According to the World Health Organisation, 1.4 million children died in 2002 from diseases preventable by routine vaccination.[1] In Malawi there is only one doctor per 100,000 people (compared with one per 164 in the UK), in an overburdened and under-resourced health system where trained doctors and nurses are migrating to richer countries for better pay, conditions and training.[2,3] Meanwhile the world's five richest people own more money than the world's 49 poorest countries put together.[4] This is just a snapshot of the all too evident crisis of poverty, debt and disease in what many refer to as the third world, but what Tearfund poignantly calls the 'two thirds' world.

As contemporary medical students we have all grown up knowing that certain countries are poor and that the western world is rich. Unfortunately we have become so used to it, that you may have been tempted not to read this article because you are tired of reading about the problems of the world and feeling relatively powerless to change anything.

Yet as we read the Bible, we cannot help but notice God's heart for justice, concern for the oppressed and passion for the poor. I, like many Christian medical students and doctors, have thought and prayed often about the unique opportunities there may be for me in the future to make an impact upon some of the gross health inequalities we see in the world today. But I have also found it a life-transforming experience to ask what we can do in the meantime, and what responsibilities we have as citizens of one of the world's most influential democratic countries. We must consider what it means to be a voice for the oppressed, as we are implored to do in Isaiah 1:17:

Seek justice, encourage the oppressed. Defend the cause of the fatherless, plead the case of the widow.

Why such a scandal?

Why are developing countries poor? The reasons are many. A history of exploitation and colonialism has had a large role to play. Many countries are crippled by debt owed to western nations. Many suffer at the hands of corrupt governments or have been devastated by war. Many suffer due to trade laws that place developed countries at an unfair advantage in the global market, leaving developing countries with seemingly insurmountable barriers to improving the wealth and health of their populations. Many of us have heard of international campaigns leading the way in challenging some of these global injustices, such as the Jubilee Debt Campaign, the Stop AIDS Campaign or the Trade Justice Movement (see websites box) to name just a few.

Two years ago I studied a BSc in International Health in Leeds, which covered many aspects of global public health, including:

• the relationship between poverty, development and health
• politics and health
• health inequalities
• global patterns of disease

This year of study really helped me think through the wider systems of today's globalised world, and I came to see that as well as serving the disadvantaged, there is a need to challenge the systems that keep the disadvantaged in their powerless position.

Since then I have been involved in campaigning along with organisations such as Christian Aid, Tearfund and Refugee Action (see websites box) on issues like trade justice, fairer treatment of asylum seekers and climate change (which is increasingly in the news and was the focus of Christian Aid's recent campaign).[5]

What would Jesus do?

Christians often differ in their views about how and in what capacity to be involved in politics. However, just as we cannot separate politics from health, we cannot separate politics from faith. Whilst Jesus respected authority he was not at all shy about challenging exploitative systems. His own description of his mission found in Luke 4:16-19 was:

…to preach good news to the poor…to proclaim freedom for the prisoners and recovery of sight for the blind, to release the oppressed, to proclaim the year of the Lord's favour.

Whilst of course the good news Jesus brought to the poor was not only about material equality, the worth he placed on each individual he encountered cannot leave us any justification for turning a blind eye to suffering caused by inequality. The Great Commission, to go into the world and make disciples of all nations,[6] would not have been at all separable in Jesus' mind from the Great Commandment - to love God with all our heart, soul, mind and strength and to love our neighbours as we love ourselves.[7]

How should we tackle global injustice?

There are many issues to be concerned with and many ways to be involved, both direct and indirect - either i) locally, by identifying the marginalised in your community, learning what their needs are and how they can be met, or ii) nationally/ internationally, such as campaigning through letter-writing and political lobbying.

We clearly cannot give time to all the many worthy issues that we could be involved in, and many feel we should concentrate on issues specifically concerning medicine. Laurence Crutchlow, writing in Nucleus in 2002,[8] rightly advocated that we as medics should prioritise our efforts into campaigning about the things we can influence most, for example medical ethics. Sadly, however, evangelical Christianity often has a bad press for not placing enough emphasis on social justice issues, and separating the gospel message from a practical response to people's needs.

We each need wisdom to know where our time and efforts are best placed, and we each need to bear in mind that fundamentally, the problem of injustice can be solved only by spiritual transformation. However, sharing faith, growing spiritually, campaigning on ethical issues and campaigning on more general justice issues are certainly not mutually exclusive, and each reflects God's heart in ways that cannot be divorced from the others. Peter Saunders recently expounded Jesus' manifesto from Luke 4, quoted above, as comprising preaching, healing, deliverance and justice – all are God's priorities, and they should be ours too.[9]

With the growing interdependency of health, politics and economics, we should find out about ways in which we can make a difference. This might be with our time, our power or our money. There are several good resources to use as a starting point. Medsin is an organisation that exists to promote medical student involvement in international and social justice issues, and SPEAK is a similar organisation that is specifically Christian (see websites box). Many of the organisations and campaigns mentioned here send regular emails suggesting small actions we can do, such as sending emails to people in positions of power, adding our signatures to petitions etc. The Trade Justice Movement has many suggestions for how we can best use our money to support fairly traded and environmentally sustainable products. Issues like trade justice take time to fully understand, but as students we have more time to get to grips with these things than we ever will as doctors, and an understanding of the nature of the current global health crisis will make us better doctors in the long run.

I gained a huge amount from the BSc that I did and some of you may consider doing something similar for your own intercalated year. The Leeds BSc is one example and further information can be found on their website.[10]

Is it worth it?

Does campaigning make a difference? Often the process is slow and results are rarely immediate. However, social justice revolutions such as the abolition of slavery (which will have its 200th anniversary in 2007) have been largely a result of Christian advocacy for justice. Wilberforce and his colleagues had to persevere for years but their legacy lives on today.

An often quoted passage is Isaiah 58:6-8, which has as much to say to us today as ever. I hope it provides food for thought as we seek to bring hope and healing to all areas of a very sick world.

Is not this the kind of fasting I have chosen: to loose the chains of injustice and untie the cords of the yoke, to set the oppressed free and break every yoke? Is it not to share your food with the hungry and to provide the poor wanderer with shelter - when you see the naked, to clothe him, and not to turn away from your own flesh and blood? Then your light will break forth like the dawn, and your healing will quickly appear; then your righteousness will go before you, and the glory of the Lord will be your rear guard.