Traditional and “Non-traditional” Health Sector
World Health Organization Director General Gro Harlem Brundtland, in
her keynote address at a recent conference in Switzerland calling for an
intensification of the fight against diseases of poverty, said that “we
must go beyond the traditional health sector – working with people in their
homes, their work places, their schools, their community halls and their
places of worship.”
Churches and Christian non-governmental organizations welcome this expanding
openness to partnerships with WHO, a U.N. agency which in the past tended
to limit its collaboration to member governments. If Dr. Brundtland had
examined the history of the engagement of Christians and other faiths in
health and healing, however, she may not have described working with places
of worship as “non-traditional.”
Care of the sick has been a traditional undertaking of religious institutions
and people of faith. Healing was a key focus of Jesus’ ministry. The word
“heal,” which has connotations of salvation in New Testament usage, appears
66 times in the four New Testament gospels. In commissioning the twelve
disciples, Jesus “gave them power and authority to drive out all demons
and to cure diseases, and he sent them out to preach the kingdom of God
and to heal the sick” (Luke 9:1-2). Other religious traditions, e.g. Muslim,
Jewish, Buddhist, Hindu, African, are also concerned with the sick.
Read about the history of hospitals in an encyclopedia and you will
see that in a major way it is the churches and religious orders that were
the pioneers of institutions for the sick. In more recent times, it was
most frequently churches and Christian missions that established organized
health and healing institutions in developing countries. In the long perspective
of history, therefore, it is governments that are often the “non-traditional”
purveyors of health services, not the houses of worship.
Although not yet ratified by the World Health Assembly, WHO has advocated
changing its definition of health to add the word “spiritual.” The new
definition would read, “Health is a dynamic state of complete physical,
mental, spiritual and social well-being and not merely the absence of disease
or infirmity.” It was largely the influences of churches that brought this
change. This wording resonates well with the CCIH motto – promoting international
health and wholeness from a Christian perspective.
20th Century Christian Role in International Health
This article focuses on the Christian contribution to health in developing
countries. Establishment of hospitals was one of the first priorities of
Christian missionaries a century ago. These ministries of health and healing
were inspired by Jesus’ example, responding to the most immediate needs
of communities. Medical missions helped to legitimize the arrival of Western
Christian missionaries and their spiritual message. A progressive movement
based on the belief that there are social and spiritual determinants to
health and wholeness brought together faith and public health in an enterprise
committed to community improvement that radically changed the world.
Medical education was an early Christian innovation at colleges such
as Makerere in Uganda and Brown Memorial in Ludhiana, India. The Vellore
Christian Medical College in India is now celebrating a century of service,
honoring its founding missionary Ida Scudder who established a college
to train women doctors. In the early 20th century, Christian missionaries
also brought in nursing education, including the value system of serving.
In the past century, health has evolved as a primary responsibility
of governments. Even so, a 1998 survey by the Institute for Development
Training found that “Religious Health Networks are the second largest health
system in the developing world, second only to government programs.”
In sub-Saharan Africa, most of the early hospitals and health programs
were established by Christian churches and mission. Even today, 40% of
hospital beds in much of Africa are in church and mission institutions.
In Asia, this proportion is estimated at 20%.
The Christian influence on the later 20th century evolution of concepts
such as “health for all” and “community-based primary health care” is a
fascinating story. In the early 1960s, an international conference in Tubingen,
Germany, shocked mission boards by pointing out the limited impact of hospitals
in improving health levels of entire communities. A second conference in
the mid-1960s on the healing role of the Christian community resulted in
the eventual establishment in 1968 of the Christian Medical Commission
of the World Council of Churches, based in Geneva, Switzerland. Many countries
soon set up national commissions to coordinate the health and medical programs
of various Christian groups.
In the 1960s and 1970s, forward looking Christians pioneers, many of
them still alive today, dared to extend the traditional mission of healing
the sick to an effort to lift the health status of entire communities and
nations through health outreach to the community, emphasizing prevention
and health education. The successes of these Christian-based programs,
integrated with the spiritual mission of the church, caught the attention
of government and aid organizations.
The Christian Medical Commission (CMC), the epicenter of much of the
fervor for these new approaches, was a short walk down the street from
the WHO headquarters in Geneva. During the time when Halfdan Mahler, himself
a former medical field worker in India, was Director General of WHO, there
was constant interaction between the officials of these two neighbors,
WHO and CMC. Over 50 WHO staff received CMC’s journal, Contact. A 1974
WHO/UNICEF study entitled Health by the People cited three models of community
health innovation (Guatemala, Jamkhed, and Java), all inspired by Christians.
Mahler told his colleagues that if they wanted to know what the cutting
edge issues of international health were, they should go down the street
to the CMC. Exciting new ideas infiltrated into WHO officialdom, so that
by 1977 WHO had adopted a health for all objective through the primary
health care approach.
The new thinking is illustrated by a question posed to early CMC leaders
Jack Bryant and John Karefa-Smart about how the World Council of Churches
should handle the problem of young churches in the newly independent states
of Africa and Asia that had inherited hospitals from rich parent churches
but were without resources to manage and sustain them. How should those
hospitals be used and managed? Their response was that this was the wrong
question. The question should be: what can the churches and the hospitals
for which they were newly responsible do about the health of poor and vulnerable
populations in the communities where they live? That question and further
suggestions for action were part of the turn of the churches toward primary
health care.
Commonalities in Church Health Programs
What are the common features of health programs managed by faith communities?
• Coverage - reaching rural villages, urban slums,
refugees, i.e. most underserved.
• Sustainability - faith communities have local roots and management
and are often linked to global religious networks.
• History and Credibility in Health- tradition of compassionate
care of suffering, pioneering in community and institutional health programs,
and reputation for quality services and management integrity.
• Holism - focusing on every aspect of human life (physical,
mental, spiritual and social), addressing human concerns that transcend
scientific medicine and public health.
• Ethics, Justice and Advocacy - addressing root causes and
core values derived from beliefs rather than empirical inquiry.
Impact of Christian Faith on Health
How does the Christian faith impact health? Here are six points presented
by Dr. Daniel Fountain, long-time missionary to Congo, at the 1998 National
Council for International Health conference:
1. Community Health – The Bible helps shift attitudes away from
fatalism toward activism and responsibility to take initiative to improve
sanitation, health, water supplies, food production, etc. The church provides
a community structure for health and development efforts and moral values
that support trusting and cooperative relationships.
2. Management of Health Services - Christian models of management
emphasizing accountability, responsibility, shared power, and service can
lead (but not guaranteed) to improvements over hierarchical power relationships
and concentration of power in the chief or director.
3. Maintaining Integrity of Health Programs - Religious faith
can provide a spirit of unity and common purpose in social and professional
relationships and a structure for managing conflict.
4. Justice, Poverty, and Health - The Judeo-Christian Scriptures
give clear principles concerning economic and social justice and demonstrate
God's concern for poor people. If followed, poverty and inequity are reduced,
enhancing health.
5. Caring for the Whole Person - A medico-pastoral approach to
healing is justified by recent developments in psychoneuroimmunology that
reinforce the belief that body, mind, and spirit are intimately interrelated
as a functional whole.
6. Epidemic Diseases - Commitment to Christ and to serving others
motivates health care workers to care conscientiously for the sick. Church
hospitals and health programs provide a surveillance network for disease
outbreaks.
Challenges for the Future for Faith-Based Institutions
Christians played a towering role in 20th century developments in international
health. What are cutting edge issues where Christians can play a pioneering
role at the beginning of the 21st century? Here are a few suggestions:
• Strengthen advocacy for the poor, oppressed and
marginalized, promoting equity and total coverage for all, leaving no one
behind.
• Integrate health programs and congregational life to promote
healthy behaviors and lifestyles, for example to reduce HIV transmission.
• Expand partnerships with other faith groups, governments,
international institutions, and secular health agencies.
• Participate boldly with national and global powers in decision-making
regarding policy and resource allocation.
• Speak out on medical ethics and moral implications of health
policies.
• Lead in research and practice of spiritual dimensions of
health and healing.
Editor's Note: This article was first presented at the 1999
APHA conference.
