6

Reflections on the Day

After the final panel session, participants engaged in an interactive Liberating Structures exercise designed to draw out potential principles and lessons learned from the workshop discussions. The activity was moderated by Emily Viverette of Wake Forest Baptist Health. Each participant was asked to share a personal thought about a potential actionable idea for forging productive collaborations among faith-based organizations, public health, and health care systems by writing it on an index card. Each idea was read and rated by five participants (i.e., five rounds of rating, meaning each card was seen by five members of the audience). Some of the ideas provided by anonymous individual participants are listed below. Exercise instructions and the full list of individual responses are provided in Appendix B; a selection of the responses (i.e., those rated highly by each of the five individuals who read the idea) are provided in Box 6-1.

Following the exercise, Sanne Magnan and Joshua Sharfstein, associate dean of the Bloomberg School of Public Health at Johns Hopkins University, reflected on the workshop presentations and discussions, and invited roundtable members and participants to share their final observations.

Reflecting on the workshop discussions, Sharfstein shared his six observations on what makes a faith–health partnership successful:

• The faith organization can bring energy and resources to a particular problem. Sharfstein referred to Wong’s discussion of UMMA as an example.

• The faith organization brings structure and a network to the problem (e.g., they often have the connections to help people obtain jobs or get legal assistance).
• Faith organizations excel at social outreach. Some of the factors that affect illness are outside the medical realm. Faith organizations are naturally working in these areas to help people.
• Faith organizations have the trust of the community.
• In a true partnership, the organizations respect each other’s expertise. In successful partnerships, the faith organizations listen to the evidence and treatment advice provided by the health and medical partners in response to their needs. Sharfstein highlighted Methodist Le Bonheur Healthcare as an example, in that they first listened to what the community wanted, and then offered relevant evidence-based approaches that were accepted by the community.

• There is potential for advocacy work by the faith community using approaches, tools, and connections to which health organizations typically do not have access.

Magnan reiterated the eight strengths that communities of faith bring to a faith–health partnership, which Joy Sharp presented from Gunderson’s work. They are the ability to accompany, convene, connect, tell stories, give sanctuary, bless, pray, and endure. Magnan also emphasized the theme of seizing opportunities. In the discussion of the work of Greater Cleveland Congregations, Donna Weinberger said that the first lesson of community organizing is to always be looking for opportunities. Magnan was reminded of a quote from Otto von Bismarck, who said, “The statesman’s task is to hear God’s footsteps marching through history, and to try to catch on to His coattails as He marches past.” In essence, Greater Cleveland Congregations is catching onto those coattails and making history, she said. Faith-based allies in communities can be collaborators for helping the health sector bring peace, healing, health, and well-being to communities, she said.

Terry Allan highlighted UMMA as an example of how the power of faith and mission are independent of denomination. As discussed by Paul Wong, UMMA was organized by Muslim medical students and the majority of donor funding comes from the Muslim community, yet only 2 percent of the people who come to the clinic are of Muslim faith.

A participant noted the importance of promoting and expanding access to mental health and behavioral health services. She recalled the comments by Kirsten Peachey about aligning with public health services and fostering trauma-informed congregations. She hoped this would happen within her state. Increased awareness around adverse childhood experiences is very important, she said, especially for the work being done at the faith–health intersection within the Native American community in her state.

David Kindig of the University of Wisconsin observed that several participants had mentioned hope as a key strength of faith-based organizations. He acknowledged not being sure whether hope was unique to these organizations, or just a shared attribute among them. He noted that he had not previously considered hope as a factor or input in the promotion of health.

A participant recalled the comment by Prabhjot Singh that there are about 250,000 neighborhoods in the United States, and about 350,000 congregations. This would seem to present great opportunity, but he was concerned that congregation memberships are dwindling in some areas. In his area of New England, he said that church attendance is low, and he wondered what that might mean for faith–health initiatives.

Phyllis Meadows of The Kresge Foundation highlighted the notion of faith communities as assets and emphasized the value of the faith community as an anchor institution in communities. They have history and longevity, and their emphasis on service minimizes the sense of competitiveness that often occurs when different entities serve the same population. She said she valued the church’s role as a safety net but hoped it would become more vocal and involved in the institutional and societal challenges that community members face, including issues of race. She was inspired by the example of Medicaid expansion in Ohio as it really is a civil rights issue. The power of the church can begin to shape what is happening politically and contextually in these communities, she said. She observed that faith-based institutions that function as human service providers are struggling with the same issues that the broader human service sector is struggling with. There is greater demand than what they can supply, and sustainability is a persistent challenge.

James Cochrane felt that many of the examples discussed were quite powerful and provided a sense of some of the phenomena of faith–health or religious health assets. Having worked with these phenomena for more than 20 years in Africa and Europe and elsewhere, he said he was disturbed by frequent attempts (in general, not at the workshop) to claim a sort of privilege for faith, to regard it as having a position that others do not have. This is not always the case, he said. He suggested that there was somewhat of a selection bias in what was presented at the workshop, and that while participants could be inspired by that, they could also mislead. These phenomena (i.e., the partnerships between faith and health entities) are very diverse, are not always positive, and are sometimes highly ambiguous, he said. It cannot be claimed that the health sector should be working with faith communities simply because they are communities of faith. Rather, what is it that binds, drives, or unites those that the health sector should be working with? What unites the phenomena behind the individual examples? What are the conditions that allow these phenomena to emerge that need to be understood and encouraged? Little has been discussed about conceptual or theoretical understandings of the phenomena that have been described. Much of what has been described still reflects what has been called the Cartesian split between empirical science and practical wisdom, in which we create categories that we separate things from, he said. We cannot avoid a siloed approach or properly address questions of alignment as long this split persists. There is a direct reflection of this in the language of health and of medicine, which is a language of “proximal and distal,” and “upstream and downstream,” Cochrane said. This language separates the activities involved when, in fact, they are in the same stream. The ambiguities in faith are rich and deep, Cochrane continued, but this is also true of medicine. The ambigui-

ties of medicine and of health care practice are not adequately addressed at this time. There is also the question of how to prioritize resources and allocate funds to the various activities discussed at the workshop. Resource allocation can be done, for example, vertically, in terms of population groups or patient groups, or horizontally, in terms of different kinds of illnesses or diseases. The fundamental flaw is that this approach creates a disconnect. There is a systemic involvement of these aspects at all levels. How can the system be prioritized, instead of prioritizing one or another aspect? An engagement of faith–health could begin to explore this more deeply. In working with faith–health and religious health assets, Cochrane said he has learned the critical importance of the intangible. A focus on the tangible and measurable is essential and important, but it is so dominant and powerful that it takes attention away from the intangible, he said. For example, the health field does a far less adequate job than the field of economics at taking sentiment into account. Sentiment is not empirical and yet it plays a significant role in economics. The intangible is very important in understanding what it means to be a human being who claims to have a faith, and to understanding where they fit in their world and what that means for how they behave (e.g., whether they follow a treatment protocol or not). This must be understood far more deeply, he said. Finally, none of this can be understood unless we go back to the beginnings of medicine and public health, Cochrane said. Why do we do this? For what purpose and toward what end? What is the moral imagination that drives us to engage in this in the first place, and which easily gets lost and allows us to ignore the people that we are ultimately there to serve?

Drawing from the discussions, a participant asked, “how do we make the invisible things that connect us visible?” She noted the need to take advantage of this moment and build the infrastructure at the community level to be able to leverage new payment models and approaches to measurement and quantification of value. She added that achieving quality and value should not be at the expense of the intangible. She suggested that telling stories, such as those shared at the workshop, is one way to show the value of the intangible and make it more visible. She also observed that the day’s discussions were focused on the positive contributions of faith organizations; however, there is also a dark side to religion that no one likes to talk about. The faith–health movement is a good place to begin having those difficult discussions.

George Isham of HealthPartners suggested that, in promoting better health in populations, there is a moral tension between the large amount of resources dedicated to health care and health care institutions, and the relatively smaller impact of health care and health care institutions on health. Many health care institutions have been or are currently governed by faith-based organizations from many faith traditions. Does the

moral imagination mentioned by Peachey include self-examination of the behavior of the institution with regard to this imbalance, Isham asked, as reflected in the impulse to acquire resources and market share in communities at the expense of resources for other key determinants of health, such as adequate housing, education, and so forth?

Bobby Milstein highlighted the need to think about what we put our faith in. Some, like Mandy Cohen, expressed optimism and faith in new ways of conveying value and paying for health services, and in seeing entrenched institutions and industries perhaps moving in a direction that rebalances investments and resources, as suggested by Isham. American culture places a lot of faith in markets, medicine, trickle-down economics, and technologies, which present both benefit and harm, he said. Communities driven by faith can put faith in people, in cultures, and in a process of learning together through common work and reaching across differences. These might be the only ways of correcting some of the harms that have accumulated by placing our faith in entities that are disconnected from that which fuels health and well-being, he said. The participant also observed a theme around flattening hierarchies of power in order to enable discussions and partnership. He highlighted UMMA and Medicaid expansion in Ohio as examples of what can happen when there is “power with” as opposed to “power over.” Finally, in addition to the eight strengths that faith organizations bring, the participant suggested that faith fuels the courage to ask the difficult questions and to face the facts. Scientists and practitioners need the courage to ask the difficult questions about a system that is not working very well, and then to do the hard work needed to remake it.