Health care and faith communities: how are they related?

The relationship between religion and medicine is controversial.1,2 Two studies in this issue of the Journal of General Internal Medicine suggest that faith communities and programs within faith communities can influence health care practices and health care planning, especially in high-risk populations. Studying a sample of 2,196 low-income African Americans, Felix Aaron et al. found that persons attending church at least monthly (regular attenders) were 20% to 80% more likely than less frequent attenders to have recently obtained a mammogram, had their blood pressure measured, or obtained a dental visit.3 For those with several chronic illnesses, regular attendance also increased by 70% the likelihood of having no delays in seeking care in the past year. Among uninsured women and women with several chronic illnesses, regular attenders were twice as likely to have a recent Pap smear. The second study tested an educational program in faith communities designed to increase the percentage of persons with a living will or health care power of attorney. Despite major efforts to get patients to sign advanced directives (ADs), only 15% to 20% have done so, and educational programs directed at healthy outpatients increase the likelihood of ADs by only about 10%. Medvene et al. tested an educational program that involved parish nurses working with 361 members of 17 faith communities to increase the percentage of those with ADs.4 Of the 248 who completed the program, 36% either revised a previous AD or signed one for the first time (the figures were 45% for Hispanics and 50% for African Americans). With the over-65 population projected to expand from 35 million to 80 to 90 million by 20405 and Medicare spending expected to increase from $260 billion/year in 2002 to $450 billion/year by 20116 (before the aging surge), health education and disease prevention have received increasing attention in recent years.7 Such efforts having been directed especially at growing ethnic minorities and low-income groups, which experience the worst health. These populations, however, are often the hardest to reach in terms of disease screening and health promotion due to a lack of health education and poor access to services. Given that two thirds of Americans are members of religious congregations (the figure is closer to 80% for minorities) and 60% attend religious services at least monthly,8 there is no single place in society where persons of all ages regularly congregate as the church. This has caught the attention of public health experts, who are now turning to the faith community for help to improve disease screening, access to services, and health care planning.9,10 Developing such connections, however, is not new. The near total separation of religion, medicine, and health care seen today is a relatively recent phenomenon of only the past two generations.11 A quick tour of history reveals that the Christian church built and staffed the first hospitals during the Middle Ages, the entire nursing profession emerged from religious orders, and most physicians during early American colonial times were also ministers. In the mid-20th century, church-related hospitals in the United States cared for more than a quarter of all hospitalized patients, and Catholic hospitals alone saw nearly 16 million patients per year.12 Arealliance between the religious community and the health care system would build on a long, long history. Two other points underscore the need for cooperation and communication between religious communities and health care providers. First, religion influences all sorts of health behaviors besides those related to health care seeking. These include eating habits, exercise, cigarette smoking, alcohol intake, drug use, sexual practices, sleep patterns, and driving safety from childhood to old age.12 Working with religious leaders and parish nurses is a natural way of influencing such behaviors and positively affecting health outcomes. Second, religious beliefs play a major role in the medical decisions that people make. A sizable majority of patients indicate that religious beliefs are likely to influence their medical decisions during serious illness.13 The fact that physicians often underestimate this influence was driven home recently by a study of factors affecting the decision to accept chemotherapy by patients with advanced lung cancer.14 When confronted with a long list of influential factors, patients and family members both picked “Faith in God” as the second most important factor, compared to oncologists who ranked it dead last. Religious beliefs are especially likely to affect end-of-life decisions such as do-not-resuscitate orders15 and withdrawal of life support.16 Including religious preferences as part of a patient's AD could provide further rationale for religious leaders and parish nurses becoming involved in securing these documents for members of their congregation. Yes, the faith community has a lot to contribute to the health and health care of our patients. How to sensitively and appropriately take advantage of this resource in terms of health education, disease screening, and health promotion will no doubt be a major challenge for our health care system in the 21st century.