On Religion and Public Health.

Before I begin today’s Note, a quick word about the SPH This Week publishing schedule. Respecting the heart of summer, we will stop SPH This Week for the next four weeks, starting up again on August 28. We will continue to update the community about events and announcements via SPH Today, and research stories and other school news will continue to appear on our website.

On to today’s Note. Religion matters. There are nearly 1.6 billion Muslims and 2.2 billion Christians in the world; in the US, three-quarters of adults say religion is at least “somewhat” important in their lives; more than half say it is “very” important. The debate over same-sex marriage, reproductive liberties, end-of-life care, and physician assisted suicide, as well as less emotionally charged subjects like research suggesting that regular religious service attendance may actually benefit well-being, has shown that religion has real implications for health, affecting social norms and the way that people determine which health behaviors are acceptable and which are not. For many, religion is the deciding factor in what they eat, what they wear, where they live, how they travel, the rate at which they reproduce, and how their children are educated. In her book Religion as a Social Determinant of Public Health, Ellen Idler writes, “There are few if any communities in the world where there is no religious institution at all, and in many communities, particularly the most vulnerable, religious institutions may be the most important, vital, and functional social institutions in the lives of community members.” Given its influence, and its direct affect on the well-being of billions—both on its adherents and on those who simply live in the societies it shapes—it seems that public health would be remiss to ignore the role religion plays in shaping the health of the public, and to fail to grapple with how we build partnerships where appropriate with religious organizations to create healthier populations.

In some ways, the interests of religion and public health overlap. Many faiths emphasize social justice and the safeguarding of vulnerable populations, a priority that is consistent with public health as a vocation. Further, many canonical religious texts contain famous passages dealing specifically with disease, or the importance of caring for the sick. In the Gospel of Matthew, Jesus even goes so far as to equate this succor with caring for God Himself. Continuing through the centuries, religion has done much to promote and, in some cases, impede health. Some of the first hospitals were established by the early Christian Church, when Christianity became the official faith of the Roman Empire. Medieval Islamic societies also strove to improve health, innovating in the areas of surgery, hygiene, and hospital administration. In the present day, religion is a key actor in efforts to help vulnerable populations and fight disease. All over the world, faith-based non-governmental organizations (NGOs) are engaged in this humanitarian outreach.

Commendable as its activities in this area can be, religion can also pose health challenges. In Conservative Judaism, controversy over the medical concept of brain death is one such example. Family planning, listed by the CDC as one of the “Ten Great Public Health Achievements in the 20th Century,” is another health-positive practice that can be complicated by doctrine—in this case Christian attitudes towards sex, procreation, contraception, and HIV and other sexually transmitted diseases. Religion has also often found itself at odds with the promotion of gender equity, a key determinant of health. This is especially true in certain Islamic countries, where women’s rights are frequently under threat. Finally, there is the use of condoms in HIV prevention. The Catholic Church has been engaged in HIV prevention efforts for a long time. More than 25 years ago, Catholic Relief Services started its first HIV project in Uganda. It now has almost 200 such programs in 35 countries, and in 2012 spent a total of $106 million on fighting the disease. They have done all of this while, for decades, lacking the Church’s permission to deploy what the World Health Organization has described as “a key component of comprehensive HIV prevention”: condoms. It was only in 2010 that the Church officially condoned the use of condoms for this work.

Despite these challenges, the success of religious institutions at mobilizing their message, and their ability to influence human behavior at a very deep level, represent, in some ways, a model that is worth emulating. Philosopher Alain de Botton discusses some of the ways that religion has achieved its remarkable ubiquity and appeal, praising the collaborative spirit and public relations savvy of the major faiths. He notes, “If you want to change the world, you have to group together … and that’s what religions do. They are multinational … they are branded, they have a clear identity, so they don’t get lost in a busy world. That’s something we can learn from.” Religions are also notable for being intergenerational, with people of many ages often worshiping side-by-side.

As we target the social, economic, and environmental factors that influence health, we can choose to view the religious institutions around us as both exemplars of organizational know-how and as potential partners in the work of serving vulnerable populations—even if our own aims are purely secular. For example, in 2014 WHO worked with religious leaders to reduce the spread of Ebola during burial rituals. Religion also played a prominent role in the American Civil Rights Movement of the 1950s and 1960s. Though the movement spoke to a wide range of social, economic, and political concerns, it had unmistakably religious roots, perhaps best exemplified by the Baptist tradition of Martin Luther King Jr. King would be joined by people of many different faiths, and some of no faith; this created a movement that was truly ecumenical. The late Daniel Berrigan, a veteran of this struggle, once spoke of this ecumenism, saying “[W]hen we saw somebody, or many, many people, in danger, we could at least stand there and utter a common outcry.”

This notion of “a common outcry” is, I think, a useful one, as we look to build the kind of coalitions that will allow us to improve the health of the public in ever more far-reaching, efficient, and justice-oriented ways. Our own Strategic Thinking exercise suggested the importance of our work with many partners, urging us to consider cross-sectoral work as one of our core principles. This seems to me a piece of our broader efforts towards building social momentum. I welcome conversation about how we may best engage religious institutions towards the goal of improving the health of all populations—faithful and secular alike.

I hope everyone has a terrific week. Until August 28.

Warm regards,

Sandro

Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Twitter: @sandrogalea

Acknowledgement: I am grateful to Katelyn Long, Dr. Abdulrahman El-Sayed, Professor Michael Grodin, and Eric DelGizzo for their contributions to this Dean’s Note.

Previous Dean’s Notes are archived at: https://www.bu.edu/sph/tag/deans-note/