As Dolores walked through the door of the community center's health fair, I could tell something was terribly wrong. She walked unsteadily, groping the wall for support, and she seemed to be sweating too much for a cool spring morning. After having her blood pressure, vision, and cholesterol checked, she came to my table to enroll in health insurance programs. She was desperately in need of health care: With advanced diabetes she barely had feeling in her feet—a sure sign of nerve damage—and her blood pressure had soared to dangerous heights.
Despite her need, as a middle-aged woman working for minimum wage without benefits, Dolores didn't qualify for any insurance programs, public or private. The only option left for Dolores was the emergency room—where her immediate problem would be addressed, but the longer term effects of diabetes would remain unchecked until she ends up back in the ER again.
Dolores' story is not unique. You may have heard the statistics: 44.3 million Americans don't have health insurance, and their ranks are growing by 100,000—enough to fill the largest stadium in the country—each day. Millions more are "underinsured," meaning that their health plan may not cover all the services needed or may make obtaining them so difficult that people quit trying. And in this country, problems with insurance mean problems with health care, since health care costs are so high that very few people can pay on their own.
Our health care system is unraveling, pure and simple. Los Angeles County tells the story all too well. In May, the private insurance system went into crisis as the California Medical Association—the largest organized group of doctors in the state—sued the state's top health plans for racketeering. The for-profit plans were posting profits in the hundreds of million of dollars, while their doctors were reimbursed so little that they could not even afford office space. On the public side of health care, the county's health services declared themselves on the verge of bankruptcy for the second time in a decade. County contracts with free clinics—the only alternative for the city's 3 million uninsured people—were going to be slashed by 40 percent, if they were renewed at all. In a situation like this, how does one possibly help Dolores?
ON A RARE RAINY SUNDAY morning in downtown Los Angeles, Caryl Bullock sets up her usual table in Wilshire Presbyterian Church's fellowship hall. She arranges colorful flyers on topics ranging from the nutritional "food pyramid" to immigration legal services to free dental clinics. Alongside the flyers lie her stethoscope, monitors to test for high cholesterol and blood sugar, and a stack of medical history forms. Parishioners arrive for the 11 a.m. service, folding dripping umbrellas and pulling off raincoats. Caryl greets them all, often with personal questions about each congregant's well-being—asking one how her new blood pressure medication is working, inquiring into the success of another's job search, or remarking on a toddler's rapid growth.
In the Sunday morning bustle of running children and animated conversation, Caryl is both a calming and vibrant presence. She serves as a parish nurse with QueensCare Health & Faith Partnership (QHFP), a parish nursing program that places nurses in more than 50 churches, religious schools, and faith-based nonprofits in one of the poorest areas of Los Angeles. QHFP is a division of QueensCare, a public charity offering several health care programs to the low income, uninsured individuals and families of Los Angeles county. The QHFP nurses play many roles: health educator, provider of basic health screenings and referrals, and even pastoral counselor. Each nurse works closely with "health committees": church members who assess the congregation's greatest health needs. QueensCare's vision is to empower individuals and communities to take responsibility for their health, defined as a greater sense of well-being—spiritual, social, emotional, financial, and physical.
QueensCare's parish nursing model is just one type of "health ministry." All over the country, people of faith are volunteering medical services, collaborating with free clinics, even running entire health care centers in larger and larger numbers. The Great Lakes region alone has 116 free clinics, most with some degree of faith-based support.
While medical care has always been one component of Christian service, why the surge in health ministries? Clearly, one reason is that the crisis in private and government-run programs has resulted in increasing health care needs, as more and more people need somewhere to turn for quality health care. But health ministries have unique aspects that make them more than just a last resort in a failing system—they have benefits that meet needs more effectively than their secular counterparts.
First, health ministry offers a level of caring that's hard to find anywhere else. As people of faith, health care providers working in these ministries have a strong model to follow: Jesus as healer. The gospels are full of stories of Jesus' healing powers and his compassion for those who suffered physically. Jerry Stromberg, director of the Christian Community Health Fellowship, says that the religious conviction of those who work in health ministries is often what helps their services provide "more bang for their buck."
"One reason why faith-based health services differ from those that aren't [faith based] is due to staff who, though they may not even be paid as much, have greater levels of dedication, give special efforts, and have higher retention rates," Stromberg explains. "These factors are measurable, as dedication and compassion really translate into better quality of care, and as the providers have chosen to be there out of a sense of mission or calling."
Faith-based health care is also unique in its emphasis on the whole person. The goal is not only to understand Dolores' diabetes, but also how well she eats, where she sleeps, who she turns to for emotional support, and how her spiritual strengths and needs might be best nurtured. As Susan Fuentes, vice president of QHFP, explains, "Health is integration of all aspects of a person. The spiritual is the core, the defining part of who a person is; all other parts of life integrate with that—the relational, financial, emotional, mental, physical, and environmental." In fact, Fuentes believes that even if a person's physical health is never completely restored, a strong and sustaining spiritual life is enough to define that person as "healthy."
Interestingly enough, health ministry's emphasis on the whole person, with spirituality playing a central role—an emphasis that Jesus modeled 2,000 years ago—is finally getting the attention of medical doctors. The notion that a healthy religious life can actually improve one's physical life is receiving increasing amounts of press. Studies by physician Harold Koenig, director of Duke University's Center for the Study of Religion/Spirituality and Health, have shown that people who regularly attend church, pray individually, and read the Bible have lower blood pressure, are hospitalized less often, are less likely to suffer depression from illness or stress, have stronger immune systems, suffer better outcomes from physical illness, and actually live longer.
And just as religious faith seems like an inherently healthy approach to life, so too are churches natural locations to care for people's health. Fuentes emphasizes to churches interested in starting a health ministry that they actually already have one. "I always ask them, ‘Do you have weddings? Baptisms? Other social events? Do you take food to people who are sick? Or start a prayer chain for someone who's suffering in the congregation? Then you already have a health ministry!' We just bring people in to help coordinate and expand what's already going on."
Fuentes believes that the two important ingredients for healing are already present in the church: hope and relationships. Hope provides the motivation to heal, while social support helps a patient through the process from sickness to health. All the factors that make health ministry unique—scriptural motivation to serve, emphasis on the whole person, the health benefits of religion, and the hope and relationships found in churches—work together to make them a compelling alternative to our crisis-ridden health care system.
With all the benefits that health ministries can offer, however, these services aren't a panacea for our health care system's ills. Many more people need health care than these ministries can serve, and hospital stays and treatment for more complicated illnesses are beyond the capacity of the primary care focus of many faith-based clinics. Even beyond practical matters, health ministries shouldn't be the solution for a crumbling health care system. The churches are not called to heal the sick while quietly accepting a health care system that often exacerbates illnesses. Dolores's diabetes is made worse by lack of good treatment, since she cannot afford health care and has fallen through the cracks of a patchwork safety net. Along with serving her medical needs, people of faith are called to challenge a system that allows situations like Dolores' to be tragically widespread.
The faith community is called to play a fundamental role in advocating health care justice. And the issue is undeniably one of justice. Already mentioned is the discrepancy between enormous profits posted by insurance plans while public programs continue to go broke. This inequality is no accident; business interests with enormous amounts of money and power stand in the way of health care reform. In 1997-98, the top two spenders on Capitol Hill were pharmaceutical and insurance companies; combined, these industries spent nearly $300 million on lobbying and $44.2 million on campaign contributions.
At the same time, those who suffer most from poor health care are those groups that all too often bear the burden of injustice: the very young and the very old; racial and ethnic minorities; and especially the working poor. Almost half (46 percent) of uninsured Americans have jobs. Only 9 percent of the uninsured are unemployed. (The remaining 45 percent are children and people out of the labor force, such as the elderly and homemakers.) Add to this the fact that medical-related expenses are the number one cause of personal bankruptcies in this country, and the correlation between working hard and reaping the benefits—at least in terms of health care—becomes even more disjointed.
As Martin Luther King Jr. said, "There is no greater injustice than inequality in health care." Yet even with such a clear-cut case of injustice, health care reform in recent years has been a pariah of a political issue; many health care advocates are still recovering from the defeat of President Clinton's 1994 health care reform plan. But the political tides are turning, and faith communities are essential to making it happen.
People of faith are to be healers in two different but inseparable ways: healing individuals through ministry and healing the system through advocacy. The Ohio Council of Churches states it well: "The responsibility to care with compassion for ‘the least of these' who are in need of health care, or who are marginalized by the illness of the health care system, is clearly a duty of those who are Jesus' disciples" (Matthew 25:34-36). Working toward healing is a challenge of spiritual significance—but a challenge as tangible as Dolores' pain. It's literally a matter of life or death.
Find Out More About Health Ministries...
The following organizations provide literature, books, and videos on subjects from community health and parish nursing to pending health care bills and the U2K Campaign.
- Christian Community Health Fellowship, 3812 West Ogden Ave., P.O. Box 23429, Chicago, IL 60623; (773) 843-2700; fax (773) 542-0468; firstname.lastname@example.org; www.cchf.org
- QueensCare Health & Faith Partnership, 1300 North Vermont Ave., Suite 907, Los Angeles, CA 90027; (323) 953-7333; fax (323) 953-6244; www.QueensCare.org
- Universal Health Care Action Network, 2800 Euclid Ave., Suite 520, Cleveland, OH 44115-2418; (216) 241-8422 or 1-800-634-4442; fax (216) 241-8423; www.uhcan.org
- U2K Campaign, 2800 Euclid Ave., Suite 520; Cleveland OH 44115-2418; (216) 902-5577; fax (216) 241-8423; www.u2kcampaign.org
When this article appeared, Emily Dossett was a medical student at UCLA, and was conducting research on ways to expand mental health services in faith communities.