The Church's Role in Health Care
by James K. Struve, M.D (July / August 2003 • Volume 19 • Number 4)
To help our society face its health-care crisis, the church should take hold of its calling to be a primary health setting that preaches, teaches, and heals through the gospel of Jesus Christ. This is especially true in the areas of lifestyle behavior, chronic-illness care, and end-of-life issues.
It is hardly news to most pastors that the health system of our country desperately needs help. Dr. Ralph Snyderman, executive dean of the school of medicine, Duke University, puts it succinctly, "The chassis is broken, the wheels are falling off."1
Though it is in many ways remarkable, the health system in the U.S. today is mostly an acute medical care system, designed to wage war on disease and its impact. It has, nevertheless, become overbooked, confusing, too complex, costly, inaccessible to millions, and often toxic to patient and provider alike.
As evidenced by the exponential growth of alternative therapies, our current system doesn't do well with chronic unfixable problems. From a purely financial perspective, it is unsustainable. The efficiencies of information technology will not forstall the need for radical change. The aging of our population makes the change imminent. "Medical care," as David Lawrence, former CEO of Kaiser Foundation Health Plan and Hospitals states, "is crumbling."2
The crying needs are for facilitation in healthy lifestyle transformation (how to change behavior), coordination of chronic illness care, and the management of end-of-life issues, none of which is reimbursed by the acute-oriented system.
Adding to the broken health system, there has evolved an increasing disconnect between preaching, teaching, and the healing function of the church. The average citizen does not comprehend the connection between faith-based living in community and what keeps people well.
Most of my Christian patients don't understand how their life in Christ works functionally to cope with disease and pain. They don't see the concrete connection between their faith in Christ and their responsibility to develop skills in changing unhealthy behaviors; to find ways to cope with chronic unfixable illnesses; and to learn of the possibility of dying peacefully in light of the connection they have with their faith-based community. They don't see how being broken physically or mentally can be related to being broken spiritually.
A Different Past
Both the needs and the relationship between health care and the church were different in the early 1900s. Jewish and Christian clergy, nurses, and doctors, seeing the need at the time for acute medical facilities, dedicated their lives to the development of our nation's hospitals. The average life span at the turn of the century was 47 years. People died mostly of trauma, infection, and childbirth. The need was for acute medical care.
Years ago, over coffee with one of the founding fathers of Lutheran Deaconess Hospital in my home city of Minneapolis, Minnesota, I was surprised to hear the connectedness in his mind, not only between good religion and good science, but also between church and health care.
"A church isn't a church without a hospital," he told me. Good science was not a fearful thing to these Christians. It was utilized functionally and perceived as church work.
When I started medical practice in 1975, Sister Anna Bergland, a Lutheran deaconess, still ran the hospital where I worked. A nursing student choir sang in the hospital wards, and one of my Jewish physician colleagues preferentially admitted patients to the hospital because he thought his patients got better faster in the atmosphere of the place. Nurses were taught to pray. One of the nation's first intensive care units was birthed at the hospital.
The two essential reasons for extending the parish as a primary health place are these:
(1) we are called to do so — to preach, teach, and heal; and
(2) there is desperate and compelling need.
For me, going to the hospital was almost like going to church. As a physician, my Christian mission in health care was alive in hospital work, in the technology, in the manner of seeing diagnosis and treatment centrally dependent upon getting to know the patient as a person, and in seeing good science as a prophetic mistress of good religious thought and action.
Furthermore, the chaplain of the hospital sat in the doctor's lounge at 7 a.m. every weekday and discussed patients with many of the physicians over coffee. There was a commonality of purpose and a sharing of know-how. Doctors and nurses knew one another personally.
Cost, increasing regulation, the Medicare system, the growth of technology, service to an increasingly diverse population, expediency, common sense, and the inevitable secularization process of the health care mission — though not the Bible — have disconnected the church from health care. Over the past 25 years, mission statements of numerous hospitals and hospital/clinic systems have subtly changed, and phrases such as "health care as an expression of the healing ministry of Jesus Christ" have been stricken.
Recently, a counselor at one of my hospitals was disciplined for praying with a patient. Economic forces have caused merger upon merger. High priced CEOs replaced Lutheran deaconesses, Catholic nuns, and Jewish visionaries. Health-care providers who felt called to the work of the church became employees of large multi-layered organizations. Health care has become institutionalized and secularized.
While not all of this has been bad (we can be thankful that we have the most advanced acute care medical system in the world for those who can afford it), it has brought us to a point of fundamental fracture of the church from what the average citizen sees as health care.
Call to Church
The desperate need today is for the church to once again step in, not to develop another intensive care unit or hospital, as important as they still are and were to develop, but rather to fulfill its mission as a primary health place and to complement the traditional health system in order to reduce its expensive overutilization.
The hospital, clinic, and skilled nursing facility are for acute, maintenance, and residential care, respectively. The congregation, or some extension of it, is the place where prayer and care begins and continues for most common preventive, chronic, and end-of-life health concerns.
The place to begin is our incredibly rich Christian understanding of health and suffering. The biblical vision for health is holistic. Holism has been around since the mid-1970s when the World Health Organization advanced its broad holistic biopsychosocial definition of health.
The Bible's view is more whole than holism. The inner life, heart, or spirit of the person, interacting as it does with God and immeasureable as it is, has a profound impact on measureable mental, emotional, bodily, and moral functioning. Health and health care have always included the measureable and the immeasureable. It is never one without the other; it is never just a physical or mental or spiritual problem. It is never prayer versus science.
Emotions are hot-wired to bodily functions. Pain and suffering are always both mental and physical. Faith-based living in community is always an influence on the whole. Religion, spirituality, and health are always linked. The soul is embodied.
There is no better contemporary scientific validation for this mind-body-spirit linkage than the recently published Handbook of Religion and Health.3 Authors H.G. Koenig, M.E. McCullough, and D.B. Larson document 1,200 studies and 400 research reviews that support what has been long suspected — that the relationship between religion and health, on average and where the rubber hits the road, is overwhelmingly positive.
|The crying needs are for facilitation in healthy lifestyle transformation (how to change behavior), coordination of chronic illness care, and the management of end-of-life issues, none of which is reimbursed by the acute-oriented system. |
The analysis is critical, comprehensive, and systematic. While there have been critics on scientific grounds of the religion and health connection,4 and there have been studies for and against the value of intercessory prayer,5 copious research supports the association of religiousness and spirituality with positive physical and emotional health outcomes, survival, coping, and lifestyle transformation.6
What separates humans from animals has to do with the way attitudes, thoughts, feelings, and willingness coming from the most advanced parts of the brain are related to bodily processes such as hormonal, nervous, immunologic, and circulatory functioning. The inner life, with its secret thoughts, feelings, unconscious fears, and doubts impacts health. Likewise, health behaviors such as exercise, nutritional habits, ways of relating to others, work habits, community service, and spiritual practices impact the inner life.
The health benefits of faith and community, as central and real as they are, however, are not the primary reason for intentionally doing more of what most of us are already doing, i.e., health care. The two essential reasons for extending the parish as a primary health place are these: (1) we are called to do so — to preach, teach, and heal; and (2) there is desperate and compelling need.
What Can We Do?
I propose the following covenants and low-cost steps to begin to recapture the fullness of the health-care function of the church:
(1) Eighty percent of all men and women in my state die in a hospital or nursing home setting. Covenant to develop support systems in the faith community such that no one need die alone or outside their home if that is desired by patient and family.
(2) Diabetes is epidemic in the United States. Its prevalence increased 50 percent between 1990 and 2000. Greater than 50 percent of all newly diagnosed diabetes is preventable through lifestyle change. Covenant to encourage all in the faith community to increase physical activity and pursue nutritional excellence.
Develop a covenant to: (a) make nutritionally excellent and fun church suppers; (b) make walking and physical activity groups integral to our public and private spiritual practices; (c) make church once again the most relevant stress-reducing, lifestyle-changing place in the community.
(3) Over 40 million people in the United States are uninsured. Design a covenant to monitor the congregation for those who are uninsured and develop spiritual/self-care resources for these people.
Imagine a place where information, prayer, education, care, and support begin and continue for most lifestyle changes, most common chronic mental and physical health concerns, and all end-of-life concerns. Imagine a country where the average citizen sees his/her place of worship or some extension of it as his/her primary health place. Imagine regular attendees growing, taking discipleship seriously in all domains of their lives — body/mind/spirit — and carrying one another's burdens with a renewed sense of community. That is the church you have now, a church called to preach, teach, and heal.
The church's historic role in health care has been to just do it. Jesus did health care. He likened his own ministry to that of a physician. One fifth of the material in the Gospels is concerned with the healing work of Jesus. These works were not only interpreted as pointers to his messiahship and the kingdom of God but were a part of a developing situation that brought about the very thing of which they were signs. "To heal the sick and to preach the Kingdom are neither complementary, nor supplementary, but both are manifestations of the same Word of God."7
His disciples did health care. Paul took his second and third missionary journeys with a physician. A doctor wrote greater than one-third of the New Testament. The church was the founder of organized health care in the fourth century. Historically, the church has always used health care as a major public witness and cutting-edge strategy as it penetrated other cultures and shared, in a compelling and contemporary way, the people's need for the good news of Jesus Christ.
Resources on Health for Rostered Leaders
- Healthy leaders enhance lives. The Division for Ministry and the Board of Pensions are partnering in the development of resources to support the health and wellness of the ELCA's rostered leaders.
- To bring health and healing to the parish or the community requires a healthy leader, one who understands the fullness of health — physically, emotionally, relationally, intellectually, vocationally, and spiritually.
- One resource for addressing health can be found at www.elca.org/health. This website includes "A Letter on Peace and Good Health" by James Wind, an excellent theological resource on health and healing, and "Ministerial Health and Wellness 2002," a report that presents the state of the health of our ELCA rostered leaders.
A few other helpful resources include:
- Clergy Self-Care: Finding a Balance for Effective Ministry by Roy M. Oswald (The Alban Institute, 1991);
- The Spiritual Leader's Guide to Self-Care by Rochelle Melander and Harold Eppley (The Alban Institute, 2002);
- Keep the Sabbath Wholly: Ceasing, Resting, Embracing, Feasting by Marva Dawn (W.B. Eerdmans Publishing Co. Grand Rapids, MI, 1989);
- Ordinary Ministry, Extraordinary Challenge: Women and the Roles of Ministry, edited by Norma Cook Everist (Abingdon Press, 2000);
- The Inner Voice of Love: A Journey Through Anguish to Freedom by Henri Nouwen (Doubleday, NY, 1998); and
- 10 Habits for Effective Ministry: A Guide for Life-Giving Pastors by Lowell Erdahl (Augsburg Fortress, 1996).
James K. Struve has practiced Family Medicine in urban Minneapolis for the past 28 years. For 11 years, he was the medical director of a church-based health clinic, Trinity Health Care. Recently, he completed a master's degree in clinical research from the University of Minnesota, School of Public Health, with a special research interest on faith and health issues. He is a member of Trinity Lutheran Church, Minnehaha Falls, in South Minneapolis.
1. Ralph Snyderman [exec. dean, School of Medicine, Duke University Medical School]. Speech delivered at the "Faith in Future Conference," March 3-5, 2001, Duke University.
2. David M. Lawrence [former CEO chair, 2002 Gaylord Anderson Lecture and Award Ceremony], "Acute Care and Public Health: Swimming Upstream Together," University of Minnesota School of Public Health.
3. H.G. Koenig, M.E. McCullough, and D.B Larson, Handbook of Religion and Health (Oxford University Press, 2001).
4. R.P. Sloan, E. Bagiella, and T. Powell, "Religion, spirituality, and medicine" Lancet 353 (1999): 664-67.
5. R.C. Byrd, "Positive therapeutic effects of intercessory prayer in a coronary care unit population," Southern Medical Journal 81:7 (July 1988), 826-29. J.M. Aviles, et al., "Intercessory prayer and cardiovascular disease progression in a coronary care population; a randomized controlled trial," Mayo Clinic Proceedings 76 (2001): 1192-98.
6. M.E. McCullough, et al., "Religious involvement and mortality: a meta-analytic review," Health Psychology 19:3 (May 2000): 211-22. W.J. Strawbridge, et al., "Frequent attendance at religious services and mortality over 28 years," American Journal of Public Health 87 (1997): 957-61. D. Oman and D. Reed, "Religion and mortality among community-dwelling elderly," American Journal of Public Health 88 (1998): 1469-75. C. Thoresen and A. Harris, "Spirituality and health: what's the evidence and what's needed?" Annals of Behavioral Medicine 24:1 (Winter 2002), 3-13. G. Ironson, et al., "The Ironson-Woods spirituality/religiousness index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS," Annals of Behavioral Medicine 24:1 (Winter 2002), 34-48. K.I. Pargament, H.G. Koenig, et al., "Religious struggle as a predictor of mortality among medically ill elderly patients," Archives of Internal Medicine, 161 (August 13/27), 1881-85. J.S. Levin, "How religion influences morbidity and health: reflections on natural history, salutogenesis and host resistance," Soc. Sci. Med., 43:5 (1996), 849-64.
7. Leslie Newbigin, "The Healing Ministry in the Mission of the Church," The Healing Church, The World Council of Churches (Geneva, 1965), pp. 8-15.