The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity,” (Poenaru, n.d., p. 2). To live and enjoy a life of dignity, one must be healthy. Healthcare is the most crucial of all the rights we are entitled to receive. Humans are frail beings, and eventually, we all need adequate healthcare. To maintain good health, we need preventative care, and to preserve life, we need treatment for diseases. Without health, we cannot live a quality life, let alone live with dignity or enjoy other human rights. Good health saves money, not only directly but increases productivity and decreases loss of days. Poor health can trigger a downward social spiral because of lost days at work with mounting medical bills. The effect of poor health on community development has been evident early in the HIV pandemic in Africa as communities crumble as many young adults in the prime of their lives become ill with AIDS.

 

From the above observation, it is evident that good health has a tremendous positive impact on communities, but that impact is not apparent because it is not universally available. Therefore, the call for universal healthcare is increasing in volume. For there to be transformational change, good healthcare must be available.

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Adequate medical care is a catalyst for human flourishing. Poverty and ill health are intimately related. Deprivation leads to ill health, and ill health leads to poverty. Researcher Adam Wagstaff (2002) states that health outcomes are influenced by social factors like access to health services, food, sanitation, lifestyle, and sexual practices. These factors are affected by human, physical, and financial assets, geographic location, health systems, and government policies and actions. The Lancet Global Health Commission claims that sustainable development concerning health systems is primarily contingent upon the quality of care given to patients—especially those who reside in the most vulnerable populations—and their surrounding communities in low- to middle-income countries (LMICs). Considering the inadequate level of care that most people receive on a global scale, the Commission argues that national governments must exercise accountability when investing in high-quality health systems to achieve sustainable development for the welfare of all people.

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Pioneering work on the social determinants of health, Sir Marmot (1991) found that health inequity is a matter of life and death. Though life expectancy has continued to increase in some countries, it has remained relatively unchanged in others. The difference is influenced by “the circumstances in which people grow, live, work and age and the systems put in place to deal with illness. In turn, the conditions in which people live and die are shaped by political, social, and economic forces.” These social factors affect health and influence whether one will flourish or their potential will be blighted.

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The World Health Organization (WHO) suggests that action on the social determinants of health should involve government, civil society, local communities, businesses, and international agencies, prompting global changes that will lead to sustainable development. The social determinants of health have some of the most significant impacts on health inequities between and within countries. To address health inequities, the WHO recommends improving daily living conditions, tackling the inequalities of power distribution, money, and resources, measuring and understanding the problem, and assessing the impact of actions.

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Conversely, researchers Ott and Olson (2011), through a case study on Operation Smile—an NGO that provides surgeries to children suffering from cleft lip and palate—found that health can also influence social factors. They discovered that the social stigma associated with this condition causes the afflicted to be ostracized, often uneducated, and limited in their social advancement. However, aligning with the WHO’s recommendations above, once a person receives treatment for this condition, they are usually restored socially. Additionally, the medical training received by locals increases their economic well-being, fosters academic advancement, and promotes sustainable development. These discussions show that despite good health being an essential component of humanity’s development, it is not free of the effects of social barriers.

On our second point regarding the impact of transformational development on vulnerable communities, literature on this topic emphasizes the importance of relationship building for transformational development to succeed. According to the JICA Research Institute (1995), a participatory development model enhances transformational development goals. It is people-centered and “aims to make self-reliant, sustainable development and social justice a reality by enabling the people influenced by development to become active agents, planners, and beneficiaries in development."

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Supporting a participatory development model, researchers Melby, Phil, Loh, Evert, Prater, Lin, and Khan (2015) focus on four core principles to prevent harm by short-term medical teams. These principles create an ethical framework for participatory development: “(1) skills-building in cross-cultural effectiveness and cultural humility, (2) bi-directional participatory relationships, (3) local capacity building, and (4) long-term sustainability.”

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Common themes in the literature on transformational development by healthcare professionals (HCPs) support these principles by emphasizing individual and community empowerment, the success and need for diverse ministries, relationship building, spiritual and physical healing, and sharing the gospel by word and deed. For transformational development to occur within the health sector, several authors stress the importance of combining spiritual with physical healing. They argue that “[t]he Church everywhere must be directly involved in healing ministries across all domains; the physical, emotional, and spiritual," (Dahlman, 2020, p. 3). The importance of physical healing is that it “naturally belongs, and contributes, to transformational development,” (Poenaru, n.d., p. 4). However, Poenaru (n.d.) cautions that the pendulum swings too far in the physical healing direction, and that Christian medical professionals miss opportunities to be “spiritual providers” in the communities they serve (p. 5). This is seen in instances where medical professionals perform their duties while overlooking the biblical mandate to proclaim the gospel of God’s saving grace. Therefore, Fitzmaurice (2014) asserts, “In gospel outreach, we are to combine saving words with loving deeds as Jesus did,” (p. 16).

Providing a practical lens to this discussion, researcher Sandra Yu shares her experiences from visiting a faith-based NGO in the Dominican Republic that trains local medical students. After interviewing the students, she emphasizes the transformational change that developed in the community due to “friendships the locals…formed with the student participants and the missionaries,” (Yu, 2007, p. 44). This change was especially evident since some locals had stopped drinking and staying out late and started attending Bible studies instead. Here, lifestyle changes led to the improved wholistic health of the community.

From the discussion above, it is apparent that good health and transformational development are intimately linked. However, the question remains: Do healthcare initiatives in impoverished communities lead to transformational development?

World Medical Mission (WMM), as a ministry of Samaritan’s Purse (SP), partners with other SP programs to achieve transformational development. WMM demonstrates a transformational development model that fulfills the mandate of transformational development by "seeking positive change in the whole of human life materially, socially, and spiritually," (Myers, 2011, p. 3). Thus, WMM intervenes in developing communities through the health sector, while supporting positive cultural and societal change. Examples include their work in war-torn South Sudan, where they provide medical and healthcare services, train nationals as nurses, midwives, and doctors, and stock necessary medicines and medical supplies. WMM then partners with SP to provide food, shelter, clean water, and other assistance to over 45,000 people living in the Doro refugee camp (Samaritan’s Purse, n.d.). While they meet the physical and social needs of the people, WMM is intentional about Christian spiritual formation offering Christian education opportunities and prayer.

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In Cambodia, WMM improves healthcare systems through medical training and the development of medical infrastructure. Through their health education programs, such as those focused on maternal health and nutrition, women’s health improves, thus advancing their opportunities socially, professionally, and academically (Samaritan’s Purse, n.d.). Similarly, in Myanmar, WMM hosts mother-to-mother groups that provide health education and peer support. This program fosters community amongst the women, offers necessary social support, and provides opportunities for women to become medical professionals like midwives. This opportunity gives women income, social mobility, and improved status in the community (Samaritan’s Purse, n.d.).

However, since the extent of such reform remains ambiguous, the critical analysis of other case studies is worthy of exploration. For example, a case study involving health research in an urban context shows how a health research project was instrumental in creating transformative change in an impoverished community. Featuring a poor urban community in Johannesburg, the study confirms the importance of intervention models rooted in understanding the underlying social factors that influence a community’s overall health. The highlighted social factors include food insecurity, drug abuse, and lifestyle diseases such as diabetes, pest infestation, and limited employment opportunities. The research suggests that a preventative approach to health concerns promotes well-being instead of solely addressing the symptoms of poor health (i.e., encouraging lifestyle changes and providing employment opportunities, instead of only building more health facilities). The research also indicates that these measures would be sustainable through local ownership and financial accountability of community leaders (Plagerson & Mathee, 2012).

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Leisinger (n.d.) furthers the conversation, regarding preventative care, by examining the role of pharmaceutical corporations, which he considers to be the health sector’s organs. Leisinger claims that these companies have a responsibility beyond doing no harm to make healthcare equitably accessible for all. Therefore, he proposed the following solutions:

1. They adjust medication prices to the purchasing power of governments and households in low-income countries, particularly for single-source pharmaceuticals;

2. Research and development (R&D) initiatives should target diseases affecting the poor in the developing world, where most treatments are manufactured;

3. The corporations should support developing countries’ broader health and development goals (e.g., training medical staff);

4. Greater cooperation between government stakeholders in manufacturing countries to ensure that access-to-medicine initiatives are integrated into national systems;

5. They should explore opportunities for manufacturing pharmaceutical products in developing countries through subsidiaries or voluntary licenses. In doing so, there would be increased access to essential medicines.

Sustainable access to safe, affordable, and effective medications is fundamental to the health and well-being of individuals and communities, thus providing a building block for transformational development.

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Furthermore, research about Community Health Evangelism (CHE)—a program that is practiced in over 100 countries—reveals that most diverse programs were created by doctors and their families after witnessing needs in the communities they served. After evaluating its success, Fitzmaurice (2014) affirms, “CHE has proved to be an effective template and launching pad for initiating intentional community-based work to lead to individual transformation and eventually to community transformation,” (p. 18). CHE programs are vital in ensuring transformation in communities where medical families reside. Such empowering programs are people-focused from the bottom up.

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Through our literature review, we found that, although good health and transformational development are intimately linked, healthcare initiatives in impoverished communities do not always directly lead to transformational development. Although work accomplished by healthcare professionals (HCPs) and medical NGOs like World Medical Mission (WMM) has been a catalyst for transformational development, no conclusive evidence was found to support the idea that good health is solely responsible for generating community development. However, our literature review does support the assertion that good health is a foundational element of transformational development. When people are physically healthy, they have greater capacity and motivation to improve their emotional, mental, and spiritual well-being. Therefore, researchers propose that medical NGOs, such as WMM, should partner with NGOs working in other development sectors to provide more opportunities for transformational development to flourish in these communities. Through such cross-organizational partnerships, faith-based and secular organizations can work together to wholistically meet all the emotional, mental, physical, and spiritual needs of the impoverished communities they serve.

Dahlman, B. (2020). Mission Hospitals as Vital Capacity Builders in the Majority World. Christian Journal for Global Health, 7(2), 3–6.

https://doi.org/10.15566/cjgh.v7i2.413

Davidson, V. J. (2011). Empowering Transformation: A Contemporary Medical Mission Case Study from Rural China. Transformation, 28(2),

138–148. https://doi.org/10.1177/0305829811400271

Fitzmaurice, J. (2014). Transforming Communities with Good News in all its Fullness. Luke’s Journal, 19(2), 44.
Global Health (STEGHs). (n.d.). Ethical Principles to Optimize Community Benefit and Learner Experience.

https://pubmed.ncbi.nlm.nih.gov/26630608/

JICA Research Institute. (n.d.). Topical and Sectoral Studies: Participatory Development and Good Governance Report of the Aid Study Committee.

https://www.jica.go.jp/jica ri/IFIC_and_JBICI-Studies/english/publications/reports/study/topical/part/part_1.html

Kruk, M. E. et al. (2018). High-Quality Health Systems in the Sustainable Development Goals Era: Time for a Revolution. The Lancet Global Health,

6(11), e1196-e1252. https://dx.doi.org/10.1016/ S2214-109X(18)30386-3

Leisinger, K. M. (2012). Poverty, Disease, and Medicines in Low- and Middle-Income Countries: The Roles and Responsibilities of Pharmaceutical

Corporations. Business & Professional Ethics Journal, 31(1), 135–185. http://www.jstor.org/stable/41705473

Marmot, M., Stansfeld, S., Patel, C., North, F., Head, J., White, I., Brunner, E., Feeney, A., Marmot, M., & Smith, G. (1991). Health Inequalities Among

British Civil Servants: The Whitehall II Study. The Lancet Global Health, 337(8754), 1387–1393.

https://doi.org/10.1016/0140- 6736(91)93068-k

Melby, M. K., Loh, L. C., Evert, J., Prater, C., Lin, H., & Khan, O. A. (2016). Beyond Medical "Missions" to Impact-Driven Short-Term Experiences in

Global Health (STEGHs): Ethical Principles to Optimize Community Benefit and Learner Experience. Academic Medicine: Journal of the Association of American Medical Colleges, 91(5), 633–638. https://doi.org/10.1097/ACM.0000000000001009

Myers, B. L. (2011). Walking with the Poor: Principles and Practices of Transformational Development. Maryknoll, NY: Orbis Books.

Ott, B. B., Olson, R.M. (2011). Ethical Issues of Medical Missions: The Clinicians’ View. HEC Forum, 23, 105–113.

https://doi.org/10.1007/s10730-011-9154-9

Plagerson, S. E., & Mathee, A. (2012). Changing an Urban Community Through Health Research: A South African Case Study. Health Promotion

Practice, 13(3), 339–343. http://www.jstor.org/stable/26738889

Poenaru, D. (2018). Holistic Transformational Development through Surgical Care. WCIU Journal: Health and Disease, 1-8.
Samaritan’s Purse. (n.d.). Bringing Hope To South Sudan Through Nursing Scholarships. Retrieved from Samaritan’s Purse Australia and New Zealand:

https://samaritanspurse.org.au/bringing-hope-to-south-sudan-through-nursing scholarships/

Samaritan’s Purse. (n.d.). Funding a Maternity Ward in Cambodia. Retrieved from Samaritan’s Purse Australia and New Zealand:

https://samaritanspurse.org.au/funding-a maternity-ward-in-cambodia/

Samaritan’s Purse. (n.d.). Myanmar Midwives: Giving Mothers and Families a Healthier Future. Retrieved from Samaritan’s Purse Australia and New

Zealand: https://samaritanspurse.org.au/myanmar-midwives-giving-mothers-and-families-a healthier-future/

United Nations. (1948). Universal Declaration of Human Rights. Retrieved from United Nations:

https://www.un.org/en/about us/universal-declaration-of-human-rights

World Health Organization. (2008). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health — Final Report

of the Commission on Social Determinants of Health. Retrieved from World Health Organization:

https://www.who.int/publications/i/item/WHO-IER-CSDH08.1

Wagstaff, A. (2002). Poverty and Health Sector Inequalities. Bulletin of the World Health Organization, 80(2), 97–105.

Yu, S. & Massachusetts Institute of Technology, Department of Urban Studies and Planning. (2007). What I learned from missionaries in the Dominican

Republic: Loosen the agenda, hold onto the vision; cherchando is an important part of transformational development. Massachusetts Institute of Technology. https://dspace.mit.edu/handle/1721.1/40131