Scriptural Basis for Public Health (Community Health) in developing countries

1. Public Health and Ministry<br />Scriptural Basis for Public Health in Ministry<br />By John R. Wible, General Counsel (retired)<br />Alabama Department of Public Health (USA)<br />Public Health in the Old Testament<br />God created the Heavens and the Earth. Then after all the “things,” God created man. An interesting thing about man, man is created in the image of God. God exists in a spiritual “community.” While God is One, He is composed of three separate personalities or persons. The three persons must of necessity exist or “live” in perfect community. Since man is made in God’s image, man is also made to live in community. While God’s spiritual community is perfect, man’s is not because of the fall of Adam and Eve. Note that it was not until after the fall that Adam “knew” Eve and she bore her first child. Many more followed and the human race was on its way.<br />Early on, we note that God institutes childbirth and states that it will be full of “sorrow” and pain. When there were few people, there was no need for many rules or practices by which to govern the human race, but as the race grew in size, God had the need to create certain conventions by which the race governed itself and by which the race protected itself from itself. One of those conventions was the giving of the Law to Moses. Obviously, prior to Moses, there were many civilizations, all governing themselves with various laws for the protection of the society. We shall, however isolate on the law recorded in the Bible as revealed to Moses, especially those that deal with community or public health. <br />Likewise, prior to the giving of the law to Moses there are a number of “plagues” referred to in the Bible, some of zoonotic origin, IE., the infestation of the frogs, lice, flies, and locusts. Others, however, are of contaminatory origin and others of pathogenic origin, IE. diseases of livestock and human boils.<br />The list of “plagues” would not be complete without reference to the plague of natural disaster, localized or “targeted” hail, and of course, the coup de gras, the plague of death itself found in Exodus 12: 29-30.We will perhaps never know the etiology of the plague of death that fell selectively on the Egyptians and apparently, the non-observant Hebrews who failed to put the lambs’ blood on the door posts as instructed by God through Moses. Professor Greta Hort theorizes that the plagues were all a “chain reaction” beginning with an algae bloom.<br /> [The] first plague, of blood, was supposedly a massive amount of red algae, plus a huge quantity of red earth washed into the Nile by excessive rains on the Abyssinian plateau. These algae allegedly de-oxygenated the water, thus killing the fish, which somehow gave rise to anthrax bacteria. The frogs then sickened, left the river (the second plague) and died. Hort’s third plague was mosquitoes, which had bred in the floodwaters, and her fourth was the biting fly Stomoxys calcitrans, breeding in the decaying plants left by the retreating Nile flood. The livestock disease of her fifth plague was anthrax spread by the dead frogs. The sixth plague, of boils on animals and people, was supposedly skin anthrax transmitted by the biting flies.<br />Of course, also according to Hort, the seventh plague, of hail and thunder, was a coincidental local weather feature, which also promoted the locusts of the eighth plague. The ninth plague, of darkness, was allegedly caused by a desert sandstorm known as a khamsin, which blotted out the sun by throwing into the air the blanket of fine red dust from the first plague, left on the ground when the widespread Nile floodwaters receded. <br /> Hort’s tenth plague was not the death of the firstborn, but the destruction of the last remains of the ‘first-fruits’ of the harvest, ‘due to a corruption of the Bible text.’ Needless to say, Hort’s theories are widely disputed by both scientists and Biblical scholars.<br /> Beginning with their freedom from the Egyptians brought about by God at the Red Sea in Exodus 14, the Hebrews or Israelites come to the critical time and place in their history – the giving of the law by God to Moses at Mt. Sinai. The first three commandments deal with man’s relationship to God, but the last seven deal with man’s relationship to himself in community.<br />While we Christians all know and can probably quote the Ten Commandments or “Words,” the ancient Israelites did not isolate on the Decalogue alone, but took God’s words on an equal footing with the Decalogue. Hebrew scholars tell us that the ancients saw God as giving in the Torah, or first five books of the Hebrew Bible, a total of 613 “commandments.” Many of them dealt with public or community health.<br />Proverbs 1:7 states that quot;
the fear of the Lord is the beginning [starting point] of knowledgequot;
. When we look to Scripture for instructions about health, it is remarkable what God, our Creator has revealed. Among the 613 “Words,” we find powerful tools designed to prevent disease and promote health. In fact, God told the Israelites, through Moses, that if they followed the “Words,” or the “Law,” they could avoid the curse of disease. <br />For example, the Biblical reference to clean and unclean animals is plan and straight forward. Nevertheless, many assume these ancient dietary regulations are no longer relevant and that Christians have been liberated from quot;
outdatedquot;
restrictions. Some commentaries often spiritualize away these important laws. However, others get the fact that quot;
priests were public health officers in addition to their religious role.quot;
Religious leaders in ancient Israel taught people not to eat unclean animals. A close examination of the life and times of the Israelites in relation to these animals reveals that many of these “unclean” animals were, in fact unclean because they carry disease-causing organisms. <br />We now know that eating undercooked flesh of pigs, bears, rabbits, dogs and horses can transmit tularemia and trichinosis to humans. Moses told them that all shellfish were considered unclean. Modern science tells us why. Crayfish and lobsters are scavengers that feed on dead organisms that can transmit disease. Filter-feeding clams and oysters concentrate viruses that cause hepatitis and paralytic or neurotoxic shellfish poisoning. Liver fluke infections are common where raw fish and crayfish are widely consumed. These diseases can be prevented by not eating foods God called quot;
unclean.quot;
A common expression is that “an ounce of prevention is worth a pound of cure.” In practice, then, avoiding these foods was cheaper and more effective than treating disease. <br />Likewise, the prohibition against drinking the blood of the animals found in Lev. 11:2, et seq., served to prevent parasitic infection. Meat was to be eaten on the day it was slaughtered or at the latest, the next day. Otherwise it must be incinerated. This obviously prevents the ingestion of meat that has become tainted. Further, meat offered for sacrifice must be “without blemish.” Besides the spiritual and prophetic nature of such command, we must remember that meat offered for sacrifice was not all consumed by the fire, but the priests were entitled to eat a portion thereof which was their sustenance. Their diet should be low in animal fat. This prevented obesity, referred to as a sign of complacency and apostasy by Nehemiah. <br />Another example of Moses’ Law and community health is found in Leviticus 11:32–40. There are found admonitions to avoid contact with animals that have died. Likewise, porous earthen vessels, potentially contaminated, were to be destroyed to avoid spreading disease. Again, in modern times, we learn that these biblical regulations are consistent with sound microbiological techniques, and are fundamentally important in fighting infectious disease.<br />It was the priests' job to teach and explain these laws. Priests were to designate as unclean those who had contagious diseases characterized by skin rashes, such as leprosy, measles, smallpox and scarlet fever. Such individuals were to be isolated from others to prevent the spread of disease.. These biblical guidelines are the basis of medically sound quarantine procedures that have been used for centuries. <br />Bible guidelines include avoiding contact with personal items of sick people that could transmit germs. Contaminated items were to be washed or burned (which destroys microorganisms). Biblical health instructions even applied to dwellings—mold or fungal growth had to be scraped off, or a house would be quarantined or demolished. Cracks, which harbor ticks and other disease-bearing bugs, were to be plastered.. The priest functioned as both a public health educator and a building inspector, to promote health and prevent disease. <br />The Levitical Laws acknowledged that body fluids could be a vehicle for transmitting disease. Contact with human waste materials, nasal discharges, tears, saliva and other fluids, or contact with soiled towels or linen, can spread infectious disease. Trachoma—a leading cause of blindness—is spread by contact with soiled hand towels and eye-seeking flies. Those coming into contact with fluids from a sick person had to wash their hands and clothes in water, bathe, and remain isolated from other people until evening as a precaution against spreading disease. Men and women were to bathe after having sexual relations. The purpose of these sanitary laws was to promote health and prevent disease. They were not just ceremonial rituals. <br />One of the most practical and powerful biblical admonitions stated that when people live together, human wastes were to be deposited outside the living area and buried. Further, the “latrines” were to be posted so no one would walk over them. The same practice was practiced even as late at World War I. Today we know that this prevents waste materials from coming into contact with people, flies and other organisms that transmit disease. It likewise, prevents the contamination of water supplies. A number of enteric diseases, such as diarrhea, dysentery, hookworm, roundworms, cholera and typhoid, result from contact with human waste. Thus, Mosaic command concerning wearing shoes and not using human waste as fertilizer were also important preventive measures. <br />The sanitary disposal of human waste, and access to clean water, are two of the most important ways of preventing disease. One physician stated that if these two goals could be achieved, nearly 75 percent of Africa's diseases would disappear! And it was to the priests, today, the pastors, that God has given leadership in the promotion of these goals. <br />The segregation of persons who had come into contact with something “unclean” or who had contracted leprosy was the early forerunner to modern quarantine.<br />The Levitical Law took a strong stand against adultery, fornication, homosexuality and other unhealthy sexual activities. Sex outside marriage was labeled a sin, and in many cases was punishable by death in Old Testament times. Public policies like this—promoted by religious leaders and backed by civil authority—were designed to prevent the spread of sexually transmitted diseases, today, including HIV/AIDS.<br />Clean water was also a public health concern of the Mosaic Law. Flowing water such that encased in limestone and freed by Moses in Exodus 17:6 was preferable to standing water as stagnant water might contain natural pollutants such as dead animals or animal waste or vectors for disease. The “fiery serpents” which infected the Israelites in Numbers 21:6, et seq. may have been caused by a parasite ingested by the drinking of stagnant water. In Exodus 15:25, Moses “sweetens” the bitter water at Marah by stirring it with a barberry stick. This may have had the effect of disturbing the stagnant water and allowing the fresh water below to well up. Lastly, Elijah is seen to be purifying by the addition of salt, polluted water that had caused an epidemic of spontaneous abortions in 2 Kings 2:21.<br />New Testament Arguments for Public Health<br />I wear a bracelet that has “WWJD” on it which stands for “What Would Jesus Do?” Jesus clearly had a wonderful healing ministry as reported by all the gospel writers. However, equally as clear is Jesus’ support the Old Testament public health requirements referred to supra. Matthew 5:17-18 tells us:<br />17 “Do not think that I have come to abolish the Law or the Prophets; I have not come to abolish them but to fulfill them. 18 For truly I tell you, until heaven and earth disappear, not the smallest letter, not the least stroke of a pen, will by any means disappear from the Law until everything is accomplished.<br />In Matthew 8:1-3, Jesus heals a leper and then tells him to go show himself to the priests as the Law of Moses commanded.<br />1 When Jesus came down from the mountainside, large crowds followed him. 2 A man with leprosy came and knelt before him and said, “Lord, if you are willing, you can make me clean.” <br /> 3 Jesus reached out his hand and touched the man. “I am willing,” he said. “Be clean!” Immediately he was cleansed of his leprosy. 4 Then Jesus said to him, “See that you don’t tell anyone. But go, show yourself to the priest and offer the gift Moses commanded, as a testimony to them.” <br />The same event is recorded in Mark 1:40-45 and Luke 12:5-16.<br />In John 8, we find the sweet story of the woman taken in sin. In this story, while Jesus is teaching, some men bring a “woman taken in sin” to Jesus to judge. In response, Jesus dares “he who is without sin” to cast the first stone. Of course, none do. Jesus forgives her sin and tells her to go and sin no more. While there is deep theological meaning in the story, it is also a statement against the spread of communicable disease. If the woman were a prostitute, and the evidence from the story is so, she could well be infected with a sexually transmitted infection (STI.) If so, by telling her to do her sin no more, Jesus is controlling the spread of the STI.<br /> 2 At dawn he appeared again in the temple courts, where all the people gathered around him, and he sat down to teach them. 3 The teachers of the law and the Pharisees brought in a woman caught in adultery. They made her stand before the group 4 and said to Jesus, “Teacher, this woman was caught in the act of adultery. 5 In the Law Moses commanded us to stone such women. Now what do you say?” 6 They were using this question as a trap, in order to have a basis for accusing him. <br /> But Jesus bent down and started to write on the ground with his finger. 7 When they kept on questioning him, he straightened up and said to them, “Let any one of you who is without sin be the first to throw a stone at her.” 8 Again he stooped down and wrote on the ground. <br /> 9 At this, those who heard began to go away one at a time, the older ones first, until only Jesus was left, with the woman still standing there. 10 Jesus straightened up and asked her, “Woman, where are they? Has no one condemned you?” <br /> 11 “No one, sir,” she said. <br /> “Then neither do I condemn you,” Jesus declared. “Go now and leave your life of sin.” <br />In 1 Tim. 5:16, we find Paul’s famous quote concerning wine, “Stop drinking only water, and use a little wine because of your stomach and your frequent illnesses.” It may well have been that Timothy was frequently infected with waterborne illness from drinking polluted water. The alcohol generated in the fermentation process in wine kills off these impurities. For this reason, Timothy is urged to avoid polluted water and drink wine instead.<br />The clear thrust of many biblical principles is to prevent problems before they arise. Proverbs 22:3 states that quot;
a prudent man foresees evil and hides himself, but the simple pass on and are punished.quot;
From a community or public health perspective many diseases can be prevented merely by taking wise precautions ahead of time. The sanitary disposal of human and animal waste prevents contact with people, flies and other organisms that can spread disease. Sexually transmitted diseases—including HIV/AIDS—can be prevented by obeying biblical instructions concerning chastity. That is why God instructed religious leaders to promote these behaviors. That is why today’s pastors must take up that mantle.<br />