National Academies Press: OpenBook

Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop (2019)

Chapter: 2 Collaboration at the Intersection of Faith and Health

« Previous: 1 Introduction
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 5
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 6
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 7
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 8
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 9
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 10
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 11
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 12
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 13
Suggested Citation:"2 Collaboration at the Intersection of Faith and Health." National Academies of Sciences, Engineering, and Medicine. 2019. Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25375.
×
Page 14

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

2 Collaboration at the Intersection of Faith and Health National Academies roundtable workshops are designed to open up a subject for consideration, said session moderation Gary Gunderson, vice president for Faith and Health at the Wake Forest Baptist Medical Center, professor of Public Health Science at the Wake Forest University School of Medicine, and professor of Faith and the Health of the Public at the Wake Forest University School of Divinity. This workshop was intended to open up the discussion of the potential for collaboration at the intersection of faith and health. He added that such collaboration must occur within the context—grounded in the Constitution—of the separation between structures of faith and public structures. (Highlights of this session are presented in Box 2-1.) To inform the discussion of faith–health collaboration Gunderson shared a matrix from the African Religious Health Assets Program that lists examples of tangible and intangible religious health assets relative to the continuum of proximal and distal health outcomes (see Figure 2-1). He encouraged participants to identify religious health assets that could be relevant to the population scale challenges that the roundtable is seeking to address. For example, a clinic, a prayer group, a recovery shelter, or a needle exchange program in a church are all both tangible and intangible assets and have health effects that are both proximal and distal. It is important to consider who owns or influences a religious health asset, he said, and the optimal alignment of that asset with other equally complex, relevant health assets. He also offered the term “communities of spirit” as a more inclusive alternative to “religion” when discussing these social structures of faith. 2-1 PREPUBLICATION COPY: UNCORRECTED PROOFS

2-2 FAITH–HEALTH COLLABORATION TO IMPROVE COMMUNITY AND POPULATION HEALTH THE FOUNDATIONS OF FAITH–HEALTH COLLABORATION1,2 Continuing the theme of “opening up the conversation” about population health and faith- based assets, Prabhjot Singh offered a perspective on the foundations of faith–health collaboration. Singh is a physician, director of the Arnhold Institute for Global Health, and chair of the Department of Health System Design and Global Health at the Icahn School of Medicine at Mount Sinai. Singh began by noting that in its 40-year history, Leonard Medical School at Shaw trained 400 doctors, among them Clinton Caldwell Boone, a 1910 graduate. After graduating, Singh narrated, Boone went to work as a medical missionary and pastor in the new Republic of Liberia, helping to bring high-quality care to a nation that was formed by freed slaves. After noting the lack of dental care in Liberia, Boone traveled to New York City to be trained as a dentist as well. Boone built a congregation in Liberia, Singh said, and that congregation formed the base of social support for his medical work. The congregation served as a means to organize the community, and to begin the challenging work of building institutions that could serve in both invisible and material ways, he said. This story could have taken place in nearly any corner of the world, at any time in history, with any set of people who faced their human condition and realized that they needed to look beyond for the strength to move forward, Singh observed. Somehow, he continued, people find the spirit to organize, to act, and to build a better future. The resulting communities of spirit, to use the term of art introduced by Gunderson, are “intangible and powerful field[s] of human energy that drive voluntary associations across the population, and in service of it.” By elevating the idea of communities of spirit, Singh said, all individuals can find themselves to be part of the discussion, regardless of how they come to it. Communities of spirit are often involved in building public health and health care institutions, he said, bringing the core values of justice and compassion together with scientific rigor, to improve population health. Singh highlighted the work of John Hatch (who was present at the workshop), who he said intuitively understood the concept of communities of spirit and built a movement that led to the development of community health centers across the country. Singh also referred to the foundational work on faith-based health assets that was carried out by James Cochrane (also present at the workshop) of the International and African Religious Health Assets Program. Cochrane surveyed countries across Africa to better understand how faith and health institutions productively aligned to serve people. Singh described his own journey toward understanding the relationships between faith and health as unexpected. Singh said that after he earned Ph.D. and M.D. degrees and completed postdoctoral work in economics, his thoughts were focused on deciphering diagnoses and solving problems, and he was not always thinking about the people in his care. That changed during his first year of medical residency when a patient named Ray died in his care. Singh lived 1 This section is the rapporteur’s synopsis of the presentation by Prabhjot Singh, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. 2 Singh’s presentation drew heavily upon an unpublished lecture by Gary Gunderson, available at http://ihpemory.org/good-news-for-the-whole-community-reflections-on-the-history-of-the-first-century-of-the- social-gospel-movement/ (accessed January 24, 2019). PREPUBLICATION COPY: UNCORRECTED PROOFS

COLLABORATION AT THE INTERSECTION OF FAITH AND HEALTH 2-3 in the same neighborhood in Harlem in New York City as Ray had, and Ray’s daughter invited him to the funeral. Singh shared the story of that experience, which changed his perspective (see Box 2-1). Years later, Singh was motivated to write about his experience at Ray’s funeral after his own relationship with his Harlem neighborhood changed significantly. While out walking at dusk, Singh (who describes himself as a visible member of the Sikh faith tradition) was attacked by about 20 to 30 men who called him a terrorist and fractured his jaw. After sharing his story with local media, he said he was unprepared for the thousands of letters and e-mails he received that both expressed sorrow for what had happened and affirmed his identity. As a physician, he had felt that he was supposed to take care of a community, yet in this case, he felt the power of the community taking care of him and saw firsthand how the invisible bonds that connect individuals locally and nationally were made visible in the community’s response. In an effort to learn more about those bonds, Singh traveled across the country. In Minneapolis, for example, he said he learned how a faith-based community organization, ISAIAH, had used a health impact assessment to change transportation policy. In Dallas, he learned how the Parkland Health Center worked with many faith-based organizations to develop shared technologies that support their most vulnerable clients. Singh said he was inspired by these and other movements of people across the country, and how they are thinking about faith– health collaborations on a very large scale. To provide context for this scale, Singh said that in the United States, there are approximately 350,000 social entities identified as congregations. Faith identities are diverse and include some that do not identify as formal religions. To put the number of congregations in context, he said there are about 250,000 neighborhoods or geographic communities in America. Singh said that faith-based assets form a connective tissue of social infrastructure that supports, connects, and protects neighborhoods, and that is also well-positioned to be a partner in health. As public health and health care institutions endeavor to work in concert to improve population health, Singh said, they are finding common ground in neighborhoods. The science of population health is identifying how clinical and nonclinical factors shape people’s health. This increasingly includes an emphasis on the social context of people’s lives, including the availability of social support, financial stability, food security, and housing. Although the science of population health can identify these social factors, public health and health care institutions cannot address them alone, Singh said. He added that, as the health sector grapples with decreasing life expectancy, the costs of health care (which can destroy people’s lives), income inequality, and social injustice are all growing, and “the moral voice of our allied health professions is difficult to hear.” Singh noted that the relationship between the health sector and faith institutions has not always been positive, with a history of sometimes disrespectful interactions. However, “people’s lives hang in this balance,” he said, and it is incumbent on both fields to acknowledge this history and deploy “the wisdom of faith and the methods of science” in facilitating dialogue and building partnerships. In closing, Singh emphasized three areas for consideration at the workshop. 1. Understanding the role of faith communities in the larger community. A better understanding is needed of the nature of the social connective tissue that faith-based assets have with their populations, not only within their congregations, but across PREPUBLICATION COPY: UNCORRECTED PROOFS

2-4 FAITH–HEALTH COLLABORATION TO IMPROVE COMMUNITY AND POPULATION HEALTH other non-faith-based organizations and institutions in their communities, Singh said. He added that Robert Putnam and other social and behavioral scientists have “documented how the social fabric influences the ability to survive and thrive, and how faith communities play an important role in health in measurable and well- described ways.” Health-sector institutions need to embrace new approaches and technologies that can help them be better partners. 2. Recognizing the value of faith-based assets for health. The growing understanding of faith-based assets can be used in practical ways, Singh said. There are many examples of faith–health partnerships across the nation that call for larger investments in children, the dismantling of racist housing policies in neighborhoods, the protection of undocumented immigrants, and helping to address social isolation and loneliness among older adults. 3. Communicating relevant health messages through trusted partners. It is important to work with faith leaders to ensure that key public health messages and health care recommendations are more relevant to communities of spirit. For example, the polio eradication campaigns worldwide required deep partnerships with faith leaders to reach the last mile. Today, misinformation about health spreads faster than evidence-based information, he said, and partnering with congregational leaders is key. The workshop presentations will provide practical, tangible examples of important partnerships forming between faith communities and health institutions, and of the role of policymakers who are forging a new dialogue while respecting the separate roles of faith and government, Singh said. He encouraged participants to identify practical insights they could take back to their respective communities, and to identify what research is needed to better understand faith–health relationships and build better collaborations. DISCUSSION In the discussion that followed, participants considered the role of faith-based assets in bringing an understanding of the whole individual and their context to the health arena. Participants also discussed approaches to establishing genuine partnerships among health and faith organizations, and raised specific issues around religious exemptions to vaccines, and overcoming the barriers to providing mental and behavioral health services. Understanding the Whole Person and Their Context Matt Guy with the Communities of Spirit Hub of 100 Million Healthier Lives highlighted the general lack of focus on the individual person in health care, despite current patient-centric efforts, and the role of faith in focusing on the individual. Singh agreed that this is a foundational concept for the workshop dialogue. He shared that the most profound result of his speaking with people in faith communities was learning to understand the whole person and their context. He also recognized that there are real limits to being able to develop that understanding in his role as a health professional. This is a journey of humility, he said—of recognizing that everyone holds PREPUBLICATION COPY: UNCORRECTED PROOFS

COLLABORATION AT THE INTERSECTION OF FAITH AND HEALTH 2-5 a piece of the puzzle and no one can see the whole picture. The challenge is to design institutions and systems that can provide pathways to understanding those individual perspectives. This is an opportunity to see how each puzzle piece fits into the bigger picture. Eva Powell of CommonPurpose Health noted an opportunity for the faith community and traditional health entities to work more collaboratively on a macro level as well. What happens at the individual level is constrained by decisions that have been made around investments and priorities, she said. When a service is not available for an individual, it is the direct result of decision making on behalf of people who are often not at the table. She suggested that discussion is needed on how the faith community can be active in decision-making circles in order to provide input to help hospital boards, public health entities, and legislatures. Angeloe Burch of the Interdenominational Ministerial Alliance of Durham emphasized the need to have the “right conversations” that demonstrate an understanding of the specific context in each case. For example, Missionary Baptists and Primitive Baptists are split over the issue of conducting missionary work, and understanding this is important. It is also important to consider how to best communicate with different populations. Regarding vaccines, for example, African Americans are often wary of immunization due to a long history of abuses and unethical treatment that has led to a lack of trust with regard to the health care system. Finally, Burch noted, health providers need to acknowledge that patients know themselves better than a provider can. Providers interact with patients briefly, and having the right conversations with the patient is critical to providing quality care for that individual. Singh agreed with the need to be aware of the historical and personal depth of these issues, and to build the dialogue needed to move toward a common purpose. In this regard, Gunderson raised the concept of “healthworlds,” which was proposed by Cochrane and colleagues. James Cochrane, professor from the University of Cape Town in South Africa and a codirector of the African Religious Health Assets Program, expanded on the concept of healthworlds. An early research project done by the African Religious Health Asset program for the World Health Organization (WHO) was focused on mapping assets owned by religious entities that might have clinical relevance. Cochrane said that WHO was interested in tangible assets that could be measured, such as personnel, equipment, materials, and transportation. This information was intended to inform decisions by national health ministries about where to prioritize resources, including finances and personnel. It became very clear to researchers that there was a need to also understand intangible networks and assets. In the philosophical and scientific literature there is a concept called the lifeworld, Cochrane said. The lifeworld is the taken-for- granted assumptions that affect the way people make decisions and behave in the world. These go far beyond the rational, calculated decisions that one makes between benefit and cost. Unless these elements of the lifeworld are understood, it is not possible to understand what is happening with the applicable technical, scientific, and instrumental capacities. Cochrane highlighted treating patients with HIV in southern Africa as an example. Medications are available, but there are complex dynamics that impact whether and how people take their medicines. For example, said Cochrane, if a patient with HIV receives medication and has a sibling or parent who is HIV positive but does not have medication or is unable to even acknowledge his or her own status, the PREPUBLICATION COPY: UNCORRECTED PROOFS

2-6 FAITH–HEALTH COLLABORATION TO IMPROVE COMMUNITY AND POPULATION HEALTH patient will share their medication with them, which negatively impacts the medical protocol designed for the patient. Expanding on the notion of lifeworld, Cochrane and colleagues coined the phrase “healthworld” to encompass the way that people construct their own sense of health and then behave accordingly (Germond and Cochrane, 2010). Every individual makes decisions based on whether they like the advice they received or not, or whether they trust it or not, Cochrane said. Even when an individual accepts the medical advice they receive, they frequently choose other alternatives anyway; one field where this happens not infrequently is cancer treatment. Cochrane and colleagues have argued that it is critical to understand the interface between the self- understanding of individuals and how those individuals are embedded in families with traditions, cultures with traditions, and religions with traditions, and the impact of this interface upon the practice of health science. Establishing True Partnerships Ella Auchincloss of ReThink Health (participating via webcast) asked about approaches that clinical organizations might take in reaching out to and engaging faith-based organizations, so that the faith-based organizations are true partners and not simply venues or assets. Drawing on his prior experience working at the Carter Center, Gunderson said that one theory of collaboration is built around limited domain collaboration, in which the area of partnership is not the sovereign space of either partner. The art of creating that collaborative space, he continued, is to define the limited domain in such a way that it has both integrity and potential efficacy for the goals of all of the partners. The limited domain also excludes aspects that are not specifically included. In other words, it is a safe space where the partners know that they are not buying into every possible implication of the collaboration; it is restricted to the limited domain (Gunderson, 1997). Religious Exemptions to Vaccines Robert McLellan, chief of Occupational Medicine at the Dartmouth-Hitchcock Medical Center in New Hampshire, raised the issue of exemption from vaccination based on religious or deep philosophical commitment, and suggested that this is one very practical area where there is friction between the faith and health communities. He noted that public health law is constructed for the good of the population and sometimes finds itself at odds with the principle of individual autonomy. He reiterated Singh’s comment about how health organizations need to work with communities of faith to connect with people in relevant ways. Singh agreed that this issue around vaccination is a vital, practical area of work. Gene Matthews of the Network for Public Health Law and the University of North Carolina at Chapel Hill said that the challenge is how to encourage, but not coerce, those who are hesitant to receive vaccines. He mentioned recent research that found that parents who were hesitant to have their children vaccinated scored the moral value of liberty as being very important to them (i.e., they do not want the government telling them what to do). He suggested that one approach might be to emphasize to them the need to be able to free their children from having vaccine-related illnesses. Another moral value PREPUBLICATION COPY: UNCORRECTED PROOFS

COLLABORATION AT THE INTERSECTION OF FAITH AND HEALTH 2-7 emphasized by parents hesitant to vaccinate was sanctity (e.g., not polluting one’s body). A different approach would be needed to encourage these parents. Meeting Mental and Behavioral Health Needs Mylynn Tufte, State Health Officer for North Dakota, shared that the governor and first lady of North Dakota have been focused on efforts to reduce the shame and stigma associated with addiction. She added that there is limited access to behavioral health services in rural areas of the state. She asked about leading practices or evidence related to tapping into faith-based assets for mental and behavioral health as they relate to decreasing the shame and stigma of addictions. Gunderson called on Melissa Stancil of CareNet Counseling to share an example. CareNet is an affiliate of Wake Forest Baptist Health, Stancil said, specializing in spiritually integrated psychotherapy and community-based work. The challenge of meeting behavioral health needs in rural settings can be daunting, she said. Collaboration with community partners usually starts with a mutual education process, she explained. People want to help, she observed, but they just do not know how. There is a lot of misinformation about substance use disorders, even within the health care professions, and a lot of internalized stigma in the health care industry around working with individuals who are living with addiction. Trust is essential, and CareNet works with congregations on educational events and relationship building with the goal of developing sustainable partnerships. There are also specific best practices that can be shared (e.g., needle-sharing programs, and leveraging unused facilities for addiction recovery services). Amy Moyer of Kaiser Permanente said that Kaiser is looking to work with faith-based organizations as an integral part of a collective impact plan, working with synagogues, temples, churches, pastoral associations, and others to understand the total health of the community and BOX 2-1 Key Points Made by Individual Speakers and Participants • People find the spirit to organize, to act, and to build a better future. Such communities of spirit can serve as a means for organizing the community, and for beginning to build institutions that can serve in both invisible and material ways. (Singh) • Faith-based assets form a connective tissue of social infrastructure that supports, connects, and protects neighborhoods, and they are in an important position to be partners in health. (Singh) • Working with faith leaders can help ensure that key public health messages and health care recommendations are more relevant to communities of spirit. It is also important to become knowledgeable of the context (e.g., of an individual, group, or community of faith) for optimal communication with different individuals and populations. (Burch, Singh) NOTE: This list is the rapporteur’s summary of the main points made by individual speakers and participants (noted in parentheses), and does not reflect any consensus among workshop participants, or endorsement by the National Academies of Sciences, Engineering, and Medicine. PREPUBLICATION COPY: UNCORRECTED PROOFS

2-8 FAITH–HEALTH COLLABORATION TO IMPROVE COMMUNITY AND POPULATION HEALTH the social determinants of health. She expressed interest in hearing more discussion on how to BOX 2-2 Lessons from a Patient’s Funeral “As I listened to Ray’s eulogy along with his family members, I could feel the thick social structure of the community. The wooden pews held Ray’s fellow veterans in uniform and his grandchildren, all dressed in dark blue. There were clusters of generations leaning on canes or hunched over smartphones. One of his nieces started talking to me and told me that he never learned how to read. That is something I did not know when I gave him written instructions. “I paid my respects to the well-dressed man in the coffin. I recognized him from his exposed ankles, located between the short pants socks and neatly pressed beige dress pants, where his skin was darkened and wrinkled from years of blood pooling in his legs. I had seen his exposed chest prior to [his] being transferred to the ICU. Now, I saw a cream-colored silk tie rest upon a dark brown vest with an unwound pocket watch frozen at ten past two. “I realized I did not really know anything about him or his life. In the hospital, this fact did not seem important. In front of him now, it felt disrespectful. If the health care system and neighborhood both care about his well-being, why are they so evidently disconnected? Before I left the funeral, I spoke to his pastor about his perspective on the health of his congregation. As I waited, I wondered for the first time how anyone who could not read manages multiple medical conditions. How many times had I scribbled a phone number for a referral or handed out information pamphlets to a patient assuming they could read it without checking to make sure? For the 32 million adult Americans who are illiterate and many more who don’t fully understand their conditions, staying on a healthy path is impossible without being able to read the signposts along the way. The medical institutions around us are not the only ones that give those signposts. “When the pastor arrived, he gently explained how part of his job is to support his congregation when he senses trouble. He is worried about obesity in kids and how to counsel young couples when a spouse needs to start dialysis. He explained that his congregation does not always make the distinctions between spiritual support and clinical decision making and he had to manage it all.” SOURCES: Singh presentation, March 22, 2018, excerpts read by Singh from Singh (2016). formulate private, nonprofit, and governmental relationships around faith-based initiatives in mental health. PREPUBLICATION COPY: UNCORRECTED PROOFS

COLLABORATION AT THE INTERSECTION OF FAITH AND HEALTH 2-9 FIGURE 2-1 Religious Health Assets (RHA)/Health Impact Matrix. NOTE: NGO = non-governmental organization; FBO = faith-based organization; CBO = community-based organization. SOURCE: Gunderson presentation, March 22, 2018; developed by James Cochrane, African Religious Health Assets Programme. PREPUBLICATION COPY: UNCORRECTED PROOFS

Next: 3 FaithHealth Collaboration to Advance the Social Determinants of Health »
Faith–Health Collaboration to Improve Community and Population Health: Proceedings of a Workshop Get This Book
×
Buy Paperback | $50.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

On March 22, 2018, the National Academies of Sciences, Engineering, and Medicine convened a workshop to examine the collaboration between the faith and health sectors, and to highlight the unique opportunities these collaborations offer to help improve population health outcomes. This publication summarizes the presentations and discussions from the workshop.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!