Thứ năm - 09/05/2019 05:30
by A. Sarath Ananda


by A. Sarath Ananda*


Buddhist approach to healthcare has been of immense value and the scholars have been studying the different places in Tripitaka and many other discourses or Suttas that contain the value of health and well-being. The modern psychologists such as William James, Carl Jung and Eric Fromm too have identified the philosophical perspective of Buddhism on healthcare. Buddha preached that if a person controls his mental, physical and verbal behaviour most of his evils will not be active. The impure body causes many illnesses even though the INSIDE evilness is hidden to the outside world. As the society at present is seen, it is understood that almost all the individuals suffer from various illnesses mainly because they have not been able to control their mind and body.

The main research issue in conducting this study was to find out how the Buddhist approach to health and well-being for individuals can establish a sustainable society. The researcher wanted to achieve the following objectives when conducting this study. Therefore, this study, first, aimed at identifying the Buddhist approach to healthy life. Second, it tried to analyze the knowledge of individuals on Buddhist approach to healthy life. Third, it analysed how the healthcare system could establish and promote sustainable societies. Finally, the researcher would suggest through

*Doctor, Department of Social Sciences, Sabaragamuwa University of Sri Lanka

the accumulated data how Buddhist approach to healthcare could enhance the sustainability of human society in many ways.

The methodology used in this study was the structured questionnaire that could be used to collect data in a cost-effective manner. It was selected due to the many advantages it had in accumulating, classifying, analyzing and interpreting data. The sample of two hundred respondents was  selected  randomly and Buddhist approach to health care and sustainability were questioned. The theoretical framework adopted in this study was the social construction of illness. It proved that the individuals would prefer to live in diseases by taking medicine continuously rather than making an effort to get rid of those by purifying their inner selves.

The Buddhist approach to healthy life has been pronounced in places like Magandiya Sutta and Bojjhanga Paritta in an extremely simple manner so that anyone can understand easily and practice to a greater effect without extra effort. But it was understood that even though the respondents knew the basics of Buddhist approach to healthy life, they have not been able to make it a part of their daily life. Implementing Buddhist approach to healthcare would have assisted the sustainability in society from a personal, group and to communal level in empowering the institutions such as economy, culture and politics. Yet the cultural and social iatrogenesis have been more powerful since the modern man has been a slave to the existing structures governed by modern medicine. Rather than having a mental effort to fight against the evils that destroy him, he has passively succumbed to the modern anti-human and anti-social forces that generate various forms of illnesses. The researcher finally recommends that an awareness program should be made available to individuals to understand the simplicity and the enormity of the value of Buddhist approach to healthy living and well-being for the betterment of all segments in society.


Sustainability has been a prominent term among the intellectual circles over the past few decades. Millennium development goals were set to achieve some of the key social, political and economic

indicators and the present sustainable development goals have been devised to achieve development indicators to make human lives better (Kumar et al, 2016). But sustainability has not been an easy goal to be achieved as predicted (Stubbs, 2017). One of the key contemporary global issues that threaten the sustainability of the globe in many ways is health and well-being. With the advent of industrialization man has been encountering a lot of health related issues (Szreter, 2004) and presently throughout the world we experience the effects of those numerous health issues. Each individual country, international institutions, non-governmental organizations and even the civil society organizations have got together to minimize or control the effects of health hazards but the daunting task still remains to be completed. Within this broader context both Buddhism and sustainability seem inseparable in terms of paving the way to well-being that prevails not only for the mankind but also for the entire universe. While, it is a generally agreed principle; further in-depth explanations seem to be needed before going for a concrete conclusion.


World Health Organization (2018) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. In another definition health is defined as the ability to adapt and to self-manage(Huber et al., 2011). Herzlich (1973) explained health in both positive and negative ways. In a positive way one is fully aware’ of his or her health because of ones feelings of freedom and of bodily and functional well-being(p. 53) and on the negative way it is seen mainly as the absence of illness(ibid). According to Anttonen and Ränen (2008) well-being results from the fulfillment of the important needs of individuals and the realization of goals and plans set for ones life. Diener and Seligman (2004) present it as peoples positive evaluations of their lives, (as it) includes positive emotion, engagement, satisfaction, and meaning. All these definitions prove that the physical and mental aspects of an individual are his assets in social contexts.
In such a context we have to understand how Buddhism views

health and well-being and how the Buddhist approach assists to promote health and well-being in society. It is understood that all the religions in the world strive to make the lives of its followers happier by creatively countering sufferings caused by disease or illnesses and pain. Buddhism does not promote material gains to continue samsara but it directs the individuals to achieve ultimate happiness by following its precepts methodically. The Prince Siddharthas decision to leave the palace was also based on three different signs that denoted suffering; an old man, a sick person, a dead body and remedy or solution through realization symbolized by the religious mendicant. Buddhist approach mainly revolves around suffering; dukkha (Wijesekara, 2008). It guides us to be away from suffering by practicing the path the Lord Buddha had shown us.

As the society progresses, the lifestyle related diseases (Tabish, 2017) have become common and similarly the medicalization has become a profession. The institutionalization of medical services has offered wide variety of services but a large number of people in the world, especially the developing world, seem to be unable to consume those facilities (Peters et al, 2008). Poverty, marginalization, geographical area, ignorance, tradition and negligence have been some of the barriers in utilizing these services. When an individual is sick he or she is not happy thus the family members are also not happy. If the population of a nation suffers from many illnesses and subject to epidemics the financial burden to attend those cannot be overlooked. Therefore, it is essential to have healthy individuals, families and societies for the world to gear towards sustainability.

One of the famous definitions given in 1987 by the Brundtland Commission claims sustainability is meeting the needs of the present without compromising the ability of future generations to meet their own needs(Graf, 2015). Sustainability has been defined initially based on the degradation escalated on the worlds natural resources. But it did not discuss extensively on preserving human resources in a spiritual way. Consumption of the present generation should be made responsible else, the future generations would lose the similar resources. A long-term stability is seen based on the interdependence

between protecting environment while enjoying economic gains. But now the scholars have understood that the environmental/ ecological, socio-political and psychological aspects of sustainability are also equally important like economic aspects.


The main research questions that arise in this context is what is health and ill-health or sickness, what is well-being, what is sustainability, how health and well-being are related, how health and well-being contribute to sustainability of the world, how Buddhism views health and well-being and finally, how could the Buddhist approach helps achieving sustainability in future.  The main research issue that is going to be addressed in this study was that whether the Buddhist approach to health and well-being for individuals could establish a sustainable society in future. Therefore, the aim of this research is to study how Buddhist approach to health and well-being contribute to a sustainable future. The researcher wanted to achieve the following objectives when conducting this study. Therefore, this study, first, aimed at identifying the Buddhist approach to healthy life. Second, it tried to analyze the knowledge of individuals on Buddhist approach to healthy life. Third, it analyzed how the healthcare system could establish and promote sustainable societies. Finally, the researcher would suggest through the accumulated data how Buddhist approach to healthcare could enhance the sustainability of human society in many ways.

The methodology used in this study was the structured questionnaire that could be used to collect data in a cost-effective manner. It was selected due to the many advantages it had in accumulating, classifying, analyzing and interpreting data. The sample  of  five  hundred  respondents   was   selected   randomly and Buddhist approach to health care and sustainability were questioned. It was decided that each and every individual in this pluralistic society would have an equal chance to get into the sample. The sample responded for the questionnaire had the following characteristics. There were 238  males  (47.6  percent) and 262 females (52.4 percent).  The  age  categories  (Table  1) and the religious affiliations (Table 2) of the respondents varied

considerably and it could be considered that the answers represent the ideas of all walks of life. The nature of occupations of the selected sample too portrayed a distinctive nature consisting all aspects to unemployed (89 – 17 percent), government sector (256
– 51.2 percent), private sector (105 – 21 percent) to other (50 – 10 percent) including self-employment categories.

The theoretical framework adopted in this study was the social construction of illness. It proved that the individuals would prefer to live in diseases by taking medicine continuously rather than making an effort to get rid of those by purifying their inner selves. Social constructionist approach to illness has a long tradition among scholars. Emile Durkheim (Dew, 2015), Talcott parsons (1951), Ervin Goffman (1961 and 1963), Alfred Schutz (1967) and Michael Foucault (Smith, 1975) are some of the scholars who explained the illnesses of individuals in various sociological paradigms. The way the illness is seen, perceived, experienced, explained and accepted has many social and cultural dimensions. Based on these dimensions the reaction towards the sick also changes.


When people fall sick they normally seek medical treatments and nowadays, preferably, the western medicine. In prevailing countries the health care professionals use the biomedical model in understanding and treating illnesses in which the biological factors are given prominence. The social, environmental and psychological factors are neglected. There is a similarity between medicine and Buddhism. Like in Buddhism the medicine too aims at alleviating pain and suffering. Unlike a medical practitioner such as a doctor, traditional healer or shaman treating the physical ailment, the Buddha showed a way of life that should be constantly and methodically practiced to refrain from suffering. The middle path, the four noble truths and the Eight-Fold path he advocated have been supreme since most of the sufferings of people are due to excessive indulgence in desire, anger and greed. If one is unable to control his desires that one would not achieve the eternal bliss in life.

In Sutta Nipata Lord Buddhas explanation of suffering is summarized as:

What, O Monks, is the Noble Truth of Suffering? Birth is suffering, sickness is suffering, old age is suffering, and death is suffering. Pain, grief, sorrow, lamentation, and despair are suffering. Association with what is unpleasant is suffering; disassociation from what is pleasant is suffering. Not to get what one wants is suffering. In short, the five-factor of individuality (panchpadanakkhanda) is suffering(Keown, 2013, p. 50).

The Buddha himself had provided an example for medical practices through his own behaviour – Putigattatissa Thero and Suppiya Upasika are two such examples. Looking after one another when we fall sick too has been highlighted.

You, O monks, have neither a father nor a mother who could nurse you. If, O monks, you do not nurse one another, who, then, will nurse you? Whoever, O monks, would nurse me, he should nurse the sick’ (Emmanuel, 2016, p. 615).

If a disciple tries to comprehend the Buddhist doctrine in a practical manner, there are many instances the Lord Buddha has shown us how Buddhism views health and well-being. The middle path itself is a good example for anyone not to get into extremes. Whatever the extreme one takes in life would lead to severe psychological or physical consequences which make one unhealthy. One of the fundamental Buddhist concepts that everyone is requested to practice is ‘metta’ – the loving kindness, it not only helps oneself but the others as well. Many individuals in the present day society, whether they are Buddhists or not, do not pay attention to the fact that emotional, mental, social and cultural aspects are inseparable from the physical aspects of life. Sustainability rests in the world when each one develops a generous feeling; empathy, for the others.

Buddhism discusses five niyamas’ or five aspects of cosmic orders. Those try to explain why things, especially suffering, happen in our lives. Those explain how our intentions, speech and actions are responsible for the degree of suffering and how our minds work in different conditions. The self is responsible for not controlling its thought process, actions and behaviour. The world view advocated by Buddhism rests on ‘kamma, the interrelationship between cause and effect. Each good or bad action has its own consequences.

Health which is seen in holistic perspective constitutes ones physical and mental status, and strong, productive  relationships with family, immediate neighborhood, workplace and environment. If a person falls sick all these relationships are disturbed and disharmony is established. So harmony among all the said aspects in society carries towards sustainability. The Buddhist world view is holistic and is primarily based on a belief in the interdependence of all phenomena and a correlation between mutually conditioning causes and effects. This belief is formulated by the principle of dependent origination (paticcasamuppada), also  referred  to  as the law of conditionality, the causal nexus that operates in all phenomena: physical, psychological, and moral.

It is understood without argument that people live happily when they are physically and mentally healthy. Mostly people go for medical treatments after knowing that they are sick but Buddhism mentions that it is better to refrain from illnesses as far as possible. Buddhism advocates the individuals to train their minds to achieve this equilibrium. It is based on the four sublime states; metta [loving kindness], muditha [compassion], karuna [sympathetic joy] and upekkha [equanimity]. Even though short-term illnesses could be accepted as a part of life, the long-term illnesses cause severe after effects which affect the sustainability of society in many ways. The most notable aspect of modern medicine is that it too has not been able to address all these effects at once. So treating the symptoms of the physical ailments would not help the patient. The treatments to the mental state also should be a part of the treatment.

Buddhist perspective on health and well-being could be understood in relation to norms. Illness is definitely the outcome of our immoral behaviour. So if one controls his evil behaviour and practice morality (sila), mental discipline (samadhi), and wisdom (panna) he could conquer many of his mental or physical illnesses. Each one should understand that particular one is responsible for all the illnesses one suffers from rather than blaming outside sources. It is accepted that medicine can cure certain illnesses permanently, some temporarily or control with certain limitations. But the stark reality is all people succumb to pain, suffering, illness and death. So everyone should determine to have a balanced lifestyle based on

sympathy, compassion and tolerance. But Buddhism never forget the conditions and contexts the individual has no control over such as environment, workplace issues, lack of finances and the unavailability or inadequate medical facilities. Sustainability of the society gets affected mainly in these realms.

The correct view (sammaditthi) of the world is seen when there is proper mental health. If we develop and nurture incorrect views, then we get into delusions against reality. All have to control greed (lobha), hatred (dosa) and anger (moha) to have an equal and just society which is essential in achieving sustainability. One who develops the three traits of existence, anicca, dukkha, and anatta he or she would understand the reality of this world and never be a part of unwholesome act. There are some Buddhist discourses (sutta) like bojjhanga paritta which is chanted when a person falls sick. It is believed that if the bojjhanga paritta chants accurately in pronunciation and the sick person listens attentively to its meaning then his mind becomes settled. Giving (dana) is another aspect that promotes sharing and social welfare. In Buddhism it is encouraged the disciples to give as they could. This helps them nurture empathy and detachment from material goods.

In discussing health and well-being, we have to understand how sickness has been portrayed by early sociologists. Durkheim had used a pathological approach (1982) in explaining the individual behaviour and anomie (1897). Goffman used stigmatization in Asylums (1961). Parsons’ (1951) sick role helps us to understand how the sick person and the others look at the same context differently. For Parsons, being sick is a dysfunction and it affects society in many ways. While the others want the sick person to be away from normal routine of duties and responsibilities the sick person and the others want the sick person to return to normalcy as soon as possible.

According to the primary data sources in this research, when questioned the respondents 72 percent answered that the family members do not expect the sick person to perform normal social roles. But 48 percent believed that the sick person should be given the opportunity to work in a normal way if the sickness is not so strong. Another 84 percent said that the sick person should be

attended with proper medical care and help the sick person to get back to normal routine of work. Thirty-two percent in the sample accepted that they suffered from a short-term illness at least once during last twelve months and sixty-eight percent admitted that at least one family member or relative in their family suffers from a long-term illness. Twenty-eight percent was suspicious that they would suffer from the same long-term illness or any form of long- term illness in future. Those who are (78 percent) in the sample thought that illnesses could affect work and people could develop a tendency to suffer from work related diseases (69 percent). Physical suffering would definitely affect mental health and the workers/ employees would get their performances reduced; deskilling.

When questioned about the well-being of the individuals, 89 percent had said that they are happy with their physical well- being whereas 56 percent was happy with their mental well-being. This itself gives an idea that there is a difference between physical and mental status of individuals. Many are suffering from various problems for which they find it difficult to answer themselves. The social relationships were better and respondents have very positive relationship with family (92 percent), friends (97 percent), relatives (83 percent), neighbourhood (87 percent) and workplace (89 percent). One contrasting answer is that 68 percent was not happy with their lifestyle these days and many of them were females (41 percent). The researcher presumes that this may be due to the pressures exerted by duties and responsibilities, financial restraints, workload at workplace and many others. This is where the research objective aims at. When an individual is unhappy with his life style it means that there could be so many latent issues in him or herself. Further these affect the family and then to the mass society. If the society gets unsettled due to the issues it has with individuals, it affects achieving common objectives of the country.

Psychological trauma or agony of an individual could be the results of many social, political cultural and economic issues. Even though the individual is irresponsible for initiating such issues, in a social context all are succumb and many of those are beyond their control. Yet the most encouraging answer was that 93 percent replied that they were optimistic about next twelve months. Another

89 percent had felt that the life they live is worthwhile and further 94 believed that there is a serious purpose in their lives. All these three answers provide that whatever the negative circumstances the people are surrounded by, their hope for a better life and future is not lost. This is the summary of Buddhist approach to life. It always convinces the individual that the way forward is very easy and productive if he or she knows how to handle situations.

The respondents (86 percent) were worried about the power exercised by healthcare professionals, pharmaceutical corporations (34 percent) and the private sector businesses like hospitals (79 percent) that operate in health industry. They have understood that the ordinary people suffer a great deal due to the helplessness over finances (92 percent), knowledge (81 percent) and power (77 percent). Even though medicalization should be beneficial to society improving the quality of life of the people in general, the reality is totally different. A notable example could be cited through the work of Illich (1975) who discussed the three forms of iatrogenesis; cultural, social and clinical. The intervention of the medical professionals and industry could increase ill health and illnesses in society remarkably.

It is revealed that a large number of instructions related to health have been mentioned in many places of Buddhist literature. The Vinaya Pitaka, the Sutta-Pitaka, The Abhidhamma Pitaka and The Mahavagga paali there are many medical instructions for the proper physical and mental health. Most of these have been based on herbal medications and maintaining a specific lifestyle. Even in temples and homes people recite themselves or invite a Buddhist monk to recite the Bojjhanga (Paritta) Sutta, Girimananda Sutta which is believed to generate physical and mental comfort to the sick. The Angulimala (Paritta) Sutta also chanted for pregnant mothers to make her childbirth easy. In particular, the Sutta Girimananda in Angguttara Nikaya is a salient example for Buddhist notion of view on diseases. The Buddha considered various forms of diseases led human to suffer such as ansa (paralyze), pilaka (cancer), bagandara (one of major disease infect recto passages according to Ayurveda), vata samuttana abadha (disease caused by air), pitta samuttana abadha (disease caused by disorders of bile), semha samuttana abadha

(disease caused by disorders of phlegm), uthuparinamaja abadha (disease caused by climatic changes). Almost all these diseases are usually identified as curable in modern medicine. On  the  other hand, there may be many other chronic, mental or physical diseases that are labeled as incurable’ in modern medical model. The Sutta Girimananda makes room to answer to the matter of incurability as ‘kammavipakaja abadha’ that diseases may be caused by bad karma accumulated in previous births. Finally, Buddhism suggests accepting some forms of sufferings taking them as typical reality of the universe rather than following uncertain promises of curability of the medical model.

In Buddhist approach to health and well-being curing is accepted to regain the former healthy position but not get into illnesses is the key. To be away from illnesses one has to train to control his mind and body. Physical and mental illnesses do not affect only the one who is sick but the others as well. Since all the organs in the body are interrelated the harmony and interrelationship is vital. Similarly, the society too rests on various elements such as individuals, groups, organizations, institutions, communities as well. Therefore, to achieve sustainability the balance of all these are important. According to Buddhist philosophy each has to start this balance with oneself. Since all understand decay is a natural phenomenon in life and falling sick could never be avoidable conquering pain and suffering should be practiced.

A special word should be mentioned when discussing Buddhist approach to health and well-being, i.e, all Buddhists and non- Buddhists should read very carefully and study The Visuddhi Magga: The Path of Purification.  It  consists  of  three  sections. The first discusses the Sīla (ethics or discipline), the second, Samādhi (meditative concentration) and finally, the third is Pañña (understanding or wisdom). Even though everyone is not expected to develop such high intellectual capacities, each individual is advised to practice the first three stages, namely, the Purification of Conduct (sīla-visuddhi), the Purification of  Mind  (citta-visuddhi) and the Purification of View (ditthi-visuddhi) of the seven stages of purification. The fundamental argument  is  to  achieve  something we have to have our foundation solid. So proper conduct, mind and

view offer the best solution in purifying the self. If one tries to purify oneself, it would pay forward leading to the sustainability of society.


Like Chukwuma (1996) says the researcher too proposes that a sustainable society should be able to provide opportunities for all its members their basic needs. Further it should allow place for healthy life in present and future. The mistake in defining, explain- ing and sustainability was based on economic development and preserving environment but the human aspect had been neglected badly. Buddhist philosophy and psychology concern three types of characters: the greedy, the angry and the deluded type. In many cases the present day people suffer from the insatiable nature which is the greedy type. They have become more materialistic rather than spiritual. This greediness increases craving for things which cements their bonds to everything rather than not allowing the let- ting those go.

The people should be able to content with what they have. Greediness in this sense makes an individual physically and men- tally sick. The conflicts and the strifes that exist between different social milieus denote the results of angry type of individuals. These kinds of people are always unhappy, finds faults with others, very pessimistic and violent. This negativity and lack of compassion would ruin the mental status of the concerned individual first and subsequently the physical status. The deluded ones do not take any responsibility and do not perform their assigned roles in society. If these three types are increased the materialistic sentiments, con- flicts and lethargy would govern the world leaving no room for sus- tainability. So Buddhists should be warned by themselves of such pessimistic qualities of life.

Kittiprapas (2016) proposes a model of Buddhist Sustainable Development (BSD) in answering the deficiencies of the traditional definition on sustainability. According to him, the sustainability we opt to practice today should be more human-oriented. The social context should be set in such a way that it can make and keep the individuals happy all the time. But the individuals should know how to control this happiness without allowing it to get in to extremes.

Consumption should be more practical and people could practice compassion and kindness towards the others in each context. Any Buddhist principle, value system, norm, attitude and practice should be incorporated to day-to-day life style to understand the purpose of living. The shortcomings of the development paradigms existed should be compensated by the new value system of BSD. Health and well-being of oneself necessarily do not rest in the hands of the others, mainly it rests on oneself. Therefore, if Buddhists think of a sustainable future they have to think of answering this crucial issue.

Finally, the researcher would like to propose the three pillars of Buddhist sustainability based on the combination of freedom, justice and peace but not discarding the original three pillars of environment, economy and society. If people do not enjoy freedoms no one could dream of sustainability. Sen (1999) opined that development is freedom. Dhammacariya or the righteous living is the need of the hour. One who gets his inner self happy could extend that happiness to the outside world, i.e., the other fellow human beings as well irrespective of the geography, language, ethnicity, religion, caste, class or any other distinction. Buddhists or non-Buddhists should be free from all evils that destroy their personalities.

Buddhism mainly evolved on justice. It promoted a set of ethics challenging the then existing religious ideologies. The society and its relations should be made on ethics. These ethical principles are the guidelines and the cornerstones of the society. Equality is the most fundamental and beneficial trait of Buddhism. It spares no one who wishes to liberate oneself from all unwholesome acts. Vasala Sutta provides a greater insight into how Lord Buddha revolutionized against the existing moral order of the Indian society. The marginalized individuals like Sunita and Sopaka became revered personalities and dignitaries in the religious tradition and society due to the justice practiced in Buddhism.

Peace and security are other burning issues at the global level. People tend to fight each other and there would be no end to conflicts. A large number of people become injured, helpless, rendered homeless, displaced, and deprived of their possessions due to conflicts. The escalation of conflicts at the global level is  unimaginable.  The  loss  of  lives  and  property  cannot  be

underestimated. The fear of death, escape from torture, starvation have been some of the critical issues for many children and women in the world. Buddhist philosophy provides answers to these entire if the individuals are sensible and they know the behavior based on reason. Rationality is the outcome of trained mind. Sustainability in the future could be the end result of trained minds. Lord Buddha visited Sri Lanka to settle the conflict between two Naga kings Chulodara and Mahodara and the intervention of Shakya Koliya on Rohini river water are two examples from Buddhist literature to prove how and why peace and security should be achieved.


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