As Christians join the rest of the country in jousting over the proposed changes to our health care system, one significant fact should inform the Christian debate: modern health care is a Christian invention. The reasons Christians developed the world's first health care system—as opposed to simply medical practitioners—are as relevant today as they were 2,000 years ago.

How and why early Christian health care came about is the subject of Gary Ferngren's book Medicine and Health Care in Early Christianity. Ferngren, a professor of history at Oregon State University, argues with his fellow academics who believe that early Christians opposed medicine, thinking that all illness was caused by demons. Instead, Ferngren says, "Christians of the first five centuries held views regarding the use of medicine and the healing of disease that did not differ appreciably from those that were widely taken for granted in the Graeco-Roman world."

Many of Ferngren's colleagues in this field of research must think that early Christians believed demons brought on disease and that exorcism was the only cure. Nothing else could explain the lengths he goes to—two-thirds of the book—debunking the notion.

Medicine, as developed by the Greeks, was a naturalistic field. Doctors studied the body, made observations, and practiced their art without appeal to Greek divinities. So Christians had no reason to oppose its practice. They did, however, advise fellow believers on how to use medicine. For example, some preachers taught that the truly spiritual would forgo medical care, relying on prayer alone, but all taught that God heals through the work of the physician. In addition, medical literature—a piece of classical education—provided a wealth of metaphors and illustrations that educated Christian preachers wove into their sermons.

Imago Dei and ancient health care

When an epidemic struck in the ancient world, pagan city officials offered gifts to the gods but nothing for their suffering citizens. Even in healthy times, those who had no one to care for them, or whose care placed too great a burden on the family, were left out to die.

Christians found this intolerable, and they set about to take care of these people and others similarly afflicted. They did so because, Ferngren writes, "Early Christian philanthropy was informed by the theological concept of the imago Dei, that humans were created in the image of God."

This led not only to a belief in the responsibility to aid others and the inherent worth of every human being, but also to a belief in the sacredness of the body itself. "It was to save the body that Christ took on flesh in the Incarnation. Not only the soul, which in traditional pagan thought was eternal, but the composite of body and soul, which constituted man, was to be resurrected."

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The idea of imago Dei also led to a redefinition of the idea of the poor. Rights in a city or society were given to members, and all members received benefits. Those outside were offered none. Christianity, in addition to seeing all people as "neighbors," developed a special consideration for the poor. Just as God demonstrated in the Incarnation his solidarity with those who suffer, so the members of his "body" must demonstrate their solidarity with the suffering poor.

The classical understanding of civic care for those who suffered "was not merely insufficient to provide the motivation for private charity; it actively discouraged it," writes Ferngren. "Christianity, however, insisted that the love of God required the spontaneous manifestation of personal charity toward one's brothers: one could not claim to love God without loving his brother."

Christian health care

As a result of these theological beliefs, Christians developed a robust system for caring for the poor, the ill, widows and orphans, and other members of society in need of care. When the plague struck, this system provided an opportunity for churches to quickly expand and care for those outside the church.

As early as A.D. 251, according to letters from the time, the church in Rome cared for 1,500 widows and those who were distressed. A hundred years later, Antioch supported 3,000 widows, virgins, sick, poor, and travelers. This care was organized by the church and delivered through deacons and volunteer societies. The churches in major cities had significant resources at their disposal, and though their care was not professional, it is likely to have saved lives and aided the growth of the church.

When the plague of Cyprian struck in 250 and lasted for years, this volunteer corps became the only organization in Roman cities that cared for the dying and buried the dead. Ironically, as the church dramatically increased its care, the Roman government began persecuting the church more heavily.

Dionysius, bishop of Alexandria, wrote, according to Ferngren, "that presbyters, deacons, and laymen took charge of the treatment of the sick, ignoring the danger to their own lives. … Their activity contrasted with that of the pagans, who deserted the sick or threw the bodies of the dead out into the streets." This care was extended even to those persecuting the church at the time.

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This care likely led to much higher rates of survival for Christians. And after the plague, with a staff of workers and an existing administrative structure, "Christian medical care became outwardly focused, now enlarged to include many who were victims of the plague."

Finally, when Emperor Constantine legalized Christianity, these services were formalized in a number of institutions, including the first hospitals. "The experience gained by the congregation-centered care of the sick over several centuries gave early Christians the ability to create rapidly in the late fourth century a network of efficiently functioning institutions that offered charitable medical care, first in monastic infirmaries and later in the hospital," Ferngren writes.

Modern health care

The experience of early Christian health care sheds light on what ought to be of foremost concern to modern Christians as the country reforms its health care system: beyond cost savings and the ability of a government agency to deliver health care, Christians must be concerned about the poor receiving care.

In the U.S., hospitals cannot typically refuse care to those without insurance; however, insurance is most often the key to receiving health care today. And expanding coverage to those who are without should be, based on Ferngren's study, a major concern for Christians.

The best way to provide care to everyone in the country may be up for debate. We may argue over whether to prefer new regulation of insurers and health care providers or a government-run plan. The need to provide care for the poor, however, was settled centuries ago.

Related Elsewhere:

Medicine and Health Care in Early Christianity is available at and other book retailers.

Christianity Today has more book reviews and more coverage of health care on the politics blog.

More health care coverage can be found in our science & health section, including:

We Need Health-Care Reform | And the real question is who gets to decide who gets attention. (July 22, 2009)
Caring for the Caregivers | Studies suggest that pastors' health declines are a church problem. (April 14, 2009)
Blessed Insurance | Many pastors lack access to adequate health benefits. (July 7, 2008)

Medicine and Health Care in Early Christianity
Medicine and Health Care in Early Christianity
Johns Hopkins University Press
264 pp., 74.5
Buy Medicine and Health Care in Early Christianity from Amazon