In the struggle to fight COVID-19, terms like “public health” and “community health” have been bandied about in an attempt to describe the ways in which our health as individuals is not dependent on ourselves alone. Wendell Berry says: “I believe that the community — in the fullest sense: a place and all its creatures — is the smallest unit of health and that to speak of the health of an isolated individual is a contradiction in terms.” Berry’s statement speaks to our intuition that not only our individual activities, but also the health of the people, animals, plants, microbes, air, water, and soil around us all affect our health and we in turn affect them. As often as modern human beings would like to think of themselves as autonomous agents who determine their own bodily destinies, the reality is that the only appreciable limit to our contingency is how many things around us we can name.
From this observation about the nature of our bodies we can move to a theological understanding of health. Daniel Fountain, a medical missionary who spent most of his career in the Congo, puts it this way:
The Biblical term for peace is “shalom.” This rich word, which has no dynamic equivalent in English, has to do with the welfare, health, and prosperity both of the person and of the community. It signifies a dynamic harmony of relationships between persons, relationships that ensure peace, rest, and fruitful cooperation.
Shalom, wholeness, flourishing, “the common good,” community health: all of these ideas are interconnected in concepts of holistic health and lengthier treatments can be found in many different sources. These systems always include the physiological and social aspects of human life and usually bring in some variation on spiritual, emotional, psychological, ecological, or environmental dimensions of existence; all overlapping circles that interact with and shape one another. Shalom is often simplified with the phrase “nothing missing, nothing broken,” and in this it draws in the idea that peace is about all human systems working together in harmony for the goods of human existence, like a beautiful tapestry made of many threads.
The Biopolitics of Fear
However, as soon as we acknowledge the interconnected at the heart of all creation, we are charged with the responsibility of what to do about it. Modern men, armed with a bevy of technologies previously unknown, have taken Francis Bacon’s imperative to use technology to relieve suffering to ends Bacon could never have dreamed of. Michel Foucault first coined the word “biopower” to describe the way in which our bodies are surveilled and acted upon in the interest of “public health,” and recent political events surrounded COVID-19 vaccination have inspired some to invoke the specter of biopolitics. The fear of death and illness can become its own cult, sacrificing everything for the sake of health and inviting the state to force the same on others. One need only look back to the eugenics movement to see how much harm can be done in the name of “public health” and the common good.
It’s one thing to acknowledge that defecating upstream from the village water supply is an assault on my neighbors’ health worthy of punishment; it’s another to let the state mandate that I receive an injection that has known side effects and might not be necessary. Public health authorities have bungled their advice and strictures throughout the pandemic, from early directives against mask-wearing to endless health security theater. Should we, in reaction, eschew all manner of biopolitics and push back on Bacon’s misguided inheritors as they chant “Health!” above all else?
As appealing as such a move might seem, it is more or less impossible to get our political and religious authorities out of the business of managing life and our bodies. As far back as Leviticus, priests were given the power of quarantine (13:46), masking (13:45), and even the destruction of property (14:43-47) in the interest of managing and containing disease. Throughout history, political authorities have exercised all sorts of powers for the sake of protecting the health of those God has given them authority over. The interdependent nature of the created order means that there is hardly a law that can be passed which does not have some effect on health. The health of our bodies is not a penultimate summum bonum requiring slavish insistence on removing all potential hazards, but our existence as embodied creatures means that whatever other endeavors are going on, health is always somewhere nearby either as a constitutive process or an important outcome.
So we are stuck with biopolitics and the state’s responsibility to protect the body politic and the bodies it contains not only from human enemy combatants, but from the natural evils that steal our life and joy. We cannot reject the CDC’s rightful authority for its mistakes just as we cannot abolish the police for its many failures to serve and protect. Instead of mocking the fearful or dishonoring the memory of the millions who have died by downplaying the very real damage to health and wholeness that COVID-19 has inflicted, we should ask what a responsible exercise of power for the sake of human health would look like.
Basic Principles for Thinking About Health
Firstly, we should conceptualize the worlds of public health policy, allopathic medicine, environmental planning, and psychological treatment as small domains meant to help people work towards shalom amidst a robust community where relationships promote spiritual, emotional, and relational health. The interactions between these domains and the larger webs of human relationships are inevitable and often helpful, but the fields of action which are legible to the state or directly shaped by policy are at best the soil and the scaffolding in and upon which the real fruit of human flourishing grows. In this analogy, doctors and other healthcare workers can prune or pull weeds but do not make shalom come forth by their will and action. Even the most precise surgeon is only a handmaiden to the natural processes of healing, as Hans-Georg Gadamer observes in his book The Enigma of Health:
Doctors can never completely entertain the illusion that health is something they simply ‘make’ or which they can fully control. They know that it is not themselves or their abilities but rather nature which they help to victory. It is this which characterizes the unique position of medicine within human science as a whole. […] [M]edicine is the only science which, ultimately, does not make or produce anything. Rather it is one which must participate in the wonderful capacity of life to renew itself, to set itself aright.
Secondly, Christians must develop and encourage practices of suffering that accompany those in pain, like Simon of Cyrene carrying the cross during Christ’s passion. The ethical imperatives of the Church are only intelligible to a watching world to the degree that Christians are willing to walk alongside those who suffer and bear their pain with them. Without these practices of accompaniment, Christian moral teaching about issues like abortion or assisted reproductive technology is a cold set of rules enforced by people who have the privilege of not having to bear their cost. It is through these experiences — and not just experiences with those who forsake an accessible but immoral technological intervention, but also accompaniment with the poor, the imprisoned, and those whose suffering cannot be relieved by any human means — that Christians are able to experience growth through suffering and acquire the perspective from below that shapes their advocacy for those who need the work-towards-shalom the most.
This still leaves the question of what can and should be measured, evaluated, and acted upon by professional authorities as they consider the health of individuals and the communities they live in. These persons and institutions with power to shape health have a responsibility for cultivating health within a community or interacting with individuals who are ill. On both ends of the continuum (that is, making policy for a broadly constituted “community” which may represent multiple nations or caring for an individual patient), understanding health in all of its dimensions will lead to (one hopes) a more measured response.
The first goal of those with power will be to maximize the power of institutions and relationships not specifically governed by any professional authority. The weaker these institutions are, the more that the physical health of the community will suffer, and the more tempted that doctors and bureaucrats will want to step in and replace the social and spiritual pillars of human mutuality with an eclectic and insufficient patchwork of programming, subsidies, and drugs. The natural benefits of meaningful work, intimate friendships, loving family, rich spirituality, and shared spaces are self-evidently critical to human flourishing, but impossible for practitioners and policymakers to produce or purchase. Laws, regulations, and authoritative communications should always consider whether or not they help or hinder these contributors to shalom, and take seriously the possibility that horning in on the territory belonging to these things could do more harm than good, even if there are good intentions in doing so. Since these things cannot be measured or evaluated from afar, such assessments will require those with power (political, administrative, or medical) to spend a significant amount of time in whatever communities they purport to represent or serve.
Second, the interventions to maintain the health of specific individuals’ health must always be weighed against the broader needs of the community, but only in such a way that maintains the core dignity and sanctity of each human life. Scarcity is a real problem in any kind of effort to improve physical or mental health, and so whether we are discussing a community health intervention in rural Africa, the care of a severely disabled infant in a Western hospital’s NICU, or a COVID-19 management strategy we must always acknowledge that there will be unsatisfactory choices and difficult compromises. The aforementioned need to accept the inevitability of suffering and its counterpart accompaniment with suffering can here help healthcare providers, families, and even policymakers to make decisions about how resources are spent in a way that honors each individual without forgetting that those individuals are part of a wider community.
The wisdom required to make these sorts of decisions requires knowledge of potential efficacy and possible harms, which is perhaps the most important and good thing that a regime driven by science and technology ought to provide in pursuing shalom. The specific health care or public health interventions that receive the most resources should be the ones that have been proven to be most effective, and interventions that we know little about should be rigorously and continually tested. We should work to build a health care system that balances the need for justice with the scarcity of the world as it is. Without a broader knowledge and appropriate control of interventions which are clearly known to be effective or ineffective, however, the sense of scarcity will only create conflict, poverty, waste, and iatrogenic harm (both individual and social).
However, the inevitability of suffering and death in this age should humble those with power in their aspirations to shalom and force us all to constantly consider whether or not we are helping the people we know and love (especially the ones that we find it difficult to love) to do good themselves. The soil-tilling, trellis-building, stake-digging, stem-pruning, weed-pulling work that allows us to cultivate shalom in that smallest unit of health, the community, is ultimately subservient to the bonds of love that hold every thread in our shared tapestry together. Pursuing shalom, especially those with some sort of professional authority, must work with nature, respect the limits of the created order, avoid the trap of making every aspect of human existence a matter of “health”, allow smaller institutions to do what they do best, and be conscientious about what kinds of suffering to try to alleviate.
Wisdom, Love, and COVID-19
So what might love and wisdom look like in the context of COVID-19? First, we should not malign those who are genuinely trying to do good and work for the health of others. We should assume that those trying to exercise biopower for good or fight back against its excesses are not malicious unless they demonstrate an unwillingness to listen, a self-exalting attitude, a disregard for basic facts, or an inability to see issues of health and science beyond culture-war tropes. There are new facts emerging all of the time and there is no public health strategy without tradeoffs, so if everyone who accepts both of those premises is able to acknowledge them and assume that other people are accepting them, our public discussions about these strategies will be more fruitful.
Second, health authorities should continue to insist on that which we know best and proceed cautiously with things we are not as sure of. There is a lot that we do not know about the strength and durability of vaccine-induced or natural immunity, and the urgency with which we have produced vaccines should now be directed towards getting those vaccines to the rest of the world and deciding whether or not there is a reliable, testable marker of immunity that would give the same assurance as being vaccinated. (A similar effort towards studying additional vaccinations is also warranted, especially for those most vulnerable to death from COVID-19.) Vaccine mandates or mask mandates are a matter of prudence that are probably more suited to individual institutions’ decision-making—I wouldn’t want to work in a hospital that didn’t mandate vaccination for their workers at this point, but I don’t think the federal government needs to be fining hardware stores because some of their employees object.
Third, Christians should continue to be more concerned with loving their neighbors than they are about preserving their own lives. I have made the argument before that I think getting vaccinated is an expression of love, and I think that, given the relatively low risk of vaccine side effects even for those who have already had COVID-19, that this judgment still applies in the case of the vaccines which have undergone rigorous testing. By the same token, allowing any preventive measure to trump other concerns in the name of health runs the risk of letting legitimate concern become paralyzing paranoia. In all seasons, those who follow Christ must not let a concern for an abstract “other” or suspicion of a malevolent “them” promulgate foolishness, grandiosity, hatred, or obtrusiveness.
The official pronouncements about public health we have heard in the last two years are merely one small facet of human health’s contingent nature. We all depend on one another for the flourishing of life, and I hope and trust that most people are willing to acknowledge that dependence and contingency as we deal with the greatest infectious health crisis of our era. In affirming that “conviviality is healing,” as Wendell Berry says, we must be willing to carefully consider about what sorts of sacrifices and risks are worth it for the sake of others — and then, having considered, to act as those who love the goods of creation and are willing to suffer as we proclaim another life to come.
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- See, for example: Myers, Dufault-Hunter, and Voss, Health, Healing, and Shalom, Willard Swartley’s Health, Healing, and the Bible, Downers Grove: IVP Academic, 2012 and James McGilvray’s The Quest for Health and Wholeness. ↑
- This image is drawn out beautifully in Allen Verhey’s Reading the Bible in the Strange World of Medicine ↑
- Examples of each of these are left as an exercise for the reader, and if you cannot think of an example who shares your tendencies then I would suggest that you need to read a bit more widely and carefully. ↑
- For those curious, I have written elsewhere about the legitimate moral concerns regarding fetal cells and vaccines. ↑