Public Health as Christian Service

21 min readJun 25, 2019

A curriculum created in the spring of 2019 by Tiffany Firebaugh, MPH.

If you’d like to start with a shorter introduction to public health, you can get started by learning about 5 public health topics in America today here.

If you’d like to read a syllabus I created introducing Christians to public health, welcome! This is for you. I’m glad you’re here.

This course is designed to introduce churches and church leadership to the concepts of public health within a single semester. The sessions build from mostly public health concepts toward mostly modern application. Each session includes a philosophical framework, real-world examples, and discussion questions. At the close of each session, the goals and objectives should be met. If not, further study is needed.

Course Goals: To push Christians to understand their service work in a way that is accountable to those they serve, those they receive money from, to themselves, and to God. To find common ground between Christians and secular humanitarians. To empower Christians to critically think about Christian intervention from larger frameworks of analysis.

Course Objectives:

Increased understanding of the complexity of aid delivery and inadequacy of good intentions alone
Increased understanding of how to foster long term and sustainable positive outcomes
Ability to think critically about how power and culture influence the practice of aid work within Christian organizations
Generation of insights as to how to reorder the system to support more ethical, contextually appropriate, and effective aid
Increased understanding of the fields of public health and humanitarian service
Increased insight into how the field of public health dovetails with Christian philosophy

Before Beginning, Reflect:

What are some of the fears you have coming in to this study?
What are some of the hopes you have coming in to this study?
What experiences do you have with the church and mission?
How might this course disrupt your thinking about things you’ve done to help in the past? Are you okay with that disruption? How would you ideally handle the new information?
What is Christian fellowship for? What was it for Biblically? Has the purpose changed today? Is that okay? What do you long for it to be for?
Who can you process this study series with?

Helpful Tools and Resources

Session I: Distinguishing Public Health

Goals: To understand the work, role, and mindset of public health professionals in the context of the larger helping field.

Objectives:

Students will identify at least 3 examples of public health interventions
Students will list the five tenets of humanitarianism
Students will name at least one active international goal (Healthy People 2020, SDGs)
Students will identify at least two international and two domestic public health organizations
Students will describe the cluster system

Reading:

Frameworks

Multimedia

What is Public Health by Let’s Learn Public Health
TED Talk: How Childhood Trauma Affects Health Across a Lifetime, Dr. Nadine Burke Harris
This Is Water by David Foster Wallace

Standards of Public Health Intervention

Applied Christianity

Matthew 25:31–46
Micah 6:8
Proverbs 21:13
James 1:27
1 John 3:17–18
Luke 18:22
Ezekiel 16:49
More than 2,000 Bible verses on poverty and justice

Reflection:

What areas of overlap in goals do you see between public health professionals and Christians who desire to see heaven on earth?
How does that vision align with who is already doing similar work? How will you find those organizations?
Would you say that you are more focused on intentions or impact when it comes to the organizations or interventions you support? How do you find out what kind of impact the service is having?
How has public health worked to decrease disparities in the last 30 years? How do we know?

Session 2: State of the World

Goals: To understand the current humanitarian landscape both domestically and internationally.

Objectives:

Students will list at least three current domestic public health issues of high importance
Students will list at least three international public health issues of high importance for low-income countries
Students will define demographic transition
Students will familiarize themselves with the current global burden of disease through many maps
Students will list three resources for acquiring this data

Reading:

United States
Maternal Mortality

Mass incarceration

Documentary: 13th by Ava Duvernay (Netflix)
Incarceration Trends Interactive Map: The Vera Institute

Education

Infectious Disease

International

Overall trends:

Mapping Resources

Reflection:

Are things better or worse than you would have guessed had you not seen the data?
Has a Christian group ever pushed you to consider an issue of justice you hadn’t considered before?
What kinds of actions did they suggest that you take to combat the injustice? Do you think the actions they suggested were effective?
What would being the body of the church look like in responding to the issues raised in these readings, both domestically and internationally? How does your church or faith community address them?
Is anyone in your church affected by any of the issues laid out in the American section of the reading? If no one in your church is affected by any of these issues, how does that affect how you see your church body in view of the larger body of American churches?

Session 3: Social Determinants of Health

Goals: To identify the complex and intersecting factors which affect a person and contribute to a person’s health status throughout a life course. To examine larger structural systems which may compound vulnerabilities.

Objectives:

Students will list at least five social-ecological factors beyond the explicitly defined healthcare system which may impact health status
Students will choose two of these five factors to explain in-depth
Students will explain the difference between equity and equality
Students will describe the seminal ACE’s study
Students will give two examples of social determinants of health

Reading:

Framework

Examples

Mapping Resources

Reflection:

How does our social ecological environment affect more than what meets the eye?
Have you ever thought about the upstream determinants of health?
How does this reading relate with the reading from session 2?
When we start to look at the social determinants of health, we expand our peripheral vision to see what else might be going on in the picture. Does becoming aware of the multiple systems at play feel overwhelming to you?
How does your faith in God relate with the systems of injustice? How would the incarnation of God be made manifest in working in upstream processes?
How does your perception of God’s omnipotence and sovereignty affect how your level of urgency in responding to these issues? How does that affect the people who are affected by these social determinants of health, today?

Session 4: Barriers to Access to Care

Goals: To critically think about systems and access to care from the perspective of a public health professional when thinking of programs. To identify where a perfect program which meets a real need may fall short in terms of access.

Objectives:

Students will define the concept of coverage
Students will evaluate intervention case studies and identify barriers to access to care
Students will list at least 6 possible barriers to access to care
Students will draw a rich picture and identify key stakeholders for a key public health access to care issue

Reading:

Frameworks

Examples

Mapping Resources

https://www.accessmod.org/

Reflection:

There are many factors that can influence whether someone can access needed medical treatment. Were there any barriers in the reading that you may not have originally named, had you been asked?
Are there any barriers to accessing your church’s social programs that could be eliminated or ameliorated?
What types of systemic barriers could be affecting people in your own congregation or neighborhood in accessing resources outside of your church? How would you find out what those needs are or how best to address them?
How is the church uniquely situated to respond to local needs?

Session 5: Capacity, Quality of Care, & Use

Goals: To understand why coverage isn’t enough for an intervention to be successful. To explain the importance of quality of care.

Objectives:

Students will list the WHO building blocks of a health system
Students will explain the importance of cultural competence and attitudes in utilization
Students will list 2 reasons good intentions are not enough for a good outcome
Students will give 2 real life examples where quality of care was low in an intervention and fatality/infection rates remained high
Students will explain why quality of care must be assessed when assessing the implementation of an intervention

Reading:

Framework

Examples

Reflection:

Let’s say someone has none of the barriers to access to care that were discussed in section 4, however they still do not want to use the social service programs at your church or non-profit. Based on the readings, what are some some possible reasons for that lack of utilization?
How do Christians sometimes unintentionally create barriers for access to care? How does religious belief sometimes unintentionally perpetuate stigma and shame, so as to prevent access to care?
How can your church utilize the systemic capacity building model from the readings?

Session 6: Community Input and Power in Decision Making

Goals: To examine who is considered an expert or put in positions of leadership or power. To explain the importance of involving the local community in intervention design, implementation, and assessment.

Objectives:

Students will give 3 examples of how interventions might fail without local insight
Students will give 2 examples of community-based interventions
Students will explain how using community-based interventions reduces disparities and increases equity
Students will consider the ethics of short term mission trips

Reading:

Frameworks

Examples

Supplemental Reading

Reflection:

Before going into a place to help, have you ever been encouraged to research the context, history, etc. of the local population? How does that research compare to the lived experience of a local?
After reading the discovering community power framework, how has your local church or social service program connected to multiple pre-existing community organizations?
What is the role of criticism within the church? Who is allowed to criticize you? Who is allowed to criticize people in power? Who should be allowed to voice concerns and how can you promote equity by promoting those voices?
How is the Christian idea of “voice for the voiceless” complicated by public health’s (ideal) focus on centering the receiving community? What does voice for the voiceless really mean in practice? How can that go wrong? What could we do or say instead?
How can the concept of unity be used for good or bad? How would you respond to someone who calls a person divisive because they brought up an issue of justice? What is the role of positive thinking in perpetuating systems of harm?
Are the people receiving the interventions in your church in any leadership or decision-making power in your intervention? How might there be disparity in who is chosen for that position, too? How does this complicate or weaken your service?

Note: Sessions 7, 8, and 9 have the same reflection questions, listed below:

Reflection for Sessions 7, 8, and 9

When it comes to church programs, should we expect more accountability in terms of impact? How can we know if our church social service program is actually helping?
What are some common ways information can be misleading? Have you ever spotted any misleading data from a Christian organization or news site?
What kinds of questions can qualitative data answer? What types of questions can quantitative data answer? How can these sources of data be of value in social service organizations or the church?
What kinds of questions can data not answer?
How can learning about methods, study design, and data quality help the faith community to make better decisions on resource allocation and service provision?

Session 7: Reading Data At A Glance

Goals: To gain basic data literacy at a glance. To know the basic approach to evaluating the legitimacy of research found online.

Objectives:

Students will explain the importance of reviewing what they expected to see and what they actually see when looking at a graph
Students will identify basic ways data can be manipulated in graphs and charts
Students will define source bias and confirmation bias, giving 2 examples of each
Students will list four ways to vet fake news
Students will identify misleading data or inadequate data
Students will explain the importance of an independent assessment

Reading:

Framework

Media

Supplemental Reading

Session 8: Data Quality and Assessments
Goals: To learn basic frameworks for data evaluation and how to determine data quality. To differentiate between good intentions and good programs.

Objectives:

Students will identify basic components of research design including: informed consent, sample size, controls, study design, baseline studies, blinding, surveillance, and IRB approval
Students will explain the difference between qualitative and quantitative data
Students will explain the difference between validity and reliability
Students will explain why self-reporting can be biased
Students will explain how better data collection can skew results in the short term
Students will list three verifiable international data sources (DHS, etc)

Reading:

Framework

Examples

Resources:

Session 9: Evidence and Conclusions

Goals: To increase literacy of research study conclusions and applicability.

Objectives:

Students will explain the difference between internal and external validity
Students will define the term confounder
Students will list at least 3 common threats to validity
Students will explain why research is not always generalizable
Students will explain how the implementation of the study affects the outcome, which in turn can affect the conclusion (inclusion criteria, attrition, dose delivered)

Reading:

Frameworks

Examples

Session 10: Identifying Public Health Failures

Goals: To look at past interventions and determine why they may have failed.

Objectives:

Students will explain the importance of knowing the local context and history of the area
Students will list 2 ways that the intervention could have been more thoughtfully designed
Students will discuss the importance of accountability

Reading:

Haiti

Ebola

Reflection:

Do you notice any patterns between the humanitarian involvement of containing cholera in Haiti and in the containment of both ebola outbreaks? How does accountability factor in? How does speaking up publicly about failures help to prevent the same failures in the future?
In what ways are you disappointed in the outcomes of both of these examples?
In what ways are people working for justice even years in the aftermath of injustice?

Session 11: Ethics in Public Health and Christian Intervention

Goals: To parse short term versus long term consequences of interventions. To be familiar with grey areas and think critically about how to make decisions in view of values.

Objectives:

Students will map the competing values and autonomy of stakeholders in view of utility, equity, and respect for individual and community interests
Students will describe the 6 main public health ethical perspectives: libertarian, collectivist, utilitarian, social contract theory, stewardship model, and Mill’s harm principle
Students will name at least one ethically difficult case in the history of public health
Students will define harm reduction
Students will list the 5 main justifications for a public health decision: effectiveness, proportionality, necessity, least infringement, and public justification
Students will explain the exploitation to dignity continuum that is present in aid work
Students will give two concrete examples of how ethics applies to Christian aid work

Reading:

Framework

Exploitation and Dignity

Christian Ethics

Evangelism in Disaster Assistance

Harm Reduction

Short Term Missions

Reflection:

How do the ethical frameworks of public health challenge your perceptions? How do ethical frameworks challenge black and white thinking?
In what ways are these frameworks being challenged and sorted out even today?
How do the concepts of exploitation and dignity play out in your local church when discussing various marginalized groups? How do you see these concepts at play in discussion of mission trips or recipients of social services?
What are the ethical considerations in evangelism in a country which needs disaster assistance? How can Christian organizations better coordinate with other organizations?
How are public health techniques like harm reduction usually discussed within your faith community? What does the evidence say about the effectiveness of these techniques?
How did you feel when reading the critiques of short term mission trips? Have you heard similar critiques before or is this brand new information for you? How do we cope with feelings of defensiveness, embarrassment, or anger when faced with our own shortcomings? How does your faith inform that? How might you change your actions or your church’s actions in the future, with this new knowledge?
The TED talk on the danger of a single story can prompt some reflection. What are the single stories you have been told?
Whose voices are missing from your bookshelf? Movies? Television? How can adding more voices make you less likely to rely on a “single story”?

Session 12: Lessons Learned Part 1: Partnerships — Commercialism and Health

Goals: To identify the ways in which commercial interests have both helped and harmed health goals.

Objectives:

Students will explain the current role and need of corporate partnerships
Students will examine case studies and utilize role play to unpack various perspectives
Students will list 2 ways that commercial interests could conflict with public health priorities
Students will describe how concerts like Live Aid and Band Aid did or did not accomplish their goal

Reading:

Benefits of Corporate Engagement

Vulnerabilities of Corporate Engagement

Frameworks

Reflection:

How have corporate partnerships been used in the past to help people?
How can these partnerships be exploited for personal gain?
How do we manage these tensions?
How can awareness of these ethical issues prepare Christians to be “shrewd as snakes and innocent as doves”?

Session 13: History of Christian Interventions (Facing the Past & Present)

Goals: To face, for perhaps the first time, the modern history of Christian service intervention failures and the effects in the short and long term.

Objectives:

Students will describe the danger of a single story in view of Christian intervention
Students will define unintended and downstream consequences
Students will list and describe at least 3 times in modern history that a Christian intervention had negative impacts
Students will discuss how Christians could structurally impact their organization so that these decisions would not be made in the present or future

Reading:
Biafra

Boarding Schools and Adoption

Racism

Supplemental Reading:

Reflection:

Have you ever studied the history of Christian interventions? Have you ever studied some of the past failures of Christian aid? What can be gained from these conversations?
How do the legacies of these actions still play out today?
Can you see any parallels between what has happened in history to what is happening today, regarding the readings?
How might these readings change your perception of current events? What types of questions can you ask to bring further clarity to a complex situation?

Session 14: Lessons Learned Part 2: Bringing it Home: Modern Christian Organizations and Outcomes

Goals: To use the frameworks of analysis learned throughout the course to analyze the effectiveness of familiar modern Christian interventions. To propose alternative approaches to more effectively “seek justice, love mercy, and walk humbly” (Micah 6:8).

Objectives:

Students will describe the difference between good intentions and good outcomes
Students will list 1 way soup kitchens serving canned food can negatively impact the health of low health populations
Students will explain how raising awareness can fall short of impact
Students will discuss the effectiveness of toy drives
Students will detail the history of Christian transnational adoptions
Students will describe the global gag rule and the potential unintended consequences in low income countries
Students will give 2 ways that posting photos online or on tinder of low-income children from another country without their permission may violate ethics
Students will discuss the policing of black people’s hair in Christian schools and institutions
Students will explain why building wells isn’t always the answer

Reading:

Church and Imagination for Justice

Systems Thinking

Theological Disagreements on Social Justice

Reflection:

The readings gave a few different examples of how modern churches are seeking to meet congregational needs. In each of these interventions, analyze:

Are the churches addressing upstream consequences?
What about social determinants of health?
How about downstream consequences?
Are they meeting a need in their local congregation?
Are they using their power to advocate for their neighbors? Effectively? What makes something effective?
How have Christian trips to orphanages unintentionally caused harm?
In what ways are good intentions not enough? In what ways does raising awareness fall short of helping?

Session 15: Current Issues and Trends: Going Beyond Fundraising and Awareness Raising

Goals: To identify places to work for justice and to create a holistic plan for engagement, both within and outside the church.

Objectives:

Students will name 3 issues they care about
Students will, for each issue named above, identify 2 ways they can get involved beyond fundraising and raising awareness
Students will provide 2 ideas of reform work within the church to structurally shift outcomes towards justice and transparency

Reading:

Reflection:

What are your 3 main takeaway lessons from this course?
What is an issue that you care about that you can approach from a systems-thinking perspective? How will your approach going forward differ from the approach you would have taken before this class?
What are some ways that your work for justice can move beyond fundraising or raising awareness?
How can the church and/or your faith community be more effective in its pursuit of justice?

Public Health as Christian Service

Written by Tiffany Firebaugh