Prevention: the Jewish Approach to Health
Since maintaining a healthy and sound body is among the ways of God . . . , one must avoid that which harms the body and accustom oneself to that which is helpful and assists the body become stronger. (Maimonides, Mishneh Torah, Hilchot Deot 4:1)
Contemporary western medicine has generally focused on the treatment of diseases, rather than on their prevention. Medical schools teach that prescription drugs are the most powerful tools doctors have for treating disease; diet and other lifestyle changes are seldom stressed as therapeutic tools. The generally accepted medical response to many diseases today is to prescribe medications first and perhaps recommend lifestyle changes as an afterthought.
Judaism’s historic approach is fundamentally different from that of modern medicine. While treating sick people is certainly a Torah obligation, Judaism puts a priority on the prevention of disease.
The foundation for the Jewish stress on preventive medicine can be found by considering the verse in the Torah where G-d is described as the rofeh — healer — of the Israelites:
“And God said: ‘If you will diligently harken to the voice of the Lord, your G-d, and will do that which is right in His sight, and will give ear to His commandments, and keep all His statutes, I will put none of these diseases upon you which I put on the Egyptians; for I am the Lord, your healer’”. (Exodus 15:26)
Rashi’s commentary on this verse notes that this means:
“I am the Lord, your healer, and I teach you the Torah and the commandments in order that you may be saved from these diseases – like a physician who says to a person: “Do not eat this thing lest it will bring you into danger from this illness.’”
What are the implications for modern medicine? Just as God’s healing role in the above Torah verse is to prevent illness, so too a physician should emulate the Divine role by stressing disease prevention. For we are obligated to “follow in G-d’s ways” (Deuteronomy 11:22; Sotah 14a).
The following anecdote about Maimonides is instructive. During the period when Maimonides served as the royal physician of the Sultan of Egypt, the Sultan never became ill. One day the Sultan asked Maimonides:
“’How do I know that you are an expert physician, since during the period that you have been here, I have never been ill, and you have not had the opportunity to test your skills?’ Maimonides replied, ‘In truth, the great and faithful physician is the Holy One, Blessed Be He, as it is written, ‘I am the L-rd, your healer.’ And this Great and Faithful Physician was able to promise his people that because He is their Physician, He will be able to protect them from all the illnesses that were put on Egypt.’ Maimonides concluded, ‘Therefore, we learn that the ability of a physician to prevent illness is a greater proof of his skill, than his ability to cure someone who is already ill.’” (Yalkut Lekach Tov, Shmot, B’Shalach)
According to the above, it would seem that physicians should put far greater emphasis on preventive medicine, advising their patients about dangers related to smoking, high-fat diets, and other lifestyle choices.
It should not be assumed that the Torah places the entire responsibility of maintaining good health on physicians. In fact, Jewish sages have stated that the major responsibility falls on the individual. To take care of one’s health is a mitzvah, mandated in the words, “take heed to thyself and take care of your lives,” (Deuteronomy 4:9) and, again, “be extremely protective of your lives.” (Deuteronomy 4:15)
Rabbi Samson Raphael Hirsch, the outstanding 19th century German rabbi, expands on the mitzvah of guarding our health:
“Limiting our presumption against our own body, God’s word calls to us: ‘Do not commit suicide! Do not injure yourself! Do not ruin yourself! Do not weaken yourself! Preserve yourself’! You may not . . . in any way weaken your health or shorten your life. Only if the body is healthy is it an efficient instrument for the spirit’s activity…. Therefore you should avoid everything which might possibly injure your health. . . . And the law asks you to be even more circumspect inavoiding danger to life and limb than in the avoidance of other transgressions.”
Judaism regards life as the highest good, and we are obligated to protect it. An important Jewish principle is pikuach nefesh, the duty to preserve a human life. The Talmudic sages applied the principle “You shall therefore keep my statutes and ordinances, which if a man do he shall live by them” (Leviticus18:5) to all the laws of the Torah. Hence as Rabbi Hirsch’s statement above indicates, Jews are to be more particular about matters concerning danger to health and life than about ritual matters (Chulin 9a; Choshen Mishpat 427; Yoreh De’ah 116).
Biblical medicine is unique because of its many regulations for social hygiene. Of Judaism’s 613 commandments, 213 are of a medical nature (Encyclopedis Judaica, Vol. 11, p. 1179). Hygiene and prophylaxis became religious mandates designed for the preservation and well being of the nation. To keep military camps clean, latrines were established outside their bounds, and soldiers were equipped with spades with which they were to dig holes and cover their excrement (Deuteronomy 23: 13-15). Lepers and others who might spread serious diseases were excluded from the camp for specific quarantine periods (Leviticus 15:1-15; Numbers 5:1-4).
The rabbis also emphasized the importance of public measures to protect people’s health. The Talmud states that no tannery, grave, or carcass may be placed within 50 ells of a human dwelling (Baba Batra 2:9), and stressed that streets and market areas be kept clean (Yalkut Shimoni 184). The sages declared it forbidden for a scholar to reside in a city that did not contain a public bath (Sanhedrin 17b).
Rabbinic literature also extended these hygienic teachings to individual behavior. The rabbis regarded the human body as a sanctuary (Ta’anit 11 a-b). They gave much advice on types of food conducive to good health (Hulin 84a, Berachot 40a) and stressed the importance of regular nutritious meals (Shabbat 140b). They mandated the one must wash one’s face, hands, and feet daily in honor of one’s Creator (Shabbat 50b), and also to wash one’s hands on specific occasions, including after rising from bed each morning, and after using the toilet. (Shulchan Oruch, Orach Chaim 4:18).
If Jews take these teachings seriously and modify their behaviour when appropriate, it would lead to a far healthier jewish community, one better able to have a fulfilling life and to apply Jewish values toward the creation of a better world.