The National Council of Churches discovered this week that people of faith care about the bodies and minds of each other and their neighbors. You wouldn’t think this would be big news, but the scale and ubiquity of the health-related programs conducted by congregations is striking. Released the same week as Hillary Rodham Clinton’s health reform proposal, it is important to understand what the thousand of churches, mosques and temples are doing and can do around health lest it become one more reason for politicians to duck the serious debate about the government can and should do.
The report has some serious limitations, most importantly because it outlines self-reported activities. It’s like judging a school by interviewing the smart kids who sit at the front and raise their hands. And, the congregations reported on the volume of activities with no way to evaluate the quality of services, accuracy of education or effectiveness of advocacy offered.
The best way to understand the report is that it shows what congregations would like to do and are beginning to do, which is encouraging, if not staggering. The NCC, not surprisingly, misunderstands why it is happening, casting the phenomenon as the trickle down of national and denominational leadership. Actually, the sheer volume of health activity shows that congregations are intimately aware of the terrible impact that an inadequate health delivery system is having on their congregants and communities. They do not—cannot—turn from the reality of a deeply broken, irrational, non-system of health that leaves people so exposed and vulnerable. So 51% of the congregations report helping to pay the medical bills of people in need. That is staggering, but those bills are even more staggering.
The data show that congregations are intimately connected to their members and available to their neighbors that results in a remarkable array of activities. The NCC suggests that denominations and public health agencies should work on increasing the capacity of congregations, but fails to mention the actual treatment providers/prescribers, which is where all the money and politics actually are. In Memphis we like to describe religious congregations (about 2,000 of them) as the true “health” system while the city’s hospitals and clinics are more appropriately called the “treatment” system. The health and treatment systems are highly disconnected, even though we know that almost 70% of our emergency room patients report having attended worship within the last month. We’re at the early stages of a serious effort to build a broad-based relationship with a critical mass of congregations (maybe 400 or so) that would share the ministry of health with Methodist Le Bonheur Healthcare. Their members and neighbors are on a journey of health that, from time to time, requires them to be our patients.
Most of the time, our patients are not in the medical system, they are in the congregational system on which their health depends in all the ways the NCC reports: 85% volunteer to visit and provide rides to services, 65% do some kind of health education focused on prevention (28%), elder care (28%), as well as end-of-life issues (24%). Direct service provision included counseling referrals (32%), screening (27%) emergency medical funding (25%) and mental health counseling (22%). Congregations don’t do any of this because of the national policy debate or because a Bishop tells them to. They are small organizations (average attendance 159) who know each other and their neighbors. Every person who gives and receives care has a name and, usually, a history. So congregational bodies can’t turn away when the cancer shows up or a child falls into a deep depression.
In New York or Washington health looks like programs aimed at what people don’t have. On the ground health looks like people helping each other to connect what they do have. You can’t build health out of what isn’t there. So we have begun to use a process to map the “religious health assets” in Memphis that was developed by friends in South Africa and Emory University along with the World Health Organization (http://www.arhap.uct.ac.za/research_who.php). In a neighborhood widely regarded as “poor”, we discovered a rich fabric of assets that includes the schools, beauty parlors, churches and mosques, clinics, parks and 23 other kinds of things (including our community hospital). Congregations are life-giving, not because of their direct services, but because of the people they connect to each other.
The report suggests that congregations naturally blend referral and provision of physical and mental health that is far, far in advance of any suggested national policy. One great example is a new bill sponsored by forward-thinking Tenn. House Rep., Gary Rowe. Inspired by what congregations in his district are already doing with almost no funding, his bill outlines how we can transform community-based mental health and substance abuse treatment by partnering with local African-American pastors to “get the message out” of understanding mental illness, decreasing stigma and offering treatment options, supervise counseling and other support services in such churches and employ and train “indigenous community navigators” to conduct outreach efforts.
Nobody will be more surprised by the scale of the health activity than the clergy themselves, who are usually most painfully aware of the vast volume of needs they can’t meet, the truly staggering scale of medical bills they can’t help with, the profound social disarray that dwarfs all their programs. But at least they look into the eyes of need and act at some real cost to themselves. This is a lot better than what is happening in Washington.