At the World Health Assembly in 1990 the Director General called for "a new paradigm of health." I wrote to the Director General strongly supporting that call, but respectfully suggesting that he could find that paradigm buried in the files of his own office. For the World Health Organization at its inception over 40 years ago adopted a prophetic paradigm that has been for the most part ignored.

WHO defines health as "not merely the absence of disease but a state of well being." But how many of the present WHO staff are working on "absence of disease" and how many on "well being?" It has been much easier to conceptualize and implement work directly attacking well-defined diseases (the biomedical model), whether through prevention or intervention, than to promote well being. The reason that this has not been sufficiently effective, leading the DG to call for a new paradigm, is that health is not primarily medical.

In spite of the impressive eradication of smallpox by sophisticated and expensive technology, it is becoming increasingly obvious that most of the world's health problems cannot be best addressed in this way. The causes of disease in the world are more economic, social, and spiritual, than biomedical.

JUSTICE AND HEALTH

It is widely acknowledged that the number one cause of disease in the world is poverty. Providing immunizations, medicines, and even health education by standard methods cannot significantly ameliorate illness due to poverty. This as a justice issue to be raised in the centers of power--local, national, regional, and global. To address the world's major cause of illness, those promoting health must lead all nations to work together to change unjust economic structures which create and perpetuate poverty. While primary health care works toward a more just distribution of available resources for health, both within and between nations, a top-down paternalism in its implementation often inhibits the development of community resources and achievement of self-reliance. The resulting dependency on outside resources for the provision of health care services has ultimately served the rich and powerful rather than the poor.

HEALTH AND PEACE

Armed conflict and other forms of political violence are another threat to the health of millions in our time. State terrorism through "low intensity conflict," torture, imprisonment and other forms of human rights violations have made well-being an impossibility. The threat of nuclear annihilation hangs over the entire globe, often suppressing hope. No medications can remedy the personal and social illness arising out of this world climate of militarism. If we are truly concerned with health, we must address this major root cause.

HEALTH AND ENVIRONMENT

Another significant proportion of illness in the world is self-inflicted. What we impose on ourselves individually and collectively--whether out of ignorance, greed, or simply lack of self-control--causes physical, mental, spiritual and ecological damage which is not best addressed by medical technology. Lifestyles and values which grow out of individualism increasingly cause disruption of social networks and life in community.

In industrialized countries, more than 80% of illness and death are reported to be due to destructive lifestyles, and the problem is growing rapidly as a result of "modernization" throughout the world. Development of heart disease, hypertension, and diabetes has accompanied industrial development in many countries with the introduction of new diets and attitudes toward manual labor. In the name of "economic growth" sophisticated methods are used to promote all kinds of over-consumption in the face of mounting evidence that it is severely destructive to health. Governments, while spending millions to prevent traffic in illicit drugs, promote the most widely used and destructive of addicting drugs, alcohol and nicotine, through duty free shops and trade agreements.

As nations large and small struggle for military and technological supremacy, nuclear wastes proliferate to endanger the health of the whole planet.

Health professionals must be active in advocating and protecting the integrity of creation, with concern both for the human body and for the critical conditions which are necessary to sustain life.

HEALTH AND LIFE

All human beings are faced with the question of the meaning of life. This spiritual dimension is most important to health. Medical science is now demonstrating that beliefs and feelings are potent modulators of the body's powerful, health-controlling immune system. We are discovering that scientific medicine is dealing very superficially with illness, ignoring root causes with the excuse that there is no "hard data."

Traditional societies have long had an approach to health which knows disturbances in beliefs, feelings, and relationships to be root causes of illness but we ignore that factor while concentrating on the pharmaceutical analysis of herbal medicines. Much can be learned from a dialogue between traditional healers and Western medical practitioners. IMPLEMENTING THE NEW PARADIGM

Although WHO's charter says health is not simply the absence of disease but a state of complete well being, all WHO programs around the world are disease oriented. That is because well being is not a scientific concept that can easily be addressed by medical science. But there is one organization in the world whose focus is primarily well-being: the Church. Jesus said "I have come that you might have life in all its fullness." That is well being. In the Old Testament the Hebrew word shalowm appears many times. We often translate it into the English word peace, but shalowm actually means well-being.

So it is the function of the Church to be the real World Health Organization. We must recognize this and redouble our efforts to address the issues outlined above. The Bible is a book of justice and portrays God's option for the poor and marginalized from cover to cover. Jesus said "Woe to you, scribes and Pharisees, hypocrites! For you tithe mint, dill, and cummin, and have neglected the weightier matters of the law: justice and mercy and faith. It is these you ought to have practiced without neglecting the others" (Matt 23:23). The role of the Church in health and healing is an idea whose time has come, again. It is the function of the Church to be the real World Health Organization.