Religion, preventability vs.

preordained
CULTURE AND RELIGION have long been known to play a vital role in influencing
one's health beliefs and health-seeking behaviors. The effect of religion on one's health-
seeking behaviors varies between religions with different belief systems. The conviction
that disease may be prevented through medicine, prayer, or repentance may have an
entirely different effect on one's health than the belief that one's disease is preordained by
a higher force. Although the role of religion in the prevention or course of cancer is often
underaddressed by healthcare professionals, research has demonstrated that behaviors
related to cancer screening, coping with cancer, seeking treatment for cancer, and overall
quality of life can be greatly influenced by one's religious beliefs.

Over the past several years, the importance of religious beliefs in the context of health,
illness, and clinical practice has played an increasing role. The use of religion and
spirituality in coping is particularly prevalent in patients with cancer, given the
potentially life-threatening nature of the illness. Failure to understand the culture and
religious beliefs of a target group can significantly hinder health professionals' efforts to
promote health activities and services to that group.

Fatalism, or the belief that all of human destiny is predetermined by a higher power, was
present in the beliefs of the ancient Stoics and still pervades much of Hindu, Buddhist,
and Islam thought today. According to fatalism, human behavior cannot change future
events, which are preordained and absolute. Fate is a cosmic determinism, irrational and
impersonal in nature. As such, disease and suffering are considered a natural part of life,
which can not be prevented.

Fatalistic beliefs have been shown to decrease participation in cancer-screening activities.

Studies have shown that routine mammography, for example, is an uncommon practice in
Chinese women raised in the teachings of Buddhism, Taoism, and Confucianism. One
study has demonstrated that only 32 percent of Chinese-American immigrant women
have ever undergone a mammography, compared to 86 percent of white Americans.
According to another study, twice as many Chinese-American women as white
Americans had never heard of a mammography or breast examination.

In interviews with Chinese women who immigrated to Australia, the women expressed
dismissal of Western paradigms of health promotion and prevention. They felt the
Western notions were irrelevant, as most of the women viewed disease as something
associated with the unchanging cycle in the Chinese philosophy of birth, aging, sickness,
and death. Some women believed that negative thoughts, such as thinking about cancer,
could possibly bring about a negative outcome and affect one's health. Many of these
women did not discuss cancer in their communities because it was an unpleasant topic,
and they were therefore unlikely to recommend screening to their friends. Other women
did not see any point to breast cancer screening, as they felt that it would in no way
change the likelihood that they could develop cancer.
Divine Providence, in contrast to fatalism, is considered to be supremely personal and
rational. According to Divine Providence, which dominates much of Jewish and Christian
thought, God plays a significant role in guiding and supporting earthly events, although
free will can ultimately affect one's future. Believers in Divine Providence argue that
disease can be prevented by physical, cognitive, and spiritual actions and that one's
behavior may even alter the course of disease.

Many people who believe that disease can be prevented feel the need to respect their
body, because it's God's creation, by participating in healthy behaviors. Furthermore,
many stress the importance of positive hopes despite a grave diagnosis, and others even
offer prayers asking God to intervene and heal the sick.

Statistics show that over half of American adults attend religious services at least once
per month; this rate is even higher among African-American adults (67 percent). As such,
the church is serving as a powerful channel for health promotion and education efforts by
incorporating religious aspects of the church into behavior-changing programs.

In recent years, the church has been used effectively to include a wide range of health
programs, including prostate cancer education, cervical cancer control, and
mammography screening. These church-based interventions have been especially
successful in African-American communities, in large part because of the central role of
the church and the strong link between faith and health in the African-Ameri-can
community.

Although many African Americans have low health-seeking behaviors because of a lack
of awareness, fear of doctors or disease, and previous negative experiences with the
screening processes, most view cancer as a preventable disease. In one study, African-
American men and women expressed affirmative thoughts that prostate cancer could be
prevented by healthy behaviors and cancer-screening methods, and it was demonstrated
that strong faith encouraged adherence to health promotion practices. The study
participants also expressed the attitude that the body is God's temple and should be cared
for properly.

Some African-American men still expressed somewhat fatalistic attitudes, which often
resulted in decreased screening for prostate cancer. Many of these men, however, still felt
that they should encourage others to actively fight the disease and hope for a cure with
God's help. Other religious beliefs in the Afri-can-American community, such as the
belief that disease is a punishment for sin, may discourage active participation in health
promotion and cancer prevention activities.

COPING WITH RELIGION

Religious activities have been shown to be among the highest coping strategies. Religious
coping with disease, although usually thought of as an emotional process, has cognitive
(i.e., attributing disease to God's master plan) and behavioral (i.e., going to church)
components. Studies have demonstrated that between 34 and 86 percent of patients with a
serious medical illness use religious cognitions or activities to help cope. Religious
coping has been shown to be typically more helpful than hindering to one's health,
particularly when God is seen as compassionate and a willing collaborator.

Religious coping has been shown to have a strong effect on the quality of life in patients
with cancer. Positive religious coping, such as benevolent religious appraisals, has been
shown to significantly improve patients' quality of life, whereas negative religious
coping, such as feelings of anger toward God, has been shown to decrease patients'
quality of life. Fatalistic beliefs have often been shown to correlate with an increased
quality of life, presumably because patients accept death and disease as an inevitable
component to the circle of life.

Studies have further demonstrated that the belief that developing a disease is preordained
certainty greatly affects whether patients will seek treatment for cancer and remain
compliant with that treatment. One study showed that fatalistic beliefs were among the
highest contributors for refusing the diagnosis for, or treatment of, lung cancer.
Physicians need to be aware of one's cultural beliefs when diagnosing cancer and
proposing a treatment strategy.

The role of religion in health beliefs and health-seeking behaviors has been gaining
increasing attention over the years. Many physicians, particularly those serving minority
populations, are currently being educated in cross-cultural awareness. An approach by
healthcare professionals that is understanding and sensitive toward patients' belief
systems, combined with effective patient education, is essential to ensuring that patients
participate in screening activities for disease and adhere to treatment strategies.

—Shaun E. Gruenbaum and Benjamin F. Gruenbaum

Further Readings

Entry Citation:
Gruenbaum, Shaun E., and Benjamin F. Gruenbaum. "Religion, preventability vs.
preordained." Encyclopedia of Cancer and Society. 2007. SAGE Publications. 16 Apr.
2010. <http://www.sage-ereference.com/cancer/Article_n512.html>.

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