THE LOGIC OF SOCIAL ACTION IS “CHARITY IN TRUTH”

“The individual who is animated by true charity labors skillfully to discover the causes of misery, to find the means to combat it, to overcome it resolutely.” (PP 75; CV, 30 )

The resurgence of social activism, the mushrooming of social movements, the awakening of philanthropists and the multiplication of charities are just among the indicators of the complex social upheavals or “social questions” of the post-modern time. They were born ideally to counter an undesirable human condition. They tried to respond to the root causes and offered solutions to alleviate human suffering. Anyone with a heart for social justice needs answers to these questions but oftentimes falls short of its resolution.

At this juncture, I would like to propose a concise reflection based on the third encyclical and first social encyclical of Benedict XVI “Caritas in Veritate”. This reflection will focus on the fundamental ideas of the encyclical and its implications to our specific situation as servants in the world of health. Caritas in Veritate calls again for a renewal of our Christian faith and commitment by going back to its original spring and intention. It challenges the ministers of the sick to work skillfully, to be active in confronting social issues related to health and together overcome it resolutely. Only this is possible, if one is animated by true charity.

Social action can be defined as a commitment to respond to a given particular social question. It is not simply an act in itself but primarily a commitment that arises from a conviction of certain values (gospel) and principles. It is a commitment to work for an authentic development of every person. For instance, a Camillian responds to the lack of access to health care because he believes in the value of respect and openness to life. However, this will work only if one is guided by the light of truth. “Truth is the light that gives meaning and value to charity. That light is both the light of reason and the light of faith, through which the intellect attains to the natural and supernatural truth of charity: it grasps its meaning as gift, acceptance, and communion. Without truth, charity degenerates into sentimentality.” (CV, 3). Truth makes charity comprehensible and meaningful, which brings about real fruits of solidarity and communion. Truth liberates charity from mere acts of “dole outs” and goodwill as well as a “ticket to heaven.” Truth communicates the real substance and essence of the love of God communicated to man.

Charity is defined as “an extraordinary force which leads people to opt for courageous and generous engagement in the field of justice and peace.” (CV, 1). It is a force, which is of divine origin. It is a gift that is independent of any human merit and offered to all human beings. Any commitment to work for justice and solidarity in the world of health must be animated by charity, or else, it will just remain only a passion that is always prone to exhaustion and dissolution. A commitment for social justice animated by charity directs one to look into competently the causes of injustices, the resources to fight for it and the wisdom that will provide the right response to the social question. (cf. CV, 30).

Charity demands justice, transcends it and completes it. “Charity goes beyond justice, because to love is to give, to offer what is “mine” to the other; but it never lacks justice, which prompts us to give the other what is “his”, what is due to him by reason of his being or his acting.” (CV, 6). Any act of charity is an act of justice but not all acts of justice are acts of charity. Justice aims to give what is due to the person and so thus charity, but it is not its end, for charity aims to establish a “relationship of gratuitousness, mercy and communion.” (CV, 6). The fulfillment of justice is not the removal of what John Paul II called the “structures of sin” but the building up communion and solidarity among peoples where each one works for the common good so that each one attains freely the fulfillment of himself, the primary vocation of man to be re-united in God. (PP, 15). “To desire the common good and strive towards it is a requirement of justice and charity.” (CV, 7). This is what health is all about, an integral well-being of man which is not only biological but also spiritual.

The mission of the Church, our mission is to promote integral human development. Integral human development is defined as a development that concerns the whole of the person in every single dimension. (cf. PP, 14; CV 11). This presupposed the perspective of eternal life, which is the end of our hope. Any attempt to limit human development to its material aspect is not integral and real. The transcendental aspect of human progress is intrinsic and completes it. So, the person is at the center in any forms of progress. Progress in ministry cannot be simply gauged by the number of institutions or organizations established but by the progress of each individual person towards the fulfillment of his/her vocation according to the design of his Creator. Working for social justice in the world of health means working for the common good, which is the sum of all those conditions of social life, which allows the human family, and each member to attain fulfillment in their lives. One of those conditions is health.

One of the main causes of the lack of access to medicines especially in developing countries is the WTO provision of intellectual property rights. Pope Benedict stated that, “there is excessive zeal for protecting knowledge through an unduly rigid assertion of the right to intellectual property especially in the field of health.” (CV, 22). This is a clear deviation and manipulation of the ends of globalization as a process of worldwide human integration and solidarity. This is an anti-development attitude that breeds massive inequality among peoples and nations. Another abuse of the process of globalization is the intrusion of the few developed nations into the internal affairs of the developing nations that led to unfair competitions and deregulation policies that resulted in budget cuts for social spending especially in health and education. (cf. CV, 25). Thus, the only way to remedy this situation is to reclaim the centrality of the person and its transcendent vision in any forms of human progress and development. The Church can do a lot to this since she has the truth, resources and mission of transforming the world through the “salt of charity.”

While it is true that the social teachings of the Church do not offer concrete programs or a middle way between two extreme approaches, it indeed provides some hints on what to pursue and the reason of doing it. One of them is to move along the line of development programs. Though this primarily concerns the field of economy, it can be also adopted in the field of health. Development program lies in the belief that the peoples themselves have the prime responsibility to work for their own development but in the spirit of communion and solidarity. People are active participants and not just mere recipients of our donations and “dole outs.” They should be directly involved in the planning and implementation. (cf. CV, 47). This is the philosophy of Primary Health Care program as envisioned by the World Health Organization. The common language used here is empowerment.

The task of promoting justice and solidarity in the world of health should take into account the fundamental truths communicated by God in his gift of charity. Love is always directed to the person and ends in the fulfillment of himself according to his divine vocation. Witnessing the merciful love of Jesus Christ and sharing his compassionate love to the sick which is a concrete expression of charity should led the person towards communion with God and solidarity with humanity. (cf. CV, 15). The problem of access of health, underdevelopment and poverty are not primarily problems of material order but of ill will, which entices man to focus only for his own sake and not for the sake of the common good. Structures of sins are its obvious effect. In order to overcome this, one should be guided by the light of truth, which is comprehensible through faith and reason. Social action then is necessary but only when it is animated by true charity.

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RE-FORM-ING IN THE WORLD OF HEALTH

In the first quarter issue of Camilliani 2009, the first article of the health and justice series was about “redeeming” the lack of attention to the structural causes of illness and inequities of health in our ministry to the sick person. The term “redeeming” is understood as an approach that compensates for what has been started but not sustained, i.e., confronting structures of injustices in the world of health. This second article will focus on the term “reforming” which is a fundamental approach used in the various programs of the healthcare ministry. Re-form-ing stands for the three-level ministry of responding, forming and influencing. It refers to the three distinct but interrelated aspects of healthcare ministry.

The relationship between the three elements of “reforming” can be compared to the dynamics of what Fr. Calisto Vendrame, M.I., called the tripod of religious life (experience of God, experience of fraternity, the mission and service in the Kingdom of God). This is only with due reference to the dynamics of the tripod, and not to its individual aspects, i.e., the interrelation of the aspects and its foundational character (i.e., one could not stand without the other). Responding, forming and influencing nourish and support one another, and find its concrete expression and embodiment in the ministry. “Reforming” takes its shapes in the acts of charity (responding), pastoral formation (forming), and social advocacy (influencing). The mission identity of the Camillian socio-health institutions defines it clearly: “to witness and incarnate in the world of health and sickness the salvific, merciful, therapeutic and salutary action of Christ. This is realized through the promotion of health, the prevention of sickness, the provision of care and rehabilitation.”

Responding

Any form of charismatic action, as an organized response to the promptings of the Holy Spirit, is borne out of a concrete historical situation. The dream of Camilla about his son Camillus was clearly interpreted and understood when Camillus found himself inside at St. James of the Incurable and the Holy Spirit Hospital. When Camillus saw and felt the sufferings of the sick person, he understood it as the call of God to do not his work or plan but the concerns of God. It was in this context that he developed charity as witnessing to the merciful love of Christ to the sick “like a mother caring for her only child” for he saw in the sick person Christ himself.

Today, this witnessing is sustained by the various works of charity through the socio-healthcare institutions, pastoral centers, chaplaincies, parishes, etc. All these came about because of exigencies that call for an immediate and an organized response. It does not arise only by pure desire or ambition of the individual to do something good for others. Any response in charity needs to be placed in context, otherwise, it will not be sustained or, will just end up contemporaneously as soon as the protagonist disappears. The factual circumstances serve as a barometer for a sound planning and effective implementation of initiatives.

This is a very vital form of ministry since charity pushes as to get in touch with the real sufferings and situation of injustices of the sick people. Its concrete contribution to the work for social justice in the world of health is the gathering of data and facts observed. People who are engaged in the ministry of charity can be a vital source of information for social advocacy in health ministry. The challenge then, is not just only to offer concrete responses to the present exigencies but also to record and document those cases.

Forming

The second aspect of ministry is formation. When Jesus began his public ministry, one of the first project he did, was to call disciples with a specific task of “to be with him.” (Mark 3,14). It was an invitation to experience and learn from Him. When St. Camillus has committed himself to stay at St. James of the Incurable, he gathered the first five devoted men wherein they prayed and work together at all times. Goodwill must be supported and equipped with competence, and competence must be guided with compassion. The first rules of the Society of the Servants of the Sick in 1584 clearly manifest the true intention of forming real ministers of the sick.

A relevant formation is one that is crafted out from the very situation in which the healthcare ministers are engaged with. In this way, direct and indirect information that has been gathered from the concrete experiences in the field are vital resources for a sound and relevant formation programs. Direct information is hands-on information while indirect information is information gathered from an in-depth studies and reflection, in other words written information. Pastoral centers are the primary users of the informations gathered from the actual ministry in the service of charity, as well as providers of prepared human resources and promoters of a competent compassionate love in the world of health.

Influencing

The third aspect of ministry is advocacy. David Cohen, a social justice advocate defines advocacy as “the pursuit of influencing outcomes — including public-policy and resource allocation decisions within political, economic, and social systems and institutions — that directly affect people’s current lives.” (Cohen, 2001). Fr. Frank Monks described this as “to be a credible voice for others” which is no other than reclaiming the consecrated persons’ prophetic identity. General Chapters produce normally substantial amount of documents that speak about advocacy coming from credible resource persons. The task of each one is to translate these voices into the language of compassion, commitment and courage in order to influence doable plans and sustainable outcomes.

What does advocacy in health really interest most? Its interest is to ask and to answer “Why?” The World Health Organization has this to say: “The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of peoples lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life. This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics.” (CSDH, Closing the Gap in a Generation…, 2008). The social determinants of health are vital instruments for any forms of health care ministry. Health issues are not natural but created. Thus, somebody is accountable to it and all of us are responsible for it.

Therefore, the experiences gathered (responding ministry), and reflected (forming ministry) need to be further analyzed and presented (influencing ministry) to whoever is accountable for it. The interplay of these three levels of ministry is vital and crucial. There are already several religious congregations and civil society groups who have representations as lobby groups in the wider international state organizations such as in the UN and the local state political organizations, who want to build better networks in order to strengthen their advocacies. They need more voices and commitments. To establish linkages and share capacities is among the best options that one can venture for a healthy world of health based on justice, solidarity and peace.

REDEEMING THE SILENCE IN THE WORLD OF HEALTH

The present global health situation reveals a stark contrast between the scientific advancement in the field of medicine and the immense inequities of health status among highly developed and developing countries. Remarkable improvements have been made in health status worldwide over the last century, but these improvements have not been shared equally. The gap between rich and poor nations has widened, as have inequities within countries, between urban and rural, men and women, and young and old. The recent World Health Report 2008 by the WHO has affirmed that, while globalization contributes to the improvement of the global health condition, it is also “putting the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should.”ⁱ

Why this is so? What causes these iniquities? There are no easy answers to this complex global health situation, unless one grounds himself into the reality, examines it with a critical eye and responds to it with a creative compassion. It is a clear invitation to redeem one’s prophetic vocation as real ministers of the infirm. It is then, a challenge to build ones commitment with burning passion to love and care for the poor sick even in danger to ones life.

Since last year, almost everyday I passed by via del Corso in Rome on my way to the university. The place is very historical and significant for us Camillians since the hospital of St. James of the Incurables where St. Camillus founded our Order is located. But in September, I was surprised to see a big banner spread from the roof to the ground of the hospital where it is written “SALVIAMOCI L’OSPEDALE” (Let us Save the Hospital). The place that used to be the savior of all the wretched, vagabonds, and abandoned sick in the society is now in need of a savior. It has been closed. Though it can’t be denied the fact that after four centuries since the time of St. Camillus in this hospital, an immensed change of the situation took place. What it was then, now becomes a memory and a part of the human history and testimony.

St. Camillus has revolutionized (the new school of charity) once the operation of this hospital by putting first the person of the sick above anything else. He did everything for the patient even amidst criticisms of the ecclesiastical and civil authorities because he saw in the sick, the person of Christ and realized himself to be the bearer of the merciful love of Christ to the sick. Everything in the hospital is subjected to the person of the sick and not the other way around.

Closing down of public health institutions, rationalizing its operation, privatizing its management, transforming it into profit-driven investment, etc. are just the toppings of the worsening global health politics brought about by monopoly global economic system. The global economic crisis becomes the pretext of several States both in the developing and in highly developed countries to lessen their responsibility of strengthening the public welfare services such as health, access to water and affordable medicines, and converts these institutions into profit-oriented institutions in the name of rationalization, efficiency and redemption of the ailing national economy at the expense of the majority who lives with less than $2 a day.

According the WHO annual report, the annual government health expenditure varies from as little as $20/person as to over $6,000/person. More than 5 billion people in the world drew out their health expenses from their own pockets. This accounts 91% of their total health expenditure. About 150 million of them or more suffered from catastrophic health care costs every year. Catastrophic spending are expenses on health coming from their own pockets, that pushed them to the margin of society and live much beyond the poverty threshold. In simple terms, sickness pushes them to extreme poverty and an inhuman condition of life. The differences of life expectancy between the richest and the poorest countries now exceed to 40 years. In the low income group there are only 5 physicians and 10 hospital beds per 10,000 population and while in the high income group there are 28 physicians and 59 beds per 10,000 populations. In terms of maternal mortality, the ratios of deaths per 100,000 live births are the following: 9 in highly developed countries, 450 in developing countries and 900 in sub-Saharan countries. In terms of HIV+ cases, one in every three people in the world living with HIV lived in sub-Saharan Africa, a total of 22.5 million, 4 million in South and Southeast Asia, 1.6 million in Eastern Europe. It is estimated at 6,800 persons infected with HIV everyday and about 6,000 died everyday.ⁱⁱ

The following picture of the global health condition shows gross shortcomings of health care delivery particularly in the low and middle income countries. These shortcomings are revealed by inequalities in health care. There is a situation of an “inverse care” which means that people whose needs for health care are minimal and has the means, consume the most, while people with less resources and have greater health needs consume the least. There is a phenomenon of “impoverishing care” where people lack social protection and payment for care is pushed to the margin of extreme poverty. According to the study done by the National Association of County and City Health Officials (NAACHO) in USA, “the so-called disparities in health status among different population groups are unjust and inequitable because they result from preventable, avoidable, systemic conditions and policies. If health inequities are unfair, effective action to eliminate them demands a perspective and conceptual framework grounded in values of social justice.”ⁱⁱⁱ If the major problems are systemic in nature, why is it that the States failed to address this perennial predicament? If the States can procure greater budget for arms and defense (for high income countries) and foreign debt-servicing (for low and middle income countries), why is it not reasonable to procure more for health and promotion of life?

Globalization of politics and economy places more control of the flow of capital and world’s resources into the hands of the few multi-national corporations that incapacitates national governments to influence their own economic policies. According to the Nobel Memorial Prize awardees and a former chief economist of the World Bank, Joseph Stiglitz commented, “that American and other western drug companies could now stop drug companies in India and Brazil from “stealing” their intellectual property rights (IPR). But these drug companies in the developing world were making these life-saving drugs available to their citizens at a fraction of the price which the drugs were sold by the western drug companies.”^iv Commercialization of health becomes the trend of the day. Health ceases to be a basic human right, and now consider as a lucrative commodity. Mission hospitals, non-profit health institutions and public hospitals are tied up to the dynamics of cost recovery system and shifted the cost of services to the end-users (patients) in an attempt to compensate for the chronic financial situation of these institutions. As Fr. Healy remarked in his speech during the 56^th General Chapter: “… institution tend to take on a life of their own. Rather than to care for the true needs of the people for which it was founded, the institution serves its own needs especially the needs of its own bureaucracy. In this process right relationship are undermined the balance of justice tilted and the common good forgotten.”^v

The people wants healthcare that heals more the person as individuals with rights and not as mere targets for programs or beneficiaries of charity. Health is an integral part of how they and their families go about their daily struggles in life towards better living and perfection of ones vocation to holiness. Centuries ago, St. Camillus was fully convinced of these principles in his life, because he lived and suffered with the sick and saw in them as the true sacrament of Christ’s eternal presence. In order to translate these convictions into reality, as the WHO proposes, one must engage in health activities that promote universal coverage, access and social protection; that organize itself around people’s needs and expectations; that promote participatory and negotiation-based leadership; and lastly, one that upholds the values of social justice and right to better health for all.^vi

i WHO, The World Health Report 2008: Primary Health Care, Now More Than Ever, WHO, Switzerland, 2008 p. xi.

ii Ibidem, pp. 2-13.

iii NAACHO, “Creating Health Equity through Social Justice”, 2002 p. 16, at http://archive.naccho.org/documents/healthsocialjusticepaper5.pdf.

iv STIGLITZ J., Globalization and Its Discontents, Penguin Books, London 2002, p. 8.

v HEALY S., Justice in a Changing World, in MINISTERS OF THE INFIRM – Documents, n. 20 (2008), P. 448.

vi WHO, The World Health Report 2008, pp. ix.

D'BETWEENs OF LIFE

Between OPPORTUNITIES and BLESSINGS

- opportunities are man-made while blessings are God-made

- opportunities are chances while blessings are certainties

- opportunities are good but blessings are best

- opportunities are enticing while blessings are unattractive

Between SUPERSTITION and BELIEF

- superstitions are human conventions that has been handed from one generation to the next while belief is a divine gift

- superstitions are coincidence-based while belief is faith-based

- superstitions are deceiving while belief is assuring

- superstitions are doomed to defeat while belief is groomed to victory

Between ACTION and MOTIVATION

- action is measurable but motivation is immeasurable

- action is the fruit and motivation is the root

- action fails but motivation prevails

- action can be bad but motivation is always good

Between INSTANT and LASTING solutions

- instant arrives at a sudden but lasting passes through a process

- instant is temporary while lasting is everlasting

- instant demands the practical self while lasting demands the reflective self

- instant is pressuring while lasting is persevering

- don’t get entice with OFFERS and BIG DEALS because it will offer you what you don’t expect and will deal you with harshness; the wisdom of small beginnings is a wisdom that has never been disproven; perseverance means years and not months that’s why God endows us with FAITH for us to persevere

Between PITY and MERCY

- pity is feeling but mercy is virtue

- pity is irrational, it precedes thinking, but mercy is rational, it proceeds with vision, mission and action

- pity is consoling but mercy is empowering

Between KINDNESS and TRUST

- kindness is human nature while trust is human effort

- kindness is innate in us while trust needs to be build among us

- kindness is appreciated but trust is valued

BUT remember in between in all these enumerations and litanies is YOU and GOD. The world will never change, resolutions will never solve, change will never take place unless you see, reflect and response what’s in between.

Aris, MI