This weekend we had both Saturday and Sunday free to reflect on our first week and explore outside of Oslo if we wanted. I spent the weekend two hours outside of Oslo in the countryside of western Sweden with two other students. We drove across an international border that didn’t even require us to stop in either direction. We stayed in an idyllic tiny house surrounded by birch trees near a quiet cow pasture. During the days we walked through nearby coastal towns and fishing villages. It was the ideal setting to reflect on a busy week and compare and contrast perceptions of health in Norway versus the United States, as we were a bit removed from each location. We also made a mandatory stop at IKEA in Sweden!
The most valuable aspect of the experience so far has been getting a glimpse into the daily lives of Norwegian nurses and patients. During such a short time it can be difficult to gain a deeper cultural understanding, but thanks to our Norwegian students and faculty we are able to dive in. My clinical days were spent conducting home health visits and entailed everything from delivering medicine, taking vitals, making breakfast, doing laundry, wound care, to one visit for twenty minutes of conversation. The pace of care is different and there is a lot more walking involved here. I have probably walked more since being here than all year on campus, yet still get a lot done! Patients are encouraged to walk as much as they are able to and even at the nursing home we visited on Friday, patients in their nineties walked with us over a mile to a local park and back. Some of the patients walked slower or needed assistance, they were met with patience and encouragement as we traversed the park. The value placed on the outdoors is evident through the numerous green spaces throughout the city. Even in an urban environment it is easy to find solace in nature no matter the neighborhood.
This emphasis on natural environment and community supports Public Health Core Competency 1B1 “Describes factors affecting the health of a community (eg. equity, income, education, environment)”. Whereas there are gaps between the West and East sides of Oslo in terms of equity, education, and income, green spaces still persist and are well kept so that everyone can access them for health benefits and leisure. Norwegians in general seem more encouraged to utilize break time whether it be a lunch break or vacation days, and often spend that time outdoors. Every person I have spoken with (throughout the lifespan) has emphasized the importance of green spaces, time in nature, and exhibited a keen awareness of climate change. Norway will see increasing numbers of climate refugees from vulnerable areas and need to be able to meet the health needs of those growing communities. Another consequence of climate change in Norway relates to the fishing industry, which is the second largest industry in Norway. The fishing industry will likely see a rise in fish populations due to higher ocean temperatures pushing fish north. While this may initially benefit the fishing industry, they also need to be aware of the potential loss of habitat, ocean acidification, and marine dead zones that could drive fish out of Norwegian waters. These are just a couple of the multitude of direct and indirect effects on natural and human systems that climate change poses.
Norway, along with many other countries, recognizes the devastating consequences climate change presents to both humans and the natural world. Norway was among the countries (excluding the U.S.) that adopted the Paris Agreement at the COP21 in Paris. Norway is working towards Sustainable Development Goal (SDG) 13: Take urgent action to combat climate change and its impacts. Norway committed to reducing greenhouse gas emissions by 40% by 2030, promoting the phasing out of fossil fuel subsidies, supporting sustainable urban development, reducing deforestation, supporting renewable energy, and contributing to the sustainable management of marine resources (Norwegian Ministry of Foreign Affairs).
With vast forests that serve as carbon sinks and a growing economy, Norway is in a good position to be a climate leader so that its inhabitants can continue to enjoy the physical and mental health benefits of green spaces.
The clinical experience in Norway has given me new approaches to use in preventive health care that I can apply in my practice as a future family nurse practitioner. I can remember to draw from my home visit experiences and that the health of the natural environment directly impacts human health from access to clean air and water to even being able to exercise safely outdoors. Spending time in nature has been linked to improved physical and mental health and wellbeing. I want to guide people in incorporating more daily walks and time spent in nature, even in urban settings. Overall, the clinical experience has encouraged me to maintain a holistic perspective, to advocate for healthier communities and environment back home, and to contribute to policy and social changes so that eventually everyone will be able to access green spaces and have the time to enjoy them.
The Council on Linkages Between Academia and Public Health Practice. (2014, June 26). Core competencies for public health professionals. Retrieved from: http://www.phf.org/resourcestools/Documents/Core_Co
United Nations. (N.d.). Sustainable Development Goals. Goal 13: Climate Action.
Retrieved from: https://www.un.org/sustainabledevelopment/cities/
Norwegian Ministry of Foreign Affairs. Climate change and the environment. Retrieved from: https://www.norway.no/en/missions/eu/values-priorities/climate-env/