On education and pedagogic development at NHV

Meeting and inspiration

The Nordic School of Public Health (NHV) was located in Gothenburg, which lies more or less in the geographic middle of Scandinavia. Scandinavia is strictly speaking, the peninsulas and islands comprising Norway, Sweden, Finland and Denmark and this area, with the inclusion of Iceland, comprises the Nordic family. Finland was for many centuries connected to Sweden and Iceland had tight bonds with Denmark. These long-lasting connections also included common and closely related languages and exchanges of culture.

During its 60 year existence, NHV served within the Nordic region as a Nordic inspiration for health workers and a platform for inquisitive discussions of the development of public health in the Nordic countries. NHV had its campus on the banks of the Göta River, where battles between Denmark and Sweden were once fought during the great Nordic wars in the 18th century. An old Scandinavian battleground thus served later as a peaceful podium for diverse health workers to meet and join courses at diploma, masters or doctoral level. The school has served as a Nordic anchor for meetings, education and exchanging ideas on cross-subject themes within public health.

Initially, courses lasted for 2 months, one was done during the spring semester and another during autumn. Most students stayed at the school in single room dormitories, which were of a high standard and located within the campus. This allowed for long evening discussions and also for communal leisure activities. The school even provided a couple of small sailing boats as well as bikes for all students and teachers at the school. Evening sessions were organised in academic fields as well as for dancing and talk. Life on this campus provided the students with academic and interpersonal skills

The NHV was effectively the place that gave birth to education in health promotion and other issues of health and health care systems in the Nordic countries. When founded 60 years ago, NHV was the only educational institution teaching public health issues at a university level within the Nordic region.

In every Nordic country today, students are able to take courses and even programmes in public health at one or more universities. Admittedly, over the years the public health courses at NHV tended to be cut into shorter pieces, involve web-based/distance learning and the on-campus-housing was reduced and so some of the initial merits of the school diminished. Nevertheless, with the closure of NHV there will not be a comparable educational facility allowing adult academic studies in a manner compatible with an ongoing working life similar to that provided by NHV.

There are multi-disciplinary areas of public health that are not handled properly by the ordinary universities, and where NHV provided a special platform. One such area developed in the final years of NHV was a programme to professionalise the work with antibiotic resistance and the handling of infections and epidemics in society. These issues were addressed by a specially created diploma programme in infection control [1] and close cooperation between the Nordic countries. The programme was successful and to date no Nordic university has adopted this educational programme.

The pedagogic basic

All courses at NVH had to be arranged to allow students to go in depth within a short period of time. Planning, preparation and follow-up therefore have been of great importance. Courses were generally arranged with an interval of weeks or months and between sessions the students had to read the literature, solve a task, make an investigation of an issue related to work at home or make some observations on a matter of special interest. This work could be done at home or at work or in a collaborating institution and was then brought back to the lectures to be discussed, evaluated and analysed. With all students coming from active work there was never a shortage of subjects for assessment. The pedagogic platform became a mix of lectures, group work and student-led investigations. A close connection to practice has always been a natural starting point for reflection and analyses. The provision of a comparative cross country perspective was a feature where NHV provided a unique platform.

Several courses were developed in collaboration between two or more members of staff, where the inter-disciplinary character and different countries of residence provided particular challenges that were well met. Many scholars from the Nordic countries as well as further afield were invited as guest lecturers. Of particular significance are the guests from developing countries brought to the school thanks to its involvement as a WHO collaborating centre. My own career at NHV began in 2004 with an invitation to guest-lecture in pedagogy in health promotion.

Most academic staff were recruited from the Nordic countries and there was a broad spectrum of scholars ranging from physicians, dentists and nurses to economists, anthropologists, sociologists and psychologists.

The examinations at both Master and Doctor of Public Health levels always involved students as co-examiners, who had the opportunity to perform the first part of the questioning. The final questioning round and assessment were, of course, done by the teacher examiner. This close cooperation between students and staff added skills to both sides and is in line with Scandinavian values in education.

The student population

There was more than one door for acceptance as a participant in courses at NHV. The ordinary way was with a bachelor’s degree. For the master’s programme the criteria for joining the school were years of professional experience related to public health, health care, social services and other related areas. The aim was for the individual student to achieve both personal development to improve their capacity to fulfil a role in the health system and a higher formal qualification in their professional field. The overall perspective included health promotion in the widest sense, the necessary conditions for successful health care, health promotion and health equality.

Coming from a practising professional life with personal interest in a wide range of public health aspects imparted a strong driving force among students at NHV and this had an impact on the pedagogic outcomes. As an academic member of staff, it has over time been my privilege to teach, challenge, counsel and reflect together with this group of knowledge-hungry students.

Scandinavian pedagogy

Seen from abroad the Scandinavian countries are quite similar. As a Dane and member of the academic staff for 7 years, I often had the privilege to cross the bridge between Denmark and Sweden. Each time it was as if going on an anthropological walk of similarities and differences. We are, of course, very similar on either side of Øresund. We speak more or less the same tongue; we have to a large extent the same welfare systems and the discourses and social values are very similar in all the Nordic countries.

Notwithstanding the similarities, several different values and viewpoints emerge when we consider almost all-micro level issues. For instance, in the field of didactics and pedagogy we can see some of the differences. The Danish tradition is influenced by a continental didactic tradition in which bildung plays a key role and where subjects and courses have to be brought into a pattern of coherence and close relationship. This tradition is closely related to educating to profession. The Swedish tradition is based more on an Anglo-Saxon didactic tradition, in which the road to skills, knowledge and professionalism is more directly related to subjects and examination on skills. Didactic traditions in Norway and Iceland are closer to the Danish, whereas the Finnish tradition is more like the Swedish.

The academic staff at NHV always have been a mix of Nordic scholars; however, with the location of the school in Sweden, a majority of the staff have been Swedish with variable numbers of teachers from Finland, Denmark, Norway and Iceland.

During the last decade some discursive debates emerged along the value lines of the two didactic schools, the central European tradition emphasising education as such and the Anglo-Saxon tradition being more goal-oriented. When teachers from the different traditions created joint courses, the differences became evident in the processes of discussion, design and management. To be brief, the difference can be expressed as follows: in the continental tradition the main weight was on how to learn to reflect and use a theory, whereas from the Anglo-Saxon perspective, the main thrust is on learning knowledge and skills. Most of the resulting discursive exchanges were fruitful for both the academic staff and students.

NHV as a site for creation and construction of a public health identity through storytelling

Even if the reality and practice dates back to the birth of humanity, the academic subjects of health promotion and public health are young disciplines. Some identify the birth with the WHO Ottawa Charter (1986) but, in some respect, the interest was born in 1953 with the decision of the Nordic Council to found NHV. At the start, the main interest was to improve the administrative and managerial skills in the Nordic health systems. Epidemiology, statistics and environmental health were soon added to the curriculum. In 1986, courses in public health, health promotion and education were included.

Storytelling is a cornerstone of identity construction [2–5]. The construction of stories and their telling give birth to learning, to the opening up of new possibilities, to the formulation of ethics, to the definition of membership of professional communities and to the creation of proper institutions as the requirements of professional performance become clear.

In the history of NHV, a large part of the discussion of scientific identity took place on campus, in courses and among the academic staff. Especially in the beginning, NHV was the fundamental hub for this construction of scientific identity. Looking back at the courses given at NHV, we see the pre-eminence of these highlighted issues. We can also see that this identity construction had a very important influence on the discussion inside and outside public health as a science. Some of the agendas are closely related to current major challenges in public health, such as obesity, smoking and alcohol consumption. In the recent and increasingly important field of infection control and multi-drug resistant microorganisms, the importance of identity construction as professional.Main-tenance through storytelling is accomplished when careful and prominent speaking professionals are able to demonstrate high standards and adequate guidelines and regulations during their daily work in hospitals and caring institutions.

With the rise of the late modern agenda during the last two to three decades [6] the discussion has more and more been directed at the challenge that public health shares with pedagogy, namely that it is easiest to reach privileged parts of society and hardest to influence those underprivileged parts of society. For scientists and practitioners of health promotion it is easy to assist those in the population having much the same educational level to help themselves. It is very hard to assist those with much poorer education and living circumstances in the same way, who to a very large extent do not live in and understand the same world. Bridging the gap between the educated professional and the most vulnerable and resource-deprived parts of the population is a matter of great importance in this field of public health. In this regard, public health has obviously become a science in very close relationship with political values and issues.