Harvard Medical School

I was awarded the Fellowship, however, and we started planning the upcoming year in the USA. The people at The Commonwealth Fund were not only extremely helpful but also had an extensive network in American healthcare and academia. This led us to the conclusion that philosopher Norman Daniels and psychiatrist Jim Sabin would be good mentors for such a project. Daniels and Sabin had recently published a standard work for everyone working with healthcare prioritization, Accountability for Reasonableness (1). Since the Harkness Fellowship is considered prestigious in the USA, most potential mentors are willing to take on such a role. This means that anyone considering applying for the scholarship can be fairly certain they will collaborate with the leading experts in their field.

Norman Daniels and Jim Sabin, professors at Harvard, both accepted. I seized this opportunity, although we had also discussed the possibility of working with Ruth Faden at Johns Hopkins University. However, after considering the overall situation, my husband and I decided that it would be more interesting for our family to be in the Boston area. Since the Harkness Fellowship is awarded to «mid-career» professionals, it often involves a spouse and/or children, and professional considerations are not the only factors at play.

The Harvard Environment

Being connected to academic communities at Harvard was highly stimulating. There was always something happening! I decided to take advantage of every opportunity I had and participated in a rather diverse academic program. This allowed me to attend discussions on topics such as the role of the Supreme Court in American society and the rise in autism diagnoses in California, in addition to seminars more directly related to health policies in general and distributive justice in particular.

Additionally, I discovered the extensive programs run by local bookstores, which featured weekly book launches and author interviews.

The Commonwealth Fund

What happened at Harvard, however, accounted for only half of my time spent there. The Commonwealth Fund has an impressive program for its Harkness Fellows, and I travelled all over the country, visiting places like the Centers for Disease Control in Atlanta, the National Institutes of Health in Bethesda, and Kaiser Permanente in Washington, D.C. Wherever we went, we met with top leaders in both politics and academia.

Meeting John Lewis

While in Washington, we also visited Capitol Hill and met with, among others, civil rights activist and Congressman John Lewis. His activism in the 1960s was instrumental in securing Black rights, particularly voting rights. He told us about the march from Selma to Montgomery—so-called Bloody Sunday—when he himself was severely injured. When we were being photographed together, I asked him if he had any recommendations for what I should do in Atlanta. He invited me to his church—which was also Martin Luther King Jr.’s church—for an anniversary celebration where he would receive an award for his work in civil rights. We were the only white people in attendance in a church filled with hundreds of elegantly dressed congregants. The powerful pastor from Harlem asked us to stand up, since we had come all the way from Oslo, Norway to participate in the celebration. At that moment, we felt very white.

Project: Patient Responsibility and Healthcare Prioritization

The intention behind spending a year as a Harkness Fellow is, among other things, to establish international contacts in one’s research field. I stayed in touch with Norman Daniels for several years until he withdrew from active academic life. He provided feedback on two articles I worked on while at Harvard (2, 3) and remained engaged in the subsequent development of this research. I attended a course on personal responsibility and health, which resulted in a chapter in a Norwegian book on challenges in the Norwegian healthcare system (4).

I interviewed so-called Benefit Design Consultants in health insurance companies about whether patients’ lifestyles should influence their access to healthcare and, if so, how this should be implemented. Should insurance premiums be higher if someone smoked, had a high BMI, or was a substance abuser? The general attitude was positive towards reducing insurance premiums for those who led an «exemplary» lifestyle, using policies framed as incentives for a health-promoting lifestyle. However, when I asked whether premiums should be increased for individuals who were injured in high-risk sports, I encountered no such openness. As the CEO of United Healthcare put it, «The problem is not that people are too physically active.»

It is interesting to note that the question of patients’ lifestyles and access to healthcare has been discussed in all healthcare prioritization committees in Norway but has never been included in prioritization criteria. This is a clear difference between American and Norwegian political cultures.

After the Year in the USA

One of the people I got to know at Harvard who became a personal friend, was Christine Mitchell. She was the Director of the Center for Bioethics at Harvard Medical School. We continued our professional collaboration through the European Commission’s major research project The Human Brain Project, where I led the Ethics Advisory Board from 2014 to 2021 and where she was a member. This work resulted in scientific articles (5–7) and expanded my international network, including connection with Julian Savulescu (8).

In 2014, the Institute for Studies of the Medical Profession organized an international seminar on physicians’ professional satisfaction, burnout, and its implications for quality of care. Several of the academics I met during my Harkness year contributed, among them Lawrence Casalino and Thomas Konrad. Our collaborative work resulted in a special issue of the journal Professions and Professionalism (9).

I have described some of what being a Harkness Fellow meant to me, both professionally and personally, in a way that I hope may be informative for someone considering applying for this scholarship. My experience has been that not only was the year itself highly stimulating, it also provided me with a much larger network and several interesting professional opportunities in the years that have followed.