Making health systems more fair and efficient
Ole Norheim brings priority setting expertise to new role as Mary B. Saltonstall Professor of Ethics and Population Health.
November 5, 2024 – Last month, Ole Norheim joined other global health leaders at the World Health Summit in Berlin to share an optimistic message: Countries worldwide, regardless of income level, can halve their 2019 rates of deaths before age 70 by focusing on a handful of key health priorities. Norheim is a co-author, along with several Harvard T.H. Chan School of Public Health colleagues, on Global Health 2050, a new report by the Lancet Commission on Investing in Health.
The report recommends investments in the drugs, vaccines, and diagnostics needed to control 15 conditions that account for the biggest disparities in life expectancy around the world, including tuberculosis, diabetes, maternal conditions, and road injuries. It’s the latest effort in Norheim’s 25-year career dedicated to helping decision makers best allocate scarce health resources.
Norheim is joining the Department of Global Health and Population full time as Mary B. Saltonstall Professor of Ethics and Population Health in January, after a decade as a part time adjunct professor. He has been primarily based at the University of Bergen, Norway, where he currently serves as a professor of medical ethics and the director of the Bergen Center for Ethics and Priority Setting (BCEPS).
“I’ve gotten to know a lot of exceptional people [in GHP],” he said. “I think it’s possible to have even higher impact on the field and on the practice of global health by being a part of their network and the wider network at Harvard.”
Much of Norheim’s research has focused on an ethical approach to priority setting in health systems, with an emphasis on addressing inequality in lower-income countries that are developing universal health care programs. He has worked to create frameworks for answering difficult health care questions at both the clinical and health systems level, for example, how to prioritize transplant recipients. His work grapples with what happens when there is a gap between a population’s needs and what its health system can provide. In such conditions, how can services be distributed fairly?
Guiding difficult decisions
Norheim traces his interests in ethics and global health to his childhood. His parents were both teachers, and filled their home in Norway, near the Arctic Circle, with books and lively discussion. They also spent time as missionaries in Ethiopia, where Norheim was born. He said the extreme poverty and inequality he witnessed while living in Africa left a lasting influence on his future career path.
As a medical student at the University of Bergen, Norheim worked on a study of bone marrow transplant patients and became fascinated by the complex issues surrounding treatment decisions. He then went on to earn a PhD in medical ethics at the University of Oslo. After graduating, he split his time between clinical and academic work at the University of Bergen and its affiliated hospital, before ultimately moving into public health research full time to explore medical ethics at the health systems level.
He established a research group around medical ethics and priority setting in 2004, and in 2019 co-founded BCEPS. He and his colleagues have provided training to physicians and policymakers in Ethiopia, Ghana, Nepal, and Tanzania, in addition to decision support to ministries of health in those countries. The Center has also worked with the government of Norway on setting priorities in its public health system, for example around introducing expensive new drugs and charging fees for some services.
Norheim has been active as an adviser on the global stage. In 2014, he led a WHO consultative group on developing guidance addressing issues of fairness and equity that arise for countries on the path to universal health coverage. During the COVID pandemic he was part of the Norwegian government’s vaccine advisory group, and worked with an international group of ethicists to publish recommendations on making global vaccine allocation more equitable.
“Medical ethics deals with difficult, contested questions. There is no one standard answer,” Norheim said. “That’s why in my research I aim to further develop ethical frameworks for fair and efficient priority setting.” Recognizing how key trust is to successful health systems, Norheim’s guidance has included ways to involve the public in discussions around difficult priority setting decisions, and he has written multiple op-eds on key issues and participated in public debates.
At Harvard Chan School, he plans to continue his work as lead editor of the Disease Control Priorities project, which works with partners in low-income countries to develop the frameworks and criteria for health care priority setting and produce evidence to help guide decisions. He also aims to expand his research into questions around climate change and health.
Norheim added that he hopes that through his new position he can formalize a collaboration with the Bergen Center that brings young researchers from low-income countries to the School. Currently, a grant from NORAD (Norwegian Agency for Development Cooperation) fully supports four postdocs, five PhD students, and 15 master’s students from Ghana, Nepal, and Tanzania and from Africa CDC.
He’s also looking forward to doing more teaching. During his years as a part-time adjunct, he typically spent six to eight weeks teaching an ethics course on campus in the fall. “I really enjoy interacting with the students here,” he said. “I find it very inspiring.”
Quick Hits
- Personal hero: Professor Amartya Sen has been my intellectual hero since I was a student because he is such a good philosopher, and a very good economist. His way of bridging sophisticated ethical thinking with quantitative methods and analysis has been an inspiration for me.
- Favorite campus spot: I’m interested in art, so I like the small stone garden by the entrance to Kresge with the beautiful sculpture.
- Hobbies: I paint abstract paintings. I get a lot of inspiration going to art museums and galleries, and reading about art.
- Book recommendation: The last book that I really loved was Nights of Plague by Orhan Pamuk. It’s about an earlier pandemic when the Ottoman Empire was at its end—a historical novel with a lot of relevance for public health by a very gifted writer.
Photo: Kim E. Andreassen / UiB
