Religion and Health

Although religion and health are historically intertwined, secular society has involved a decrease in the formal influence of religion over everyday lives. At least two of sociology's founding fathers studied the role of religion in social life and predicted that its significance would decline. However, sociological and public interest in the link between religion and health has grown since the 1990s, and research has found that in matters of health, religion largely exerts a positive influence. In general, people who participate in religious activities and events live longer, experience less poor health, and are found to cope better with stress. Although the mechanisms associated with this relationship are unclear, researchers argue that religious beliefs and practices likely protect people from disease and ill health. For instance, membership in certain religious groups encourages moderation in diet and exercise and actively discourages behaviors that are known to be potentially harmful to health, such as excessive alcohol consumption, drug and tobacco use, and premarital sex.

Keywords: Integrative Function; Phenomenology; Regulative Function; Religion; Religiosity; Sacred Canopy; Social Solidarity; Spirituality

Overview

Although religion and health are historically intertwined, secular society has involved a decrease in the formal influence of religion over everyday lives. At least two of sociology's founding fathers studied the role of religion in social life and predicted that its significance would decline. However, sociological and public interest in the link between religion and health has grown since the 1990s, and research has found that in matters of health, religion largely exerts a positive influence. In general, people who participate in religious activities and events live longer, experience less poor health and are found to cope better with stress. Although the mechanisms associated with this relationship are unclear, researchers argue that religious beliefs and practices likely protect people from disease and ill health. For instance, membership of certain religious groups encourages moderation in diet and exercise and actively discourages behaviors that are known to be potentially harmful to health, such as excessive alcohol consumption, drug and tobacco use, and premarital sex (e.g., see Musick, Traphagan, Koenig & Larson, 2000). Before exploring this link, however, it is necessary to identify what researchers are referring to when they discuss "religion."

Conceptual Foundations

Historical Perspectives on Religion & Health

Historically, religion and health have been closely intertwined, and as the historian Andrew Wear has noted, the words "salvation" and "health" were interchangeable (1985, p. 67). On the one hand, drawing on biblical perspectives, seventeenth-century English writers and artists depicted the human body as a temple to be glorified and cared for through appropriate and careful dietary and physical practices. On the other, medical metaphors were used to describe the sinner as a sick man (Lupton, 1994, p. 57). In the Middle Ages, people with chronic ailments and illness often turned to religious healing systems via pilgrimages and direct contact with the relics of saints (Lupton, 1994). Religion played a crucial role in offering reasons for illness and disease, with explanations ranging from poor health and disease as the result of demonic possession to disease as punishment from God. Indeed, like the Puritans, who saw illness or disease as correctives or punishments from God, many twentieth-century conservative politicians in the USA and the UK viewed the emergence of HIV as evidence of God's wrath on a wicked and sinful world. In 1986, John McKay, at that time Secretary of State for Health in the UK, asserted that AIDS was a "punishment from God" (Howson, 2004, p. 83).

Despite increasing secularization, religion continues to provide a framework for understanding health and disease. Since the 1990s, researchers have become increasingly interested in how adherence to religious beliefs and practices are linked to the experience of health and to health outcomes. This emerging interest in the relationship between religion and health explores both physical and mental health. At least two of sociology's founding fathers, Emile Durkheim and Max Weber, identified religion as a factor contributing to general health and well-being because of its overarching role in influencing how members of a particular society think and act. They viewed religion as a human endeavor that helped people make sense of their lives, by giving them explanations for social life that help them cope or by providing ways of behaving that enable people to express the desire for meaning in everyday life (Bilton et al., 1996). However, their approaches to the significance of religion differ.

Durkheim's Functionalist View of Religion

In the functionalist view, religion is an institutionalized form of thinking and acting that functions to regulate and integrate members of society for the purpose of securing social solidarity and order. Durkheim argued that, first, religion has a regulative function that helps to create and sustain social order through rules and regulations that prohibit (proscribe) or permit (prescribe) certain behaviors and practices. These rules typically govern practices and behaviors around sexual intimacy, eating, and drinking. They help integrate people by providing meaningful and tangible connections to others. Moreover, as Ellison and Levin (1998) point out, by internalizing religioethical norms, people are likely motivated to conform to rules and regulations and avoid breaking them through fear of embarrassment and social sanctions (such as formal rebukes from their church or informal sanctions such as gossip or ostracism by others in their religious network).

Second, religion has an integrative function that binds people to the societies of which they are members. By publicly attending and participating in religious ceremonies, people affirm the beliefs they hold in common with others. This shared value and belief framework may, in turn, create the potential for sharing tangible and intangible resources (housing, food, transport, and clothing on the one hand, and intangibles like intimacy, affection, and touch on the other). Some researchers argue that these regulative and integrative functions may have a direct bearing on people's health and well-being.

Phenomenology

Drawing on the tradition of phenomenology, some sociologists in the 1960s (e.g., Berger, 1967) argued that humanity is characterized by an inherent religiosity that drives people to interpret the world by allocating meaning to events and experiences through symbolic means, such as language and rituals. Religiosity involves the creation of a symbolic world, or a "sacred canopy" under which people live their lives. In the modern, secularized world, people continue to search for meaning, whether through collective membership of formal religious organizations or through looser, more informal practices (e.g., meditation). Within the phenomenological view, religion provides a means of creating individual meaning in a world where people feel dislocated from others; it helps to bring coherence to an otherwise chaotic world, especially in times of stress or sickness; and relieves emotional suffering by providing a worldview (Marsh et al., 1996).

Religion, Religiosity & Spirituality

In modern research on religion and health, the concept of religion (from the Latin root religi) can mean different things. Religion is generally considered to include both individual and institutional aspects of the search for the sacred and refers to beliefs, attitudes, and practices that are a part of or constitute membership in an organization or religious institution (Ziegler, 1998).

The concept of religiosity is important in exploring the relationship between religion and health, since researchers use it to capture both attendance at and participation in public ceremonies (such as going to church) and the holding of religious beliefs and values. As Hardy and Carlo (2005) note, there are three types of religiosity:

• Intrinsic,
• Extrinsic and
• Quest religiosity.

Intrinsic religiosity refers to people who see religion as the answer to life's questions. Extrinsic religiosity refers to people who use religion as a means to an end (e.g., to develop social contacts). Quest religiosity refers to the religious seeker who constantly asks questions and may not believe there are any clear answers. Broadly, the dimensions of religiosity used by researchers include:

• Belief,

• Practice (acts of worship conducted publicly, such as communion, or privately, such as meditation or prayer),
• Experience (a personal of connection and communication with a transcendent or divine being),
• Knowledge (understanding basic teachings of the religion of which one is a member), and
• Consequences (visible indicators of religious membership, such as a particular way of dressing or diet) (Marsh, et al., 1996).

Typically, researchers use the frequency of religious attendance as the main measure of religiosity or religiousness.

Finally, spirituality refers to the individual search for the sacred (Emmons & Paloutzian, 2003) and denotes views and behaviors that express relatedness to something greater than the self (Ziegler, 1998). Therefore, a person can be described as spiritual without participating in formal religious membership. Nonetheless, much of the research that explores the relation between religion and health tends to use the term “religion” or “religiousness” to refer to practices and beliefs associated with formal religious organizations. For instance, researchers view attendance at religious services (and the frequency of attendance) as an indicator of a person's religiousness — that is, the sum of beliefs, practices and attitudes that might be described as religious.

Further Insights

Mortality

The empirical evidence for the positive impact of religion on physical health is strong, and there are hundreds of studies that show how high levels of religious involvement are associated with better health status across gender, age, ethnicity, and religious affiliation. First, participating in religious activities and holding religious beliefs reduce the likelihood of an early death and reduce mortality rates from hypertension circulatory, digestive and respiratory diseases (Oman, Kurata, Strawbridge & Cohen, 2002), and other various chronic diseases. In addition, researchers have shown that members of specific religious groups (e.g., Zen Buddhist priests, Catholic monks and nuns, and Orthodox Jews) have lower mortality rates than the general population (Fraser & Shavlik, 2001). One key study followed 5,000 respondents over 28 years and examined the association between frequent attendance and mortality (Strawbridge, Cohen, Shema & Kaplan, 1997); frequent attendees had lower mortality rates than did nonattendees. Similarly, a 2008 study using data from the Women's Health Initiative (Schnall et al., 2008) found that women aged 50 and older were 20% less likely to die in any given year if they attended religious services weekly, compared to those that never attend religious services. Infrequent attendees of religious services also appear to have mortality rates similar to infrequent attendees of nonreligious groups (Shor & Roelfs, 2013), suggesting that mortality is more strongly linked to frequent social interaction rather than religiosity.

Such studies raise the question of whether healthier people are more likely to participate in religious activities. In addition, researchers have wrestled with the question of what it is about religion that appears to have this positive impact. For instance, in the Women's Health Initiative study, the lower mortality rates observed among those who participated in religious activities more frequently were explained by differences in personal and social behaviors—those with lower mortality rates and high religious participation rates were also among those more likely to cease smoking, increase exercise, increase social contacts, and remain married. The range of social and personal behaviors associated with religious participation is more evident in research on morbidity.

Morbidity

Religiosity, or religiousness, has also been found to protect people against diseases such as heart disease, hypertension, diabetes, and stroke (Hummer, 1999). Generally, people who hold religious views and practice religion tend to report greater subjective well-being, life satisfaction, and ability to cope with stress, and fewer symptoms of depression (Koenig et al., 2001). Moreover, the more frequent attendance and the greater the level of religiousness, the stronger the benefits appear to be for health. For instance, studies have found that there is a relationship between the frequency of attendance and blood pressure: higher attendance is associated with lower blood pressure (Gillum & Ingram, 2006). For adherents of religions with firm and specific behavior guidelines, such as Seventh-Day Adventists and Mormons, the risk of chronic diseases such as hypertension (Brathwaite, Fraser, Modeste, Broome, & King, 2003) and stroke is lower still.

While many studies on the association between religion and health have focused on elderly or seriously ill patients, more recent research is suggesting that these patterns of association hold for younger people as well, although it is spirituality that is important. For instance, one study published in 2005 examined the roles of spirituality and religiosity on cardiovascular responses during stress and self-reported illness and health in a sample of young women. The study found that while spirituality had a health protective effect for this population, religiosity did not. These findings suggest that spirituality may be more important to younger groups than membership of and participation in formal religious organizations (Edmondson et al., 2005).

Depression

Since the nineteenth century, researchers have also found a positive association between religion and improved mental health regardless of age, gender, ethnicity, class, and geography. In particular, religiousness appears to have a protective effect against depression, and studies report fewer depressive symptoms among the religiously active, especially among the elderly (Koenig et al., 2001).

Viewpoints

Explaining the Impact of Religion on Health

Broadly, there are three mechanisms through which religion appears to affect health:

• The promotion of health behaviors,
• The provision of social support, and
• The provision of coherence (George, Larson, Koenig, & McCullough, 2000).

Research suggests that people who participate in religious activities and practices are also more likely to participate in positive health practices and avoid harmful practices (McCullough & Smith, 2003). Certain religious groups (e.g., Mormons) actively encourage moderation in eating and exercise and discourage potentially harmful behaviors, such as smoking, drug use, excessive alcohol consumption, and premarital sex (Musick, Traphagan, Koenig, & Larson, 2000). Some groups avoid diets that are known to be harmful to health (e.g., Seventh-Day Adventists consume low amounts of red meat). In addition, "simply believing or expecting religious practice to benefit health, or by expecting God to reward expressions of devotion" or obedience with health and well-being—"learned optimism"—"may be enough to account for positive health outcomes among more religiously committed populations" (Ellison & Levin, 1998, p. 708). Therefore, researchers argue that the doctrine and teaching of certain religious groups may regulate lifestyles in ways that have the effect of promoting health.

Several studies have documented the relationship between social support, coping, and religion (McCullough & Smith, 2003). Social support is typically measured objectively (e.g., the size of one's social network, the frequency of interaction with one's network) and subjectively (e.g., satisfaction). People who are frequent attendees of and participants in religious activities are also more likely to be part of larger and denser social networks, which offer the potential for more support through exchanges of goods, services (e.g., transport, meals), and information. Religious groups also provide a source of friendship and kindness through both formal programs and intangible mechanisms such as touch and prayer. Therefore, both objective measures of support and subjective measures, such as how people feel about this support and whether they feel loved, accepted, and cared for, may be important predictors of mental and physical well-being and help explain why religiousness has a positive effect on health. Religious beliefs provide a buffer against distress, especially among those who experience multiple life stressors (such as divorce, death, etc.), symptoms of depression, and also against the sense of hopelessness that accompanies depression (McCullough & Smith, 2003). "Piety indicators" such as frequency of prayer, feelings of closeness to God, and subjective religious identity create a sense of meaning and purpose and provide a source of coping with everyday life, which is linked to well-being (McCullough & Smith, 2003).

Religion may provide ''a sense of coherence and meaning so that people understand their role in the universe, the purpose of life, and develop the courage to endure suffering'' (George et al., 2000, p. 108). In Durkheim's terms, the shared values and practices that emerge through religious participation contribute to group solidarity by affirming common values and beliefs on a regular basis (e.g., weekly church attendance). They provide a framework that helps people manage and respond to stressful events and conditions. In particular, devotional practices (such as prayer or meditation) may protect against disease and speed illness recovery because they help people establish a sense of control or "reassess the meaning of potentially problematic conditions as opportunities for spiritual growth or learning, or as part of a broader divine plan, rather than as challenges to fundamental aspects of personal identity" (Ellison & Levin, 1998, p. 708). In addition, McCullough and Smith (2003) note that studies have suggested certain religious practices, such as prayer and worship, may induce the experience or expression of certain emotions such as forgiveness, contentment, and love, as well as to release negative emotions such as guilt and fear. There is some evidence that religion, through complex sequences of events, may give rise to positive emotions and release negative emotions.

Conclusion

Although the relationship between religion and health is strong, and that relationship appears to mainly have a positive impact on health, it is difficult to isolate specifically what it is about religious participation that affects physical and mental health. The main pathway through which religion appears to affect health is through observable, behavioral aspects of religious involvement, such as frequency of religious attendance. That is, religion affects health largely through the choices that participants make, the social support they receive through religious membership, and the emotional support they receive from people who share a similar worldview. A second pathway suggests that religious participation, especially through devotional practices such as prayer and meditation, may affect biological and physiological mechanisms (e.g., hormone release and stress responses) in ways that are beneficial to health. A third emerging pathway involves examining how religious interventions, such as intercessory prayer—which 89% of praying adults in the United States practice (Schafer, 2013)—affect health outcomes. As one leading researcher in this field has commented, the study of religion and its impact on health is just beginning, since critical questions remain about how and why it works (Aten & Schenk, 2007).

Terms & Concepts

Integrative Function: Social practices that bind people to the societies of which they are members (e.g., through participating in ceremonies and sharing values and belief systems).

Phenomenology: An approach in sociology that focuses on consciousness and experience from the first-person perspective.

Religion: An institutionalized form of thinking and acting that functions to regulate and integrate members of society for the purpose of securing social solidarity and order.

Religiosity: Involves the creation of a symbolic world that provides people with meaning in the modern world, whether through collective membership of formal religious organizations or through looser, more informal practices (e.g., meditation).

Sacred Canopy: A symbolic world that provides meaning in a context of secularization.

Social Solidarity: The extent to which a society is integrated.

Spirituality: The individual search for the sacred (Emmons & Paloutzian, 2003) and denotes views and behaviors that express relatedness to something greater than the self (Ziegler, 1998).

Bibliography

Aten, J. D., & Schenk, J. E. (2007). Reflections on religion and health research: An interview with Dr. Harold G. Koenig. Journal of Religion and Health, 46:183–190. Retrieved January 12, 2010 from EBSCO online database Academic Search Complete. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=24940472&site=ehost-live.

Bell, R. A., Suerken, C., Quandt, S.A., Grzywacz, J. G., Lang, W., & Arcury, T. A. (2005). Prayer for health among U.S. adults: The 2002 National Health Interview Survey. Complementary Health Practice Review, 10:175–188. Retrieved January 15, 2010 from Sage Journals http://chp.sagepub.com/cgi/reprint/10/3/175

Berger, P. (1967). The Sociology of Religion. Harmondsworth: Penguin.

Bilton, T., Bonnett, K., Jones, P., Skinner, D., Stanworth, M., & Webster, A. (1996). Introductory Sociology. London: Macmillan.

Brathwaite, N., Fraser, H. S., Modeste ,N., Broome, H., & King, R. (2003). Obesity, diabetes, hypertension, and vegetarian status among Seventh-Day Adventists in Barbados: Preliminary results. Ethnicity and Disease, 13, 34–39.

Edmondson, K. A., Lawler, K. A., Jobe, R. L., Younger, J. W., Piferi, R. L., & Jones, W. H. (2005). Spirituality predicts health and cardiovascular responses to stress in young adult women. Journal of Religion & Health, 44 :161–171. Retrieved January 15, 2010 from EBSCO online database Academic Search Complete. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=16675081&site=ehost-live.

Ellison, C. G., & Levin, J. S. (1998). The religion-health connection: Evidence, theory and future directions. Health, Education and Behavior, 25:700–720. Retrieved January 15, 2010 from http://www.religionomics.com/old/erel2006s/readings/Ellison-Levin%20--%2 20Religion-Health%20Connection.pdf

Emmons, R. A., & Paloutzian, R. F. (2003). The psychology of religion. Annual Review of Psychology, 54 , 377–402. Retrieved January 15, 2010 from EBSCO online database Academic Search Complete. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=9688617&site=ehost-live

Fraser, G. E., & Shavlik, D. J. (2001). Ten years of life: Is it a matter of choice? Archives of Internal Medicine 161, 1645–1652. Retrieved January 15, 2010 from website http://archinte.ama-assn.org/cgi/content/full/161/13/1645

Ganga, N. S., & Kutty, V. (2013). Influence of religion, religiosity and spirituality on positive mental health of young people. Mental Health, Religion & Culture, 16, 435–443. Retrieved October 28, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=86009613

George, L. K., Larson, D. B., Koenig, H. G., & McCullough, M. E. (2000). Spirituality and health: What we know, what we need to know. Journal of Social and Clinical Psychology, 19, 102–116.

Gillum, R. F., & Ingram, D. D. (2006). Frequency of attendance at religious services, hypertension, and blood pressure: The third National Health and Nutrition Examination Survey. Psychosomatic Medicine. 68, 382–385. Retrieved January 15, 2010 from http://www.psychosomaticmedicine.org/cgi/content/full/68/3/382

Hardy, S. A., & Carlo, G. (2005). Religiosity and prosocial behaviors in adolescence: The medicating role of prosocial values. Journal of Moral Education, 34: 231–249. Retrieved January 15, 2010 from EBSCO online database Academic Search Complete. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=17394952&site=ehost-live.

Howson, A. (2004). The Body in Society. Cambridge: Polity Press.

Hummer, R. A., Ellison, C. G., Rogers, R. G., Moulton, B. E., & Romero, R. R. (2004). Religious involvement and adult mortality in the United States: Review and perspective. Southern Medical Journal 97, 1223–1230. Retrieved January 14, 2010 from EBSCO online database MEDLINE with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=15646761&site=ehost-live

Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. Oxford: Oxford University Press.

Lupton, D. (1994). Medicine as Culture: Illness, disease and the body in Western cultures. London: Sage.

Marsh, I., Keating, M., Eyre, A., Campbell, R., & McKenzie, J. (1996). Making sense of society: An introduction to sociology. London: Longman.

McCullough, M. E., & Smith, T. B. (2003). Depressive symptoms and mortality as case studies. In Dillon, M. (Ed). Handbook of the sociology of religion. Cambridge: Cambridge University Press.

Merrill, R. M., & Lyon, J. L. (2005). Cancer incidence among Mormons and non-Mormons in Utah (United States) 1995–1999. Preventative Medicine, 40:535–541.

Musick, M. A., Traphagan, J. W., Koenig, H. G., & Larson, D. B. (2000). Spirituality in physical health and aging. Journal of Adult Development, 7, 73–86. Retrieved January 15, 2010 from EBSCO online database Academic Search Complete. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=11304067&site=ehost-live

Oman, D., Kurata, J. H., Strawbridge, W. J., & Cohen, R. D. (2002). Religious attendance and cause of death over 31 years. International Journal of Psychiatry in Medicine, 32, 69–89.

Schafer, M. H. (2013). Close ties, intercessory prayer, and optimism among American adults: Locating God in the social support network. Journal for the Scientific Study of Religion, 52, 35–56. Retrieved October 28, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=85862280

Schnall, E., Wassertheil-Smoller, S., Swencionis, C., Zemon, V., Tinker, L., . . . & Goodwin, M. (2008). The relationship between religion and cardiovascular outcomes and all-cause mortality in the women's health initiative observational study. Psychology and Health, 23 , 1001–1006.

Shor, E., & Roelfs, D. J. (2013). The longevity effects of religious and nonreligious participation: A meta-analysis and meta-regression. Journal for the Scientific Study of Religion, 52, 120–145. Retrieved October 28, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=85862273

Strawbridge, W. J., Cohen, R. D., & Kaplan, G. A. (2001). Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships. Annals of Behavior in Medicine, 23:68–74. Retrieved January 15, 2010 from EBSCO online database Academic Search Complete. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=8546110&site=ehost-live

Wear, A. (1985). Puritan perceptions of illness in seventennth century England. In R. Porter (ed). Patients and Practitioners: Lay perceptions of medicine in pre-industrial society. (pp. 55–99). Cambridge: Cambridge University Press.

Ziegler, J. (1998). Spirituality returns to the fold in medical practice. Journal of the National Cancer Institute. 90:1255–1257. Retrieved January 15, 2010 from EBSCO online database Academic Search Complete. http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=9731729&site=ehost-live

Suggested Reading

Blasi, A. (Ed.). (2011). Toward a sociological theory of religion and health. Leiden, Netherlands: Brill.

Dillon, M., & Wink, P. (2007). In the course of a lifetime: Tracing religious belief, practice, and change. Berkeley, CA: University of California Press.

Koenig, H., King, D., & Carson, V. B. (2012). Handbook of religion and health (2nd ed.). New York, NY: Oxford University Press.

Krause, N. (2004). Religious doubt and health: Exploring the potential dark side of religion. Sociology of Religion, 65 , 35–56. Retrieved January 15, 2010 from EBSCO online database Academic Search Complete. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=12775058&site=ehost-live

McFarland, M. J. (2009). Religion and mental health among older adults: do the effects of religious involvement vary by gender? The Journals of Gerontology, Series B. 10:1093.

Schnittiker, J. (2001). When is faith enough? The effects of religious involvement on depression. Journal for the Scientific Study of Religion 40, 393–411.

Yeary, K., Ounpraseuth, S., Moore, P., Bursac, Z., & Greene, P. (2012). Religion, social capital, and health. Review of Religious Research, 54, 331–347. Retrieved October 28, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=85862273

Wuthnow, R. (1994). Sharing the journey: Support groups and America's new quest for community. New York: Free Press.