In America, the issue of health disparities is often considered as a matter of black and white…and Hispanic and Asian-American, and so on. Most of the time, U.S. populations are sliced into categories of race and ethnicity so that researchers can compare health measures and determine culturally relevant interventions where needed. But racial identity is only one of many possible cultural influences on an individual’s health. In a new article, two physicians at the University of Chicago Medicine argue for approaching health disparities in the United States from a new, religious perspective.
When Americans are placed into categories of race or ethnicity, it cuts across socioeconomic, geographic, and even cultural lines. But the assumption is that all people of a given race experience some of the same societal pressures and engage in similar cultural practices that may influence health. By the same logic, religion could be considered a useful category umbrella for defining a population of people that share attitudes about health and healing and some aspects of social experience, said co-author Aasim Padela, assistant professor of medicine at the University of Chicago.
“People talk about institutional racism, the idea that there is a systematic racism within the way we think about the world and the expectations we have for people from particular races,” Padela said. “I think the same can apply to religion. We have certain innate biases and stereotypes of people from a specific faith. If you find that, systematically, Muslims independent of race and ethnicity rated their health worse than other ethnic groups, that means something very tangible.”
In the Journal of Religion and Health, Padela and co-author Farr Curlin, associate professor of medicine, urge disparities researchers to begin collecting data to study the influence of religion on health behaviors and outcomes. As an example of how such studies would work, they lay out a research agenda for examining the relationships between religion and health in American Muslims, building off of Padela’s previously published work conducted as a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan.
Padela proposes that Islam — or any other religion — can influence its followers’ health in three dimensions: by defining health and healing within and beyond the medical sphere, by setting ethical and legal standards for acceptable or unacceptable healthcare therapies, and by exposing adherents to the deleterious effects of social prejudice. While some of these influences have been discussed in terms of race and ethnicity, they are rarely talked about in religious terms, Padela said.
“I think it’s challenging, because it’s almost taboo,” Padela said. “In the United States, where you have this diverse melting pot, we often neglect religious influences on health. We’re much more comfortable saying that there’s a cultural issue, because it’s not normative. But if we’re saying it’s an issue that stems from religious teaching and understandings, we’re concerned that maybe someone’s saying we’re putting down your religion or making a normative judgment about it. So people are not comfortable discussing religious values and beliefs, and therefore we ignore it in many ways. ”
Many disparities researchers recognize that “health” is not a purely medical concept for many patients, who may also see their illness and recovery in religious or psychological terms. Padela’s 2011 report on the healthcare needs of American Muslims found that many see illness as “a trial from God” that requires spiritual healing as well as medical treatment. Collecting data on health disparities in this population or in other religious groups can help pinpoint areas where this need is not being met by the American health care system.
“We are in a reductionist biomedical society in medicine sometimes, meaning we think there’s a disease that’s causing everything; there’s a physical problem, a medical issue,” Padela said. “But people might feel they have a need for psychological or spiritual support as well. For Muslims, they might feel that there is a relationship between their spiritual health and physical health, so they might resort to some spiritual guidance or therapies before, or in conjunction with, medical care. If you don’t think about it, we can never address that.”
The tenets of Islam also may impact health by forbidding the use of some medical interventions. Medication or vaccines derived from pig products could violate the Islamic prohibition against consuming pork, and rules against using mind-altering substances could be interpreted to apply to drugs such as sedatives or narcotic painkillers. On the other hand, Islam also discourages unhealthy behaviors such as smoking and drinking alcohol and encourages breast-feeding — religious standards that may actually improve health outcomes for the Muslim population. While adherence to these guidelines is unlikely to be uniform, and consensus on the guidelines themselves (as in the case of whether organ transplantation is permissible) may not always be reached, categorizing patients by religious affiliation would provide insight into the healthcare disparities impacted by religion.
Additionally, people of some religions may be subject to the same powerful negative influence on health that racial minorities often encounter: discrimination. Multiple studies have shown that Muslims suffered adverse health consequences after 9/11, including higher rates of pre-term or underweight birth and depression after the terrorist attacks in New York and Washington DC. Women wearing the hijab headdress also said that healthcare providers often make diminutive assumptions about their modesty and intellect based on their traditional attire, leading to distrust.
“Obviously, if you systematically feel or perceive discrimination and bias towards you, that’s going to impact your health behaviors,” Padela said. “You might do things that are not advantageous to health like smoking or always feeling stressed. Or if you perceive negative stereotyping, you might then not want to enter the health care system, and try to stay away from public resources available to you.”
However, Padela acknowledged that collecting data to measure an individual’s religious life is simpler in theory than i practice. While checking a box self-identifying as a Christian, Jewish, Muslim, atheist or other affiliation sounds simple enough, one would also want a measure of how religious an individual is, a criteria called religiosity. Objective measures of religiosity that make sense for one religion, such as attendance at worship services, may not accurately represent religious involvement under a different belief system. There are also serious questions about what policymakers would or could do with data on health disparities by religion, should it be successfully collected. But Padela argued that measuring these potential health gaps is far better than pretending they don’t exist at all.
“I think without asking the question we’ll never know what’s occurring, we’ll never have an accurate picture of how people are thinking about their health and what they need,” Padela said. “In the absence of data, you can’t make any educated decisions.”
Padela AI, & Curlin FA (2012). Religion and Disparities: Considering the Influences of Islam on the Health of American Muslims. Journal of religion and health PMID: 22653653