is an analytical approach to understanding the complex behavior of often nonlinear systems over time. In the context of public health, system dynamics might involve the development of computer simulation models that portray processes of accumulation and feedback in an effort to develop better prevention or treatment protocols for infectious diseases such as tuberculosis or public health campaigns for smoking cessation.
According to Selya, the grant-funded program, which has sent three UND students to Bergen to date to study system dynamics, began in January 2017 and runs through December 2020. One University of Bergen student has come to North Dakota to study.
“The hope is that MPH students training in Bergen will return to UND and use system dynamics in their MPH activities,” Selya said. “This is the first and only formal graduate-level international student exchange program at UND.”
Although Bachman and Scherr spoke highly of their system dynamics training, equally important to their intellectual and personal growth has been the experience of living abroad.
“I have never studied aboard before so this experience has definitely made me grow as an individual,” Scherr added. “I’ve learned a lot about myself and the subtle differences between cultures.”
Having also spent the fall 2018 semester in Bergen, Ruby Olerud agreed, explaining how simply being forced to try to make her way in a foreign country has helped her become a more patient and sophisticated problem solver.
“It has been an interesting living and learning environment, being surrounded primarily with students from countries other than Norway and the U.S.,” said Olerud, who is also focusing on population health analytics at UND. “It’s great to have had a chance to live somewhere besides the U.S. America tends to live in its own little secluded bubble, but in Europe travel among the countries is much more common. Living in a place in which the native language is not English has definitely been an eye-opener and I think has humbled me.”
Such feelings go in both directions, it seems.
“The University of Bergen student who came here this past spring worked with Ian Watson, a representative from Altru Health System who is also affiliated with our MPH Program,” Selya said. “She developed a model to help the day-to-day workflow and operations in one particular department, and they found her model very helpful. She has since successfully defended her master’s thesis and presented her work at the International System Dynamics conference. So this exchange has been mutually beneficial to both sides.”
Norway photos courtesy Abby Bachman and Ruby Olerud