Modern Insights into the Policies affecting Public Health in the Islamic Caliphate (622CE – 1258CE) Basem A Khalil A thesis submitted to The University of Gloucestershire in accordance with the requirements of the degree of PhD (Public Health) Faculty of Applied Sciences January 2016 1 Abstract Background/aim: In the Western world, the emergence of historical research on the effects of the social determinants of health has provided the discipline of public health with new insight into this aspect of population health complementing the more traditional focus on the history of medicine. The Islamic Caliphate was a dominant power in its time and little is known about its public health history. This thesis aims to provide a chronologically historical account of the policies taken in this period and analyse them in the light of modern theories of public health. Materials and Methods: This thesis employed a qualitative research technique. Known primary and secondary historical sources were examined and data translated and presented in a chronological order. Modern historical sources analysing the historical accounts of that era were also used. Policies affecting health were retrieved and analysed using modern day research into the same policies. Results: The analysis has resulted in a revisionist argument that policies affecting public health in a positive way did exist in a sophisticated manner in the Islamic Caliphate albeit in an inconsistent manner. The study complements the works of medical historians who identified a “Golden Age” in the later era of the Caliphate with advancements in medical science with a potential “Golden Age” in the early era related to the social determinants of health. Conclusion: This thesis provides for the first time a chronological study of policies affecting public health in an era of public health history that has not been studied before. In addition it provides for the first time a modern analysis of these policies. 2 Acknowledgements I would like to thank my Supervisors, Professor Walid El Ansari and Dr Malcolm MacLean who for the last few years have guided the development and indeed evolution of this work. Their patience, experience and flexibility made this work finally come to an end. Their expertise in both public health and historical research especially in welfare systems was invaluable in the research process that yielded the results in this thesis. In addition, I would like to acknowledge the work of two modern scholars whose work helped immensely in the development of this thesis. Dr Ali Mohammed Salabi is a modern Arab Historian who has written several works on the history of the Islamic Caliphate. Dr Salabi’s monumental works were instrumental in the data retrieval used in this thesis. Not only did Dr Salabi’s work provide a historical analysis of the Caliphate but helped provide the student with several of the medieval sources and indeed modern analytical and historical works that are present with us today for further referencing and citations. In many of the references of the historical sections, where a second reference is placed after Salabi’s work, it is usually a reference that he himself has also cited. Dr S Hasanuz Zaman is a modern Islamic Economist who has written on the Economic functions of an Islamic State with special emphasis on the early Islamic Caliphate. His PhD on the same topic was submitted to the University of Edinburgh. His work served as guidance in this thesis with regards to methodology and historical sources. Finally, I would like to thank my wife Mrs Shaimaa Elshorkobaly who is also a specialist in Linguistics and Interpretation especially between the Arabic and English Languages. Her moral and specialist support are acknowledged and for her unparalleled dedication to her family and her commitment to their education, I dedicate this work. 3 Table of contents Contents Page Title Page 1 Abstract 2 Acknowledgements 3 Chapter 1: Introduction, Aims and Objectives 7 Chapter 2: Literature review 26 Chapter 3: Methodology 38 Results/Discussion Chapter 4: The era of the Prophet and The Righteous Four 55 The Era of the Prophet 55 The Era of the Righteous Four: Abu Bakr 88 The Era of the Righteous Four: Omar Ibn Al-Khattab 98 The Era of the Righteous Four: Uthman Ibn-Affan 129 The Era of the Righteous Four: Ali Ibn-Abi Talib 127 Specific analysis of the era of the Prophet and the Righteous Four 142 Chapter 5: The Ummayad Caliphate 161 The Ummayad Caliphate - Overview 162 The Ummayad Caliphate: Muawiyah Ibn-Abu Sufyan 168 The Ummayad Caliphate: Abdel Malik Ibn-Marwan & Al-Walid Ibn-Abdel Malik 179 The Ummayad Caliphate: Omar Ibn-Abdelazeez 185 The Ummayad Caliphate: Analysis 192 The Ummayad Caliphate: The Decline 199 Chapter 6: The Abbasid Caliphate 208 The Abbasid Caliphate - Overview 209 The Translation Movement in the Abbasid Caliphate 215 The Abbasid Caliphate: Hospital System 222 Decline and Final collapse of the Abbasid Caliphate 242 Chapter 7: The Economy of the Caliphate: an Overview 251 Chapter 8: Leadership and culture in the Islamic Caliphate and its effect on Health Care 273 Chapter 9: Conclusions, Reflections and Further research 282 References 294 4 Lists of Tables Table Page Table 1: List of Ummayad Caliphs and their period of rule 18 Table 2: List of Abbasid Caliphs and their period of rule 20 Table 3: Islamic Environmental ethics 64 Table 4: Comparison of Islamic and NHS hand washing techniques 67 Table 5: Summary of the Public health care principles and their applications that the Prophet laid down in Medina 87 Table 6: Summary of the welfare system at the time of Abu Bakr 97 Table 7: Summary of Initiatives in the time of Omar 128 Table 8: Summary of Uthman’s Era 136 Table 9: Summary of Ali’s Era 141 Table 10: Life span of some of the most prominent companions of the Prophet 159 Table 11: Annual revenue from Iraq 263 Table 12: Estimated Annual Collections from Syria and Palestine in dinars 265 Table 13: Annual income from Egypt in Dinars 267 5 List of Figures Figure Page Figure 1: Map of the Islamic Caliphate 14 Figure 2: The Ummayad Mosque in Damascus (Completed in 715CE) 28 Figure 3: The Dome of the Rock in Jerusalem (Completed in 691 CE) 28 Figure 4: Conceptual Framework 40 Figure 5: WHO Map of alcohol consumption in the world 76 Figure 6: The Rainbow Model 145 Figure 7: Time line of the Development of the Islamic Health Service 288 6 Chapter 1: Introduction 7 In this Chapter the following topics will be covered: 1. The relationship between public health and social welfare 2. The Rise of Islam 3. An introduction to the Caliphate 4. Medicine prior to Islam 5. Medicine in the Arabian Peninsula 1.1 Public health and social welfare – modern and historical context: In recent times, public health experts have recognised the impact of social welfare on the health of individuals and society. Public health is no longer restricted to delivery of medical care or control of infectious diseases. Indeed the WHO reviewed its definition of health as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”(WHO, 2003b). Thus public health experts seek to improve all these aspects in order to improve the health of society. These aspects are directly related to national policy and the politics of government. The inter-relationship between public health and politics is complex. Health systems are regarded as open systems subject to the effect of non-medical factors including peace, general education and the economy. Good communications, media and even mechanisms of transportation can have significant effects on the overall health of society. The World Health Organisation thus defines a health system as: “A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behaviour change 8 programmes; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well-known determinant of better health”(WHO, 2007). Taking the above argument further, to confine public health simply to the delivery of medical care to the sick is no longer accepted by modern day public health experts. In 1986, the WHO convened a conference on health promotion in Ottawa that ended in the release of a Charter. The WHO Ottawa Charter provided nine social determinants of public health (WHO, 2014c) . These are: 1. Peace 2. Shelter 3. Education 4. Food 5. Income 6. A stable ecosystem 7. Sustainable resources 8. Social justice 9. Equity These social determinants of health would later influence Government policies especially in the developed world. The scope of public health itself would change from simply the control of communicable diseases and preventive medicine to include health promotion, health maintenance, health systems management and health care policy. Indeed the UK Faculty of Public Health defines public health as: “the science and art of promoting and protecting health and well-being, preventing ill- health and prolonging life through the organized efforts of society”(FPH, 2010) 9 Furthermore, the WHO now emphasises on the term “healthy public policy” where all Government departments and societal sectors are integrated with the aim of assessing the effect of any policies on health (WHO, 2014a). Thus the way public health history would be viewed or studied would in itself change to include many of these aspects.