Can a good God have created a world with disease?

If you had an almighty-creator toolkit at your disposal - the ability to create a world of your own making in whatever way you saw fit - what would you create? 

Perhaps, like Tolkien, you would have a vast history and various races. Or maybe you would want to include a complex magic system like in Robert Jordan’s The Wheel of Time? Perhaps you might prefer something imaginatively quaint, such as a faun serving afternoon tea, like in the Chronicles of Narnia.

Although there are certainly dreamers among us like Tolkien, Jordan and Lewis, I think most of us struggle to answer this question more than we expect. When I spring this question on an unsuspecting observer, often the answers I receive more promptly are about what they would not include in their world. Social injustice, sexual abuse, human trafficking and death are only a few of the items that might be on your list of things that you would not want in an ideal world.

Personally, I find that disease and the breaking down of the human body is one of these matters that is most close to my heart. This is partly reflected in my career path - I spend many hours a day thinking about how to understand, slow down and fix disease. But my desire to end disease also has a personal dimension: like many others, I have seen up close the disruption and pain of disease. And I do not think I am alone in wanting total eradication of disease.

Disease is bad

To modern ears, assigning to something the label of ‘bad’ or ‘evil’ is at best outdated, or perhaps childish. However, based on economic and cultural evidence, I think disease is one of the few things that can still be squarely categorised as bad. 

In spite of the steep economic, environmental and animal welfare cost, we are committed to ending disease on a societal level. On an average year the UK invests around 4.8 billion pounds in medical research [4]. Every year 5.5 tons of plastic are generated [5] and 100 million animals are sacrificed [6], all in the name of ending disease.  Ultimately, these are significant decisions being made on a national and international scale of investments and policy which we should not take for granted: I believe they reflect a deep human longing for an end to disease. 

This longing is also reflected in one of the oldest human traditions: story-telling. The three stories I referenced in the beginning include significant events whereby an individual is healed from a disease or a curse which takes away their sanity or their self-control: whether this is King Theoden in Lord of the Rings [1], Rand al'Thor in the Wheel of Time [2] and the prince in The Silver Chair [3]. Within the context of those stories, these are important arcs which are often a pivotal point for the plot. It is a sign that things are changing and being fixed, that the grand finale is nigh and we are almost there. 

The concept of disease being bad was driven home to me on a personal level when my mother, on an average and rainy Sunday afternoon, had a brain injury while walking our miniature schnauzer.  At the time I didn’t grasp the severity of what had happened or how much this would turn our lives upside down. A long sequence of doctor's appointments, tests and lists of symptoms ensued until we found a neurologist who could diagnose and treat her. Apart from caring for her with excellence, he was incredibly generous with his time to me - knowing that here before him was a 15-year-old, scared out of her wits about what was happening. He took the time in appointments to explain to me exactly what was happening to her brain: the flow of cerebrospinal fluid, the response to injury, the cause of the debilitating headaches. Suddenly, rather than a mysterious shroud of unknownness covering the entire situation, he showed me how knowledge could make the whole business of dealing with disease a lot less scary if we take the time to understand both what it is and what it is not. 

This may well have defined my career, there and then. However, while this was wonderfully helpful, I eventually found that there were some questions that no amount of science could help me with. 

Here was I, a self-professed Christian, claiming I believed in an all-good, all-powerful God, and yet when I looked at the world he created, I saw disease, pain and suffering. How could this be? Was this God I believed in incompatible with the world I was living in? 

Ultimately, I couldn't come up with a comprehensive answer to the existence of disease. But I decided that I could settle for a world view that could answer these two questions: (1) Is there a reason why disease is bad? (2) Do we have any reason for hope in the face of disease? 

I wanted to find out if there was a way of understanding the world that could simultaneously validate my experience and give me hope. 

Disease as a natural process 

Most people working in my area, life sciences, see the world through the lens of naturalism. So how does naturalism address the question of disease?

Let us start with a definition of naturalism according to the Stanford encyclopaedia of philosophy: 

“A central thought in ontological naturalism is that all spatiotemporal entities must be identical to or metaphysically constituted by physical entities. [Many ontological naturalists] hold that there is nothing more to the mental, biological and social realms than arrangements of physical entities” 

(Stanford encyclopaedia of philosophy)

In this worldview, we are no more than a statistically unlikely arrangement of carbon and hydrogen which eventually became sentient. While some people believe this sounds poetic, this also means that 

“In a naturalistic universe, there is no God, no afterlife, and no immortal soul.” 

(Erik J Wielenberg, Virtue and Value in a Godless Universe)

Therefore, assuming this is true, every time I handle a frozen brain sample and sequence the RNA in those brain cells, that may be all that is left of that person. There are many statements we make routinely that fit this assumption. We have all heard it the heart-breaking description of an individual with dementia: ‘My mother just isn’t there anymore’.  Our assumption is that because brain function has become impaired, then that person has now ceased to exist. 

What does naturalism say to us about disease? Disease is a natural process by which bodies decay and die, no differently from leaves falling from a tree during winter. It is simply a part of life. 

This actually makes it surprisingly difficult to say that a naturalistic worldview considers disease to be evil or bad. In fact, if considering disease from the perspective of a species or a society, it has an important role in enabling the genetic pool of the population to improve over time through natural selection. 

Following this line of thinking, many influential thinkers have made statements which are difficult for modern sensibilities. Plato said children must be “malleable, disposed to virtue and physically fit.” If they did not prove themselves worthy, parents would “properly dispose of [them] in secret, so that no one will know what has become of them” [7]. Similarly, Aristotle thought defective children should be exposed - discarded at rubbish tips, abandoned on hillsides, thrown down wells or drowned in rivers. Friedrich Nietzche called pity a poison. “Pity on the whole thwarts the law of evolution, which is the law of selection.” He explicitly said “The weak and ill-constituted shall perish: first principle of our philanthropy. And one shall help them to do so.” More recently, in 2014 Richard Dawkins, when asked on twitter what someone that had a defective child should do, responded “Abort it and try again. It would be immoral to bring it into the world if you have the choice”. 

Just to be clear, I am not saying that all individuals who believe in naturalism and atheism are in favour of eugenics programs or infanticide. I have many dear friends who are atheists or agnostic and are also kind, empathetic and defend the vulnerable fiercely. There is no faith or belief system that has a monopoly on kindness. But I am saying that the logical conclusion of ontological naturalism, if followed through to its source, is that disease has a positive impact on the fitness of a population overall. If the only law we are left with in a naturalistic worldview is that of competition and survival of the fittest, these are rational conclusions. This is the best the natural world without God has to offer. Suffering, disease and death have no meaning or consequence. Whether we believe it or not also makes no difference to the outcome of this impersonal universe. 

In naturalism, there is little acknowledgment of the evil of disease, and there is no hope. 

Disease as a tool for justice

In 2014 I visited the city of Bath in the UK. There I did as the Romans did (literally) and went to the Roman baths, formerly a place to worship the celtic-roman deity Sullis Minerva. A common practice was to carve in small pieces of lead prayers which were then thrown into the warm spring water. Reading the content of these prayers was striking. Most fell into one of two categories: prayers for healing or curses being cast upon people who had wronged the faithful. Most were curses for the wrongdoer to be afflicted with disease. 

Nineteen centuries later, we still believe that the state of an individual's health should be a reflection of their behaviour. Upon hearing about a tragic diagnosis, we have all heard or said: "But how could this happen to _______? They are such a good person." 

This is still a central feature of many current worldviews. This includes, for example, karmic religions - such as hinduism or buddhism - where an individual experiencing suffering is a consequence of a wrong done, whether in this or a past life. Many monotheistic religions also rely on disease as being a mechanism of justice. In a setting of karma, this is built into the blueprint of the universe. In religion, disease is a tool in the hand of a god. This includes, for instance, certain branches of Christianity, where God is a merciless law enforcer, ready to smite you at the slightest mishap. 

Although this perspective gives us a framework to consider disease evil - whether because of karma or fire-and-brimstone, no one wants to be on the wrong side of justice. However, this view gives you very little in the way of hope. In these belief systems, the best one can try to do is get their ticket out of this life and out of this world. In a performance-based approach, these worldviews tell you your only way out of experiencing disease is by keeping a law or set of rules. If you do this well, you will be freed from the suffering of this world, whether you call that Heaven or Nirvana. 

This view might be tempting when we and our loved ones are thriving and healthy. It justifies to us that we are good people. However, the moment we or someone close to us gets ill, this illusion is shattered. The sickness becomes our fault due to moral failure, and trying to bypass the illness could be seen as immoral. Tragically, in a community setting, this can mean that individuals facing terminal or chronic illness have the burden of blame and accusation added to the burden of disease. While this way of thinking acknowledges the evil of disease, it lacks hope. I also do not believe this view is Biblical.

In the first book of the Bible, Genesis, it is said that after God created the world: “God saw all that he had made, and it was very good”. This, says Christianity, was the starting point of the world: a job well done. 

It then goes on to describe that there was a breaking of this goodness. The relationship between God and humans was broken because humans did not think that God had their best interest at heart. Humans decided they had to ‘decide for themselves’ and not listen to the instruction they had been given. This rebellion had cosmic consequences for the relationships between humans, for our work, for the environment, for wildlife and for our physical bodies - and, I believe, this includes the incidence of disease. 

This is the point at which this interpretation of the Bible differs from many monotheistic religions. What they would say is that, since this world is broken, we might as well make sure we have our ticket out of here. An interpretation I believe is much more consistent with the Bible is "since the world is broken, it is time to get to work to fix things here". 

In fact, I believe God is leading the way on this - and disease is an excellent clue for this. 

The redemption of every body, cell and atom

We have abundant evidence that God is invested in ending disease. In one passage he chooses to introduce himself as ‘Jehovah Rapha’, which is Hebrew for ‘I am the God who heals you’. 

In early Jewish history recorded in the old testament covering ~4,000 years, we see 18 occasions of miraculous healing - including healing from barennes, skin infections like leprosy and even a resurrection. However, in the new testament something changes. Even though what we call the new testament covers a much shorter length of time in history (~100 years), there are at least 100 times where healing is mentioned. This includes specific episodes of people being healed from blindness, haemorrhaging and skin infections, up to general sweeping statements such as "they healed all who were there". 

Many might say that the old and new testament depictions of God are inconsistent with each other, but an alternative question I think is more helpful to ask is: What happened in between the old and the new testament? Could something have inherently changed the fabric of the world? 

In this transition point the major event is that God himself comes in the form of a man, Jesus. His message is that the Kingdom of God is coming to earth. This is beginning a process by which the world is being made right again: cell by cell, atom by atom. The book of Colossians summarises this: “God was pleased to have all his fullness dwell in Jesus, and through him to reconcile to himself all things, whether things on earth or things in heaven” (Colossians 1:20a). 

When Jesus' work is increasing in scale he sends off his followers to visit many villages, he instructs them to "heal the sick that are there and tell them the kingdom of God has come near them." This is saying that part of the kingdom of God coming is healing of disease. 

A central piece of this cosmic redemption story is not only God caring about us enough to come to join the physical world in the form of Jesus, but God himself knowing our suffering to the point of death, and this really is the ultimate culmination of disease. 

One way of looking at this is to say that clearly this can't be true, as 2,000 years later we obviously still have disease among us. An alternative way of looking at it is looking at how the course of history was before and after these events. 

The historian Tom Holland makes a comprehensive summary of many ways in which Christianity has impacted thought, values and culture in the West. Values such as kindness and empathy have deeply Christian roots, and they have in turn impacted research and policy surrounding disease. From the establishment of free healthcare for all through initiatives such as the national health service (NHS) in the UK to investment in medical research, our understanding and approach to disease have been deeply shaped by Christian views. 

But has the trend of disease being healed continued since the arrival of the kingdom of God? Life expectancy in Ancient Palestine at the time Jesus was around was 30 years. Since then we have discovered vaccines (1796), germ theory (1861), antibiotics (1928), organ transplants (1954), antiviral drugs (1960). Life expectancy in the UK is now 81. For most of history 27% of children born died before turning 1 year-old, and a total of 50% died in childhood. The global mortality rate for children is now 3%. This is like one of the fantasy stories we saw in the beginning: the world is broken, and the protagonist - God himself - is overcoming the brokenness of the world. We haven’t reached the end of the story yet, but we are seeing signs of what is to come.

Having reflected on this for over a decade, I believe Christianity provides us with unparalleled resources to deal with disease. It allows us to mourn disease and call it the evil thing we all know it can be. But it also tells us that when we speak to this personal God he understands, because he has experienced it. He has been human to the point of death, because he wanted to make the world right again and he did not want disease to be part of the world forever. In summary, Christianity both provides us with a framework that disease is bad, but there still is hope in face of it. 

This finally brings me back to my initial question: Can a good God have created the world with disease in it? My conclusion is yes. Yes, God created the world in a perfect way and this became broken with horrific things like disease. Our longing for healing is a reflection of this. 

The goodness of God this: he gave us freedom to make choices - even when they hurt him - and he was willing to, at a great cost to himself, make a way to restore the world. Restoring it to the rightness that is imprinted in our deepest longings, in our stories and in our hope for those we love most. 

References

[1] This story arc is conveyed in Peter Jackson’s second Lord of the Rings movie, The two towers. It is a distinct interpretation from the events of J.R.R. Tolkien’s book, but makes for a compelling and impactful interpretation. 

[2] Winter’s Heart, The Wheel of Time book #9 by Robert Jordan

[3] The Silver Chair, The Chronicles of Narnia book #6 by C.S. Lewis

[4] Largest analysis of UK health research funding published, https://www.publichealth.hscni.net/news/largest-analysis-uk-health-research-funding-published

[5] Exeter scientists call for reduction in plastic lab waste, https://www.exeter.ac.uk/news/featurednews/title_488903_en.html#:~:text=Drs%20Mauricio%20Urbina%2C%20Andrew%20Watts,of%20plastic%20waste%20last%20year.

[6] Animals in science, https://science.rspca.org.uk/sciencegroup/researchanimals

[7] Republic, Book 5, p. 460d, http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0168%3Abook%3D5%3Apage%3D460, quoted in Scrivener, 48

[8] Politics, Book 7, Section 1335b, quoted in Scrivener, 48

[9] The Anti-Christ, Aphorism 2, https://human.libretexts.org/Bookshelves/Philosophy/Philosophy_Readings_(Hagman_and_Nesse)/7%3A_Kant_and_Nietzche/07.2%3A_Nietzsche%3A_The_Anti-Christ

[10] Post on X (former twitter), https://x.com/RichardDawkins/status/502106262088466432