What Can Health Care Chaplains Do about Social Determinants of Health?
Health care chaplaincy has historically focused on the person-to-person encounter between a patient (or their loved ones) and the clergy person not on the care of large populations. Pastoral care focused on the individual’s needs, not on the congregation’s or community’s. As health care chaplaincy developed into a distinct allied health profession, the focus on one-to-one pastoral care has persisted. However, with governmental and health care systems putting more attention on social determinants of health, attending to communities and populations’ spiritual health is becoming a priority for spiritual care providers, primarily when religion or spirituality (R/S) are understood as a social determinant of health.
Many factors influence social determinants of health, including education, socioeconomic status, physical environment, and access to health care (Artiga and Hinton, 2018). Non-profit, health care and governmental agencies have developed many initiatives to address the negative impact of various social determinants of health. However, one often overlooked social determinant of health is R/S, which is where chaplains can play a significant role.
Idler (2014) critiqued the World Health Organization’s Commission on Social Determinants of Health’s report for omitting R/S as a social determinant of health. Idler (2014) argued that R/S is hardly ever mentioned in the social determinants of health literature, but it should be. When R/S is mentioned, it is usually in the context of ethnicity and listed as a cause of discrimination without recognition for how R/S may positively influence health (Idler, 2014). Oman (2018) built on Idler’s argument by pointing out the absence of R/S in the social determinants of health literature even though, over the past two decades, a large body of research was published in peer-reviewed journals about the connection between R/S and health. Oman (2018) surmised R/S is overlooked because of the prevalence of the secularization theory of the 1960s and 1970s that influenced many of today’s public health professors and leaders. This theory predicted that science would make R/S irrelevant in the future - a prediction that did not come to pass. In fact, as of 2017, almost three-quarters of Americans identify with a specific religion, while about one-quarter identify as spiritual but not religious (Pew Research Center, 2017). Oman (2018) argued that the relevance of R/S to health might best be viewed through the science of health behavior motivation. When one’s R/S beliefs center on improving one’s health (and that of one’s community), the catalyst for change may impact society’s micro, meso, and macro levels. For example, Seventh Day Adventists believe that their bodies are temples of the Holy Spirit, and they should follow a diet aligned with what is prescribed in the Bible. Consequently, they tend to experience fewer disease incidences and live longer than others in the U.S. (Fraser, 1999).
Chaplains can look to existing models of faith-health partnerships that bring together communities of faith and health care systems to improve health and seek to replicate them.
What can health care chaplains do to leverage the positive power of R/S as a social determinant of health and reduce its adverse effects on health? Chaplains can look to existing models of faith-health partnerships that bring together communities of faith and health care systems to improve health and seek to replicate them. Parish nursing (now called faith community nursing to be more inclusive of non-Christian congregations), for example, was developed in 1984 by Granger Westberg, the Director of Chaplaincy at Lutheran General Hospital in Park Ridge, Illinois, as part of his vision to improve community health by building bridges between health care systems and communities of faith (Packett, n.d.). The Health Ministries Association (HMA) was established in 1989 to advance faith community nursing and other health ministries in congregations. This movement persisted, and as of October 2020, the HMA has 308 faith community nurses (Health Ministries Association, 2020). Faith community nursing is a recognized sub-specialty of nursing by the American Nurses Association (Packett, n.d.). Westberg serves as a role model for today’s health care chaplains who are increasingly aware of social determinants of health and seeking ways to improve community health.
Chaplains may also educate themselves more on public health. To increase research competence and awareness of large-scale factors that influence population health, a growing number of chaplains have earned public health degrees. For example, Transforming Chaplaincy enabled 17 board-certified chaplains to earn Master’s degrees in Public Health (White and Fitchett, 2020). These Transforming Chaplaincy Fellows are changing the field of health care chaplaincy by bringing greater attention and resources to the ways chaplains and spiritual care departments can work with other health care leaders to focus on R/S as a means to improve public health.
Social determinants of health are the central focus of public health professionals who seek to decrease global health inequities. Health care chaplains have historically focused on two-person dyads to improve spiritual health, neglecting large-scale population-level initiatives. With the increasing understanding of R/S as a social determinant of health, chaplains have more impetus to look for ways to improve public spiritual health. A few programs exist, such as faith community nursing, that serve as models for how chaplains can improve public health. Chaplains should continue to educate themselves about public health generally and specifically about existing community-based health interventions that catalyze the power of R/S to improve health behaviors.