11 December 2019

How Christianity Changed the World: Biblical Christianity’s Impact on Healthcare and Philanthropy

The latest issue of Affinity’s Social Issues Bulletin is out now. It is free to download, as are all previous editions. One of the articles is the fourth in a series of five papers under the general heading of ‘How Christianity Changed the World’. They are adapted from a series of talks given by the author at Word Alive in April 2019. Christian Focus are releasing Sharon’s book on this theme in March 2021.

How Christianity Changed the World:

Biblical Christianity’s Impact on Healthcare and Philanthropy

This series of articles offers some snapshots from history to demonstrate that the world has been changed immeasurably for the better because of the life and witness of Christ’s followers. In this fourth article we see that Christians through history and today are in the forefront of providing healthcare and other humanitarian reforms for a world in great need of such.

The God of mercy has compassion on all he has made, and his followers have been at the forefront of efforts to relieve suffering and need. The West has a strong tradition of philanthropy that has created a culture of giving and sharing that is unmatched in any other civilisation in history. The parable of the Good Samaritan has been described as the parable that changed the world.

The whole Bible bears witness to the reality that our triune God is a God of mercy and compassion. He is the God who is gracious, full of compassion, slow to anger, great in mercy, and good to all (Psalm 145:8-9). He insists that anyone who wants to honour him will have mercy on the needy (Proverbs 14:31). And he tells his followers that if we merely profess belief but do not take pity on their suffering, our faith is dead (James 2:14-17).

Today, whether or not we were raised in a Christian home, we have been brought up in a culture which has been deeply impacted by the Christian worldview, and we take for granted that ‘compassion’ is a good thing. But that was not the case in the pagan world.

Compassion: A Revolutionary Concept

Jesus’ teaching that his followers were to love their enemies and show mercy to all was revolutionary in his day. In pagan culture, compassion for the needy was often regarded as foolish; Plato and others held that a poor man should be left to die if he could no longer work. Certainly, in the pagan world people gave gifts, but something was generally expected in return; wealthy benefactors would expect public honour and recognition.

By contrast, Christians were widely noted for their compassion; their message, lived out, resulted in radical communities offering love and care. It was a profound contrast with pagan religion. Pagans attended the temple to make offerings. They attended. They didn’t belong to a familial community. Christians did belong; Church was the body of Christ, it was community, and it was family. If one member suffered, all suffered.

As we have noted earlier in this series, Christianity spread rapidly during the first three centuries in the face of opposition and persecution. There were probably no more than a few thousand Christians in 40 AD. But by the third century, Christianity was growing at the rate of 40 per cent per decade. Some reckon that by 350 AD there were 33 million Christians in the Roman Empire out of a total population of 60 million.

Why was this? Their ethic of compassion and care was a major factor. Sociologist Rodney Stark paints a bleak picture of the misery and brutality of life in the urban Greco-Roman world:

To cities filled with the homeless and impoverished, Christianity offered charity as well as hope. To cities filled with newcomers and strangers, Christianity offered an immediate basis for attachments. To cities filled with orphans and widows, Christianity provided a new and expanded sense of family. To cities torn by violent ethnic strife, Christianity offered a new basis for social solidarity. And to cities faced with epidemics, fires and earthquakes, Christianity offered effective nursing services.[1]

The Christian response to poverty was grounded in beliefs about human dignity. David Bentley Hart writes:

Christian teaching from the first placed charity at the centre of the spiritual life as no pagan cult ever had, and raised the care of widows, orphans, the sick, the imprisoned and the poor to the level of the highest of religious obligations.[2]

In the third century, a Christian handbook, The Didascalia, insisted that church leaders were to ensure that arrangements were made for orphans to get education, widows to receive aid, and the destitute to be provided with food and firewood.[3]

By the middle of the third century, the church at Rome had more than 1,500 needy people enlisted who were receiving regular help. Even small churches kept storerooms of provisions for the poor, such as oil, wine and clothing. So, long before Constantine, the church had created a system of social assistance that no department of the pagan state had ever provided.[4] Once Constantine became emperor, those modest storerooms were transformed into larger store houses. The church became the first organised institution of public welfare in Western history.[5]

The early Christian apologist Tertullian (c.155–240 AD) noted that Christians willingly gave to the church. The donations given to pagan temples were commonly spent on gluttony and feasting. By contrast, the Christians used their funds to support poor people, orphans, the elderly and even those who had suffered shipwrecks.

The Emperor Julian the Apostate (who reigned from 361-363) lamented that the Christians, whom he hated, showed love and compassion, whereas his pagan countrymen did not, famously saying: that the ‘Galileans – to our disgrace – support not only their poor but ours’.[6] He argued that the Christians’ philanthropy towards strangers had done most to spread their beliefs.

The Christian Contribution to Healthcare and Hospitals

The teaching of Jesus was the dynamic motivation behind the rise of hospitals, orphanages, leprosariums and hospices for the dying. For those who followed Jesus, the poor, the sick, the homeless, the prisoner, the unemployed, the stranger and the dying were the focus of the love of God and therefore of human care.[7]

Christian Hospitals

Christian hospitals for the destitute and dying were founded by the reign of Constantine (ruled 306-337). They could be found right the way from the Syrian and Byzantine East to the Western fringe of Christendom. The only previous ‘hospitals’ were the institutions used by the Roman army to restore soldiers to their fighting capacity. During the fourth century, the great city of Edessa (modern day Urfa in Turkey) was ravaged by an outbreak of plague. The Christian deacon Ephraim the Syrian (306-373 AD) founded hospitals to care for the victims.

Basil of Caesarea, now Kayseri in Turkey, who lived from 329 to 379 AD, had been a prominent and gifted law teacher. When he was converted, his life was turned around and he gave away his personal family inheritance to help the poor. As a church leader in Caesarea, he organised a soup kitchen and distributed food during a famine following a drought; he worked to rehabilitate thieves and prostitutes; he didn’t hesitate to challenge public officials if they failed to administer justice. He preached every morning and evening in his own church to large congregations. In addition to all that, he supervised the building of a huge complex which included a poorhouse, hospice and hospital, which was described as one of the wonders of the world.

John Chrysostom (347-407 AD), while patriarch of Constantinople, used his influence to fund hospitals. Rich members of the laity were personally involved in care for the poor and sick. In addition to medical care, these hospitals provided food for the hungry and cared for widows and orphans.[8] Benedict of Nursia (c. 480-547 AD) founded a monastic order, and caring for the sick was one of the main duties of the monks of his order. He opened a free infirmary at Monte Cassino.

We too easily forget that before the Islamic conquests of the 7th and 8th centuries, the middle east and North Africa were covered with Christian churches. And the Christians established numerous free hospitals which were well served by physicians and surgeons; there was convalescent care; there were some specialising in the care of the elderly; there were shelters for foundlings, and the homeless and orphans. Hospitals on that model were built all over Western Europe throughout the Later Middle Ages: the Benedictines alone were responsible for more than 2,000 hospitals in Western Europe. But in addition to the hospitals, by the mid-15th century there were 37,000 Benedictine monasteries caring for the sick.[9]

At Montpelier in 1145 the Hospital of the Holy Spirit was founded. It soon became a centre of medical training. By the 14th century in Europe, England alone (with less than four million people), had 600 hospitals; France, Germany and Italy had even more.[10]

Christian Nursing

Nursing world-wide has been pioneered by Christian voluntary efforts. During the period of the early church, widows, deaconesses and women who committed to be celibate cared for the sick. During the Middle Ages, monks and nuns provided nursing care.

Modern nursing dates back to the pioneering practice of an order of Lutheran deaconesses at Kaiserswerth in Northern Germany.  This began when Pastor Theodor Fleidner gave refuge to one poor, sick and destitute prisoner and nursed him in his own home. He then established a hospital with 100 beds, and trained poor women as nurses. His hospital and the professional care given became famous throughout Europe. By the middle of the 20th century, there were over 35,000 deaconesses serving in parishes, schools, hospitals and prisons throughout the world.[11]

When the young English aristocrat Florence Nightingale (1820-1910) visited Kaiserswerth, she was inspired to defy her horrified parents, and devote her life to nursing. Famously, she transformed the vile conditions in the British military hospital in the Crimea during the Crimean War (1853-6). She then spent the next fifty years pioneering and publicising modern nursing.

Few today have heard of Andrew Reed (1787-1862). He was a great pioneer in care for orphans, those with learning disabilities and the terminally ill. Reed came from a very humble background – he left school early, and trained to work as a watchmaker. He was converted at the age of 15 and aged 19 he entered ministerial training at a small nonconformist college. At 24 he became pastor of New Road Chapel, London where he served faithfully for fifty years, during which time the church grew from 60 to 2,000 members.

Situated in a poor area, it was surrounded with pitiful scenes of squalor and destitution. Life expectancy was short; infants might be orphaned with no-one to care for them. Before he married, Andrew lived with his sister Martha and they took destitute orphans into their home and cared for them. Before long, Andrew raised funds for a large home to accommodate orphans.[12] When Andrew married, his wife Elizabeth worked alongside his sister Martha in charitable ministries. Meanwhile Andrew juggled pastoral responsibilities and preaching with ceaseless fundraising and practical oversight of the orphanages.

Reed became increasingly disturbed at the lack of provision for children with learning disabilities. There was no distinction made between those who were born with learning difficulties, and those suffering mental illness. Asylums, hospitals and workhouses would have sections for those labelled as ‘lunatics’. All were just put together indiscriminately and often appallingly treated. Reed travelled through Europe researching how such children were cared for in a number of pioneering institutions run by Christians. He then opened a home in 1848 at Park House, Highgate for children with learning difficulties, the first in Britain. He then raised funds to purchase the Earlswood Estate, near Redhill, Surrey. Prince Albert laid the foundation stone in 1853. This was transformed by voluntary gifts into the Royal Earlswood Hospital which could house up to 500 children. It became internationally known for the enlightened way in which children with severe learning difficulties were treated.

As if that were not enough, Reed also became a pioneer in the care of the terminally ill. Pastoring a church in a very poor area meant that he knew first hand of hospitals discharging patients who were ‘incurable’. They might end up on the streets, or in the workhouse. Reed opened a home in Carshalton in 1855, which looked after about forty people. This was then replaced by a much larger hospital and home for terminally ill patients at Putney (now the Royal Hospital for Neuro-Disability).

Others followed this lead, and a host of other initiatives to help the terminally ill followed. To bring Reed’s story up to date, Cicely Saunders (1918-2005) opened St Christopher’s Hospice in 1967, widely considered the first modern hospice. Like Andrew Reed, Cicely Saunders was motivated by her deep Christian commitment. The hospice movement and a commitment to palliative care has spread to many countries.

Healthcare is now regarded as the obligation of the State, but Christian voluntary contributions laid the foundation. Researcher James Bartholomew has spent years studying the Welfare State. He documents that before the National Health Service was founded in 1948, Britain had one of the leading medical services in the world, and much of it was due to Christian charitable giving and input.[13]     

Christian Mission and Healthcare

World-wide, it is Christian missionaries who have led the way in providing medical clinics, blood banks, mental health programmes, and alcohol and drug rehabilitation.[14] Working in some of the toughest situations on earth has led to some major medical breakthroughs, such as the missionary Paul Brand’s pioneering treatment of leprosy, which has been internationally recognised.  

Robert Woodberry spent years researching the impact of Bible-believing missionaries around the world. He found that: 

Missionaries… typically opened the first hospitals and clinics, and pioneered Western medical education around the world. Informally, many missionaries also taught hygiene and rudimentary medical knowledge, and introduced new crops and livestock that improved the quality of local diets. Thus, the historical prevalence of Protestant missionaries is associated with longer life expectancies and lower infant mortality rates.[15]

The Evangelical Awakenings of the Eighteenth and Nineteenth Centuries

The great revivals of the eighteenth century in Great Britain led by preachers such as George Whitefield and John Wesley, and in America, led by preachers like Jonathan Edwards, were sparked off by earlier renewal movements on the continent of Europe.

In Europe, mainstream reformers such as Luther had introduced biblical reform with regard to salvation. But they maintained the belief that all the infants in a given territory should be baptised into the national church. This inevitably led to the nominalism and spiritual decline of second, and then third generation Christianity. Luther’s doctrine of salvation by grace alone all too easily then became a doctrine of cheap grace. By the 17th century in Lutheran areas where everyone had been baptised into the Lutheran church, ministers reported:

Those who come to service are usually drunk… and sleep through the whole sermon, except sometimes they fall off the benches making a great clatter, or women drop their babies on the floor… They play cards while the pastor preaches, and often mock or mimic him cruelly to his face… cursing and blaspheming, hooliganism and fighting are common.[16]  

‘Pietists’ was the name given to those Christians who called the church back to a real biblical faith and walk. I will mention just one of them: Auguste Hermann Francke (1663-1727). As a young university student, Francke struggled to find direction in life. In his autobiography he wrote:

For twenty-four years… I loved the world and the world loved me… I grasped heaven with one hand and the earth with the other. I wanted fellowship with God and the friendship of the world at the same time, and could hold neither properly.[17]

But then he was converted. In 1692 he became both a pastor, and a professor of Oriental Studies at the newly established Halle University (in what is now central Germany).

Over the next twenty years, he taught generations of pastors, emphasising a changed life. He himself was an exceptionally active pastor; he preached five times a week, held daily catechism classes for young people, published a religious magazine and promoted world missions. Under his leadership at Halle, the believers provided an orphanage, two homes for widows, free food for needy students, a home for beggars, job creation schemes for the unemployed, free medicine for the poor, and care for the physically disabled. The motto of the pietists was ‘God’s glory and neighbour’s good’. The two went together. They believed in social engagement as an outflow of love for neighbour.

Francke was fearless in speaking truth to power. When he was called on to preach at the funeral of the ruler, Friedrich I, he declared to the grandees, nobles and politicians present: ‘You, the mighty, the ruling and the wealthy are truly pitiable people if you do not have the Spirit of God’,[18] and he reminded them of their duty to care for all their citizens. It was through the witness of some of those continental evangelicals that two Church of England clergymen, John and Charles Wesley, came to real living faith.

Whenever God has moved to revive the church, there has been ethical fruit – an outpouring of mercy and compassion. That is certainly the case when we look at the evangelical awakenings of the 18th and 19th centuries.  Despite opposition, multitudes in the church, among the clergy, and in the world were born again, their lives were transformed, and the evangelical revival inspired a nationwide moral reformation and outpouring of mercy ministries.

The evangelical awakenings in Britain and America created a whole culture where ‘benevolence’, ‘sympathy’, ‘compassion’ and ‘fellow-feeling’ became a social ethos which found practical expression in numerous reform movements and philanthropic enterprises that flourished during the 18th and 19th centuries. The whole tone of public life was elevated. For example, public hanging, which had become a form of mass entertainment, was ended; also ended was the opening to provide amusement for the general public of so-called asylums for the mentally ill.

It was very different in France. There a much more aggressively secular enlightenment resulted in the French Revolution, but the revolutionaries did little to improve the lives of the poor. Historian Gertrude Himmelfarb argues that the French philosophers produced neither the community of philanthropists nor the multitude of private societies that were so prominent in Britain.[19] The poor were worse off at the end of the French Revolution than at the beginning.

A second Great Awakening at the end of the 18th century and continuing through the 19th century, led to tens of thousands more people on both sides of the Atlantic converting to living Christianity.  Evangelical Christians were responsible for a remarkable range of social changes: prison reform, care of the mentally ill, factory reform, rescuing women and children from sexual abuse, the provision of education, and of course, the abolition of the slave trade.

By the mid-nineteenth century, according to historian Owen Chadwick, evangelical religion ‘seemed suddenly to be the most potent religious and moral force in England’.[20]  Probably three-quarters of the total number of voluntary charitable organisations in Britain during the second half of the nineteenth century were evangelical.[21] Large numbers of laymen and women gave time, energy and money to help an extraordinary variety of organisations reaching out to help street children, prostitutes, orphans, prisoners, the sick and disabled, and other vulnerable members of society. We should note that evangelicals were also at the forefront of campaigning against cruelty to animals.

Many of the leading figures such as Lord Shaftesbury are very well known. But there were numerous humble Christians who served sacrificially but have since been forgotten. I will give just two examples: 

Thomas Jones (1752-1845) was a Welsh clergyman. He was driven away from his parish church in Wales in 1785 because he had been converted to genuine living Christianity. His parishioners were embarrassed by his ‘enthusiasm’. Eventually he became curate of a tiny hamlet of 46 houses in Northamptonshire with an annual stipend of £25 a year. He ministered faithfully in that obscure place for 43 years.

From that humble base he transformed the surrounding community. He wrote devotional books in English and Welsh. All the profits were ploughed into charitable enterprises. He was the founder of Sunday Schools, elementary (‘Dame’) schools, Sick Clubs and Clothing Clubs; he built six alms-houses for aged widows; he founded an Education Society which enabled fifty evangelical laymen to enter the ministry. He created a wonderfully named ‘Society for Poor Pious Clergymen’ and he managed to raise funds to distribute more than £35,000 to clergy more needy than himself.[22] He did incalculable good but few today have heard of Thomas Jones. And he was just one of many active Christians.

Another example of a now forgotten Christian is Sarah Martin (1791-1843). She had been orphaned at an early age, and had gone to work as a seamstress aged fourteen. But in 1810, aged 19, she felt compelled to go into a chapel service in Great Yarmouth. That morning she heard a preacher expound 2 Corinthians 5:11: ‘Since, then, we know what it is to fear the Lord, we try to persuade others.’ Sarah was converted. She soon was able to testify: 

I wished to give proof of my love, and desired the Lord to open privileges to me of serving my fellow creatures, that happily I might, with the Bible in my hand, point others to those fountains of joy, whence my own so largely flowed.[23]

She continued to work long hours as a dressmaker. But she devoted every other waking hour to serving others: visiting those in the nearby workhouse hospital; providing schooling to poor workhouse children; teaching factory girls. When she was 27 she began visiting prisoners in the Tolhouse Gaol in Great Yarmouth. Conditions were among the worst in the country. Men and women indiscriminately were crammed into two vile underground dungeons infested with rats and lice. At first, Sarah read the Bible to prisoners. She then organised Sunday Services, began literacy classes, and introduced schemes for paid work. Eventually the town authorities were so delighted with improved conditions in the prison, and declining reoffending rates in the town, that they paid her to work full time with the prisoners. Her health broke down as a result of all her work. She died in 1843 aged 52.[24] 

Sarah Martin was just one of tens of thousands of Christians during the 19th century in England who expected to devote significant amounts of time in voluntary service to those more needy than themselves. It was the expectation that genuine Christians would be engaged in active benevolence: taken for granted just as much as we might expect a real believer to engage in prayer and Bible reading.

Christian Compassion Today

In the UK

We can be tempted to be gloomy about the situation for Christians here in the UK. But we should be thankful to God for all those who are daily showing mercy and compassion in their own communities. Since 1960 evangelicals have formed as many charitable and philanthropic organisations as had been established in the golden age of evangelical influence in the 19th century.[25]

A 2003 Home Office Citizenship Survey calculated that a quarter of regular churchgoers, or around a million people, are involved in voluntary community service outside the church, concluding that people who follow a religion were significantly more likely to formally volunteer.[26]

The 2005 report, Faith in England’s Northwest, estimated that volunteers contributed around 8.1 million volunteer hours each year, (the equivalent of 4,815 full-time jobs), with the annual financial value of this contribution being between £61 and £65 million.

Another study, Faith in the East of England, recorded a similarly wide range of activities supported by worshipping communities, from the ‘traditional’ such as visiting the sick (80 per cent of faith groups do this) and running lunch clubs (36 per cent) to the more innovative such as IT training (7 per cent). The report estimated that the value of faith community volunteer work to the region was around £30 million a year. 

In 2006 a UK survey found that Christians give 7.5 times as much as others of their salary to charity/church/good causes.[27] 


Where the followers of Christ have gone, and where the followers of Christ are, there are people who are obeying his commands to care for the needy. We will just take one case study: Vietnam. There, Christians play an outsized role in education, health, aid to the poor and vulnerable, and the upholding of human rights.

From the 1880s… missionaries began to found orphanages, hospitals, dispensaries, leper colonies, houses for the elderly and terminally ill, all of which were rare… Such institutions introduced to Vietnam the concept of public welfare. These services, freely offered to [all] played an important part in meeting social needs… and helping people conceptualize a more just and humane society.[28]

Right into the current century, evangelicals have played a major role in promoting the common good in Vietnam, through relief, schools, clinics, hospitals and development projects. Where people convert to Christianity in Vietnam, it is demonstrated that they are motivated to make positive social contributions. Importantly, also in Vietnam, Christian missionaries developed the romanized script which replaced the far more difficult character-based script. This made possible the achievement of an extremely high literacy rate, more than 95 per cent.[29]

That is just one country. But the world-wide picture leads us to conclude:

A world from which the gospel had been banished would surely be one in which millions more of our fellows would go unfed, unnursed, unsheltered and uneducated.[30]

Sharon James

(This article was originally published in the Affinity Social Issues Bulletin for February 2021. The whole edition can be found at www.affinity.org.uk)

[1] Rodney Stark, The Rise of Christianity: A Sociologist Reconsiders History (Princeton University Press, 1996), 155.
[2] David Bentley Hart, Atheist Delusions (Yale University Press, 2010), 164.
[3] Ibid., 164.
[4] Ibid., 163.
[5] Ibid., 164.
[6] Ibid., 191.
[7] Os Guinness, Renaissance (Downers Grove: IVP Books, 2014), 26ff.
[8] Hart, Atheist Delusions, 30-1.
[9] Alvin J Schmidt, How Christianity Changed the World, (Grand Rapids: Zondervan, 20014), 157.
[10] Ibid., 159.
[11] ‘Vår historie’. Lovisenberg diakonale høgskole, Wikipedia entry for Theodor Fliedner, https://en.wikipedia.org/wiki/Theodor_Fliedner (accessed 11 December, 2019).
[12] Ian Shaw, The Greatest is Charity: The Life of Andrew Reed, preacher and philanthropist (Darlington: Evangelical Press, 2005).
[13] James Bartholomew, The Welfare State We’re in, (Politico’s, 2006), 87-150.
[14] Christianity and Freedom, vol. 2, (Cambridge University Press, 2016) 4, 92. 
[15] R. D. Woodberry, ‘Protestant Missionaries and the Centrality of Conversion Attempts for the Spread of Education, Printing, Colonial Reform and Political Democracy’, in Christianity and Freedom, vol. 1, 385.
[16] Rodney Stark, Bearing False Witness (London: SPCK, 2017), 211.
[17] A. H. Francke, ‘An Autobiography’, 1692, quoted in Christian History, ‘The Pietists’, 7, 8, 33.
[18] https://christianhistoryinstitute.org/magazine/article/moving-on-many-fronts (accessed 23 December, 2019).
[19] Gertrude Himmelfarb, The Roads to Modernity: The British, French and American Enlightenments (London: Vintage, 2008), 181.
[20] Owen Chadwick, The Victorian Church, Part 1 (A&C Black, 1966), 454.
[21] Kathleen Heasman, Evangelicals in Action (Geoffrey Bles, 1962), 14.
[22] J. Wesley Bready, England before and after Wesley (Hodder and Stoughton, 1939), 57-8.
[23] Frank Prochaska, Women and Philanthropy in 19th Century England (Clarendon Press, 1980), 165.
[24] Matthew Pickhaver, ‘Walking in good works – the Sarah Martin story’, Evangelical Times, August 2015.
[25] Peter Brierley, UK Christian Handbook, 1985/6, 365-75; 410-416; 421.
[26] Nick Spencer, Doing God: A future for faith in the public square (Theos, 2016), 43.  https://www.theosthinktank.co.uk/cmsfiles/archive/files/Reports/TheosBookletfinal.pdf (accessed 11 December, 2019). 
[27] Quoted in Lynda Rose (ed), What are they Teaching the Children (VFJ/Wilberforce Publications, 2016), 263.
[28] Christianity and Freedom, vol. 2, 261.
[29] Christianity and Freedom, vol. 2, 261.
[30] Hart, Atheist Delusions, 15.


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