Question

Discuss how Biblical worldview provides guidance to the Christian health administrator in developing willingness and hope as an organizational leader

Answer 1

A Christian worldview has the stamp of reason and reality and can stand the test of history and experience. A Christian view of the world cannot be infringed upon, accepted or rejected piecemeal, but stands or falls on its integrity. Such a holistic approach offers a stability of thought, a unity of comprehensive insight that bears not only on the religious sphere but also on the whole of thought. A Christian worldview is not built on two types of truth (religious and philosophical or scientific) but on a universal principle and all-embracing system that shapes religion, natural and social sciences, law, history, health care, the arts, the humanities, and all disciplines of study with application for all of life.

A worldview must offer a way to live that is consistent with reality by offering a comprehensive understanding of all areas of life and thought, every aspect of creation. As we said earlier the starting point for a Christian worldview brings us into the presence of God without delay. The central affirmation of Scripture is not only that there is a God but that God has acted and spoken in history. God is Lord and King over this world, ruling all things for his own glory, displaying his perfections in all that he does in order that humans and angels may worship and adore him. God is triune; there are within the Godhead three persons: Father, Son, and Holy Spirit.

Health is an issue which profoundly affects everyone from conception to death. Much Christian concern about health is about the ethical issues surrounding the beginning and ending of life.
But health is an issue throughout our lives, affecting patients, carers and health professionals in many ways. This project has sought to look at a wide range of biblical material to provide a resource to enable Christians to respond faithfully and effectively to these important issues. It has particular relevance for Christian health care professionals and the challenges and opportunities they face, but addresses issues of concern to everybody. We are all affected by health: personally; as friends; colleagues; relatives or carers of those who are ill; and as members of a society which invests a significant proportion of national income in health care provision.

Increasingly health is being seen as a responsibility for all and this was made explicit in a national contract for better health in the Green Paper "Our Healthier Nation". This includes an expectation that as partners in a national enterprise (rather than as passive consumers) we should:

• look after our own health
• take care for the health of others (e.g. responsible parenting and transport use)
• be members of families and communities able to provide care in the community
• play a part in local decisions about health strategies and resource prioritisation.

There is a challenge to us here as individual Christians, and also as a church. Historically the church has played a major role in the care of the sick. A continuing expression of this is through hospital chaplaincy as well as the disproportionately large numbers of Christians in caring professions. However as hospital stays become shorter and the focus shifts from hospitals to primary and community care, new ways of linking church and health care will need to be developed. As Christians we have often received little teaching about our role in health care. Prayers for healing and visits to the doctor too easily become unrelated activities, informed by different worldviews. By looking at biblical teaching on health and the relationships involved in its provision, this paper seeks to make a start in bridging that gap.

Some of the challenges currently facing Christians working in the health service to provide a focus and context for the rest of the paper. Christian views on past and current reforms vary widely. Our concern here is not to make judgements about policy orpractice but to highlight the issues where biblical reflection can inform better responses. Those who personally and professionally face these issues on a daily basis will have a more graduated understanding of them Our hope is that, standing back a little from the daily pressures, we will provide a resource which will enable those with a longterm commitment to the health service to work faithfully and effectively for its continuing improvement. There is a long history of Christian involvement in health care provision, both independently and as part of state provision. In the course of this history health provision has been seen as an act of charity and compassion, as an economic imperative, as a right and more recently, as a commodity. Not only has the basis of valuing and providing health changed, but so too have definitions of health and the structures and practices for providing health care. Attitudes to change in the health service vary from the pioneers keen to pilot the latest method/drug to those who keep their heads down and gradually let change wash over them. Responses to particular changes are almost always varied. Some key elements of recent changes have become widely accepted, but a range of concerns remain such as unequal access, management costs, perverse incentives created by performance management indicators, poor coordination of care and too short a term focus. Regarding the practice of health care there is a continuing struggle to integrate adequately the three cultures which can be stereotyped as scientific cure, compassionate care and managerial efficiency. Challenges and opportunities which can be summarised as:

• Developing relationships between General Practices to form Primary Care Groups. These will need to work together in contributing to Health Improvement Plans and in commissioning care. Christian GP practices will have to work with other practices, and communicate and share their vision for health care.
• Changing patterns of relationships between GPs and health visitors and community nurses as their role in public health and developing partnerships with other agencies becomes more important.
• Developing relationships with local authority and voluntary agencies as part of the "duty of partnership" in the pursuit of improved public health and to bridge the cultural differences between them.
• Having the courage to devolve power and risk failure to secure wider involvement in health strategy development.
• Foregoing some personal, organisational and professional body interests to make new structures and partnerships work.
• Accepting some loss of freedom and independence in primary care in return for more responsibility for care provision and commissioning.
• Agreeing local health strategies which take adequate account of spiritual, aspects of health care.
• Keeping patients at the heart of the process.
• And doing all this without significant additional resources.

There are plenty of technical challenges here, but underlying them are fundamental questions about what sort of health we are trying to achieve, who is responsible for achieving it, and what sort of relationships are needed to best provide it. There are many tensions surrounding these questions, and underlying them are clashes in philosophies and values. In the following sections we seek to identify the heart of these debates and see how the Bible can guide their resolution. There are plenty of technical challenges here, but underlying them are fundamental questions about what sort of health we are trying to achieve, who is responsible for achieving it, and what sort of relationships are needed to best provide it. There are many tensions surrounding these questions, and underlying them are clashes in philosophies and values. Underlying the range of definitions are two polarised views: one which generally understands determining factors of disease to be biological malfunctions (the Biomedical Perspective); the other view is broader, taking into account social and environmental factors as causes of disease. It is in this context of the debate between these two perspectives, that Section Two seeks to provide a biblical view of health in order to provide the basis upon which to implement biblical principles for health care. However, in order to comprehend the biblical understanding of health and its relevance in the light of the current confusion surrounding the nature of health and health care, it is necessary to begin by examining briefly these two different schools of thought concerning health. No one can doubt the benefits of biomedicine over the years for its development has contributed greatly to health and well-being. Indeed, prior to its development many died unnecessarily from diseases which today, with biomedical methods, are easily treated and cured. The clearer understanding of the causes of diseases and their physiological consequences has enabled the development of more effective treatment within surgery, radiology and pharmacology as well as preventative programmes through immunisation.

Until recent years, the scientific approach towards health and disease has been pre-eminent. However, this approach is now being challenged by a broader approach towards health (holistic health). Advocates of this approach wish to encourage health consciousness and in doing so enable society to understand the inadequacies of biomedicine. Indeed they wish to show that the concept of health is broader than that which is found within the biomedical perspective. There are two strands or elements within holistic views of health. One strand focuses upon the individual and is mainly associated with alternative medicine. Here, disease is understood as being a sign that there is either dissonance between the individual and the environment, or that the individual's personal dimensions are fragmented. Thus a prerequisite of health is that the spiritual, psychological and physiological dimensions of the person should be integrated. The aim of this strand is to highlight the disunity, and accordingly healing will include restoring unity. This necessarily demands first, that both the professional and the patient work closely together in the healing process; secondly, recognition of the significance of the spiritual experience and thirdly that patients develop the necessary ability to cope independently with the problem. Thus the main concern and role of the professional is to show how patients can deal with their illness, how they can achieve a better state of health and also how they can
maintain it. Therefore, the patient plays a role in the healing process itself and in the aftermath, by engaging in activities and adopting behaviours that are conducive to health. There is also an emphasis on remedies which are perceived to work with the body's natural healing processes rather than against them. This approach has received less acceptance within the health service, partly because many believe that too often it does not withstand scientific assessment of clinical effectiveness. In this debate a fundamental clash of underlying philosophies is revealed. There is much greater acceptance of this strand of holism, not least because it can be seen to complement biomedicine by balancing any reductionist understanding of the causes of ill health whilst still valuing biomedical treatment as a major part of the response to ill health. The emphasis now is to broaden the practice of biomedicine, which advocates of holismperceive as being narrowly scientific and excluding other factors which may contribute towards health and disease. However, as the previous subsections have indicated, this view is largely a misinterpretation of the biomedical approach and is possibly the consequence of the bioreductionist philosophy which underpins biomedicine. In both public health and primary care there is debate, and at times tension, between biomedical and more holistic approaches. This can be superimposed upon rivalries between different professional groups within the health service. Although it is only right that holistic and biomedical approaches towards health are to be integrated, there is the danger that if the balance is not maintained, medicine could be forced into areas of life which may be inappropriate for it. On the one hand biomedicine could become used in areas of life which previously had been outside its control. Consequently, these areas could become dependent upon medicine. Moreover, there is also the danger that the nature of life itself with all its uncertainties and problems may become medicalised and treated by pharmaceutical or psychological means (i.e. counselling). For example, there is the danger that drugs may be prescribed for the housewife who suffers from depression because she feelsundervalued as a person in a society which values careerism, power and status Intervention ofthis nature however, only adds weight to the bioreductionist view that all problems which affect health are to be regarded as resembling disease disorders and malfunctions. By concentrating upon the individual and the spiritual dimensions of cure encouraging immediate forms of respite, such as meditation, exercise and healthy eating patterns, thisindividualistic strand of holistic thinking fails to address the needs of vulnerable members of society who are most at risk from economic and social forces. Indeed, this ideology is unlikely to touch those who are at high risk. This is because those who live in despair and without a sense of hope may find their primary source of pleasure and consolation in adopting unhealthy behaviours (such as excessive drinking). Many of the techniques and practices are unrealistic for the poorer and marginalised members of society. For example, healthy and fresh foods such as organic foods, wholemeal bread and high fibre based products are often more expensive than products which are high in fats and sugars. Moreover, some of the techniques (health clubs, yoga classes, etc.) require substantial financial resources and are unattainable for those whose immediate concerns may be issues such as job insecurity, poor income and occupational health hazards which in the latter, could result in longterm sickness and therefore lower income. Within our present system, there is much diversity concerning the nature of health care and therefore the responsibilities of health care professionals. On the one hand we have professionals who advocate a purely scientific understanding of health and disease. On the other, we have holistic perspectives which, being comprised of two different views, may focus upon the integration of persons with themselves and the environment (whole person centred) or upon the implications that environmental, economic and social factors may have health and disease. Arguably as we shall discuss below both medical and holistic upon approaches to health fail to address the roots of the problems and issues surrounding health today - the issues which cause problems in the environment and society and put pressure upon individuals and their relationships, perhaps even driving them towards adopting unhealthy behaviours.

By turning to the Bible, we can gain great insight concerning health. The Bible informs us of the proper nature of health and therefore provides guidelines concerning responsibilities healthwise - for professionals, members of society and for society as a whole. Moreover, biblical teaching concerning health goes a step further for it is in its understanding of the person, and of society as a whole that we find the roots of the issues and problems surrounding health and health care today.