P. William Dysinger, MD, MPH
The Historical Perspective of Health Evangelism in the Adventist Church—Part 3
In part one and part two we covered the founding of the College of Medical Evangelists and the early challenges that the institution faced as it tried to implement Ellen White’s counsels regarding medical missionary training and evangelism. In 1910, John H.N. Tindall was chosen to implement Ellen White’s vision for a “new approach” to evangelism; his lifetime of experience can be instructive to modern health evangelists. The experience in training evangelists at Loma Linda in the 1960s and ‘70s was also reviewed.
Lifestyle Medicine
The initial training of “medical evangelists” at the College of Medical Evangelists was an attempt to produce lifestyle-change specialists. Unfortunately, it was sixty years ahead of its time. The philosophy and practice of medicine of that day (the 1910s and the 1920s) did not place special emphasis on preventive medicine. When the School of Public Health (SPH) was established at Loma Linda in 1967, its organization was towards the preparation of lifestyle-change specialists. It was quickly recognized, however, that if the practice of lifestyle medicine was to achieve the stature foreseen by Ellen White, a new doctoral program would need to be established. This goal was announced by the Dean of the new School of Public Health, Mervyn Hardinge, in the 1960s.
With much planning and work by the faculty, the new Doctor of Health Science (DHSc) program was initiated in 1972. It was built on the basic health sciences similar to medical study: anatomy, functional histology, biochemistry, physiology, exercise physiology, pathology, basic and advanced nutrition, lifestyle diseases and risk reduction, community mental health, dimensions of stress, alcohol and drug dependency and behavioral counseling. These were some of the health sciences offered. The program was designed to train a new type of health specialist expert in health and lifestyle risk assessment and counseling regarding lifestyle changes. The design, marketing, implementation, and evaluation of health promotion programs in community, church, industry, or hospital settings were part of this new doctor’s expertise.
From the beginning, there was opposition. There might have even been an element of jealousy by some ‘regular’ medical doctors who recognized that in areas such as nutrition, exercise physiology, stress control and working with dependency behaviors and other lifestyle changes, the new doctoral graduates were more knowledgeable than they.
An evaluation of the first 68 graduates of the DHSc program in 1979 revealed that 46 percent were working for Adventist institutions or programs, about 20 percent were in government or university employment, and the remainder were in private practice. Some were simply pursuing fellowships or further training. Outside observers such as the Council on Education for Public Health (CEPH) always recognized Loma Linda’s program as unique and on the “cutting edge” of preventive medicine. In a letter to the University, the accrediting council referred to the DHSc as “one of the most innovative programs in existence. It addresses the specific needs of health.” CEPH recognized it in 1987 as “a strong program.”
In 1991, in an effort to make the lifestyle change program even more acceptable, a new Doctor of Public Health (DrPH) program in Preventive Care was initiated to replace the DHSc. This program continues today in the section of Preventive Care in the Department of Health Promotion and Education. Continued good enrollment gives evidence of continuing interest in lifestyle medicine in the School of Public Health at Loma Linda.
Lifestyle Medicine in the Medical School and General University
In the 1920s, Dr. Newton Evans, then dean of the Los Angeles division of CME, bemoaned the lack of interest and knowledge of public health at CME. Referring back to the Church’s early stand on “health reform,” he noted that public health professional interest was moving from environmental sanitation to a large concern for personal hygiene and individual health promotion. In 1928, the CME Board accepted a proposal from Evans. He had requested that a few selected fourth-year medical students be allowed to modify their senior year programs and continue on for an intern year in public health, after which they would receive a “certificate of public health.” This was twenty years before the American Board of Preventive Medicine was formed and residency requirements established.
Eleven medical students enthusiastically signed up for the new program. Despite endorsements from highly placed professors at Yale University and elsewhere, the National Board of Medical Examiners and the American Medical Association refused to accept this new program in lieu of the regular required internship. Thus, the first “preventive medicine residency” plan failed.
The idea of a preventive medicine program emerged again at Loma Linda in the 1960s. Elvin E. Adams, fresh from his MPH study at Johns Hopkins University, was accepted as the SPH’s first post-doctoral fellow in preventive medicine (1969). The school then announced a forth-coming residency, but the residency did not actually launch until 1979. As with all medical residencies, the medical school (Department of Preventive Medicine) is its primary home, but Loma Linda’s residency is also a cooperative effort with the SPH.
The general preventive medicine residency at Loma Linda has now been operating for more than 30 years. It has always emphasized a unique combination of preventive medicine with primary health care. In 1993, the program was reviewed by the American College of Preventive Medicine and was recognized as one of the ten model programs among the more than 80 preventive medicine residencies in North America. In 2000, the acute shortage of occupational medicine professionals stimulated the beginning of that sub-specialty at Loma Linda. In 2006, there was the good news that both the American Board of Family Medicine and the American Board of Preventive Medicine had approved a new Loma Linda subspecialty in “lifestyle medicine.”
The first such lifestyle program approved anywhere in the world, this four-year program includes an MPH degree from the SPH and makes graduates board-eligible in both specialties—family and preventive medicine. Most importantly, it is the first medical training program specifically designed to train physicians to help prevent and treat lifestyle related chronic disease, and provide long-term health maintenance. Those with such lifestyle disease problems as coronary atherosclerosis, diabetes, hypertension, obesity, some cancers, osteoarthritis, depression and other lifestyle manifestations are helped. These problems, of course, are now pandemic worldwide. With its unique history, it is very appropriate that Loma Linda pioneer the new specialty of “lifestyle medicine.” This new program is the passion of the current Chair (since 2003) of the Department of Preventive Medicine, Wayne S. Dysinger.
Other indicators of increasing interest in “lifestyle medicine” includes the approval by the University Board of an LLU Institute of Lifestyle Medicine to coordinate all the activities and efforts of all the schools and entities at Loma Linda. Although authorized in 2008, indicative of current financial problems and low priority, this Institute has not yet been funded and initially exists on the basis of volunteer work.
Outside the University, other work continues. In 2004, the American College of Lifestyle Medicine (ACLM) was chartered to bring together health professionals interested in this new sub-specialty and to create services and functions to enable and support the real world practice of Lifestyle Medicine. Recently, relations have strengthened with the American College of Preventive Medicine (ACPM) so that ACLM’s annual meeting is fully integrated with that of the ACPM. Although an independent publication of Elsevier Publishing, the Journal of Lifestyle Medicine is another benefit available to all members of the ACLM. The need for and recognition of lifestyle medicine increases daily.
Lessons to be learned from the history of Adventist Medical/Health Evangelism
- Although specific medical evangelism/medical missionary training at Loma Linda has twice failed, the call for “many” medical evangelists to be trained is still before the church. To prepare the way for the time when no work can be done in ministerial lines but medical missionary work, there is a challenge to health professionals today to recognize that their vocation as medical doctors is primarily to help informally train and supervise others as local church or community “health evangelists.”
- The challenge of Ellen White’s vision of new approaches to cities by use of teams to proclaim the last message of God’s love to the world also remains with us. Tindall used an approach that Ellen White supported, but we should not be afraid to experiment with new approaches to cities and large populations. How can this health evangelism approach be used, for instance, with the Internet or in large satellite efforts?
- Can Adventists develop a “trademark” in lifestyle medicine that is universally recognized by both the public and insurance companies? In this day and age, insurance coverage is necessary for the practice of lifestyle medicine to more fully flourish.
- The lifestyle medicine approach is a natural way to initiate health behavior change. Once begun, it is much easier (with the help of God’s Spirit) to keep the momentum going until full spiritual conversion occurs.
For much of its history, the American Public Health Association had as its logo a tree in a circle with the words, “And the leaves of the tree were for the healing of the nations.” Rev. 22:2. For more than a century Adventists have been identifying “health promoting leaves” to share with the world. Can the Church learn from its mistakes and become more successful in helping the public understand the spiritual significance of health and how to heal and preserve abundant health both in this life and in preparation for the eternal life to follow.
Many years ago the American Public Health Association abandoned the tree-of-life motif. May Loma Linda and the Adventist Church never reject its spiritual heritage, its own “Tree of Life.” May it understand and lovingly add the word “spiritual” to the World Health Organization definition of health “as complete physical, mental, and social well-being.” No other institution can provide the world what it needs as well as the Adventist Church can. I believe, God is waiting for all Seventh-day Adventist health professionals to accept the challenge to take the health message to people everywhere. And to take it in its most complete form: the health message fully integrated with the gospel message.
Note: For those interested, Health to the People by P. William Dysinger is the illustrated history of Public Health, Preventive and Lifestyle Medicine, and Medical Evangelism Training and Outreach from Loma Linda from 1905 – 2005. It is the amazing story of committed individuals who have for a century remained in the forefront of health education, preventive and lifestyle medicine. It is published by Trafford Publishing and is available online at Trafford.com/07-1126, at Amazon.com, or directly from the School of Public Health, Nichol Hall Room 1704 (Phone 909-558-4664), or through the University Book Store. For those interested in the details, including hundreds of references, the “reference” CD, also entitled Health to the People is available only through Loma Linda University at the addresses listed above.
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