Enthusiasm and community spirit
The interwar period was a rich and varied era for preventive healthcare work in Norway, as described by Aina Schiøtz (10). The area of work was broad, initiatives were numerous and new knowledge quickly materialised into new practical policies. Numerous actors were involved: public health nurses, hospital nurses, doctors, teachers, architects, bureaucrats and politicians – and not least the large number of people involved through voluntary aid organisations. The entire country was swept up in a national community effort (10). Much of the health promotion of the time emerged 'from the bottom up', following grassroots initiatives. One good example is provided by the Norwegian Women's Public Health Association, which had established a large organisation and came to set the standard for voluntary health promotion in Norway.
This work bore fruit. Despite economic crisis, poverty, high unemployment and political unrest, the health of most people improved. Communicable diseases were on the decline, child mortality fell and life expectancy rose. Within a few years, schoolchildren became healthier, stronger, taller and cleaner (11). All statistics pointed in the same direction, in Norway as in many other European countries (10). In 1920, Norway had 2.6 million inhabitants, half of today's number. The country had 1 346 doctors, five percent of today's number (12). Life expectancy at birth was approximately 60 years. It is difficult, however, to quantify how much of this improvement in health was due to the community effort and how much should be ascribed to broad political programmes that helped improve living conditions.
The primary goal of the preventive efforts undertaken during the first decades of the 20th century was to combat and prevent the spread of the deadly communicable diseases, first and foremost of tuberculosis. Tuberculosis mortality was more than halved in the period 1900–1930, from 31 to 15 per 10 000. Mortality from pneumonia and bronchitis was close to halved from 1920 to 1940. The same applied to mortality from epidemic communicable diseases in the age group 15–39 years (13). A large part of the honour for this progress is due to public hygiene, Carl Schiøtz stated (14). It is worth mentioning that these impressive results were achieved before the advent of antibiotics.
The strategy in the battle against communicable diseases gradually changed character. Since the bacteriological breakthrough in the 1880s, emphasis had been placed on isolating patients and disinfecting houses and belongings. The authorities continued with classic public hygiene measures that consisted in development of infrastructure in cities and towns, such as water supply, waste collection, sanitary facilities and food inspection. This new brand of social hygiene also targeted individuals (11). From the 1910s, there was an increasing awareness of the importance of strengthening resistance to disease in the population, and there was a desire for more emphasis on physical exercise, nutritious diets, strict sleep regimens and better hygiene (10). Light, air and cleanliness were in focus (15). Priorities changed from preventing disease to fostering health (11). Health prevention in schools was one of a number of preventive efforts that flourished in the interwar period (10). The good results convinced people of the advantages of hygiene (16).
Attempts were made to organise this enormous enthusiasm and community spirit regarding public health in broad popular movements where doctors played a key role (8). Doctors developed relevant knowledge. The columns of the Journal of the Norwegian Medical Association were replete with material on hygiene and social medicine (17). In the education of mothers, the doctors collaborated with women's groups such as the Norwegian Women's Public Health Association, the Association of Norwegian Housewives and the women's organisation of the Norwegian Labour Party (18). In line with the thinking of the time, an idea was launched to establish a college for mothers, to provide training in the work of motherhood (19).