Kari Tove Elvbakken

From poor law society to the welfare state: school meals in Norway 1890s-1950s.

This article examines the main trends in the history of publicly organised school meals in Norway, while casting comparative glances at Britain. First, it argues that the status of school meals today is strongly influenced by three intertwined strains of past tradition: poor relief, universal welfare and the ideal of full-time and nutritionally competent housewives. Second, tradition is also visible in the extent to which publicly organised meals are seen as solutions to problems – in the past to hunger or malnourishment, today to obesity and malnourishment – and not simply as a meal. Third, the creation of civil and health conscious citizens has, to varying degrees, been a part of the school meals programme, as the school itself has had, and continues to have, such an agenda.

Evidence-based medicine – an appropriate tool for evidence-based health policy? A case study from Norway

BackgroundEvidence-based policy (EBP), a concept modelled on the principles of evidence-based medicine (EBM), is widely used in different areas of policymaking. Systematic reviews (SRs) with meta-analyses gradually became the methods of choice for synthesizing research evidence about interventions and judgements about quality of evidence and strength of recommendations. Critics have argued that the relation between research evidence and service policies is weak, and that the notion of EBP rests on a misunderstanding of policy processes. Having explored EBM standards and knowledge requirements for health policy decision-making, we present an empirical point of departure for discussing the relationship between EBM and EBP.MethodsIn a case study exploring the Norwegian Knowledge Centre for the Health Services (NOKC), an independent government unit, we first searched for information about the background and development of the NOKC to establish a research context. We then identified, selected and organized official NOKC publications as an empirical sample of typical top-of-the-line knowledge delivery adhering to EBM standards. Finally, we explored conclusions in this type of publication, specifically addressing their potential as policy decision tools.ResultsFrom a total sample of 151 SRs published by the NOKC in the period 2004–2013, a purposive subsample from 2012 (14 publications) advised major caution about their conclusions because of the quality or relevance of the underlying documentation. Although the case study did not include a systematic investigation of uptake and policy consequences, SRs were found to be inappropriate as universal tools for health policy decision-making.ConclusionsThe case study demonstrates that EBM is not necessarily suited to knowledge provision for every kind of policy decision-making. Our analysis raises the question of whether the evidence-based movement, represented here by an independent government organization, undertakes too broad a range of commissions using strategies that seem too confined. Policymaking in healthcare should be based on relevant and transparent knowledge, taking due account of the context of the intervention. However, we do not share the belief that the complex and messy nature of policy processes in general is compatible with the standards of EBM.

The Norwegian welfare state on the threshold of a new century.

A primary function of the welfare state is to protect citizens against social risks. Within the Norwegian (and Scandinavian) ones, this protection has in general been provided in the form of universal social rights to relatively generous benefits. During the last hundred years an increasing number of risks (old age, sickness, unemployment, disabilities etc.) have been recognized as matters of public responsibility. Risks that have not been granted this recognition have been subsumed under residual Social Assistance Acts, i.e. by a means – tested, far less generous social security system. The foundation of welfare policy has been full employment, and when a number of welfare states were stricken by unemployment problems in the 1970s many feared that this basis was crumbling. In 1981 the OECD published a report that should become influential, The Welfare State in Crisis (1). According to the OECD’s analyses of demographic and economic challenges, too generous welfare programmes and too strict regulations of markets had caused oversized, bureaucratic, inefficient, and costly welfare states (2). This diagnosis of the relationship between economic and welfare policies has been repeated over more than 20 years. However, on the threshold of a new century we can ascertain that the financial foundation of the Norwegian welfare state has not been crumbling away. The question remains, though, whether the architecture of this state is in a process of reconstruction. For, even if the OECD’s diagnosis was rather broad and vague regarding concrete symptoms of crises in various welfare states, the fact remains that these experienced more or less serious endogenous and exogenous challenges in the 1980s and early 1990s. The economic recession that hit the Nordic countries during the 1990s did not hit Norway as it has been described in Sweden (2) and Finland (4). The oil economy ensured a steady income for the state and generous welfare benefits could be maintained. But nevertheless, efforts were undertaken to modernize the welfare state, partly as a response to criticism from the OECD, and partly from a more general shifting political ideology.

Relationships between Academia, State and Industry in the Field of Food and Nutrition: The Norwegian Chemist Sigval Schmidt-Nielsen (1877-1956) and His Professional Roles, 1900-1950

The aim of this article is to shed light on the relationships between science, state and industry in the field of food and nutrition in Norway in the first half of the 20th century with reference to the scientist Sigval Schmidt-Nielsen (1877–1956). Schmidt-Nielsen was a health authority employed state chemist at the university in the Norwegian capital and later professor of technical organic chemistry at the Norwegian Institute of Technology in Trondheim. We explore his roles, his research and his consultancy for state and industry at the university and at the institute. The early 1900s were important for the shaping of food and nutrition science as well as the growth of the food industry. During this period, food control and food regulations were implemented. Norway, the context in which Schmidt-Nielsen worked had only become an independent nation in 1905, and the state administration, as well as the university and institute were young institutions. We argue that this specific situation paved the way for the roles Schmidt-Nielsen played in academia, state and industry. By combining a biographical approach and a multi-institutional perspective, new relations between different fields within food and nutrition became visible.