Institute of Christian Teaching
Education Department of Seventh-day
Adventists
BIBLICO-HISTORICAL
FOUNDATIONS OF PUBLIC HEALTH:
AN ADVENTIST
PERSPECTIVE
by
Godwin Nwadibia Aja
Babcock University, Ilishan-Remo
Nigeria
460-00 Institute for Christian Teaching
12501 Old Columbia Pike
Silver Spring, MD 20904 USA
Prepared for the
28th International Faith and
Learning Seminar
held at
Babcock University, Ilishan-Remo, Nigeria
June 17-29, 2001
Introduction
History of public health can be said to be
as old as the Bible. Yet, it is often taught at different tertiary levels, at
different times, places and by different authorities without due reference to
this significant historical source. From my personal experience as a public
health student in a secular higher institution, the teaching of this very
important subject was based purely on "rational speculation, a scientific
study of the [recent] past, or simply [an] experience of the passage of time…."1 Historical perspectives focused mainly on
classical, traditional conventions, modern or community health statutes/laws,
and contemporary or primary health care declarations.
The purpose of this paper, therefore, is
to pinpoint an existing gap in the teaching of history of public health and to
build a bridge between contemporary historical perspectives and biblical
history of public health. How this is integrated in the teaching of History of
Public Health at Babcock University (a Seventh-day Adventist institution of
higher learning) is presented.
Brief Contemporary Historical Perspectives
"No health system ever
emerges in a vacuum."2 History
of public health as it is taught in many secular institutions, is closely tied
to the culture of the people: traditional, ancient, medieval, oriental cultures
etc. For example, as far back as 2500-1500 BC, the Mohenjo-daro and Harrappa in
Northern India had organized community health action. Middle Kingdom Egypt had
public toilet facilities between 2300-1800 BC; Cretan Knossos had central
baths, running water and sewers; and Ancient Rome had integrated public health
system.3 Invariably, in Ancient, Medieval and
Early Modern eras, public health practice was in place. Reasons for the
emergence of health systems in these periods and ever since were based on
prevailing socio-cultural situations of the people, influenced by science,
technology, education, religion etc. The biblical foundation is rarely
mentioned in contemporary historical discussions.
In Nigeria, for example,
history of health care development started midway through the centuries in a
similar pattern. It could be traced from the pre-colonial period: an era of
traditional medicine in its full course. Health care was basically provided by
the traditional bonesetters, traditional surgeons, traditional birth
attendants, diviners, koranic healers etc. And during the colonial period, the
colonial authorities provided health care to colonial administrators and their
families only. A vast majority of the people had no access to orthodox health
care. They depended largely on traditional medicine. But the postcolonial
period witnessed an era of independence and strategic development plans that
culminated in the provision of basic health facilities and services, especially
in urban centres.4 This is a major landmark
in the history of health care development in Nigeria. However, it had major
pitfalls. For example, the entire health system depicted the British model of
care that was patient-oriented, hospital-based, doctor-centered and curative in
nature. Health manpower was limited;
coverage and access to care was inadequate; management of health facilities was
inefficient; and there was obvious imbalance between curative and preventive
care. Generally, rural communities lacked access to care and, therefore,
community participation and involvement was virtually absent.5
The above example illustrates
history of health development "in the middle of [the beginning]."6 It shows how public health evolved in
the recent past, at different stages in history, but not how it all began. In
other words, history of public health in Nigeria is usually presented without
due reference to biblical records. As a result, a wide gulf is created and a
very weak foundation is laid for public health students being trained to serve
as health educators and promoters in the communities. Bridging the gap is
essential.
In 1978, global history of
public health changed gear at Alma-Ata, Kazakh Republic, former USSR, when
primary health care (PHC) was universally adopted as the strategy for achieving
Health for All (defined as a level of health that guarantees socially and
economically productive lives). Primary health care7
by definition means:
Essential health care based on practical,
scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community through
their full participation and at a cost the community and country can afford to
maintain at every stage of their development, in the spirit of self-reliance
and self-determination.
PHC is made up
of key elements or components:
1.
Education concerning
prevailing health problems and the methods of preventing and controlling them
involves helping people to freely and wisely change their personal and social
behavior to prevent and control diseases. Students of public health, and
community health workers play a major role in accomplishing this.
2.
Provision of food supply
and proper nutrition is geared towards helping people to learn how to improve
the quality of food served to the family. Effective and systematic combination
of various food groups to achieve balanced diet is emphasized. Proteins,
carbohydrates, fats/oil, fruits, vegetables and water are essential for the
healthy growth of children and adults. Breast-milk, which contains all the
essential nutrients a baby needs during the first four months of life, is
promoted.
3.
Adequate supply of safe
water and basic sanitation is an essential need of humans. Protected wells and
pipe borne water help control water-related diseases. And proper disposal of
refuse and other wastes are necessary for effective vector control. Overall,
personal and community hygiene is very important in disease prevention and
control.
4.
Prevention and control
of locally endemic diseases such as flies, rats, snails, mosquitoes and others
can help prevent sickness and death. Keeping the environment clean and personal
hygiene such as hand washing before meals is highly encouraged.
5.
Immunization against the
major infectious diseases: For example, the six childhood diseases (diphtheria,
measles, pertussis, poliomyelitis, tuberculosis, and tetanus) plaguing the
lives of children in developing countries are preventable. DPT, measles, polio,
BCG vaccines and tetanus toxoid are helpful.
6.
Appropriate treatment of
common diseases and injuries require early diagnosis. Prompt treatment helps to
avoid complications. For example, early treatment of diarrhea with oral
rehydration therapy (ORT) saves the child from becoming severely dehydrated.
Recognizing early signs and symptoms of malaria helps prevent the onset of
cerebral malaria.
7.
Maternal and child
healthcare, including family planning promotes the health of the mother and the
child. Adequate provision for prenatal care, safe and hygienic deliveries,
postnatal care, child-care and family planning are essential. Women need to be
taught simple health practices to help save the lives of their children and the
family. The traditional birth attendants need to be taught how to practice clean
and sanitary birthing procedures.
8.
Provision of essential
drugs is needed to treat more common diseases and injuries. They should be
available at all times and at a reasonable cost. For example, drugs for malaria
should be readily available to those who need them.
Adventist Health Ministries
Long before Alma-Ata
Declaration, Seventh-day Adventists (SDAs), through her renowned health
reformer, Mrs. Ellen G. White, had maintained (as early as 1863) that one of
the social responsibilities of the church should include a system of health
care that would help members lead a socially satisfying and spiritually
uplifting life8. This idea was conceived
115 years before PHC was universally adopted and christened "Health for
All"9. There is a very strong emphasis on the
close relationship between physical, social and spiritual health: a legacy
consistent with biblical standards.
The General Conference of Seventh-day Adventists
Working Policy clearly reaffirms the obvious fact that:10
The Seventh-day Adventist Church has, since its
inception promoted a philosophy of health and healing. While developing a
system of health care institutions which belt the globe, a health-promoting way
of life has been taught to the church membership. Teachings based on broad principles
found in the sacred Scriptures, and more explicitly expressed in the counsels
given by Ellen G White, have in recent years been increasingly substantiated by
the findings of scientific research. These findings have clearly demonstrated
the health superiority of Seventh-day Adventists, especially of those who more
closely adhere to the health philosophy of the church.
The concept of PHC, therefore,
is not new to SDAs. The components or elements (outlined earlier) are closely
related to what Mrs. Ellen White and indeed the Seventh-day Adventist Church
call natural remedies - "Pure air, sunlight, abstemiousness, rest,
exercise, proper diet, the use of water, trust in divine power."11 The acronym that is often used to
summarize this is NEWSTART:
N = Nutrition
E = Exercise
W = Water
S = Sunlight
T = Temperance
A = Air
R = Rest
T = Trust in God
NUTRITION: Seventh-day
Adventists promote the use of plant-based foods such as vegetables and fruits,
legumes, nuts and others. These constitute the original diet God recommended to
man. They are known to contain the required vitamins, minerals, proteins,
carbohydrates and fats and oil. However, adequate preparation and effective
combination of these foods require great care and skills. Less emphasis is
placed on the use of animal foods because the "practice of eating largely
of meat is causing diseases of all kinds, - cancers, tumors, scrofula,
tuberculosis."12 To the
SDAs, what you eat and how, when and where you eat what you eat is of great
importance.
EXERCISE: Overeating and
inactivity are often the major causes of some diseases. Clearly put, "Continued
inactivity is one of the greatest causes of debility of body and feebleness of
mind."13 A well-planned regular
exercise program that lasts for not less than 20 minutes, and for a minimum of
three days per week is healthful.14
WATER: Regular use of clean
water to replenish what is discharged through urine, sweat, etc is very vital
to ensure good health.
In health and sickness, pure water is one of Heaven's
choicest blessings. Its proper use promotes health. It is the beverage which
God provided to quench the thirst of animals and man. Drunk freely, it helps to
supply the necessities of the system, and assists nature to resist disease.15
SUNLIGHT: Exposure to mild
sunlight provides the body with the Vitamin D it needs to function effectively.
According to Mrs. White, "…plenty of sunlight…[is] essential …to the
cheerfulness and vigor of the inmates of the home."16
TEMPERANCE: Avoiding the use
of dangerous substances and judicious use of non-harmful foods is essential for
healthful living. SDAs believe, "In healthful living by moderate use of
that which is good and total abstinence from harmful, unclean foods, alcoholic
beverages, tobacco, narcotics or other drugs"17.
In other words:
The human family [has] brought upon themselves
diseases of various forms by their own wrong habits. They have not studied how
to live healthfully, and their transgression of the laws of their being has
produced a deplorable state of things. The people have seldom accredited their
sufferings to the true cause – their own wrong course of action. They have
indulged in intemperance in eating, and made a god of their appetite.18
AIR: Pure air provides oxygen that the body needs for proper functioning.
Lack of it could cause the following health problems:
The system becomes weak and unhealthy, the circulation
is depressed, the blood moves sluggishly through the system because it is not
purified and ventilated by the pure, invigorating air of heaven. The mind
becomes depressed and gloomy, while the whole system is enervated, and fevers
and other acute diseases are liable to be generated.19
REST: The human body needs
adequate rest each day. About 8 hours of sleep is good for effective living.
Summarily:
Those who make great exertions to accomplish just so
much work in a given time, and continued to labor when their judgement tells
them they should rest, are never gainers. They are living on borrowed capital.
They are expending the vital force which they will need at a future time. And
when the energy they have so recklessly used is demanded, they fail for want of
it...20
TRUST IN GOD: Absolute
confidence in the Holy One that formed man is the key to health. As the
Designer, God has given prescriptions on how man may use his potentials to the
fullest. Constant dependence upon Him who designed the body and man's
environment is a sure way to a life of health and wealth.
The overall goal of
Seventh-day Adventists health message is to bring complete physical, social and
spiritual restoration to all - "health for all". It originated from
the Scriptures and it is community oriented and eternity directed.
Biblical Perspectives
There is always a beginning. No wonder the
first book of the Bible, Genesis, started with the words "in the
beginning."21 Indeed, the beginning is
very significant in many ways. It states how it all began, the major actor(s)
in the event and appropriate solutions applied (Gen.1-3).
The Bible describes the human condition.
In brief, God created a perfect universe and a perfect man, with specific
instructions, including diet. It was not long before man rebelled and brought
upon himself sickness/ill-health and death. Obviously, the consequences were
apparent. Human choice was put to the test and the result was devastating. Even
though God is all knowing, He could not stop Adam and Eve from making a very
important public health decision. That choice had a dramatic impact on the
entire human race. However, man was not left to his fate. God had a plan to
restore him back to Himself. So Christ came to teach us how to live
harmoniously in a hostile world.
This is the beginning of all history and
indeed the beginning of public health. Mrs. White notes:
Before the entrance of evil, there was
peace and joy throughout the universe. All was in perfect harmony with the
Creator's will…. Had [man] remained obedient to God, he would have lived
forever. But when he sinned… he became subject to death. 22
The Bible story is not a fairy tale. "It
is rather the unfolding story of God's creation, our rebellion, His redemption
and our future glory with Him."23
It is, therefore, moral to let the student understand this in the teaching of
history of public health.
Progressive Link
Governments and organizations
are making frantic efforts to address public health questions at the local,
national and international levels. Yet, "over a billion … [in] the 21st
century [are] without having benefited from the health revolution: their lives
remain short and scarred by disease"24
An integration of biblical history of public health, including how health
principles were applied in biblical times could be a very useful tool for an
action-oriented community program designed to enable the student to develop a
culture of health education/promotion that is Kingdom-directed. The student
needs to be equipped to show concern for not only man's physical well being but
also for spiritual healing that comes through Jesus Christ.
Figure 1 illustrates how faith and learning can be
integrated in the teaching of public health. Three historical sources relevant
to public health are presented – Bible, Adventist Health Ministries and
Secular. The Bible relates
the beginning (Creation, Fall, Hope and Public health) to man's present social
and physical health needs, as espoused by the Adventist Health Ministries. The
Secular, historically connected to the Bible via Adventist
Health Ministries provides a focus and a clearer direction to Eternity (Restoration,
New earth and New health (Health for all).
There should be a progressive link between the
beginning, the present and the future. Therefore, a clear perspective on the
foundation of public health based on 'The Beginning"25 is vital in teaching history of public
health in our schools. Sire (1990) identifies the period of history in which we
are now as the "interim period".26
… all of history, as seen by the Bible is interim
between beginning and end. The beginning is in a garden where humankind began
in harmony with God. The end is in a city lit solely by the glory of God where
God's people again will live in peace. The middle is the middle that began with
the Fall and the expulsion from the Garden and ends only when the Lord returns
in triumph over sin and death …27
Sire (1990) quoting Karl Lowith further asserts:
Man's sin and God's saving purpose- they alone require
and justify history as such, and historical time. Without original sin and
final redemption the historical interim would be unnecessary and
unintelligible.28
The Christian philosophy of history, rooted in the
Bible and essential for a balanced curriculum in the teaching of public health, begins from the Bible and precedes contemporary historical
thought. We cannot continue to remain "in the middle of things, in the
middle of history"29
Educated Christian minds need to understand history from the biblical
beginning. They must also firmly maintain the progressive link with the
past and adequately address the global health needs of the community in a
sustainable manner. A deliberate, consistent and systematic link of biblical
history of public health to contemporary historical perspectives is important
in helping the student to comprehend eternal truth.
Integrating Faith and Learning in the Teaching of
History of Public Health: A Case Study
History of Public Health is one of the
core topics on the public health program of the Health Sciences Department of
Babcock University. One of the objectives, among others, is to help the student
understand current historical perspectives of public health and how they tie
with biblical history. The approaches used to ensure that this objective is
achieved include:
a.
Presenting
popular definitions;
b.
Raising
questions from the definitions;
c.
Project:
Students to discover Bible references to public health;
d.
Project:
Students to discover Mrs. White's counsels on health; and
e.
Allowing the
student to reflect on both the historical and biblical viewpoints as the
foundational basis for addressing public health problems.
a.
Defining
public health:
It is a common practice to elicit class
discussion by defining a subject or topic. The three definitions presented
below illustrate how definitions and "matters arising" from such
definitions can become a building block for integrating faith in the study of
history of public health.
Winslow (1920), defines public health as:
a science and art of preventing disease, prolonging
life and promoting health and efficiency through organized community effort for
(a) the sanitation of the environment; (b) the control of communicable
infections; (c) the education of the individual in personal hygiene; (d) the
organization of the medical and nursing services for the early diagnosis and
preventive treatment of diseases; and (e) the development of the social
machinery to insure everyone a standard of living adequate for the maintenance
of health, so organizing these benefits as to enable every citizen to realize
his birth-right of health and longevity.30
Fundamental question 1: when did this "science
and art of preventing disease…" begin?
WHO (1948) defines health as, "a state of
complete physical, mental and social well-being and not merely the absence of
disease or infirmity."31 This definition suggests that there was an occurrence or
event, may be physical, spiritual or both, that caused imbalance or disharmony
in human health.
Fundamental question 2: What is this
event? When did the state of "incompleteness" begin?
According to McGrew (1985), public health
is:
an interdisciplinary field which uses
scientific medicine, engineering specialties, and the social sciences to study
the effect of various environments on human health and to mobilize the
technologies necessary to protect and promote community well-being.32
Fundamental question 3: What is the actual CAUSE of these
"various environments on human health…?"
Common to the definitions above is the
obvious fact that at a point in history, something went wrong with the health
of the people and public health, as a discipline, was designed to attempt to
address the problem. Posing probing questions "foster a safe class
environment that encourages…discussions in the context of mutual trust."33 Answers to these questions are very
pertinent for the student to understand the origin of public health and how
health issues can affect life here on this planet and hereafter.
b. Bible answers to the questions raised
above:
Genesis 1:1: There was a beginning; the
beginning of all created things, including the beginning of human history and
indeed the history of public health. The seal of the Creator God was placed on
all created things as He pronounced them "good"34.
The whole of Gen. 1 depicts, very clearly,
the state of man and the natural world at creation - PERFECT.
Genesis 2: A specific instruction
concerning the knowledge of good and evil was given.
Genesis 3: Events took a dramatic turn
(Gen. 3:6, 7) when Adam an Eve disobeyed the Creator. This singular event,
therefore, changed the history of humankind and of course the history of public
health. The impact was and is still so drastic and indeed traumatic that the
whole creation was directly affected (Romans 8:22, 23). Sire (1990) states that "Jesus [is] the
key to human history – not just as the center point of history where God
redeems His people for their sins but as the key to what history is all about".35
The above perspective helps the student to reflect on
how Divine history impacts on his own life and the health of others.
Seventh-day Adventist philosophy of health could be said to be second to none.
It is Christ-centered and Bible-based. According to Land (1998):
The Bible does not present a
philosophy of history as such, however. Instead it tells stories of the past.
We work with these stories in an effort to analyze the understanding of history
that lies behind them…. As we move from the concrete descriptions of historical
events to the abstractions of the philosophy of history, we need to be careful
that we do not lose sight of the fact that history is the story of people and,
in the Biblical view, their encounter with God.36
There is no doubt that
the study of recent or contemporary history of public health is invaluable. But
a wider understanding of the underlying issues from biblical records is very
important. Lessons learned from teaching history of public health reveals that,
in addition to the student having a balanced viewpoint about the subject, he
looks forward to a time in history when "there shall be no more death,
neither sorrow, nor crying, neither shall there be any more pain…"
(Revelation 21:4). Understanding the total framework helps
the student to discover and examine the underlying presuppositions of the
subject. Disintegration of secular or contemporary and Bible history, which is
the situation in many tertiary schools where public health is taught, denies
the student the opportunity of having this vital background story of human
existence. Public health training anchored on Bible history is relevant not
only in preparing the student for life now but also for life hereafter.
WHO (1999) observed:
It is urgently necessary to recognize and acknowledge
that many of the most serious health problems remain largely untouched by
development efforts. These residual problems, which contribute so heavily to
the human burden of death and disability, sound an insistent call for careful
assessment and most vigorous application of current approaches, as well as for
new approaches - new mechanisms, new partnerships (intersectoral
collaboration), new researches- in order that these problems may be overcome.37
Integration of faith into our public
health curriculum could be a model for addressing lingering public health
questions. It may be the new approach, new mechanism, or new partnership that
the World Health organization (WHO) is looking for. The foundation is Bible
based and can be used to make a difference in the global health care arena.
Our students should not only learn
contemporary history, but also biblical history. One side of the entire picture
is not enough. What is required is to offer students an ample opportunity to
see the entire picture clearly. He should be given all the information needed
to make informed decisions and to develop strategies to address physical,
social, mental and spiritual well being. A
bridge between contemporary history of public health and biblical history
points the way forward.
Conclusion
A missing link exists in the teaching of
history of public health. To bridge this gap, the student of public health
needs to know that there is a beginning (the beginning of all things). Public health definitions and perspectives raise
important questions. Answers to the questions provide a smooth link for
building a biblical foundation needed to discuss current historical
perspectives on public health. A biblico-historical flavor linked to the
current middle-of-the-road contemporary history of public health provides a
balanced worldview that points the student to ETERNITY (new life, new health – Health
for All).
Endnotes