Public Health and Its Ethical Aspects in Ottoman State - Some Good Examples for the Modern Age -

1. Public Health and Its Ethical Aspects in Ottoman State -Some Good Examples for the Modern Age- Sahin Aksoy M.D., Ph.D. Harran University Faculty of Medicine Department of Medical Ethics and History of Medicine, Sanliurfa-TURKEY saksoy@harran.edu.tr

2. Bursa Ottoman State (1299-1923)

3. Turkish Republic [29 October 1923]

5. Ottoman State had been governed by Islamic Law (Sharia). Ottoman State had a unique social, legal and governmental system. Ottoman Sultan had been the leader (Khaliph) of Muslim Nations for centuries. Ottoman State was a typical Islamic State, and its application can be considered as the prototype of Islamic understanding on public health care.

6. Public Health in Islam Public Health Applications in the Ottoman State

7. Although it is possible to argue that public health is as old as humanity, the public health we know is originated during the industrial revolution of the 19th Century. Health care has been sick care, disease care, health restoration rather than ‘health care’ and health promotion as an emerging concept for a New Public Health represents a venue of hope.

8. “Nothing can change without changing the whole” “The body of the Muslim community is just like the body of the human being: if one organ got diseased, the whole body will suffer and develop fever, sleeplessness and weakness.” Prophet Muhammad

9. Distribution of health services is central to the new health promotion. Justice and equity at all levels of human relations and interactions are the basic message of Islam. It is the most important of the supreme values of Islam and is the first principle of social life.

10. Three Main Institutions • Hisbah • The Muhtasib • Waqf

11. Hisbah In an Islamic State, in order to make sure that the system works perfectly Hisbah system should be allowed to function. The Hisbah is a religious institution under the authority of the state that appoints people to carry out the responsibility of enjoining what is right and forbidding what is wrong. The purpose of this is to safeguard society from deviance, protect the faith, and ensure the welfare of the people in both religious and worldly manners according to the Law of God (Allah).

12. Muhtasib If Islamiclaw is applied properly, then inequities in health care provision should not be allowed. This is a function that requires direct attention of the head of state and his subordinates, high judiciary system and Muhtasib. The Muhtasibis a municipal officer responsible for public morals and regulation of markets.

13. Muhtasib He should make sure and report about that safe water supply is provided to people, sanitary conditions are adequate, living and housing conditions are satisfactory, provision of food to the markets is flowing, drugs are available, and prices are reasonable and are not a cause for depriving the people from the essentials. He should collect data and monitor the feelings and satisfaction of people towards the basic public services and if they have any complaints.

14. “TheMuhtasib" by Caroline Stone, illustrated by Penny Williams

15. Waqfs Another important aspect in the reorientation of health services is the financing constraints facing governments. Islamic system of Waqfs (endowments) was an important means of ensuring and granting revenues for all vital social and health services in Muslim communities.

16. Waqfs The great Islamic libraries of the 10th and 11th centuries, the foundation of mosques, hospitals, health care institutions and the pay for the health professionals and their needs for scientific writings and publishing as well as teaching students during an extended period of Islamic governance from the 9th and up to the 18th century, all ensured their functions actively through Waqf as well as Zakhat funds. Zakhat:Every adult Muslim is obliged to donate 1/40 of his/her personal wealth each year to some in need or to an institution.

17. Environment The protection of natural environment and the conservation of natural resources are top issues to be addressed in any health promotion strategy. Although Islam suggests humans as having dominance on nature, it is not through opposition; its sacred views stress the complementarity of all phenomena.

18. Islam makes emphasis that people should live in an environment that is clean, beautiful and peaceful. “God loves those who keep themselves pure and clean.” Holy Qur’an; Chapter: 3, Verse:104 ‘God is beautiful and loves beauty.’ Prophet Muhammad ‘Purity/Cleanliness is half of the faith.’ Prophet Muhammad

19. Ottoman Empire The Ottoman Empire had a long history of tending to the health of its population through subsidized health institutions. Sultans endowed religious charitable foundations (waqfs) that sponsored medical and social service complexes. Records show that the most significant portion of hospitals’ expenses went simply to the provision of food for patients. There is also evidence that the state attempted to regulate public nuisances, such as slaughterhouses, that could pose a threat to sanitation and health.

20. Ottoman Empire • The Provincial Municipal Law, which restructured local government throughout the Ottoman Empire, entrusted municipalities with significant public health duties. • The general duties of municipal councils covered a wide array of public health responsibilities, including: • The removal of refuse; • The establishment of suitable public markets: • The supervision of inns, coffee shops, festivals, and other public places; • The verification of the weight and cleanliness of bread and flour; • The prohibition of the sale of spoiled meat; and • The supervision of sanitation in slaughterhouses.

21. Ottoman Empire Although municipal government, and not the central government, was the primary enforcer of public health standards under this system, the presence of a national law setting the standards for public health and hygiene is significant. With the Provincial Municipal Law, the central government thrust itself into the field of public health, even if it would rely on municipalities to work out the details and to exercise primary enforcement power.

22. As a conclusion, it is possible to argue that Islamic principles and institutions are ideal to provide a well organized and ethical public health services. This was demonstrated in different Muslim communities since 10th Century, and Ottoman Empire was a good example among these states.