What should characterize public health done by Christians?

Public health skills are powerful tools to promote flourishing of communities; they complement medical care of individuals.  Christians also want to promote human flourishing, since this demonstrates the goodness of God.  What will characterize public health done by Christians?

Some of the ancients were inclined to treat disease and plagues in terms of supernatural forces and magic, shamanism and religious practices. The Hebrews stressed regulation of personal and community hygiene, isolation of lepers and other ‘unclean conditions,’ and family and personal sexual purity; God gave to Moses commands related to a weekly day of rest, limits on slavery and oppression, sanitation and food regulations.  The children of Israel gave to the world the teaching concerning human dignity since all are made in the image of God.

Modern public health is a noble sphere of human endeavor, whether done by Christians, Muslims or Secular modernists. Good public health practice should be characterized not only by good science but love for humankind. Christians are especially motivated by the value of human beings, as well as God’s command to love the Lord our God with all our heart, and love our neighbor as ourselves. We glorify God by seeking His best for our fellow human beings.

At the same time, modern public health – Jenner and vaccination, Snow on cholera, germ theory, bacteriologic revolution, hospital reform, immunology, the development of epidemiology – has grown up as part of the modern scientific revolution and out of Enlightenment thinking.  It is often characterized by a ‘split’ of sacred and secular, and a peculiar perspective that things ‘scientific’ define reality whereas things of God are confined to personal and private belief. I believe this is an inadequate foundation for public health as it tends to relegate ethical and moral matters to a private and subjective world.

As Christians we have much we can learn from our public health teachers, and much to give in order to alleviate the suffering of this world.  But ultimately our motivation for doing public health is to demonstrate the character of Jesus Christ to the world; we cannot bring utopia to this world but we can point to a Savior who cares about men and women – body and spirit. He is the Savior who not only frees us from our sinful selves but also frees us for His purposes in a world which He has made and is in the process of re-creating.

As a Christian epidemiologist, I will use the techniques of case control studies, disease surveillance and risk identification just the same as anyone else. The tools are the same, whatever our faith orientation. Our desired outcome – disease prevention and health promotion – will be the same; public health professionals seek the best for others.  Christian public health is not just public health done by Christians; it becomes activities, programs, policy and advocacy informed by God’s Word – which commands us to ‘love justice, seek mercy, and walk humbly with.. God.” (Micah 6:8)

A Christian perspective on public health and human flourishing will be informed not only by material success, but also by an understanding of the darker forces we face, including suffering and death. It will seek to address these matters with courage and meaning. A Christian perspective on public health can deal with life well because of the hope God offers in His promises in both life and death. The cross of Jesus Christ has won the victory of sin, darkness and rebellion in order to usher in life here and eternally.

Ultimately health is not an achievement of man but a blessing of God. And He is working in the world to bless the world through His Son Jesus Christ, who gave His own life for the ultimate in public health – salvation from sin, rescue from darkness and oppression, and the freedom of a life of love and grace.

Why should public health be part of our Christian commitment to mission? Isn’t curative care enough?

There are a great many ways that public health skills are being used in preventive and community health programs around the world. Yet when we think of ‘medical missions’ over the last 200 years there has been a strong clinical (medical) approach.  Why should a preventive approach complement this strong medical component of medical missions?

If diseases all responded to a curative approach, there might not be a need for disease prevention. But in almost any category of “disease,” there is need for BOTH a curative and a  preventive approach.  This can be illustrated with just an example or two.

Neonatal tetanus must be dealt with by antitoxin and medication to avert death and respiratory paralysis, and yet it can be prevented by careful care of the umbilical cord at birth. In one animistic tribe in Ethiopia there was the belief that the umbilicus must be covered with dirt from the entrance of the house in order to control access to the spirits to the entrance of the body; clearly there was a need for both medical intervention for the sick but also for education – addressing not only the biology but also the fear of spirits which were part of the local worldview.

In Nepal there is a high maternal mortality rate because of lack of access to facilities with good midwifery and caesarian section capability. The problem cannot be addressed with clinical care alone, but there must be attention to community education, early detection of high risk pregnancies, and training of community based midwives.

Ebola needed both treatment units (highly intensive and technical) as well as community education and contact tracing – both a highly clinical approach to the individual as well as a highly preventive approach in the community.

Road traffic accidents must be treated with competent facilities and personnel, but to reduce the incidence of accidents also requires community and government initiative, safe roads, helmets, seat belts, and a shift in mindset away from fatalism.

Almost every condition requires both a clinical and non-clinical approach. Physicians and nurses are superb at what they do, but there is much that remains undone, either in prevention of illness and injury, or in follow up management of those with chronic conditions, infections and disabilities.

God’s covenant promise to Abraham was to bless all the nations of the earth through him and through his descendants. God showed his concern for justice and human flourishing as he gave to his descendants the commands, promises and laws which reflect the best of human flourishing. Jesus – the descendant of Abraham – continued to show God’s character by healing many and sending his disciples out preach good news and to heal many others. The compassion of Jesus has led many over the centuries to sacrifice their own comfort out of compassion for others.

Is God concerned with prevention of human suffering? Does He encourage us to promote health as well as cure disease?  Yes!  God’s Word stands in contrast to the thinking of behaviorists or other forms of fatalism – those who believe we can’t really change things.  We are not able to manipulate the universe but God does sovereignly control the world and works out all things according to His purposes and design.  He has demonstrated His promised blessing to Abraham and His children, and ultimately in the person of Jesus Christ.  This is a universe created and sustained by a Person – good, righteous and true — not an impersonal force.

A Christian can confidently work to show God’s care for human life. As followers of Jesus Christ we trust that the Lord of the universe can change things (He has authority and power) and that He (not we) ultimately works for the blessing of mankind. The salvation Jesus accomplished on the cross bridges the sin problem (our separation from God) and thus enables us, by His grace, to both love God and love our neighbor. That love extends not only to care but to the prevention of human misery.  That’s public health from a Christian point of view.

Why health is more than medical care

Why is health more than just medical care?  Here are some reasons:

  1. Medical care tends to address matters of the body but not of the spirit. As medical professionals we are trained to diagnose, treat and manage medical conditions. We seek to apply scientific evidence to our craft.  And yet health is something more than science, scopes and surgery.  The best doctors and nurses treat the person, not just the disease.  Illness is not just chemistry and biology; it includes the non-material aspects of existence, such as meaning, dignity and reconciliation.
  2. Health is an outcome of many complex factors, not just medicine. These include things like nurture, nutrition, good housing, healthy relationships.  The reduction in deaths from infectious diseases in the West, for example, was mostly due to non-medical factors, not antibiotics.  Again, the evidence is that the best correlation with worldwide infant mortality is the educational level of the mother. Those who want to improve health of populations must think beyond individual care to the social and enviornmental determinants of disease.  Health is more than just medical care.
  3. Ultimately health is not ‘controlled’ by any one discipline or profession. As health professionals we have a fairly narrow focus – to treat or manage conditions in individual patients.  But health — since is is more than the absence of disease but the well-being of people — results from more than our medical tools.  Smoking, gun violence, human traffiking, poverty, inadequate vitamin A in the soil, deforestation, natural disaster — all contribute to human suffering and poor health!
  4. Health is about dignity, not just treatment. While excellent medical treatment is essential, not all conditions are curable, and some remain fatal. Even when we can’t cure or treat, our work must sill say, “You are a person. You are made in the image of God!” Restoring dignity must be part our motivation.  We are not treating machines, but human beings. Too often in our bio-psycho-social disease model we think mostly about physical treatment.
  5. Ultimately, health is a blessing of God, who created the body and also gave it tremendous powers of healing.  The tagline at a mission hospital in Chiang Mai, Thailand reads, “We treat. Jesus heals.”  We have the privilege to serve in medicine in humble ways to alleviate suffering; but in the end it is our Lord and Creator who gets the glory.

I welcome hearing about your reasons for thinking beyond medical care to health.

A new era in Roman healthcare

We take for granted that compassion is a natural response to the suffering of those who are ill. But compassion was not well-developed as a virtue in Roman culture.  Rome had not developed a culture of compassion; “mercy was discouraged, as it only helped those too weak to contribute to society.” Family members may come to one’s aid, and the wealthy could afford physicians, but “the common folk were often left to rely on folk healers and sellers of herbs, amulets and quack remedies.” *

“If a father decided that the family couldn’t afford another child, that child would be abandoned to the steps of a temple or in the public square. Female infants were exposed much more often than males.” These attitudes and practices are still with us today.  In India and China the practice of aborting female offspring is distressingly common.  In many parts of the world the handicapped are treated with disdain or neglect.

“The classic world possessed no religious or philosophical basis for the concept of the divine dignity of human persons, and without such support, the right to live was granted or withheld by family or society almost at a whim.”

What made the difference between attitudes then and now?  At least in many parts of the world today, human rights and dignity are considered absolutely fundamental (and they are!). Where then did these more ‘progressive’ beliefs come from?  The new ‘era’ in Roman healthcare came from the least likely place: from a new, small and persecuted culture which penetrated the classic Roman world: the culture of the Christians.

Despite a series of ten devastating persecutions, beginning with Nero in AD 64, Christians “carried on an active ministry of philanthropy which included the care of the sick. Far from the stereotype of shriveled ascetics who hated the body, early Christians valued the body and the medical arts necessary to heal it as good gifts from God.”

“James defines “religion that is pure and undefiled before God” in part as caring for ‘orphans and widows’ (James 1:27) — biblical shorthand for all those without protectors and in need. Christian theology thus birthed a personal and corporate charity which surpassing any previously known. Church leadership encouraged all Christians to visit the sick and help the poor, and each congregation also established an organized ministry of mercy.”

How different this is from our practices today!  How often we are concerned about ourselves without hearing the Lord’s commands to love God with all our heart and our neighbors as ourselves.

“A devastating epidemic began in 250 AD and spread across northern Africa to the Western Empire.  It lasted 15 to 20 years, and at one point in Rome 5,000 people died in one day. Beyond offering supplications to the gods for relief, public officials did nothing to prevent the spread of the disease, treat the sick, or bury the dead. This is not surprising, since the pagans believed that nothing effective could be done in a time of plague other than appeasing the gods.”  However in places like Carthage, north Africa, where the plague swept in with force, the Bishop Cyprian  “encouraged Christians to donate funds and volunteer their service for relief efforts, making no distinction between believers and pagans.”  They continued these organized emergency relief efforts for five years.

“The ministry of medical care in early Christianity began as a church-based diaconal, not a professional, ministry.  It was provided by unskilled, ordinary people with no medical training. Yet the church created in the first two centuries of its existence the only organization in the Roman world that systematically cared for its destitute sick.”

This is not a secret we want to keep from believers around the world today.  From Syria to Thailand, believers are caring for those who are marginalized and ill.  But sometimes I fear we forget our history, and we forget God’s command to love our neighbor.  Medical missions are a wonderful calling and ministry. But as we go about it we must not ‘overly professionalize’ ministry to those who are sick and brokenhearted. Unskilled believers ushered in a new era of healthcare in the Roman empire.  We have the opportunity to do the same among multiplied countries around the world, demonstrating goodness and grace of God, and the dignity of men and women created in His image.  This can be done only as professionals work together with non-medical professionals to care for the needs around them, especially those who are least able to help themselves.

Despite the cost, let’s help usher in a new era of healthcare around the world.

*Quotations are from “Christian History, Healthcare and Hospitals in the mission of the church,” Issue 101, pages 6-12

HOPE for AIDS

It is encouraging to see Hope for AIDS mature over the last 16 years. This initiative began with the aim of building capacity among churches and non-governmental Christian organizations to respond to those suffering with AIDS, not just meeting the needs ourselves. In this way many of the projects and programs have become sustainable. Local believers have taken leadership, learning how to minister to the brokenhearted with both the words and the compassion of Jesus.

HOPE for AIDS

HOPE for AIDS is an international family of more than 40 projects spanning 12 countries in Africa and Asia. The majority of the work in these projects is done through the time and commitment of the nearly 2,000 local volunteers drawn from our partner organisations. Our vision is to build capacity in the local community to enable them to deal with the AIDS pandemic in the most effective way in each culture. Partners often include local churches and community groups that benefit from periodic networking, shared training, and relevant support among themselves. A shared goal of sustainability is vital to maintaining ongoing transformative care with minimal dependence on outside supporters. In this, ongoing efforts to build local strengths and internal supports make it possible for local partners to continue relevant long term engagement with the community.

HOPE for AIDS engages and supports local partners in an effective, holistic and compassionate…

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A cheerful heart is good medicine

In medical school I learned that the death of a spouse is a risk factor for one’s death, and many times the surviving spouse dies near an anniversary of the sad event. The connection between our soul and body is closer than we can imagine. The book of Proverbs says it this way: “A cheerful heart is good medicine, but a crushed spirit dries up the bones.” (Proverbs 17:22).

Increasingly science is recognizing the intimate connections between the heart and the body. A crushed spirit dries up the bones. Brokeness can be emotional, relational or spiritual; whatever the cause, it impacts the body. It can a factor resulting in high blood pressure, anxiety, cardiovasular disease, autoimmune disorders, cancer, etc.  All of these things have multiple causes (genetic, environmental, and so on) but the condition of the spirit is a vital factor.

Modern medicine has brought us some marvelous physical interventions, from drugs to CT scans. And while we are grateful for these, we must not overlook the effect the heart can play.  All of us in general practice have seen cheerful hearts which bring healing, and crushed spirits that dry up bones.

I’ve seen nurses literally bring patients back to health by the care they demonstrated to the sick. On the other hand I have witnessed others who see their role as a job more than a service of love. Love becomes a powerful medium for healing. “A cheerful look brings joy to the heart, and good news brings health to the bones.” (Prov 15:30).  What a privilege to see health professionals who give not just technical help, but sacrificial love.

Where does one get such a cheerful heart? Ultimately the source is not in ourselves, but in knowing the sacrifice which God has made for us in history. The objective fact is that Jesus Christ came to earth to give His life for our sin and rebellion, rising to offer hope and new life.  This Easter week we are celebrating not just the idea of resurrection, but the historical fact of the resurrection of the Son of God.

That kind of cheer just doesn’t go away.

Not the way it’s supposed to be

“The veins of sin interlace with most of the rest of what’s wrong with our lives — through birth disorders, disease, accident and nuisance. Thousands of Third World children die daily from largely preventable diseases: out of laziness or complacency, certain grownups fail to prevent them. Thousands of First World children are born drug addicts: their mothers have hooked them in the womb. Some people with sexually transmitted diseases knowingly put their partners at terrible risk. It happens every day. Many accidents are, in retrospect, both accidental and predictable: somebody who needed to concentrate on his job in order to protect others (a pilot for example, or a lifeguard, or a ship’s captain) got drunk instead, or careless, or wholely preoccupied. Often, a number of such factors combine in some lethal and intricate way to bring havoc to human well-being.”

Cornelius Plantinga helps us look at sin and how it affects, and corrupts, the beauty and design of God’s creation. Most of us do not hear as much in our churches about sin as our grandparents did. It is at the root of much pain and suffering in this world. “Self-deception about our sin is a narcotic.” He wants to “renew our memory of the integrity of creation and sharpen our eye for the beauty of grace.”

In looking at root causes (and possible prevention) of diseases in Ethiopia in the 1980s I was struck that the causes were not just ignorance but sin. Nowdays in the West we classify intolerance as sin, but there is so much more lurking in the background which we tend to ignore: promiscuity, cheating, corruption, power-grabbing, pride, lying, dishonoring of others.  Ultimately this comes from the dishonoring of God who created and designed us.

I said to a colleague at the time, “My community program would work just fine if it weren’t for sin!”

That is largely true, and shows us our need for the forgiveness of sin found only at the cross of Christ. Community health is a good work, but community change is most effective when founded on love.

“Sin distorts our character, a central feature of our very humanity. Sin corrupts powerful human capacities — thought, emotion, speech, and act — so that they become centers of attack on others or of defection or neglect…. Sin, moreover, lies at the root of such big miseries as loneliness, restlessness, estrangement, shame and meaninglessness… In fact sin typically both causes and results from misery.”

“Sin is disruption of created harmony and then resistance to divine restoration of that harmony.”

“At the center of the Christian Bible, four Gospels describe the pains God has taken to defeat sin and its wages… Christians have always measured sin, in part, by the suffering needed to atone for it.  The ripping and writhing of a body on a cross, the bizarre metaphysical maneuver of using death to defeat death, the urgency of the summons to human beings to ally themselves with the events of Christ and with the person of those events, and then make that person the center of of their lives — those things tell us that the main human trouble is desperately difficult to fix, even for God, and that sin is the longest-running of human emergencies.”

So as we serve others with compassion, let us not ignore the longest-running of human emergencies.  Things are not the way they are supposed to be. Let’s make a full diagnosis of our human condition and receive God’s full remedy.