Religion and Health Research Paper

1. Religion As A Factor Affecting Health

The earliest examples of practices designed to promote the public health are to be found, among primitive peoples, inextricably mingled with the ritual of religion.

These are the opening words of C-E. A. Winslow in the entry for ‘Public Health’ in the original 1935 Encyclopedia of the Social Sciences. Winslow, professor of public health at the Yale School of Medicine, known for his studies of the decline in infectious disease mortality, draws attention to early quarantine efforts in ancient Persia and among the Biblical Hebrews as effective public health practices, motivated and given form by religious beliefs. The burial of the dead, the separation of lepers from the community, or the ritualistic preparation of meat for consumption are but a few of the early examples of practices carried out for religious reasons that had unintended public health consequences. In general, this characteristic of being unintended is typical of the work discussed under this heading—religious practices or beliefs seen to have associations with health are not undertaken for the purpose of improving individual or community health, but rather, are ends in themselves.

The social scientific origins of both theoretical and empirical work on religion and health can be found in Emile Durkheim’s (1951) Suicide. Durkheim demonstrated, with the use of European national and regional statistical records, that suicide rates varied dramatically and predictably with certain social characteristics, among them the rates of Protestants, Catholics, and Jews in a population. His demonstration that suicide rates were lower among regions with larger Catholic and Jewish populations led him to denote types of suicides (anomic and egoistic) in modern societies. Suicides were prevented in religious and other social groups that regulate or constrain the behavior of individual members, and also provide them with integrative and socially supportive relationships.

Despite this foundation in late nineteenth century classical sociological thought, research on religion was largely absent from social scientific work in health until the latter half of the twentieth century. When such work did appear, it was limited to studies of small, peripheral subpopulations, or to suicide as the only cause of death. Beginning in the 1960s, studies finding lower rates of mortality and morbidity (particularly hypertension) for clergy, members of religious orders, and certain sectarian groups including Seventh-Day Adventists, Mormons, and Amish, appeared in US medical and public health literature (Jarvis and Northcott 1987). Work on religiousness and suicide rates has also appeared steadily, with generally consistent support for Durkheim’s original findings (Pescosolido and Georgianna 1989). More generalizable findings came in 1979, when the well-known Alameda County (California, USA) analysis of social networks and mortality appeared (Berkman and Syme 1979), quickly followed by similar findings from large population studies in Tecumseh County, Michigan (USA), and Evans County, Georgia (USA). In each of these longitudinal studies, social ties, including ties to religious congregations, were associated with lower mortality risks.

These studies were important for many reasons. Until this time, the social environment, long a member of the agent–host–environment triad in multifactorial models of disease causation, had primarily been thought of as having negative influence on health. Social environments were considered sources of stress; social conditions were frequently operationalized as poverty, urban crowding, time-pressured working conditions, or the stress of modern life. The social network studies opened for consideration the possibility that the social environment also provided positive or protective factors in health. The first social network studies were also important because they included some measure of affiliation with a religious group or attendance at religious services.

In the 1980s and 1990s, studies focusing specifically on religion as a mortality risk factor appeared, primarily from the US and Israel, most showing a moderately large and significant protective effect, even after adjustments for possible selection factors, confounders, and mediators (Kark et al. 1996). For example, Hummer et al. (1999) found that frequent attendance at religious services reduced mortality risk such that seven years was added to life expectancy at age 20. These findings were different from the earlier studies of homogeneous religious groups or clergy, in that they represented the general population, with its natural heterogeneity in religious behaviors and beliefs. Like the social network studies, they were longitudinal, and thus were able to adjust for the health status of respondents at the start of the study. Data from prospective observational studies with well-designed health status assessment at baseline is critical, particularly when measurement of the religion variable is limited to the indicator of attendance at religious services. The potential selection effects of healthier members of the population attending religious services more frequently, and being at simultaneously lower risk of mortality, are obvious. Additional important selectivity variables included in these analyses include age, sex, socioeconomic status, education, ethnicity, and marital status, as religious participation is generally higher for women, married couples, blacks, older people, and those with higher education and income.

However, a chief criticism of the studies in this emerging field is that most contain only one or two indicators of religiousness, inadequate conceptualization and measurement for such a highly complex set of practices, beliefs, and institutions. Most frequently, attendance at religious services has been the only available measure. When some measure of private religious feelings or practices has been included and compared, attendance is usually the measure with the largest protective effects. Better measurement of the independent variable is clearly necessary before a larger understanding of explanatory mechanisms can be gained. At the present stage of research, however, several mechanisms through which religiousness might affect mortality have been described.

1.1 Reduction Of Behavioral Risk Factors

The health economist Victor Fuchs observed in the early 1970s that religious teachings regulate and constrain human behaviors in numerous ways that have known health consequences (Fuchs 1974 pp. 52–5). He noted the enormous differences in infant, child, adolescent, and adult mortality rates in the two adjacent states of Utah and Nevada. Population density, climate, health care, income, and education levels in the two states were rather similar; any advantage went to Nevada. Yet death rates in Nevada for males aged 40–49 were 54 percent higher, and for females 69 percent higher than in Utah. When the causes of death were limited to cirrhosis of the liver and cancer of the respiratory system, Fuchs found that the corresponding figures were 111 percent and 296 percent. He attributed the dramatic differences to the ‘different lifestyles’ of the residents of the two states, Utah being primarily inhabited by Mormons who do not drink alcohol or smoke tobacco and ‘in general lead stable, quiet lives’ with high marriage and fertility rates and low divorce rates. Even within the Mormon church, levels of adherence to church doctrine have been shown to be associated with reductions in smoking and alcohol-related deaths (Gardner and Lyon 1982).

Most religious groups, however, do not have specific, doctrinal beliefs regarding these behavioral health risk factors, and yet rates for cigarette smoking (Koenig et al. 1998a) and substance use (Kendler et al. 1997) are significantly lower among those who attend religious services regularly, even in studies of religiously heterogeneous populations. A US national study of high school seniors found that the more frequent attenders, and those who thought religion was important in their lives, had lower rates of smoking, alcohol and marijuana use, carrying weapons, getting into fights, and driving while drinking. They also had higher rates of positive health practices such as seat belt use, and eating fruits, vegetables, and breakfast (Wallace and Forman 1998).

Religious involvement among adolescents that lowers many behavioral health risks is especially important because it represents a lowering of lifetime risks for behaviors such as smoking, which are most likely to begin in adolescence. Moreover, an analysis of data from the Alameda County study shows that religious attenders who do smoke are more likely than nonattenders to quit smoking during the course of a follow-up study, and hence further reduce their mortality risk (Strawbridge et al. 1997). Thus one of the mechanisms through which religion influences health consists of the constraints placed on behaviors that are sensation-seeking, self-stimulating, and increase risk to the self and others. The reduction in lifestyle risk factors results in lowered rates of lifestyle-related causes of death, and in at least one study a temporal pattern of religious practices preceding risk reduction behaviors has been established.

1.2 Enhancement Of Social Support Networks

A second mechanism by which the effects of religious involvement may operate is through the expansion and maintenance of social support networks. The study of religion and health is in some ways derivative of the study of social networks and health, and indeed the latter studies provided the earliest modern findings, in Alameda County and elsewhere, as noted above. This mechanism represents the parallel strain in the Durkheimian theoretical tradition, that religious institutions provide both regulation for the behavior of members, as well as integration, or feelings of belonging in a social group. Religious congregants report larger social networks of both friends and relatives, and also more social support from them, compared with nonattenders (Ellison and George 1994). There are several reasons why religious congregations would serve as centers of effective social support for members of all ages, but particularly for the elderly. Congregations offer a mix of strong and weak ties, and can thus offer a broad range of emotional and instrumental supports.

Congregations of all major faiths share values and beliefs about the importance of helping others who are less fortunate and also provide organizational structure for mounting such efforts. Religious institutions provide both support and opportunities to support others, and reciprocal or bidirectional social support may be the most beneficial. Finally, as a corollary of this, members of religious groups who have served others in the past, and who have seen others receiving help, have reason to anticipate support in the future in the event of need.

Population studies of religiousness and health outcomes, particularly mortality, have generally included some assessment of these two explanatory mechanisms (e.g., Hummer et al. 1999, Strawbridge et al. 1997). Usual findings have been that: (a) religious involvement, particularly public participation in services, is associated both with better health practices and with higher levels of social support, and (b) these known behavioral and psychosocial risk factors explain some proportion (but not all) of the effect of religiousness on later health outcomes. In studies of healthy populations, then, religion (conventionally operationalized as attendance at religious services) appears to be related to a lower risk of mortality after adjustment for known confounders and selectivity variables, and the effect is partly explained by existing explanatory mechanisms and partly independent of them. This is just an emerging field, however; the number of extant studies is relatively few, the measurement of the religion variable is undeveloped, the research has been largely done in the US in regional samples with Judeo-Christian beliefs, and other explanatory mechanisms should be tested.

2. Illness And The Search For Meaning

The first part of this research paper has been concerned the unintended health consequences of religious practices, or measurable changes in health that result from religious practices undertaken for religious and not health-related purposes. Equally important for a social scientific study of religion and health, however, are religious beliefs and practices that are engaged in as a direct result of illness. Religious groups can offer both spiritual and tangible support to the sick, including prayers and comforting rituals, but also meals, visitation, childcare, and even financial help. A US survey of the use of unconventional medicine found that 25 percent of their national sample reported that they had used prayer as a treatment for illness in the past 12 months; only exercise, with 26 percent, was used more often (Eisenberg et al. 1993).

Research on the effects of religious coping (including but not limited to prayer) has frequently taken indicators of mental health and well-being as outcomes; studies of recent widowers, parents who had lost a child, women with hip fractures, or elderly men with multiple chronic illnesses have shown lower rates of depression among those with religious beliefs or participation compared with those who have none. For example, hospitalized patients diagnosed with major depressive illness were found to have a shorter time to recovery from depression if they felt themselves to be more intrinsically religious (Koenig et al. 1998b). In another study, heart patients who felt that they received strength and comfort from their religious beliefs had a lower risk of death during the six months following surgery than those who did not (Oxman et al. 1995). At the same time, not all forms or styles of religious coping may be benign, for example, when the cause of an illness is attributed to moral failure; research is just beginning on maladaptive religious coping (Pargament 1997).

Classical sociological theories of religion again anticipate these functions of religion in health. Weber’s concept of ‘theodicy’ provides a historical model of the articulation of the problems of individuals with religious language. Religious individuals can draw on the experiences of fellow believers or the stories of their faith tradition to put their own lives into a larger context, to learn lessons from others who have faced similar circumstances, to reduce fear, or to gain hope for the future. Religious ritual practices for mourning or for healing can assist individuals in making transitions to new life stages in which adaptation to loss is required. Religious coping strategies appear prominently in the coping repertoires of aged individuals faced with their own serious illness, or the illness or death of a loved one, situations over which the individual has little direct control, and which may lack clear explanations or challenge beliefs that the world is just (Pargament 1997). In contrast with the population studies described above, in which attendance at worship services was most predictive of later health outcomes, studies of religious coping frequently find that subjective religious beliefs or nonorganizational forms of religious practice (e.g., private prayer) play an important role.

Religious beliefs and practices are especially prominent in the care for and concerns of individuals at the end of life. The modern hospice, begun in England in the 1960s, was modeled after medieval Christian institutions that cared for the dying, and the spiritual concerns of patients are still a central aspect of the new field of palliative medicine. There is also some evidence that the observance of religious holidays may alter the timing of death for elderly individuals; multiple studies in both Jewish and Christian populations have observed short delays before death that permit the celebration of a last sacred ritual (Idler and Kasl 1992).

Despite a background in the Durkheimian and Weberian traditions of the sociology of religion, the field of research in religion and health remained mostly unexplored through the century, but has begun growing quite rapidly in the 1990s, especially in the US, where levels of interest in religion are generally higher than in Europe. One may anticipate further growth in this field, as the measurement and conceptualization of the relevant domains of religiousness and spirituality improve, and as the population ages and the prevalence of chronic illness increases.

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