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CMC Archive Project

The Question

In 1974, the World Health Organization (WHO) formulated a program for the provision of medical services known the primary health care movement that was subsequently expanded and adapted at the WHO's Alma Ata Conference on PrimaryHealth Care in 1978.  The conference and the ensuing Alma Ata Declaration has provided the basis for the primary healthcare movement of the WHO and other public health and development agencies up to the present.  The Declaration stated that"governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attainingthis target as part of development in the spirit of social justice."[1]

The Christian Medical Commission (CMC) of the World Council of Churches (WCC)played a formative role in the primary health care movement.[2]  A decade before the WHO's formulation of primary medical care, the WCC convened medical missionaries, health care professionals, and Christian theologians in Tübingen, Germany on two occasions.  These consultations occurred at a certain historical and cultural point in which the concepts of medical missions and evangelism were being strongly critiqued and independent nations were rising across Africa and Asia from the former colonies of the European colonial powers.  The health systems that were created and supported in these countries through faith-based networks were part of the legacy of colonial medical missions.  They provided a structure for providing services in the newly independent colonial states that made healthcare delivery possible; in fact, in many instances they still provide a significant proportion of health service delivery today.[3]These cultural and theological critiques also sought to reformulate the role ofsuch health systems, constructed and maintained as part of colonialist assumptions, in light of a new conceptualization of community centered medical and public health service provision in the newly emergent postcolonial context.The Tübingen consultations were the foundation for this reformulation.  As such, they laid the foundation for the creation of the CMC in 1968 and the CMC laid the groundwork for the establishment of the WHO's primary health care movement.

The world of 2012 is far removed from that of the mid 1960s or 1978; however, those differences are not well understood or examined in the emerging scholarship on the relationship between religion and public health care.  Interdisciplinary scholarship that helps us understand the meanings between these dates using the history of the CMC as alens could illumine those differences and enrich our understanding of the effect of religion on global health and development initiatives in at least four ways:

First,this research could examine the historical antecedents that led to the rise of the CMC in the 1960s.  Those antecedents were both theological and cultural in nature. At that time, the World Council of Churches was influenced by theological perspectives from liberal Protestantism that supported an attitude of self critique regarding Christianity's involvement in colonial power structures.  As I mentioned above, this self critique in regard to health care demonstrated the ways in which missions and evangelization were religious forces exercised in support of colonization.  Such perspectives led to are-imagining of the role and purpose of mission work, to an appreciation for other religious traditions existing in cooperation with Christianity, and to a cultural-political critique of the ways in which Christianity had been implicated in colonialism.

These ideas created a rich ground from which the ideas of the primary health care movement could spring.  In this light,the second contribution of this research would be in tracing the connections between these theological and cultural perspectives and the values and emphases embedded within the primary health care movement within the WHO.  Those emphases included a focus on the social forces that contribute to poor health not only for individuals but also for larger communities, an appreciation of local practices that contribute to health rather than the knowledge of the outside medical expert or of Western models of health care delivery, an acknowledgement that healthcare service delivery had been implicated in the broader socio-political agendas of colonialism, and a broader recognition that medicine and healthcare services always have cultural and political implications.

These ideas emanating from the early primary health care movement have continued to influence public health research up into the present.  The examination of those influence constitutes the third contribution of this research. Today, the WHO and other public health researchers and practitioners contribute to a burgeoning field that is examining the social forces that contribute to health disparities or encourage greater health equity.  The study of these forces, commonly referred to as the social determinants of health, has led to a much broader, sustained engagement between the health sciences and the social sciences.  This collaborative research grant could employ humanities disciplines to demonstrate the ways in which religion created the precedent for this present-day research and illuminate the complexity of this field in new ways.

Fourth and finally, the research could highlight the cultural changes that have impacted Christian theological thought and practice and public health research and practice since the formation of the CMC and articulation of the Alma AtaDeclaration. As research into the influence of religion on medicine and public health has emerged over the last decade, the predominant theological and cultural perspectives employed have mirrored those that were prevalent fifty years ago at the birth of the CMC: a spirit of self critique, an emphasis on social justice as the foundation for the church's work in the world, and an appreciation for various religious traditions. While these perspectives have undoubtedly shaped religion's relationship to medicine and public health, a cultural historical perspective demonstrates that these are not the only—or even the predominant—perspectives in globalChristianity in 2012.  Evangelicalism andPentecostalism have become more widespread and yield much greater social power than does liberal Protestantism.  Public health practice has also experienced tremendous changes since the Alma AtaDeclaration.  The unforeseeable impact ofHIV/AIDS has fundamentally changed the landscape of global health and development.  In addition, neoliberal economic policies and structural adjustments to long-term debt have impacted global health policy and development.

The rising influence of Evangelicalism and Pentecostalism, the widespread of prevalence of HIV/AIDS, and the adoption of new macro economic policies are forces that create a different context from that of the 1960s and 1970s.Understanding these forces will be important for advancing the interdisciplinary field of religion and health. A Collaborative Research Program could be developed with just such an agenda.

Academic Fields Involved in This Study

Unique Resources at Emory That Could Contribute to a Successful Proposal

[1]"Declaration of Alma-Ata International Conference on Primary Health Care,Alma-Ata, USSR, 6-12 September 1978," (Geneva: World Health Organization,1978).  Online: www.searo.who.int/LinkFiles/Health_Systems_declaration_almaata.pdf

[2]For a fuller description of the role of the CMC in the primary health care movement, see Socrates Litsios, "The Christian Medical Commission and theDevelopment of the World Health Organization's Primary Health Care Approach," American Journal of Public Health 94, 11 (2004): 1884-1893.  See also Gillian Patterson, "The CMC Story,1968-1998," Contact 161-162 (1998):2-52.

[3]See Pamela Klassen, Spirits ofProtestantism: Medicine, Healing, and Liberal Christianity (Berkley:University of California Press, 2011), 52-56 for a discussion of the Tübingen consultations, the theological perspectives that supported them, thehistorical-cultural context that led to them, and the influence on the consultations in the establishment of the Christian Medical Commission.