EDITORIAL
May 2016. Christian Journal for Global Health, 3(1):3-10.
Theological foundations for an effective Christian response to
the global disease burden in resource-constrained regions
Daniel W. O’Neill
a
a
MD, MA(TS), Managing Editor, CJGH; Assistant Professor of Family Medicine, University of Connecticut School
of Medicine, USA
Introduction
Given the global spread of Christianity,
Christians are in a critical position to effect radical
change in individuals, communities, and systems
for human flourishing and confront the global
disease burden, injustice, and resource disparity
that exists in the world. The increasing presence,
activity, and faithfulness of Christians among all
peoples are necessary both for improved global
health equity as well as the universal receiving of
God’s healing message. As an expanding move-
ment, the Church has an increasing opportunity to
define health, speak truth, provide care, make
peace, cooperate, set priorities, and mobilize
resources for maximum stewardship in low
resource settings.
Theological Correctives
Understanding the theological roots of our
Christian calling to be a healing community is
vital to an effective and sustainable response to the
current complexities of the global burden of
disease in resource-constrained regions. Serving
God who is the Healer, Comforter, Revealer,
Reconciler, Sufferer, and Redeemer, we ground
our response in the very character and actions of
God. His justice and mercy is revealed in his
actions in history and reflected in his call to social
justice and mercy among the poor and afflicted (Ps
82:3; Prov 31:9; Jer 22:16; Mat 10:8). His call to
stewardship of limited resources and opposition to
greed and partiality is corrective to the waste and
favoritism found in many global health systems
(Lev 19:15; Col 3:5). The high value of all human
life, as made in the image of God, drives his
people to protect and care for the most vulnerable
populations of all races such as the under-
resourced, the unborn, the disabled, and the elderly
at a time when materialist utilitarian ethics and
eugenics are still persuasive forces in a world of
exponential global population growth (Gen 1:27).
1
Jesus’ model of compassionate care-giving to
individuals (sparrows) as well as populations
(crowds) in Matthew 9 affirms both curative care
and public health interventions toward human
health and well-being, in contrast to purely
scientific and rational approaches driven by data.
The concept of new covenant modeled in God’s
character and laws counter an increasingly
impersonal, technologically driven, and mal-
distributed $6.6 trillion global healthcare industry
(2 Cor 3:6).
Global Inequalities and Opportunities
There is an estimated shortage of 4.3 million
health professionals globally, and 57 of the poorest
countries in the world have disproportionately
severe shortages. One billion people have no
access at all to a trained heath worker. Sub-
Saharan Africa has the lowest ratio of trained
health workers and the greatest burden of disease.
There are also marked inequities within each
country with rural areas having the least access,
underlining a call for more innovative system-
based education to meet the demands.
2
There is a similar maldistribution of Church
resources among the unreached and unengaged
4 O’Neill
May 2016. Christian Journal for Global Health, 3(1):3-10.
peoples of the world. Over 2 billion people are
living in 4,841 people groups with very few, if
any, Christ-followers.
3
The value added to the
health of communities when the Church is planted
is inestimable. As communities flourish, there is
increased opportunity for the message of the
saving grace of God to be heard. The ultimate
divine goal and the end of history include every
tribe, tongue, and nation in the manifest blessing
of God’s presence (Rev 7:9). The leaves of the
currently inaccessible tree of life are for the
healing of all nations without exception (Rev
22:2); so neglect of a systemic, cooperative
movement to proclaim this healing message and
plant healing communities everywhere is off track
with the purposes of God. This can be thought of
as a pursuit of universal health coverage.
As the Church has expanded globally, and
has increasing human and material resources in the
global South, she has positioned herself as a
potential influencer for health, particularly among
the poor where Christianity has “a breathtaking
ability to transform weakness into strength.”
4
There are several ways in which the Church can
lead in the contemporary global health enterprise.
Each of these can be grounded in a robust
theology informed by perspectives from the
globalized Church.
Defining Health
The biblical definition of health is more
expansive than the broad generalization from the
World Health Organization (WHO) and involves
restored wholesome relationships with:
1. self — image, self-care, purpose, meaning
2. others — peace-making, intimacy, family
integrity, care for neighbor, equality,
forgiveness, just societies
3. nature — environmental harmony, clean
water, nutrition, medicines, micro and macro-
organisms
4. the Creator — reconciliation, intimacy, and
presence.
Health was the complete state described in
Genesis 2 and corrupted in Genesis 3 and is the
complete state to be gained in the consummation
of a new heavens and earth (Isaiah 66:22; Rev
21:1). This state is best described with the
Hebrew word shalom and can be approximated
and pursued earnestly between these two bookends
of history.
5
Worshiping communities seek to
embody this principle of harmony, but have often
fallen short in practice. When limited definitions
of health are pursued, limited solutions are
applied. Technical and material solutions to moral
and spiritual problems are insufficient — they are
not sustainable. The extent to which Christ-
followers seek to flesh out the fullest definition of
health in public conversations is the degree to
which more effective and sustainable solutions
will bring true lasting and widespread
transformation to the nations.
If human flourishing necessitates a coalesce-
ence of well-being in these four areas, then global
health promotion requires engagement with
concepts of identity and purpose, ecological
stewardship, environmental dominion, economic
consciousness, justice in governmental and non-
governmental systems, and reconciliation with
God. The HIV pandemic highlights the
multifaceted effects of such a disease burden on
whole communities and nations — affecting
economic, social, physical, and emotional
livelihood — “an evil that tears at the very heart of
human life on God’s earth.”
6
This and the myriad
of other diseases & infirmities globally are
tangible expressions of the corruption of the
planet, the often indiscriminate and far-reaching
effects of sin, and the inter-relatedness of all
aspects of life. The divine healing intent toward
human well-being and the purpose of the gathered
community as the “face of healing in the world”
are manifestations of His grace.
7
The gospel
provides a tangible expression of the only hope for
complete healing, and the holistic mission of the
Church must include engagement with all four of
5 O’Neill
May 2016. Christian Journal for Global Health, 3(1):3-10.
these areas to promote sustainable movements
toward health and human flourishing.
Speaking Truth
As Revealer, God not only reveals Himself
in the inspired Word, but also in the magnificence
of the created order and through His Spirit.
Creating the material world as knowable, He calls
us to apply science and observation in a rational
and empirical way to address human problems.
Exploring the mysteries of causation and
following evidence-based interventions is an
exercise of dominion over the natural world.
Discerning solid realities from myths, while at the
same time not denying spiritual truths, creates a
full-orbed approach to human affliction. As He
spoke the world into existence and the Scriptures
into writing, so He calls his people to speak the
truth in love, to provoke one another toward love
and good deeds, and to teach and admonish with
all wisdom (Eph 4:15; Heb 10:24; Col 1:24). This
means that skills, best practices, and reflections
must be shared — growing and learning together
toward the goal of God-honoring improvements in
global health.
8
As Creator, God mandated the naming of
every creature, (Gen 2:19) and Jesus named
demons (Mark 5:9), casting them out when
necessary (Mark 16:17). Likewise, humans
participate in identifying the cause of diseases,
pursuing a cure or prevention when possible.
These include more than pathogenic micro-
organisms or genetic mutations. Increasingly, the
diseases of excess, addiction, and meaninglessness
are affecting low and middle-income countries
(LMICs) — the non-communicable diseases
(NCDs). Three quarters of the 38 million deaths
per year from NCDs are in LMICs.
9
With
economic development and globalization have
come unhealthy food access, sedentary lifestyles,
urbanization, motor vehicle trauma, disordered
mental health, and markets of addictive
substances. Biblical injunctions against gluttony,
drunkenness, inordinate pleasures, abuse, violence,
and laziness are truths that are increasingly
recognized to have widespread health impact in
communities. Neglect of nurture and bonding in
infants also has major effects on public health.
10
Naming these causes of chronic illness and
disability by looking at the evidence and
addressing the systems which promote them are
part of fulfilling this mandate.
Providing Care
A sincere longing for personal and family
well-being is an innate drive of humans who retain
the image of God and long for wholeness, but is
often exploited by the healthcare industry or
denied by oppressive social, governmental, or
religious systems.
11,12
Caution must be given not
to allow the idolatry of physical health and safety
(the diseases we fear) or the idolatry of trusting in
technological healthcare systems or governments
or organizations (the things we trust) to replace
abiding trust in the living “God who heals.” (Ex
15:26)
5
Healthcare contextualized to the culture is
of supreme importance, such as affirming African
traditions of a dying process surrounded by family
at home instead of a hospital.
13
The care rendered
by Jesus was exceptionally compassionate,
personalized, indiscriminate, holistic, contextual,
and self-sacrificial. He expects no less from His
followers, who have unprecedented opportunity to
retain and embody agape other-centeredness in
contextualized care for the afflicted and work
toward justice in all areas of life. After Pentecost,
the Holy Spirit as Comforter empowers believers
to comfort others with a care and concern that is
unnatural and transformational (2 Cor 1:4). A
more robust theological understanding of God as
Healer will empower the Church to follow in
Jesus’ footsteps in the power of the Spirit as
caregivers.
Making Peace
The Church’s mandate to be a blessing to all
nations, founded on the promise to Abraham in
Genesis 12, is a means to counter the curse on the
6 O’Neill
May 2016. Christian Journal for Global Health, 3(1):3-10.
earth and begin to restore shalom on the planet.
Peacemaking is a divine movement to work amid
corruption to restore shalom within individuals,
between people and nations, with the environment,
and with our Creator. As ministers of
reconciliation, we participate in God’s work of
reconciling the whole of creation to Himself (2
Cor 5:18-19). Beyond proclaiming peace with
God through Jesus Christ, this call to the Church
includes mental and physical health promotion and
care, and extends to promote peace in areas of
tribal, gender, class, and ethnic conflict. Those
who sow in peace reap a harvest of righteousness
(justice) in communities impacted by their
presence (James 3:18). This peace is not made
with principalities and powers bent on destruction
and the devaluation of human life such as
pathogenic microorganisms and unjust oppressive
systems. Rather, peace is made with that which is
redeemable: restored self-identity and the
discipline of self-care; favorable pathogens in our
microbiome and soil; the land’s crops and animal
resources; geological and ecological balances;
right relationships in our family and neighbors;
witness in communities; affirmation of wholesome
ethnic traditions and international harmony to
reduce civil conflict.
Cooperating Broadly
Though the Church is designed to embody
the fullness of truth, she does not have a monopoly
on the truth. There was wisdom in the men of the
east in Solomon’s day (1 Kings 4:30), the Queen
of Sheba was thought able to judge the generation
of Jesus’ day (Matt 12:42), and the Cretan poets
were true in their self-assessment of unhealthy
practices in Paul’s day (Titus 1:12-13). If God can
call Nebuchadnezzar His servant (Jer 25:9) and
move the heart of Cyrus (Ezra 1:1), could He not
also use governments and other global health
actors to accomplish His purposes for the health of
the nations? Could the Church consider greater
levels of cooperation to help build health systems
through ministries of health in LMICs?
14
Lancet published a series of articles in June
2015 that showed the important role the Church
plays in healthcare delivery, particularly in areas
poorly served by governmental resources. They
called for greater cooperation and mutual
recognition between governmental organizations
and faith-based organizations (FBOs).
15
Though
Jesus recognized that the people of this world are
more shrewd than the people of the light (Lk
16:8), He also called His disciples to be as shrewd
as serpents and innocent as doves (Mt 10:16).
There are times when the wisdom of the world
uninformed by God’s Spirit and Word will be
foolishness (1 Cor 1:20-25) and that powers
designed to promote human flourishing may be
corrupted and end up constraining it. However,
the Church must witness to those powers,
working, in the words of N.T. Wright, cheerfully
“with the grain of good will” with people of all
faiths or no faith in the art of “collaboration
without compromise and of opposition without
dualism.”
16
This requires deep trust in the
sovereignty and immanence of God in all aspects
of life, relying not on human wisdom alone but on
God’s power to see true transformation and
reconciliation (1 Cor 2:5).
Interdenominational dialog and recognition
of the charismatic nature of the global Church in
the majority world will be necessary for a unified
approach to transformation. Understanding that
among the grassroots poor in Asia, for example,
Christ is seen not as political liberator as in Latin
American liberation theology or among the elites,
but as liberator from fear and fatalism caused by
centuries of internalizing the law of karma, from
fear of spirits, from demonic oppression
(perceived or real), and through healing of
diseases — especially when access to modern
health care is limited or unattainable.
17
Offering
what Samuel Escobar called “transforming
service” validates and confirms the truth and
fullness of the gospel message.
18
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May 2016. Christian Journal for Global Health, 3(1):3-10.
Setting Priorities
Jesus modeled the priority of touch and the
spoken word in healing the sick and integrated the
redemption of the whole person — not resorting to
its reductionist parts, nor to purely technical
solutions. Primary Health Care, embraced in the
1978 Alma Ata Declaration through the influence
of the Christian Medical Commission, and
reiterated in 2008 by the WHO, can be embraced
and enhanced for greater global distribution.
19
Christians can continue to influence goal-setting as
they did with the Millennium Development Goals
(MDGs) and become more engaged to inform
decisions for the next 15 years and beyond.
`This year, the new Sustainable Develop-
ment Goals (SDGs) bring a new level of
sophistication in seeking to be inclusive of many
interrelated elements that contribute to human
health, development, and also to planetary well-
being. Focusing on the complexities of systems,
this goal-setting is explicitly calling for
“transforming our world.”
20
To presume this can
be accomplished without the transforming
presence of Christ and his followers is wishful
thinking.
While both the WHO definition of health
and the SDGs seem utopian, there is value in
setting goals for human flourishing and ecological
stewardship as part of the cultural mandate of
Genesis 1:27-28. Cooperating with all global
health actors with similar goals, Christians can
participate in praying and acting toward these
preferable futures. The third SDG is to “ensure
healthy lives and promote well-being for all at all
ages.”
21
This includes continuation of the MDGs
for reduced maternal and child mortality, access to
essential medications, and control or eradication of
infectious diseases, but adds goals to reduce non-
communicable diseases, mental illness, tobacco
and drug abuse, environmental hazards, and to
enhance work-force and health systems along with
global health threat preparation. Resources, such
as the Disease Control Priorities (DCP-3), help
countries improve health using evidence-based
approaches in low-resource settings.
22
Setting
priorities based on Jesus’ statement, “It is not the
well who need a doctor but the sick” (Luke 5:31)
and Paul’s ambition to make Christ known where
He is not (Rom 15:20) will help us focus on the
poorest, most vulnerable, and most infirm among
global populations and the people-groups who
have not yet experienced the presence of His
people or His word in their own language and
cultural context. This can be thought of as
working toward global health equity.
Mobilizing Resources for Maximum
Stewardship in Limited Resources
Areas
God has graciously provided a collective
abundance of resources on the planet, but they are
just not distributed equally or fully appropriated.
Just as material deprivation can lead to
malnutrition, impaired immunity, crime, and
disease; overabundance of resources can be
harmful to body, mind, and spirit. This unequal
distribution may be the results of oppression,
corrupt systems, climate change, personal sin, etc.,
but it also may be part of the sovereign plan of
God to call his people to exercise the grace of
giving (2 Cor 8:14-15) and to practice justice and
mercy in the world as a sign of the kingdom (Mat
11:5). Would eradication of poverty undermine
Jesus’ statement that we will always have the poor
with us (John 12:8)? Are not the two extremes
worth opposing (Prov 30:8-9)? Is not some degree
of human deprivation beneficial: to feel the need
for redemption, to seek interdependent relation-
ships, to practice patience, and to respond to good
news with gratitude and long for a better hope?
After healing the crowds, Jesus spoke of the
blessings that reside with the poor and gave
warnings to the rich that both may become a
blessing to the nations (Luke 6:17-26).
As Sustainer, God can mobilize unforeseen
resources, but the injustice of an estimated 6%
8 O’Neill
May 2016. Christian Journal for Global Health, 3(1):3-10.
fraud and embezzlement of global Christian
resources must be faced.
23
Participating in
training healthcare professionals for retained
service in LMICs helps meet the vast shortages
and multiplies knowledge, as well as serving as an
opportunity for mentoring. Engaging in advocacy
at the government level to create laws favorable to
enhanced public health and justice is a calling to
witness to the powers and cooperate with
reforming systems for human flourishing.
24
Embracing the public health movement to utilize
community health workers to provide greater
access to care can be a way to distribute Christ-
followers into suffering communities. As
extensions to the reach of health knowledge, these
empowered workers can move the locus of control
from a minority of highly educated to the
“strengthened hands of the poor” (Ezek 16:49),
and through approaches such as Community
Health Evangelism create greater witness to the
truth of causes and cures of disease and the
application of the gospel of peace.
Conclusion
Expanding Christian communities through-
out the world are indeed in a critical position to be
faithful witnesses to the God who heals, to be salt
and light to a health care industry that desperately
needs to provide affordable, accessible,
compassionate whole-person care to every
population, and to influence policy and practice in
global health toward equity and justice. The very
character and nature of God and the call to those
who follow Him inform and inspire intelligent
action, compassionate and comprehensive service,
and effective results for human flourishing.
Though often unrecognized and underappreciated,
the Church needs to press on with increased
confidence and vigor — standing in the gap to
care and advocate for underserved populations,
witnessing to corrupt systems for the greater good,
extending God’s healing presence, and actively
sending multipliers across cultures into all peoples
until all things are made new.
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Peer Reviewed
Competing Interests: None declared.
Disclosures: The contents of this article were presented by the author at the International Conference on
Christian Response to Global Heath Issues at the Universitas Pelita Harapan on December 3, 2015 in
Jakarta, Indonesia and published in the conference proceedings.
Correspondence: Daniel O’Neill, dwoneill@cjgh.org
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