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Religious organizations in the public health paradigm

If you think about big public health challenges of our day — the Ebola virus in Africa, the rising rates of suicide among the middle-aged in the United States, the HIV epidemic everywhere — religions are playing a role. When I speak, I ask audiences, “What was the first thing you heard about the Ebola crisis?”, and they always say “The missionaries who got it were taken to Emory.” “That makes my point,” I say. “You didn’t know anything about it up until that moment, but they did.” Those missionaries, and the faith-based organizations they worked for (Samaritan’s Purse and Serving in Mission) were already there on the ground along with other faith-based organizations, volunteering their time, putting their lives in danger, and providing valuable resources of equipment, supplies, and knowledgeable helping hands to try to contain the outbreak.

In another challenge, the crisis of rising suicides among US veterans and Baby Boomers, religion’s role is more in the background, but no less important. Since sociologist Emile Durkheim first studied the subject in late 19th century France, researchers have consistently found that individuals with more social ties – particularly to religious groups — are more protected from suicide. Religious ties provide caring, support, warmth, and intimacy — the “carrots” of social interaction. They also provide rules for living and guidance for behavior that often require individuals to sacrifice their self-interest for the good of the group. These are the “sticks” of social interaction, which Durkheim argued were just as necessary as the “carrots” in keeping individuals from taking their own lives. So here are two quite different roles that religions play in public health: first in the foreground, deploying resources and religious social capital as partners with public health authorities in countries around the world, and also in the background, providing the sustenance of social integration and regulation that prevents the tailspin of suicide.

But religions are complicated, and in the HIV epidemic we have seen faith traditions playing all of these roles and other less helpful ones as well. One positive thing that religions do — very effectively through religious ritual and practice — is to give individuals a sense of belonging to something larger than themselves; they bestow a social identity that marks individuals as valued members of a group, with all of that group’s rights, privileges, and responsibilities. But group membership by its very nature implies that there are other individuals and groups — outsiders — who are not members, who may be less valued. This is an obvious source of conflict around the world and can lead to violence on a small or large scale. This too, sad to say, is an instance of religions taking a role in determining the health of populations, but not in a good way. And at a less extreme level, if an individual violates the norms of the group, or breaks its rules, it can lead to sanctions, punishment, or even being cast out from membership. So in the HIV epidemic, individuals who were victimized by the disease first, in many cases experienced a secondary victimization of being stigmatized by religious groups who perceived that the disease was a sign of forbidden behaviors, and therefore a just punishment.

Public health organizations and religious organizations are both looking to promote the well-being of their communities. In many cases those interests are perfectly aligned and the two institutions function, implicitly or explicitly, as partners. When they do not, it makes sense that two powerful forces should identify all of the ways in which they can work together, finding a way around the contentious issues to leverage each other’s constructive responses. Religion, along with income inequality, education, and political structures, is one of the social determinants of public health in countries around the world, despite its usual exclusion from the public health paradigm.

Headline image credit: The fight against Ebola in West Africa. ©EC/ECHO/Jean-Louis Mosser. CC BY-ND 2.0 via European Commission DG ECHO, EU Humanitarian Aid and Civil Protection Flickr.

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