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Paper presented at The Annual Training for Better organization and Islamic Health Conference organized by the Islamic Medical Faculties of Indonesia at Universitas Islam Sultan Agung Semarang on 20th December 2008 by Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine Institute of Medicine Universiti Brunei and Visiting Professor of Epidemiology Universiti Malaya. EM: http://omarkasule.tripod.com
ABSTRACT
The paper describes Qur’anic holistic concept of health comprising spiritual, physical, psychological, and social components. Health is a trust and the human has responsibility to take good care of it. Good health is a bounty, ni’mat for which the human must be grateful to Allah. Nutritional, environmental, life style, psych-social, and spiritual factors determine health. The paper explains Islamic principles for family and community health as well guidelines on health promotion.
1.0 DESCRIPTION OF HEALTH
1.1 Four components
The components of good health are spiritual health, sihat ruhiyyat; physical health, sihat al jasad / rahat jasadiyyat; psychological and mental, sihat nafsiyyat / rahat nafsiyat), and social health. Spiritual health is maintaining correct relations with the Creator that in turn orders relations with other humans and with the environment. Health in the biological sense is maintaining physiological function in the optimal situation. Psychological health is being aware of and at peace with the self as well as the social environment around. Health in the social sense means harmonious functioning in the social milieu involving give and take relations. The various components of health are inter-related and closely inter-dependent such that a problem in one can easily lead to disequilibria in others.
1.2 Holistic outlook
Islam looks at health in a holistic sense. If any part of the body is sick the whole body is sick, mathal al jasad al waahid idha ishtaka minhu ‘udhuwun tadaa’a lahu saairu al jasad bi al sahar wa al humma. If a member of a family is sick the rest of the family are affected emotionally and psychologically. Any sickness in the community will sooner or later have some negative impact on all the members. The holistic outlook also means that physical, emotional, psychological, and spiritual health are considered together. A person who is spiritually sick will sooner or later also become physically sick. The reverse is also true unless the iman is very strong.
1.3 Health is relative
Health is relative and subjective. It varies by age, place, norms, gender, and state of iman or tawakkul. A physical state that is healthy in an elderly person may not be so in a younger one. The conventions and norms, ‘aadat, of what is good health vary from place to place and even in the same place may vary from era to era. The subjective feeling of good health varies by gender, females generally being more worried about disease than males. Those with strong iman and trust in Allah, tawakkul, may feel subjectively healthier than those who do not have these attributes.
1.4 Health as amanat
Keeping the body in good health is a responsibility, amanat. The Muslim must keep his body physically fit to be able to undertake the functions of vicegerancy, istikhlaf, and building a civilization, isti’mar. Poor health not only deprives society of the contributions of an individual but also creates a burden for others. Neglect of one's health is a sin. It is a religious obligation, fardh, for the sick to seek treatment. It is also obligatory to undertake disease-preventing measures such as dietary regulation, general and oral hygiene, avoiding violence, avoiding spiritual diseases, amraadh al qalb, that precede mental illness, or in general avoiding anything that impairs good health.
1.5 Health as a bounty, ni'imat al sihhat wa al ‘aafiyat
Good health is a gift from Allah, ni’mat al sihat wa al faragh[1]. Humans must be grateful to Allah for the gift of good health. This gratitude is in the form of worshipping Him and doing good things. Humans tend to take Allah’s gifts for granted and are therefore not grateful. They only understand the gifts when they are taken away. An ordinary person may not understand or appreciate the value of good health when in good health. On falling sick, the value of good health is understood and is appreciated but most often for a limited time. Everything is forgotten as soon as the illness is over.
2.0 DETERMINANTS OF HEALTH
2.1 Nutrition
Diet is at the root of many diseases[2]. The prophet practiced and taught control of appetite. He never ate never ate to fill his belly[3]. He taught that a believer eats in one belly but a non-believer feeds in 7 bellies[4].
2.2 Environment
The environment is the source of food and water that are necessities of life. Fertile soils give crops and food[5]. The environment is also the source of water and oxygen that are essential for life. The elements of the weather like heat and cold have direct effects on health. The environment also harbors many pathogens that cause disease in humans. Some habitats may not be healthy for some people for example the companions of the prophet found the climate of Madina unhealthy, ‘adam mula’amat jaw al Madina li al sihhat[6]. The habitat also determines the character and behavior of people for example those who live in desert areas adopt a nomadic life-style with a militaristic aggressive tendency whereas those who live in forested regions are sedentary and are less aggressive.
2.3 Life-style
The life style that people choose affects physical and mental health. The Qur’an has described several life-styles that are injurious to health such as taraf[7], israaf[8], and fasaad[9].
2.4 Psychological factors
Personality and behavior are perhaps the most important determinants of health. The Qur’an has described several negative personality types and behaviors that are related to ill health mental or physical. Humans have been described as fakhuur[10], dhaluum[11], ‘ajuul[12], qatuur[13], khasiim[14], haluu’u[15], jazuu’u[16], and kanuud[17]. What starts as a psychological malady soon turns into a physical malady for example envy could lead to murder.
2.5 Spiritual factors
There is a strong relation between iman, character, behavior and health. Humans suffer from diseases of the heart, amraadh al qalb[18]. Iman cures diseases of the heart. These diseases may manifest physically as psychosomatic illnesses or may manifest more dramatically as injury to self or others. Among these diseases are lahaw[19], ghaflat[20], ghill[21], ghaidh[22], kibr[23], and nifaaq[24]. Diseases of envy, hasad and rancour, hiqd, lead directly to violence.
3.0 FAMILY HEALTH
3.1 Children and the family
Good mental and physical health requires that children grow in a healthy family so that they can be balanced adults. A healthy family promotes the health of all its members. There is no alternative to the family for child up-bringing. The family teaches trust, loyalty, a sense of belonging, and rights and responsibilities. These are attributes needed for balanced psychological health. The family is an economic unit. It is the main source of primary health care
3.2 Mutually satisfying spousal relations
Good, balanced, and mature marital relations are conducive to psychological and physical health. A family is a source of calmness and tranquility. A spouse is a source of psychological calmness, sakinat[25]. Islam has enacted several measures to ensure family health. Marriage is encouraged[26] as a basis for family formation. Islam recognizes no alternative family arrangements. Religion is the basis for selection of a spouse[27]. For the family institution to be stable, temporary lust-driven sexual relations are forbidden[28]. To ensure stability of the marital relation, marriage must be contracted by mutual consent without force[29]. Good treatment of the spouses is ordained[30]. The Law prescribes preventive measures against family break-up. The psychological and physical health of spouses and children suffer when the family breaks up on divorce more so than on death of one of the spouses.
3.3 Prevention of family break-up
There are many measures to preserve marriage. There are procedures for resolving marital disputes[31]. Divorce is the worst of legal measures; it is however allowed when there is no other alternative. Even in cases of divorce the process is structured in such a away that reconciliation is possible[32].
4.0 COMMUNITY HEALTH
4.1 Good healthy communities
The concept of community health was not recognized widely until the last quarter century. It is however a very old concept found in the Qur'an. The Qur'an has told us about many communities in the past as lessons for us[33]. Good, al balad al taib[34] and safe, al balad al amiin[35] are adjectives that the Qur'an has used about some communities. Some of them were blessed and lived in peace and plenty[36].
4.2 Bad unhealthy communities
The Qur'an also told of communities that were victims of collapse, khiraab[37], those that were punished by famine[38], or were destroyed by Allah, ihlaak[39]. The physical destruction was due to moral deviations like transgression, dhulm[40].
4.3 Community diagnosis
Community diagnosis is identifying and describing health problems in a community with a view to initiating public health interventions. Many communities in both developed and developing countries are dysfunctional. They are unhealthy in the physical and social or mental sense. The reasons underlying community ill health are the same as the Qur'an mentioned above. Social injustice is responsible for the conditions of poverty and deprivation that lead to malnutrition and infectious disease. Immorality and sexual promiscuity encourage the spread of sexually transmitted diseases. Over-indulgence leads to over-nutrition that is associated with coronary heart disease. Alcohol and drug addiction lead to a lot of long-term mental problems.
4.4 Improvement of community health
Community health can be improved in three ways. The beginning is having healthy individuals in the community. Then capable or designated members of the community should undertake the communally obligatory functions, iqamat al furuudh al kifaiyat. Finally the community should aim at establishing mutual cooperation and mutual complementation.
5.0 HEALTH PROMOTION
5.1 Spiritual promotion at the individual level
Most diseases can be prevented using spiritual approaches. These involve ‘aqiidat, ‘ibadat, avoiding haram and promoting halaal.
5.2 Spiritual promotion at the community level
This involves enjoining the good, amr bi al ma'aruf, and forbidding the evil, nahy 'an al munkar.
5.3 Physical promotion at the individual level
Islam encourages a human to take measures to protect the body from harm by preventing disease. Thus immunization, good nutrition, personal hygiene, and disinfection are all acceptable measures for protecting health.
5.4 Physical promotion the community level
This involves various measures aimed at environmental improvement
5.5 General health promotion
There are activities that Islam encourages to promote health. They essentially put the body in the best state to withstand disease and illness. These include diet, exercise, and recreation. Health promotion involves pro-active measures that make health better. These include exercise, good nutrition; adequate rest; mental calmness; and tranquility of a family life, sakiinat. Iman and spiritual calmness, tama'ninat, contribute to health promotion.
5.0 FUTURE ISLAMIC HEALTH CARE
I am talking about the future. My futuristic vision is that in the next 15-20 years a vigorous Islamic healthcare industry will have emerged and will be well established. There will be many Islamic hospitals, polyclinics, free standing diagnostic centers, rehabilitation centers, and palliative care centers.
The Islamic healthcare industry will in my vision outperform the Islamic banking industry in terms of revenue generation and contribution to GDP. There are 3 main reasons for this. The first reason is that Islamic health care is an added value. Patients are dissatisfied with the biomedical model of medical care delivery because of its emphasis on technology at the expense of the human dimension that would be obtained in an Islamic holistic care that takes into consideration spiritual, psychological, and social dimensions of health care. The second reason is that whereas every Muslim is a stakeholder in health not everybody has the money to participate in the banking industry. The Islamic healthcare industry will involve all Muslims of various social strata because all seek healthcare. The third reason is that there is a general trend in the Muslim world to rebuild Muslim civilizational institutions such as Islamic economics, Islamic education, and Islamic nutrition (halal food). Islamic healthcare is part of this trend that has been growing stronger since the dawn of the 15th century of hijra.
The emergence of the Islamic health care industry necessitates a theoretical definition and refining of the concept of the Islamic perspective of medicine as well as the training of physicians and nurses to deliver care from an Islamic dimension. I have been working with several brothers and sisters over the past 13 years on both issues and I feel we have now reached a point of take-off. Starting in Malaysia in 1995 and extending to neighboring countries and even beyond the East Asian region we have been holding workshops at faculties of medicine with the aim of reforming the curricula to integrate Islamic values and Islamic law, fiqh tibbi. The details of these efforts can be found at our website http://omarkasule.tripod.com. Over the past 7 years we have graduated medical doctors trained in this system and we have anecdotal evidence that patients who interact with them find them different and superior to physicians trained in the traditional way.
Our basic sciences curriculum is based on the tauhidi paradigm in which we reject the dichotomy between sciences and religion. We teach our students that signs of Allah, ayat al llaah, are found in the book of revelation, kitaab al wahy, and the book of empirical science, kitaab al kawn. What is needed is to read the 2 books together, al jamu’u bayn al qiraatain. Thus our students’ iman increases as they delve deeper into medical sciences and realize the miracles of the human body and Allah’s signs, ayaat Allah fi al anfus & ayaat al Allah fi al aafaaq.
The clinical part of the curriculum consists of teaching students to help patients fulfill their religious ‘ibadat and social obligations using Islamic Law.
The community health part of the curriculum deals with how social problems that are root causes of disease can be prevented or solved using Islamic teachings.
We also deal with the ethical problems and challenges of modern medical technology such as assisted reproduction and artificial life support by using the bird’s eye view that is provided by the theory of the Higher Purposes of the Law, maqasid al shari’at. It is these maqasid that form the basis for the Islamic medical ethics theory. Medicine to be ethical must fulfill and not violate any of the 5 maqasid: hifdh al diin, hifdh al nafs, hifdh al nasl, hifdhn al aql, and hifdh al maal.
I invite all of you to join us on the road to the future of Islamic healthcare based on Islamic medical education.
Wassalam
[1] Bukhari
[2] Bukhari
[3] Bukhari
[4] Bukhari
[5] Qur’an 32:27, 80:24-31
[6] Bukhari
[7] Qur’an 11:116, 17:16, 21:13, 23:33, 23:64-67, 34:34-35, 43:23, 56:45
[8] Qur’an 6:141, 7:31, 25:67
[9] Qur’an 7:86, 7:103, 10:91
[10] Qur’an 11:10
[11] Qur’an 14:34
[12] Qur’an 17:11
[13] Qur’an 17:100
[14] Qur’an 36:77
[15] Qur’an 70:19-21
[16] Qur’an 70:19-21
[17] Qur’an 100:6-8
[18] Qur’an 2:10
[19] Qur’an 21:3
[20] Qur’an 18:28
[21] Qur’an 7:43
[22] Qur’an 3:118-119
[23] Qur’an 40:35
[24] Qur’an 2:8-10
[25] Qur’an 30:21
[26] Bukhari
[27] Qur’an 2:221
[28] Bukhari
[29] Bukhari
[30] Bukhari
[31] Qur’an 4:34-35
[32] Qur’an 2:227232, 2:236-237
[33] Qur’an 11:100
[34] Qur’an 7:58, 34:15
[35] Qur’an 95:3
[36] Qur’an 16:112
[37] Qur’an 2:259
[38] Qur’an 16:112
[39] Qur’an 6:131, 7:4, 7:96-98
[40] Qur’an 11:102, 18:59, 21:11, 22:45, 22:48