Faith, Health and the Vitality of the Church – by Gary Gunderson
“There is only one stream of water. What passes through the bodies of humans, passes through the bodies of animals, insects and plants. It flushes through our sanitation systems, flows through the rivers, seeps through wetlands, rises to the heavens to become clouds, and returns to nourish us and all living things. There is no life outside this cycle, and theology has to get real about it.” –Steve de Gruchy, Water and Spirit: Theology in the time of cholera.[1]
Steve DeGruchy was a generative mind on a number of the leading edges where theology is helping those in other fields find their way of hopeful labor amid a time of fundamental vulnerability. Those fields, which appeared to others to be eclectic assembly of mere “issues” were united in Steve’s mind as essential to the sustained livelihood of God’s creation, including the most curious part, we humans. One of those emergent fields of study which Steve thought useful for life, was the Africa Religious Health Assets Programme.
It is now common in public health fora from Geneva to the Gates Foundation and many government, intergovernmental and philanthropic agencies around the world to talk of using faith communities to advance health or resist this or that disease or disaster. But while the functional value of faith entities to advancing health is increasingly acknowledged, it is far less clear what that partnership brings to advance the vitality and faithfulness of we came to call “the faith forming entities.” Faith groups can advance the work of health, but in what way is this healthy for their core work, forming faith?
Early in the work of ARHAP we recognized a need to disaggregate faith forming entities (such as local worshipping congregations) from faith based organizations (FBO’s). The distinction is critical for those doing theology because FBO’s are derivative, not seminal, nearly always organized around a temporal, functional purpose that reflects only a portion of what FFE’s do, especially the most distinctive thing they do, which is to form faith. This is especially important to do as the evidence becomes more vivid that faith groups do help to advance health in very measurable ways.
For instance, we can rely on the evidence emerging from the electronic medical record of Methodist Le Bonheur Healthcare, which allows us to tract the journey of members of the Congregational Health Network in those times when they enter our medical halls and them compare their journey to those of other patients matched by diagnosis code (DRG), race, sex and age. The detailed differential outcomes are interesting to researchers from health systems, as the affect is striking in terms of cost, quality and even mortality: 20% lower gross charges, 20% fewer re-admissions and half the morality.
I want to follow Steve’s curiosity about what might be making such a difference and what that means for the faith forming entity apparently doing most of the heavy lifting. Steve, looking not at Memphis, but Zambia, suggested six key elements:[2] spiritual encouragement, compassionate care, knowledge giving, material support, Moral formation, and finally curative interventions ( which covers the range of ways in which religion consciously intervenes to cure ill health in either a biomedical or alternate way, and includes the participant responses “facilities, healing, health services, infrastructure, human resources). Steve was not at all happy that the research showed very little public advocacy going on, which he took as a sign of the ill health of the body of the Church.
So what do we make of these causes and affect? Steve suggested six theological seeds out which might grow some useful theology. (He actually called these “stepping stones,” but I think are more generative than stones.)
The six seeds were: a) affirming the importance and significance of healing in African Christianity, b) celebrating the work of Jesus Christ as healer, c)link the Kingdom of God to the Old Testament vision of shalom, d) make the connection between torah and shalom, e) consolidate the link between healing and social vision of shalom by reflecting on precisely the kinds of social conditions are given divine legitimating—those characterized by freedom and justice and finally, f) a caution about works righteousness and the suspicious confidence of public health professionals in the myth of modern progress.
I accept these six with barely a quibble. I would add only two:
g) the mysteriously vital way the connectional tissue of the worshipping Body or People is itself both the means and evidence that carries the promise of abundant life. And finally
h) the radical claim that out of turbulence—even that which shocks us with random death—God astonishes, never gives up, and keeps on creating life. God does this not because of anything we do (especially of a technical manner) but, well, God seems to simply be that kind of God. God desires to create and just can’t help it. God desires to health and just can’t stop trying.
The first I propose is about the body. Theologically it is critical to take a clue from our findings that suggest that which heals is the whole community—what are some now speak of inelegantly, but evocatively, as a “superorganism.” Shalom is not a quality among individuals who are merely taught by God how to behave correctly toward each other, even for the purposes of healthy outcomes for all the individuals. Shalom, like Bophelo, is a quality of a social body that is not “sort of like a body” or one only in the mind of a poet or prophet. Shalom/Bophelo is language describing a functional living entity that has qualities of other living entities. It is, in the more crude language of our day, a network attribute. But a network is not normally thought of as sacred. That sacramental nuance concerning the social body is exactly the theological point. Shalom is what a web of people—made into one people by God’s action—has, not what one individual person has, even by participation. This is not just an emergent aggregate quality, at least for those of us in the tradition of Jesus. Shalom/Bophelo is the work of God; for Trinitarians, the work of the Spirit.
This sense of superorganism is quite different than the technical utility secular or governmental entities have begun to praise us for. And we have become a bit too proud of being congratulated for those techniques. My point is that whatever successes we are being credited for (and for which we take credit) are actually being produces because of the superorganism—the Body—and not because of our ability to apply techniques to individual autonomous persons.
We are asked to provide outcome measures and are pleased to show in many different ways that the Body of Christ does show capacity to do all sorts of useful things from counseling, to running medical clinics with negligible levels of corruption, to extending the miracles of complex medical regimes because of the clever interweaving of religious ritual (such as in the Masangane model of linking ART to morning and evening vespers). In Memphis our hospital data indicates a quite remarkable positive correlation between participation in our “congregational health network” to cost, quality and mortality indicators in the absence of any clinical differential care. What is going on in these positive indicators? It is well known among those who read the literature with any level of care that the affect is not correlated impressively with remote prayer or some spiritual practice that is not mediated by human interaction. Some are quick to point to this as evidence of a null hypothesis concerning God. Theologically, it is more useful to explore how we understand the existence of human webs of meaning as evidence of God’s action, not of human cleverness.
Human webs of relationship are on the learning edge of public health, noted in the work of Nicolas Christakis, whose recent work in the British Medical Journal explored the ways that intangible qualities such as happiness can be mapped as properties of networks, which clusters and nodes extending in quite remarkable ways that are obviously associated with other qualities of health and of life itself. (BMJ 2008;337:a2338). While Christakis does not mention religion as a factor in the formation of networks or as a positive or negative contributor to the happiness of anyone, this is a rather obvious place for sociologists of religion to offer some help to those in public health. And it is a place where students of the practices of religion can offer nuanced and experienced guidance as to how the rituals and methodologies relevant to forming, sustaining and expressing faith might be relevant. Steve, who offered his gifts not only to the academy, but also to his local congregation up the hill as a musician, would have been capable of exploring this fruitfully.
My point is that those looking for magical or remote actions of God and those looking for functional techniques of healthcare or disease prevention are both missing the most vital and interesting contribution of faith. It creates webs of relationship that can add efficiencies to many human systems and also add intelligence and creativity that allows systems to break through into other possibilities. The best way to understand the curious data from Memphis is to give credit to the mundane and at the same time revolutionary affect of webs of trust that are free to embody that trust in acts of faithful connection. It is not the techniques or clinical behaviors; it is the accurate evidence of trust, which is a quality, like shalom or Bophelo, of a network.
Humans live in webs of relationship that are capable not just of happiness (or not), as Christakis notes. Humans live in webs capable of transformation. Theologically, Steve warns us against the hubris of worshipping the web as if it by itself was capable of wise and certain progress (his sixth theological clue). Public health is confident that the world allows for more health than humans have been expecting to be possible. But public health hardly knows how to speak of such a thing as a “public.” Theologians can, but usually fail to do so. It would help a very great deal, if they would find their voice. The existence of a public (that is more than a statistical aggregate) is the proper subject of reflection for theologians and a potentially vital gift to the discourse about what faith has to do with the health of whole.
The webs of relationship that emerged as the Body of Christ recorded in Acts as evidence of God’s continued creative work did not produce “health ministries” as we know them today. But from its earliest baby steps as a new Body, the church did do ministry diakonoia (which almost certainly has a positive affect on the health outcomes of those in and nearby the Body). Deacons were appointed almost immediately and the church has been allowing its Body to assume every increasing varieties of diaconal work — ministry—ever since. Those diaconal ministries have always been informed by the tools and insights of whatever passed for science of their day. ARHAP noticed that in just the past 20 years southern Africa has experienced an explosion of new organizations and ministries related to health, especially HIV/AIDS. These kinds of creative flowerings have occurred many times in the history of the church, which is also the history of health science. Both faith and science stories are woven of chaos, discovery and human webs of meaning that end up creating institutions almost immediately repress all three in favor of a meta-narrative of rational planning and careful discernment.
Nobody even has an accurate count of how many religious hospitals have been born in the past two centuries. But it is important to note that hardly any of them were formed out of anything but a web of humans bound together in hopeful meaning capable of ministry–diakonoia– amid chaos. In my part of the world this is obvious in every major city, including the one I call home. Even a cursory glance at the tangled and tumbling stories of how the institutions of healing came to emerge alongside the wild Mississippi reveals a twisty bit of chaos. A hospital that was built to care for a very white UMC pastor by a plantation owner in the heart of the Delta now provides the preponderance of indigent care for mostly African American men and women, upon whose ancestors’ backs and suffering that early wealth was built. Closely aligned academic and research institutions share the same intertwined ironies that are almost too incendiary to fully map. Today we are wrestling real relationships and care-giving from this bitter landscape partly by means of relationships that dare to bear the name of a “covenant” designed to weave a “web of trust” to not just ameliorate disease but actually improve health. We hope to do this even amid ongoing unpredictability at the heart of liquid modernity. We live on the banks of a very turbulent river that never lets us forget that history emerges from unpredictability which produces good, bad and tangled things all along the journey.
I like that. And I suspect the future will be sort of like that, too, so if you don’t appreciate how God astonishes and surprises with creativity and hope amid the wild tumult of human systems, you will probably not entirely enjoy the future. God works in chaos and seems to enjoy it.
[1] This paper was first presented by Steve de Gruchy at the annual meeting of the Theological Society of South Africa, Stellenbosch, June 25, 2009.
[2] Here I am following the report quite closely, with much of this section of the report written by Steve.