This social statement begins the public conversation within the ELCA on health and health care. If we take this statement seriously, we will be agents of change. The impact of this statement depends on the action of individual members, congregations, and institutions of the church toward improving health within their spheres of influence. This is a complex, global issue but the answers start in our homes and in our communities.
 Changing our world starts with understanding the need to change, being willing to participate in change, and being active in changing our own community.
 Why is health and health care a burning social issue? Bioethicists Beauchamp and Childress suggest two main arguments in support of health care as a public good and an individual right: 1) collective social protection, and 2) fair opportunity. The first argument suggests that threats to health are similar to threats posed by crime, fire, and pollution and that the government has an obligation to provide protection against such public threats. Counter arguments suggest that all government services are expendable and nonessential or that health is an individual good, not a social good. Fair opportunity suggests that a just society will assure by fairly allocating health care resources that no one suffers unfairly as a result of bad luck or misfortune for diseases, injuries or disabilities that are out of his or her control. They go on to suggest that without additional qualifications, acceptance of these two arguments would be an immense burden on society.
 Recent events such as the SARS epidemic, West Nile virus or acts of terrorism are vivid reminders of the threat of injury or illness to individuals and to the public which resulted in government responses to increase safety and security, including readiness to respond to emergency situations. These examples alone are extraordinarily expensive and do not address other significant health issues affecting many of us such as increasing obesity, heart disease and diabetes or the increasing rate of depression. Health care is an urgent social issue, as steadily rising costs and inadequate systems of health care are resulting in increasing numbers of uninsured. From a global perspective, the United States' per capita spending on health carein 2000 was 44% higher than Switzerland's, the next highest spender; 83% higher than Canada, and 134% higher than the average of developed countries; and that gap is widening. At the same time, measures of utilization such as physician visits and hospital days in the United States were less than the median. In addition, the United States ranks at or near the bottom of the developed countries on many measures of health.
 The proposed social statement on health, healing, and health care sets the stage for discussion and action within the ELCA by presenting biblical perspectives on health and healing, setting the vision of health and health care, and looking toward a better system of health care. Three issues are particularly important in this statement: the vision of health care as a shared endeavor, the responsibility to be stewards of our own health, and the commitment to steward resources on behalf of our neighbors.
A Shared Endeavor
 Caring for Health: Our Shared Endeavor states that we have a commitment that comes from a grateful response to God's saving love in Jesus Christ that frees us to love our neighbor. If, as members of the ELCA, we take this commitment seriously "to work for and support health care for all people as a shared endeavor," we will take an important step toward the changes needed to reverse the current trend of increasing costs, decreasing access and variable quality of care.
 Taking this step means helping others who are living with chronic diseases or disabilities or are without access to good health care services with what we have and with what we know. It means working in partnership - individuals with physicians and other providers, providers with hospitals and health plans, clinics and congregations with communities, mental health providers with physicians and alternative healthcare providers, state and federal governments with providers and health plans. We cannot point the finger at or make this problem or its solution the responsibility of the government or health plans or employers alone. It means being willing and prepared to share in the responsibility and the benefits.
Self-Care and the Wholeness of Health
 We must take our individual responsibility for personal health seriously. In America, the most prominent factor resulting in illness or early death is lifestyle behavior that can be controlled. Being good stewards of our health means evaluating and understanding our current state of health and intentionally making changes in our lives toward improved health. That includes the wholeness of health, or "positive health," defined by the Institute of Medicine as a healthy body, high-quality personal relationships, a sense of purpose in life, self-regarded mastery of life's tasks and resilience to stress, trauma, and change. As individuals, that means developing healthy habits such as three daily nutritious meals; moderate physical activity at least 5 times a week; regular quality time with family and friends; regular time for prayer and devotions; seeking and practicing forgiveness; scheduling time for recreation, relaxation, vacation, sabbath, and sabbatical; regular evaluation of our vocation and ministry; and taking regular opportunities for lifelong learning.
 As individuals who belong to congregations and communities that means holding each other accountable and supporting each other toward improved health. The ELCA is committed to addressing health and wellness as we believe that healthy leaders enhance lives. As individuals, committed to improving health, we will impact the lives of our families, congregations and communities. This means serving nutritious foods at potlucks, in school, at homeless shelters and assuring that nutritious foods are available in grocery stores, restaurants and fast food places. It means participating in group physical activities, supporting school events and congregational outings that encourage physical activities, and seeing that the communities have safe and accessible parks and roads for walking, biking and other physical activities. It means assuring equitable access to education and to the arts and affordable public transportation. It means encouraging public conversations toward a better understanding of diversity and in celebration of unity.
 It means encouraging employers and the government to promote health and provide access to quality essential health care services. It means encouraging health care systems to provide quality health care teams that can work in systems of care to provide evidence-based quality health care services that are affordable. It means increasing education and support to address chronic diseases and provide palliative care to reduce suffering and to enable a peaceful death. It means being active and informed for meaningful discussions with those who make policy or law and those who provide and pay for health care services.
Population Health and Stewardship
 Stewardship of health care for all people means that, in addition to supporting and improving health, we must steward the financial and human resources used to provide health care services. Approximately 5% of the more than $1 trillion spent annually in the United States on health care services is currently spent on population-wide approaches toward health improvement. Approximately 30% of Medicare funds are spent in the final year of life.
 Working for and supporting health care for all people does not mean demanding extraordinary technological means or expensive and unproven treatments to rescue individuals - ourselves or our family members. It does not mean assuring convenient access to the highest technology at the expense of unnecessary duplication of services. It does not mean postponing death through prolonged mechanical or pharmaceutical support. It does not mean worshiping the means of treatment - the newest drug or technology - without considering the ends - the suffering of individuals or the cost to society. It does not mean avoiding the reality of illness, injury or death by paying someone else to take care of it.
 It does mean being aware and knowledgeable about the health of our communities and the barriers to improving health. It means working toward meeting those needs with appropriate preventive services and the provision of the right health care services at the right time in the right place by the right health care team. It means understanding that health is more than the absence of disease and that other aspects of health - social, intellectual, vocational, and spiritual - need to be in balance. It means encouraging gifted and caring individuals to pursue vocations in health care, and supporting those whose vocational ministry is health and healing in their daily work and encouraging them toward the changes needed to address health more effectively. It means taking personal time and energy to meet the needs of others to improve the health of the community.
Why should the ELCA take this on?
 We have been commanded to love God with all our heart, soul, mind, and strength and to love our neighbor as ourself. Loving ourselves means reaching for positive health. Martin Luther wrote: "This life, therefore, is not godliness but the process of becoming godly, not health but getting well, not being but becoming, not rest but exercise. We are not now what we shall be, but we are on the way. The process is not yet finished, but it is actively going on. This is not the goal but it is the right road. At present, everything does not gleam and sparkle, but everything is being cleansed."  To be whole empowers us to love God with all our heart, soul, mind and strength and enables us to love our neighbor. Loving our neighbor means not just wanting positive health for them but actively teaching, supporting, providing, and seeking the changes needed to provide health.
 This is a call to action. Read the social statement. Start with your personal life and health. Take a good look at the health of your family. Raise the issue of health in your congregation. Evaluate the barriers to health in your own congregation. When you have an understanding and a commitment to address your personal and congregational health issues, look to the community. Understand the health risks and barriers within your own community. Understand the needs and realities of your neighbors. Start a conversation with your health care provider and your community leaders about those needs and realities. Be willing to change the world by learning, acting, and participating in change in your own life and the life of your congregation and community.
 Beauchamp TL and JF Childress. Principles of Biomedical Ethics. Oxford University Press, 1994.
 Anderson GF et al. "It's the Prices, Stupid: Why the United States Is So Different from Other Countries." Health Affairs, Volume 22, Number 3, 2003.
 National Academy of Sciences. Institute of Medicine. "Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences" (May 21, 2001).
 McGinnis JM. "The Case for More Active Policy Attention to Health Promotion." Health Affairs, Volume 21, Number 2, 2002.
 Rao JK et al. End of Life is a Public Health Issue. American Journal of Preventive Medicine, Volume 23, Number 3, 2002.
 Luther M. "Defense and Explanation of All the Articles," Luther's Works, 1521.
© August 2003
Journal of Lutheran Ethics
Volume 3, Issue 8