Spirituality/Religion & Health Research:

A Few Introductory Points

Chaplain John W. Ehman

Penn Presbyterian Medical Center
Philadelphia, PA

6/3/14
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[ Includes the variations: religious, religiosity, religiousness, and spiritual ] John Ehman, 2012
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[ Includes the variations: religious, religiosity, religiousness, and spiritual ] John Ehman, 2012
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John Ehman, 6/30/09
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John Ehman, 6/30/09
 Among the factors in the mid-1990s affecting
the study of spirituality/religion & health:

• Greater attention paid to religious values, beliefs, and

practices as key aspects of patient diversity (e.g., new
emphasis by the Joint Commission)

• Growing sense among health care providers and researchers

of religion’s role in health-pertinent behaviors and health
care decision-making -- important for “knowing your patient”

• Research begins accumulating significant data that patients’

spirituality/religiosity may be important to medical outcomes
and thus to the process of “healing your patient”
Two things to keep in mind about the
modern field of Spirituality & Health:

1) It is still nascent in the current form

2) It has somewhat fluid terminology

In the health care literature, religion is associated
with institutional systems of beliefs and practices,
whereas spirituality is associated with personal
experiences and an individual quest for meaning.

Spirituality is generally seen as a broad concept,

going beyond the “limits” of religion.
 The Two Most Common Views of the
Relationship of Spirituality to Religion
in the Current Health Care Literature

Spirituality Spirituality

Religion

Religion
A New and Important Definition of Spirituality:

‘‘Spirituality is a dynamic and intrinsic aspect of

humanity through which persons seek ultimate
meaning, purpose, and transcendence, and
experience relationship to self, family, others,
community, society, nature, and the significant
or sacred. Spirituality is expressed through
beliefs, values, traditions, and practices.’’

— p. 646 of Puchalski, C. M., et al., "Improving the Spiritual Dimension of

Whole Person Care: Reaching National and International Consensus,"
Journal of Palliative Medicine 17, no. 6 (June 2014): 642-656
While the broad concept of spirituality holds
strong appeal in the practice of health care and
is prominent in the literature, religion tends to
be favored as the focus of research because
the concept highlights factors that can be more
easily specified, observed, and quantified.
While the broad concept of spirituality holds
strong appeal in the practice of health care and
is prominent in the literature, religion tends to
be favored as the focus of research because
the concept highlights factors that can be more
easily specified, observed, and quantified.

However, a growing problem with religion-

focused research is that Americans are
increasingly less likely to see themselves
and fit themselves in traditional categories
of religion.
 Americans and Religious Affiliation

A 2012 Pew Research Center survey found that one-fifth of

the U.S. public – and a third of adults under 30 years old –
now describe themselves as “religiously unaffiliated.” This
is partly due to an increasing trend to drop all sense of
connection to a specific religious tradition when there is not
an active social involvement in a congregation.

Moreover, 18% of American adults describe themselves

now as “spiritual but not religious.”

Pew Research Center’s Forum on Religion & Public Life,

"'Nones' on the Rise…,” report issued October 9, 2012
 Polls re: Religion/Spirituality in the US

• 90-96% of adults in the US say they “believe in God”

• over 40% say they attend religious services regularly, usually

at least once a week

• 50-75% say religion is “very important” in their lives

• 90% say they pray, and most (54-75%) say they pray at least
once a day

• over 80% say that “God answers prayers”

• 79-84% say they believe in “miracles” and that “God answers

prayers for healing someone with an incurable illness”

--These percentages are summary characterizations of numerous

national surveys showing fairly consistent results across time
 Religion-focused research remains the driving force
in the overall field of “Spirituality & Health” because
it is conducive to drawing practical connections
with health issues.

For example:

• fewer dangerous behaviors (e.g., less substance abuse,

unsafe sex, or neglect of health screenings)

• less suicide and generally greater aversion to suicide

• less depression and faster recovery from depression

• greater sense of meaning/purpose in life, hopefulness

--See: Koenig, H.G, et al., Handbook of Religion and Health, 2001/2011;
and Koenig, H.G., Testimony to the US House of Representatives
Subcommittee on Research and Science Education, 9/18/08
• lower rates of coronary artery disease

• lower cardiovascular reactivity

• greater heart rate variability

• lower blood pressure and generally less hypertension

• tendency for better outcomes after cardiac surgery

• better endocrine function

• better immune function

• lower cancer rate and better outcomes

• lower mortality and longer survival generally

--ibid.
 Theoretical Model of How Religion Affects Physical Health
--adapted from Koenig, et al., Hand-
book of Religion and Health, 2001
Stress
Hormones Infection

Mental Cancer
Health Immune
R System Heart
E Disease

L Hyper-
I Social Autonomic tension
Nervous
G Support System Stroke
I
O Stomach
N Disease Detection & Bowel
and Treatment
Health Compliance Liver
Behaviors & Lung

Religion also affects Childhood Training, High Risk Accidents

Adult Decisions, and Values & Character; Behaviors & STDs
which then in turn affect mental health, (smoking, drugs)
social support, and health behaviors.
 Recent health care literature largely
addresses religion/spirituality as…

… a ground for “religious” social support

… a value basis for personal meaning-making

(and therefore understanding illness and
coping with crises) and decision-making

… a context for behavior that can influence the

way the body works (e.g., meditation that
can affect physiological reactions to stress)