OPINION PIECE
Robert E Aronsona
a DrPH, MPH, Professor, Public Health Program, Taylor University, Upland, IN, USA
Disparities in population health statuses are tied to inequities in society, and not just differences in personal decision-making and behavior. Christians should (and must) play a role in confronting these inequities, based upon three biblical themes: 1) the instructions in the book of Leviticus regarding the Sabbath year and the Year of Jubilee as a way to protect the economic system from producing insurmountable inequities and degrading the environment; 2) the eschatological image of the New Jerusalem in the book of Isaiah, with its focus on shalom in contrast to a religion focused on personal piety in the face of oppression and social injustice; and 3) Jesus’ teachings about the kingdom, which include its imminence and the counter-cultural nature of its ethic. The notion of the kingdom can be applied in the lives of Christians, particularly those involved in public health, through individual acts, corporate acts in the context of the church, and state-led actions to bring about social change to achieve social justice. Social change can be described as an act of reconciliation in which systems of society are redeemed by the power of kingdom principles.
Key words: social change, kingdom of God, public health, systems thinking, justice.
In American evangelicalism, and the society more generally, the approach often taken to explain disease (as well as any kind of misfortune) reflects the broad cultural value attached to personal responsibility and the promise of the American dream. Individual success is built upon individual effort, and failure indicates individual deficiencies of effort, skills, or ambition. While individuals must make responsible choices, and their behaviors are important to their health, health and disease are not solely explained by the behaviors of those afflicted, and not all behaviors are a matter of choice.
In the Gospel of John the disciples asked a question about a particular man born blind. “Rabbi, who sinned, this man or his parents, that he was born blind?” (John 9:2 [NIV translation used throughout]) The question reveals an assumption about disease causation that was common in that day. Even in our day, when looking upon an individual with a chronic condition, we are likely to ask the same question. Instead of “sin”, we may substitute the word “behavior”. Because public health looks at populations rather than individuals, the questions we ask are different. We may be more focused on recognizing patterns of exposure and disease across communities and populations. Different questions lead to very different conclusions. For instance, if we ask the question, “Why did this infant die?” our response might be related to the infant’s gestational age and weight, congenital malformations, or issues related to health or behaviors of the mother during pregnancy. An alternative question might be, “Why do we see rates of infant mortality among African American infants that are twice the rates among white non-Hispanic infants?” When asked this way, we must examine patterns of exposure that may help to explain differences in rates of disease between population groups.
The field of public health has throughout its history recognized the important role that characteristics of the physical and social environment contribute to the health status of individuals by exposing people to hazardous or stressful conditions, and by shaping or constraining people’s behaviors. By recognizing these patterns, we can identify features of the environment that can be changed to produce better population health, including changes in the physical environment, changes in policies and systems, and changes in social norms and culture.
In this article, I will provide a biblical foundation for Christian engagement in social action to correct the injustices and inequities of societies that contribute to public health problems. This will require, first of all, an understanding of how disparities in population health statuses are tied to inequities in society and not just differences in personal decision-making and behavior. Then I will describe the role that Christians should (and must) play in confronting these inequities based upon three biblical themes: 1) the instructions in the book of Leviticus regarding the Sabbath year and the Year of Jubilee as a way to protect the economic system from producing insurmountable inequities and degrading the environment; 2) the eschato-logical image of the New Jerusalem in the book of Isaiah, with its focus on shalom in contrast to a religion focused on personal piety in the face of oppression and social injustice; and 3) Jesus’ teachings about the kingdom, which include its imminence and the counter-cultural nature of its ethic. Finally, I will describe how the notion of the kingdom can be applied in the lives of Christians, particularly those involved in public health, through individual acts, corporate acts in the context of the church, and state-led actions to bring about social change to achieve social justice. Social change can be described as an act of reconciliation in which systems of the society are redeemed by the power of kingdom principles.
Public health as a profession began to take shape in the mid to late 19th Century, but did not appear out of thin air. Populations have lived with issues surrounding birth, illness, disability, and death throughout history and found ways to explain them that reflected worldviews, culture, and societal values.1 This is as true today as it was during the time John Snow was investigating the great cholera outbreaks of 1848 and 1854 in London.2,3 Some believed it was punishment for sin, others felt that it was due to bad smells (miasma), but no one knew about the tiny bacteria that caused it. Even without knowing the cause of cholera, Snow was able to determine that it was being spread by something in the water.
Exhaustive histories of public health describe the developing profession and the competing theories of disease causation (and prevention) from pre-modern societies to present post-industrialized societies,2,3 including the unmistakable influence of the socio-political thought of the times with explanations of disease.1 Sylvia Tesh describes the major views of disease causation during the 19th century to include contagion theory, supernatural theory, personal behavior theory, and miasma theory (sometimes referred to as the “bad smell theory”). Moving into the 20th century, these evolved into germ theory, lifestyle theory, and environmental theory, with little room for supernatural theory.1
While germ theory dominated the thinking and funding priorities in public health through much of the 20th century, it was environmental theory rising out of the earlier miasma theory that led to many of the changes that resulted in the reduction of infectious disease mortality. Thomas McKeown’s analysis of mortality data from the 18th and 19th centuries show that most of the reductions in mortality due to infectious disease can be attributed to improved standards of living and living conditions, rather than advances due to bacteriology and the development of vaccines and antibiotics that took place much later. In fact, looking at the decline of infectious disease through the 20th century, we see that most of the reductions took place prior to the introduction of most vaccines and antibiotics.4
With the reduction in mortality due to infectious disease, life expectancy increased. The aging of the population made possible the epidemiologic transition that occurred when chronic diseases (or degenerative and man-made diseases) became the major contributors to mortality.5 With a changed mortality profile, germ theory lost its dominance, giving way to what would eventually become complex multi-causal theories and a greater emphasis on issues related to the life course, the context of people’s lives, and the interaction of physical, social, economic, and cultural factors that increase risk as well as influence behaviors that increase risk.6 This gets us back to the point about the man born blind. The disciples wanted to blame the problem on sin. We like to blame problems on people and their behaviors, such as smoking, eating poorly, and being sedentary. Despite the desire for simple explanations and quick fixes, the problems we face are complex and need responses that will interrupt the cycles and systems that produce the problems. My oft-quoted motto cautions students about jumping to solutions when we do not fully understand the problem or the people experiencing the problem. “Don’t solve problems you don’t understand for people you know nothing about.”
Starting in the mid-1970s and extending throughout the 1980s, both the USA and Canada engaged in a process of re-examining public health approaches to address the health problems we were experiencing. In 1974, the Canadian Minister of National Health and Welfare, Dr. Marc Lalonde, issued a report titled A New Perspective on the Health of Canadians.7 The report included a framework called “the health field concept” that included four categories of factors that came to be referred to as “the determinants of health.” These included human biology, health care systems, environment, and lifestyle.
This report, which had come to be known as The Lalonde Report, determined that issues related to “lifestyle” were more important to explaining premature death or illness than biology/genetics, access to quality health care, or the conditions of the physical environment. With the focus now turned to issues of lifestyle, the result was a shift from a physician-centered approach to one that increased the role of the individual in improving his/her own health by not smoking, eating wisely, and engaging in sufficient physical activity.8 This marked the beginning of the “health promotion movement.”9
In the decade that followed the Lalonde Report, challenges related to encouraging voluntary behavior change to improve health and prevent disease became more apparent. Health promotion practitioners began to realize that an excessive emphasis on asking individuals to voluntarily change their behaviors could result in a “blame the victim mentality.”9 In addition, they recognized that the category “lifestyle” from the Lalonde report was in many ways inseparable from the other categories of determinants. What was needed was greater cross-sector collaboration to create conditions in which healthier behaviors were encouraged and supported through health education, public policy, new legislation, the enforcement of existing laws, and eliminating barriers to healthy behavior and healthy living.9
A broader notion of “health promotion” emerged during an international conference on health promotion sponsored by the World Health Organization in 1986. This conference took place in Ottawa, Canada, and resulted in a report called The Ottawa Charter for Health Promotion.10 This report became highly influential and still remains so. The document clearly pushes public health in the direction of addressing the fundamental causes of population health problems.
It is here where evangelical objections (and societal objections more generally) to public health efforts begin to become more apparent. With public health’s embrace of a perspective that understands that population health is a result of a broad set of health determinants, including social determinants, solutions to public health problems extend far beyond education and persuasion for voluntary behavior change or technical and medical interventions to halt the spread of disease. Furthermore, the public health field recognizes the limits to personal autonomy and recommends responses that advocate for the common good and to correct the systems of society that produce inequities. In contrast, views among evangelicals are strongly influenced by individualistic ideals, which results in a “toolkit” of responses that do not lead to social justice efforts focused on structural or systems change.11
In the past 30 years, there has been an abundance of literature in public health that describes the work of public health as the work of social justice.12-17 This focus on social justice stands in sharp contrast with an ethic based on market justice and individual responsibility that so permeates our churches and our society.12 In their highly regarded study of attitudes and practices regarding race among evangelicals, Divided by Faith, Emerson and Smith note the important role that individualist ideology plays in shaping attitudes among white evangelicals.18 Tranby and Hartman summarize the perspective of Emerson and Smith regarding the important role of this ideology:
What makes white evangelicals unique, according to Emerson and Smith, is not that they are more racist or supremacist, but rather that they adhere stringently and consistently to individualist, anti-structural ideals and discourse.19
There is evidence that evangelicals may understand the structural or systems factors that may produce inequities or social injustices (including systemic racism), but that this understanding may not lead to engagement in systems change. In effect, social injustices are recognized, but there may be differences among evangelicals in their willingness to take action to change structures.11 In their grounded theory analysis of interviews with 15 self-identified Christians in a Midwestern state, Todd and Rufa identify differences in meaning of the term “social justice” among respondents, including social justice as: meeting basic needs, changing social structures to address inequities, promoting human rights and dignity, and as a religious responsibility.11
Interestingly, even among Christians that recognize the systems factors that produce inequities, internalized religious views may be in conflict with this understanding, producing responses that focus solely on meeting basic needs.11 These may include an emphasis on accountability for personal behaviors or even fear of losing the balance between evangelism and social action.20,21
Furthermore, the public health system in the USA is largely (but not exclusively) a function of the government, particularly government at the local level (county health departments). Certainly, private non-profit organizations, community associations, local congregations, and community members are also engaged in working to enhance the health and well-being of populations. Nevertheless, the significant role of the government in public health is unmistakable. Services provided by government agencies at either the local, state, or national level require funding from somewhere, usually taxes. In addition, some of the tools of the government to create conditions where people can be healthy include policy/legislation and regulation. Some of these impose restrictions on individual and corporate freedoms. In recent decades, evangelicals have been disproportionately represented among conservative Republican voters, whose platform emphasizes small government, low taxes, and individual liberty.22 At times, these values appear to be syncretized into conservative Christian teaching and beliefs.
While there are many approaches to laying out a biblical foundation for Christian engagement in social change, I will focus my attention on just a few. From the Old Testament, I will focus on Levitical instructions regarding the Sabbath Year and the Year of Jubilee, Isaiah’s rebuke of personal piety in the face of injustice and oppression, and Isaiah’s eschatological view of the New Jerusalem and shalom. From the New Testament, I will pull these ideas together using Jesus’ teaching on the kingdom of God as a central organizing framework.
In Leviticus 25, prior to crossing over to the promised land, the Lord God revealed his instructions for the people of Israel regarding the Sabbath year and the Year of Jubilee. This passage provides instructions for living that will protect the health and vitality of individuals, of the land, and of the society. God had already displayed His desire for a rhythm of living that set aside a day of rest every seven days through His example set in the creation narrative. He commands us to follow this example, and Jesus reminds us that this Sabbath day was made for our benefit (Mark 2:27).
The instructions on the Sabbath Year require every seventh year to be a year in which the fields are given a rest from the normal agricultural practices, and allowed to remain fallow.
For six years sow your fields, and for six years prune your vineyards and gather their crops. But in the seventh year the land is to have a year of sabbath rest, a sabbath to the Lord. Do not sow your fields or prune your vineyards. (Lev 25:3-4)
It has been argued that such a sabbatical year for the land represents good practice in sustainable agriculture, as the absence of this practice requires regular application of chemical fertilizers to maintain productivity.23 Increased crop yields after fallow periods have also been widely documented.24
Leviticus then goes on to provide instructions on a year that follows a period of seven Sabbath years, or 49 years. This 50th year is known as a Year of Jubilee. The passage goes on to instruct the people on practices related to the land, possessions, and economic relations during the Year of Jubilee. “In this Year of Jubilee everyone is to return to their own property.” (Lev 25: 13) The passage clarifies what is meant by property. First, the passage states that the land belongs to the Lord, “The land must not be sold permanently, because the land is mine and you reside in my land as foreigners and strangers.” (Lev 25:23) God recognizes that over time, people will be buying and selling, succeeding and failing, and thriving and suffering. This passage makes provisions for His people to prevent the permanent creation of an underclass. Over time it is likely that land and other possessions will naturally (within the economic system of the times) be redistributed within the population, creating disparities in wealth and earning potential. The Year of Jubilee instructs people to return to their lands, even when poverty or misfortune led to the loss of those lands. So the Year of Jubilee made it possible for people to redeem any land that was theirs at the beginning of the 50-year cycle, and anyone who was sold into slavery would be freed at that time.
God’s provision of the Sabbath indicates that He feels that individuals have a need for rest and restoration. The same can be said about the land and the need for a Sabbath year. From the instructions regarding the Year of Jubilee, it seems clear that God is concerned about the growing inequities among his people and that these inequities will occur naturally through differential rates of crop loss, sickness, or misfortune. To prevent permanent inequities among His people (multi-generational poverty), God provided the Year of Jubilee. In summary, God provided a Sabbath for the people, for the land, and for the economy.
The book of Isaiah provides rich insight into God’s heart for His people and His plans for His kingdom. In multiple places, Isaiah provides a strong rebuke of a faith that focuses on personal piety while ignoring oppression and injustice, and a faith that fails to look out for the oppressed, the defenseless, and those who cannot provide for themselves. In the face of these injustices, God declares that He hates their religious practices, that He is hiding His eyes from them, and that He does not hear their prayers.
When you spread out your hands in prayer,
I hide my eyes from you;
even when you offer many prayers,
I am not listening.
Your hands are full of blood!
Wash and make yourselves clean.
Take your evil deeds out of my sight;
stop doing wrong. Learn to do right; seek
justice. Defend the oppressed.
Take up the cause of the fatherless;
plead the case of the widow.
(Isaiah 1:15-17)
And again, in Chapter 58, Isaiah once again sharply rebukes God’s people for failing to address the needs of the oppressed, the hungry, the poor, and the naked.
Is not this the kind of fasting I have chosen:
to loose the chains of injustice
and untie the cords of the yoke,
to set the oppressed free
and break every yoke?
7Is it not to share your food with the hungry
and to provide the poor wanderer with
shelter—
when you see the naked, to clothe them,
and not to turn away from your own flesh
and blood? (Isaiah 58:6-7)
The book of Isaiah is not the only place in the scripture that condemns inaction in the presence of injustice and overt acts of injustice. For instance, similar themes and language are used by both the prophets Amos and Micah. These passages reveal aspects of God’s character and His will for His people. He detests the hypocrisy of personal piety that is blind to injustice or that participates in injustice. His will is that His people actively engage in overcoming injustice both individually and corporately.
In chapter 65 of the book of Isaiah, the prophet paints a literary picture reflecting an eschatological image of the New Jerusalem and the complete sense of wellness or shalom that will characterize this new kingdom. He describes a place where work will continue, but without exploitation. People will enjoy the fruits of their labor and live in peace and harmony with others. Health and longevity will characterize the lives of the people who reside there. Passages such as this provide a window into the future kingdom of God, so that when we pray, “Thy kingdom come, on earth as it is in heaven,” we will have some insight into what God has in mind.
The kingdom of God is considered the central message of Jesus’ life and teaching.25 As a central message, it is reflected in Jesus’ birth, His life, and ministry, His death and resurrection, and His future coming. The books of the Old Testament end with the book of Malachi, in which the people were waiting expectantly for the return of Elijah who would call God’s people to obey God’s law and conform to their calling as God’s holy nation.26 After 400 years of waiting, God broke into history with the urgent call of John the Baptist, saying, “Repent, for the kingdom of heaven has come near.” (Matthew 3:2) The Gospel of Mark begins with the recognition that John the Baptist represents the Elijah that the people were waiting for, and that he was the prophet about whom Isaiah had prophesied.
… as it is written in Isaiah the prophet: “I will send my messenger ahead of you, who will prepare your way”—“a voice of one calling in the wilderness, ‘Prepare the way for the Lord, make straight paths for him.’” (Mark 1:2-3)
The kingdom of God was a central theme in Jesus’ teaching. Matthew and Luke both refer to the proclaiming of the kingdom of God as a summary of His ministry.
Jesus went throughout Galilee, teaching in their synagogues, proclaiming the good news of the kingdom, and healing every disease and sickness among the people. (Mat 4:23)
But he said, “I must proclaim the good news of the kingdom of God to the other towns also, because that is why I was sent.” (Luke 4:43)
The kingdom of God is both now and in the future. The timing of the fulfillment of the kingdom has been debated for centuries, with views reflecting either non-eschatological or eschatonlogical interpretations.25 The implications of these views can be seen in the lives of Christians and the ministry of the Church. Perhaps this is reflected in the differences between those who wait for the rapture of the church and the second coming as the start of the kingdom, and those who work tirelessly to establish God’s kingdom here and now. Some with a pietistic interpretation may see the kingdom in purely spiritual terms, while others may view it as the impetus for social reforms.26 Or perhaps it is reflected in the differences between those who see the central mission of the church as social action and those that see it as the preaching leading to personal salvation. Many evangelicals now see the kingdom as both already inaugurated and waiting for its consummation.25
Luke records an encounter with the Pharisees in which Jesus addresses some of their misconceptions about the kingdom and what it would look like.
Once, on being asked by the Pharisees when the kingdom of God would come, Jesus replied, “The coming of the kingdom of God is not something that can be observed, nor will people say, “Here it is,” or “There it is,” because the kingdom of God is in your midst. (Luke 17: 20-21)
Furthermore, the scripture is clear that Jesus is Lord and that He rules over all things. In short, Jesus rules over His kingdom, which is here right now.
Then Jesus came to them and said, “All authority in heaven and on earth has been given to me. Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age.” (Mat 28:18-20)
And, we are participants in His kingdom right now.
For he has rescued us from the dominion of darkness and brought us into the kingdom of the Son he loves, in whom we have redemption, the forgiveness of sins. (Col 1:13-14)
Yet it is unmistakable that the kingdom is not manifest to its fullest; it awaits its complete consummation. Jesus, in talking to his disciples about the day of his return, said:
Immediately after the distress of those days “the sun will be darkened, and the moon will not give its light; the stars will fall from the sky, and the heavenly bodies will be shaken.” Then will appear the sign of the Son of Man in heaven. And then all the peoples of the earth will mourn when they see the Son of Man coming on the clouds of heaven, with power and great glory. And he will send his angels with a loud trumpet call, and they will gather his elect from the four winds, from one end of the heavens to the other. (Mat 24:29-31)
Jesus’ teaching, as recorded in the Gospels, provides us with insight into the nature of the kingdom of God. Through parables recorded in Matthew 13, Jesus described some of the mysteries of the kingdom: 1) it will not be achieved by power but by hearing and believing (13:1-9, 18-23); 2) good and evil will continue to coexist until the end of the age (13:24-30), and, therefore, it is not about withdrawal; and 3) it begins almost imperceptibly but grows (like the mustard seed) and permeates (like yeast) (13:31-33).
Perhaps the richest passage about the nature of the kingdom is recorded in Jesus’ “Sermon on the Mount.” In these passages, Jesus’ teaching focuses on the ethics of the kingdom.25 Once again, the debate seems to revolve around the issue of whether these ethics are eschatological or non-eschatological. In the beatitudes, Jesus describes qualities of the heart and expressions of the heart that are blessed. “Blessed are the poor in spirit, for theirs is the kingdom of heaven.” (Mat 5:3) With each of these, there is the tendency to write them off as utopian ideals that will not be realized until the consummation of the kingdom. At the same time, it seems clear that Jesus is calling His followers to embrace these qualities now and that the blessings are both now and for the future. The list is challenging to the way the world seems to work. They include those who are poor in spirit, mourning, gentle, hungry and thirsty for righteousness, merciful, pure in heart, peacemakers, and persecuted. (Mat 5:3-11) Jesus goes on to state, “Unless your righteousness surpasses that of the scribes and Pharisees, you shall not enter the kingdom of heaven.” (Mat 5:20) More than just rules of behavior (which the Pharisees were good at keeping), these reflect values of the heart, which result in lives of righteousness.
The Sermon on the Mount redirects the intent of some of the commandments by focusing on the condition of the heart. This is an even harder standard to reach. Rather than the commandment not to kill, Jesus calls His people not to hate or be slanderous of others (Mat 5:22). Going further than the command not to commit adultery, Jesus calls his followers not to look lustfully on another. Because these directives seem to be so unreachable, many evangelicals will set these aside until the fulfillment of the kingdom.27 Some of the other difficult themes of the sermon include the following: forgiveness, grace, faithfulness, integrity/honesty (no need to make an oath), non-resistance, love your enemy, love the unlovable, humility, and simplicity/non-materialism.
Teachings regarding the Sabbath Year and the Year of Jubilee, as well as the rebukes from Isaiah to the people for ignoring injustice while practicing personal piety, are instructive to us regarding values reflective of the kingdom. These focus on responsibilities to each other. The teachings of Jesus on the kingdom instruct us on our responsibility toward relationships and society, and also add an emphasis on the attitudes of the heart. Together (behavior and heart) they provide guidelines for righteous living. Interestingly, early in Jesus’ ministry He cited Isaiah 61:1-2 when speaking in the synagogue in Nazareth, saying:
The Spirit of the Lord is on me,
because he has anointed me
to proclaim good news to the poor.
He has sent me to proclaim freedom for the
prisoners and recovery of sight for the
blind, to set the oppressed free,
to proclaim the year of the Lord’s favor.
(Luke 4:18-19)
He astonished everyone when He sat down and declared that, “today this scripture is fulfilled.” In effect, He was declaring a Year of Jubilee and the emergence of His kingdom.
On a final note to tie some of these themes together, the apostle Paul talks of the current and future work of reconciliation that God is performing both to us and through us. In 2 Corinthians 5:16-20, Paul clearly speaks of the reconciliation that has already taken place in believers, and the mission that God has for us as ambassadors of reconciliation.
So from now on we regard no one from a worldly point of view. Though we once regarded Christ in this way, we do so no longer. Therefore, if anyone is in Christ, the new creation has come: The old has gone, the new is here! All this is from God, who reconciled us to himself through Christ and gave us the ministry of reconciliation: that God was reconciling the world to himself in Christ, not counting people’s sins against them. And he has committed to us the message of reconciliation. We are therefore Christ’s ambassadors, as though God were making his appeal through us. We implore you on Christ’s behalf: Be reconciled to God.
(2 Cor 5:16-20)
In Romans 8:18-23, Paul speaks of the future reconciliation that all of creation eagerly awaits:
I consider that our present sufferings are not worth comparing with the glory that will be revealed in us. For the creation waits in eager expectation for the children of God to be revealed. For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope that the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God. We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption to sonship, the redemption of our bodies. (Rom 8:18-23)
So, God has called His followers to a ministry of reconciliation in which we embody the values of His kingdom and work toward the redemption of all things which God Himself will achieve upon the consummation of His kingdom.
Equipped with insight into the heart of God from the book of Leviticus, the prophet Isaiah, and Jesus’ teaching regarding the kingdom of God, how are Christians called to live? If we have insight into God’s heart and the values that drive His kingdom, shouldn’t we reflect these as well? Shouldn’t these values guide our lives and behavior? What seems to be diverting us from focusing on this? I will suggest at least three reasons.
Evangelicals in the USA have historically placed a great deal of emphasis, and rightly so, on the importance of individual relationship with God and personal salvation. For many, this may mean personal time spent in prayer and worship in which the believer can experience the presence of God and His Holy Spirit. It also provides an assurance to the believer that a place is reserved for her/him in heaven after death. In addition, it may mean a commitment to sharing these truths with others so that they can also receive salvation. While these reflect critical aspects of kingdom living and discipleship, these aspects of the Christian life tend to emphasize the spiritual over the physical and the individual over the societal. Often ignored is the significance of life this side of heaven, except on viewing this life as a trial before real life begins. Salvation is seen as something that individuals receive and not something that comes to creation and society. The important work of redemption extends beyond the soul or spirit of individuals, and includes the whole person (body, mind, spirit, and relationships), as well as all of existence (nature/creation, social systems, political structures). The passages from 2 Corinthians 5 and Romans 8 provide evidence that God wants redemption and reconciliation for people, all of creation, and the created order.
Secondly, the identities of many Evangelicals are tied to their beliefs in Jesus and their membership in His body, which is the church. Very often it is in the context of the local church that the Christian strives to live out her/his faith and where discipleship takes place. At times, this can lead to a protective insulation from the world and a focus on separateness. Forays into the “world” may be brief, structured (as in the context of work), and as “sojourners, aliens, and strangers.” Sometimes this results in an exaggeration of the differences in values between Christians and non-Christians, and an ignorance of the concerns, sufferings, and joys that we share with all of humanity.
One more very important reason why we may not fully embrace kingdom living in the present, may be related to the absence of a robust theology of the kingdom within our churches or what Carl Henry describes as a deficient vision of the kingdom of God.20 According to Russell D. Moore, in Carl Henry’s publication The Uneasy Conscience of Modern Fundamentalism, Henry created the platform for a differentiation of evangelical from fundamentalist.20 Fundamentalism’s perspective of isolationism from engagement in addressing the broader concerns of human life stood as a contrast to the approach taken by the fully engaged Social Gospel orientation held by liberal theologians and mainline Christians. With the leadership of Carl Henry as well as the National Association of Evangelicals and Fuller Theological Seminary, evangelicalism sought to place itself as a third way distinct from these two camps. Theological differences, however, resulted in significantly different understandings and visions of the meaning of the kingdom of God. Dispensational vs. Reformed theologies reflected contrasting views between “Kingdom then” and “Kingdom now” (p. 382).20 Ongoing theological reflection has resulted in a much more widely accepted “third way” referred to as “inaugurated eschatology”, which recognizes the presence of the kingdom now and the final culmination of that kingdom in the future. This perspective is now visible in the greater engagement of conservative Christians in addressing social concerns from HIV/AIDS, human trafficking, and orphan care to the protection of the environment.
Besides these three explanations for evangelicals’ difficulty in embracing broader kingdom living and kingdom values, a significant contributor is the American notion of individual autonomy and personal responsibility while denying the importance of systems and structures that impede or facilitate individual action. These notions appear to be thoroughly syncretized into American evangelicalism which neglects or opposes efforts to engage in action focused on social or systems’ change to address such things as poverty and inequality. Assistance to individuals who are willing to take responsibility is approved.
In this manuscript, I have described public health as having a mission “to create the conditions in which people can be healthy.” This broad view of public health is in response to the decline of infectious disease, the aging of the population, and the growth in importance of chronic diseases and diseases of civilization (including violence, inequality, oppression, etc.). In addition, advances in understanding risk factors for poor health outcomes and disappointment in the potential to impact population health through voluntary behavior change have led to increased consideration of structural and social contributors to health. Public health has always been associated with progressive reform movements for the improvement of the environment and the conditions in which people live. With the emergence of “germ theory” came decades of focus on addressing the biological agents of disease through immunization, antibiotics, and interfering with the chain of transmission. The inability of germ theory to address diseases of lifestyle and living conditions moved public health activists to shift their attention to the social and environmental factors that produce poor health. In keeping with the tradition of progressive reform movements in public health, the field now seeks to reform and/or transform the systems that lead to inequality—those systems that grant advantages (privilege) to some and disadvantages to others. For many in the field, public health is driven by a quest for social justice with the aim of addressing the factors that produce inequity.
In my review of the instructions regarding the Sabbath, the Sabbath year, and the year of Jubilee, I refer to the view that this passage indicates that God is concerned about the wellbeing of individuals, of the land, and of the society. In the instructions regarding the Jubilee, God provided a plan to prevent generational poverty and disadvantage. Furthermore, the passages from Isaiah describe God’s disgust with displays of personal piety while turning a blind eye to injustice and oppression. Finally, the teachings of Jesus declare the emergence of the kingdom, which is both now and yet to come. The fullness of the kingdom will appear with His final return that will bring redemption to all of creation.
The point that I want to make is not that the work of public health is equivalent to the work of the kingdom, but that a Christian engaged in public health work can be assured that efforts to reform the systems and structure of society based on kingdom principles can reflect the Christian’s responsibility to be an ambassador of reconciliation. This ministry can take place through individual redemptive acts to bring about reconciliation of people to God, to each other, and to the creation. It can also be expressed through working together as the body of Christ to bring about transformation of people, places, and policies. Finally, it can also be through Christians joining in societal efforts (such as through the mechanisms of the public health system) to create the conditions needed for people to live healthy lives.