Fighting health disparities: the educational role of the African American church.

Religion and religious institutions are an integral part of the lives of many Americans. For African Americans, the Black Church (1) has been the one entity that has constantly served their needs and interests. Even so, African Americans continue to die prematurely and have higher incidents of disease. In this article, we briefly discuss African American health and the educational role of the Black Church and its efforts and potential to eradicate health disparities.

African American Health

African Americans today find themselves experiencing higher incidences of major diseases than their white counterparts. There are several factors affecting these disparities, many socio-cultural in nature. Eradicating health disparities between African Americans and whites entails more than relying on individuals to visit their local primary care physician. According to the National Urban League:

    Achieving an equitable, universal health system in the Unites States
    will not be easy, given the nation's long history of tacit (and
    sometimes explicit) tolerance of inequality in health care. Active
    partnerships between government, healthcare providers and
    institution's health systems and other important stakeholders-such
    as the ... faith groups ... will be necessary to create the
    political will to develop and sustain these policy goals. (2)

In 2006, the Institute of Medicine reported that "even after adjustment for socioeconomic differences and other healthcare access-related factors there are still disparities in care based on racial and ethnic status." (3) As a result of "health care discrimination" and "ongoing extensive evidence of racial disparities," there is a need for "vigilance in the area of health care and civil rights." (4)

With the proliferation of diseases, such as some forms of cancer, AIDS, and the increasing number of African Americans affected by them, the Black Church cannot be overlooked as a context to address health care issues facing the African American community. As a health promotion headquarters, (5) the Black Church is in a unique position to aid African Americans in their quest for better and improved health through programs that are culturally and spiritually relevant. The new socio-psychological paradigm of disease and health encourages further mergers of medicine and spirituality to combat illness effectively. Interestingly, two studies in 1994 and 1995 correlated religious involvement in the African American community with health status and reduced depression. (6) Projects and research agendas have been initiated between Black Churches and the Black Nurses Association, American Cancer Society, and colleges and universities.

Historical Uniqueness of the Black Church

The historical uniqueness of the Black Church has been its primary focus on the social, political, cultural, and religious well-being of its parishioners. From the days of religious gatherings on hilltops, cotton fields, and barns to revivals in open fields or abandoned shacks to worship services in modern, stately buildings, the Black Church has been a place of worship, teaching and learning, and a place to gather in order to seek refuge from the turbulent times. To that end, the Black Church has assumed many roles in the African American community. It has been described as an epicenter for artistic and leadership development, and politics, a social club, and a cultural and health center.

The Black Church has strong roots in African traditions that naturally link religion and medicine in a very holistic manner. Hence, our natural inclination to improve conditions for people may be partially inherited from African spirituality. This natural tendency was reinforced by the Great Awakening emphasis on sanctification as improving people and society. In the 19th century, anti-slavery and temperance efforts were merged in the Black Church and congregations were given a thorough education against tobacco use, the over indulgence of alcoholic beverages, along with other activities that could adversely affect them.

As L.N. Jones points out in The Black Church: The New Agenda, (7) one of the earliest agendas of the Black Church was education. The Ku Klux Klan often set Black churches on fire in an attempt to retard their educational activities. Despite the important educational role the Black church has maintained, however, it has received little attention in the literature on adult education.

Although the Black Church taught religious doctrine and scriptures, it also taught Blacks how to contend with difficulties and adjust to life in a society that did not value or honor them or their heritage. The Black Church was a haven from societal injustices and a place where African Americans acquired skills, knowledge, and values through the church's educational programs. The belief and faith that one can rise above personal struggles, adversity, racism, and poverty is a familiar refrain that echoes throughout the African American church today. These beliefs have been inculcated through a variety of educational programming in the church.

By espousing a temperance movement, the historical Black Church promoted a healthy lifestyle for African Americans. The mind and body connection resonated throughout the Black Church with a promotion of the body as the "temple" of God. Today, demonstrating a commitment to address the even more complex health issues that African Americans face, many churches have employed a health practitioner. It appears health education programming in the Black Church is as important today, if not more, than it was in the early Black Church.

Some churches have health programs or ministries whose purpose is to educate members, provide emotional support, and/or empower individuals to take better care of themselves. Many churches are fortunate to have members who are health care professionals aware of the disparities of African Americans and who can provide the leadership in health education programming in the church.

Black churches of various affiliations have already demonstrated their ability to integrate lifestyle changes. There are many reports of churches sponsoring successful programs that have targeted drug addicts, prisoners and ex-offenders, at-risk youth, African American males, teen mothers, and other populations. The Church has demonstrated its ability to serve as a powerful health motivator even in such traditional areas as risk reduction of cardiovascular disease, smoking cessation, weight loss, and diet change, just to name a few. According to a 2002 study conducted by Cleveland's Institute for Research on Unlimited Love, (8) some churches have been more effective in providing social services than their secular or public counterparts. The Black Church can generally disseminate information "within the wider African American community" and it is associated with "positive healthcare practices." (9) This could be attributed to its array of learning experiences and embodying therapeutic factors that promote empowerment. (10)

While a correlation between church resources and church activities exist, some churches, despite their size, provide health education programming. Educational formats may include health screenings, seminars, and health fairs. More astute pastors will preach about or include health in their sermons. Many churches display health materials, such as pamphlets, in heavy traffic areas (i.e., vestibule) in the church. Occasionally, health information is placed in worship bulletins.

The continued need to address the issue of minority health disparities was highlighted by a 2006 historical-ethical study by xx Washington that describes the history of medical experimentation on African Americans from colonial times to the present day. (11) In Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present (2006, Doubleday), Washington describes the development of an AIDS vaccine that at first appeared to be promising in effectiveness for African Americans and Asians, but not for Whites. Although the medical researchers involved eventually concluded that the vaccine did not help anyone, Washington affirms that the vaccine held promise for minorities, raising serious issues of "justice" in healthcare.

The Black Church stands in a unique position to serve as an advocate for eradicating health disparities among African Americans by continuing to show how important health education and health promotion are to the African American community and through the exercise of its "prophetic" role to challenge the norms and standards of the larger society to create an equal healthcare system.

Notes

1. For purposes of this article, the Black church refers specifically to an African American Christian church regardless of its denominational affiliation, whose church leader (pastor) is African American and whose congregation is predominately African American or Black. Also, in this article, we use the terms Black and African American interchangeably depending on the time frame and to refer to people of African descent.

2. National Urban League, The State of Black America (2006) p.8.http://www.nul.org/publications/SOBA/2006/SOBA%20ABSTRACTS.pdf

3. Institute of Medicine. Unequal treatment: Confronting racial and ethnic disparities in health care. (Washington, DC: National Academies Press, 1999) p. 5.

4. Rosenbaum, S., Markus, A., & Darnell, J. (2000). "U.S. Civil Rights policy and access to Health care by minority Americans: Implications for a changing health care." Medical Care Research and Review, 57(s1), 236-259.

5. Chatters, L. M., Levin, J. S., & Ellison, C. G. (1998). "Public health and health education in faith communities." Health Education and Behavior, 25(6), 689-99.

6. Brown, D. and Gary, L.E. (1994) "Religious involvement and health status among African American males." Journal of the National Medical Association, 86 (11), 825-831 and Ellison, C.G. (1995). "Religious involvement and depressive symptomatology in a southeastern U.S. community." Social Science & Medicine, 4(11), 561-572.

7. Jones, L. N. (1985). "The Black churches: A new agenda." In M. C. Sernett, Afro-American religious history: A documentary witness (489-497). Durham, NC: Duke University Press.

8. Johnson, B. (2002). "The sociological study of faith-based communities and their activities in relation to the spiritual ideal of unlimited love." Research Topic White Paper # 6. Cleveland, OH: Institute for Research on Unlimited Love, Altruism, Compassion, Service.

9. Carter-Edwards, L, Jallah, Y.B., Goldmon, M. V., Robertson, J.T., Hoyo, C. (2006). "Key attributes of health ministries in African American churches: An exploratory survey." North Carolina Medical Journal, 67 (5), 345-350.

10. McRae, M. B., Carey, P. ML., Anderson-Scott, R. (1998). "Black churches as therapeutic systems: A group process perspective." Journal of Health Education and Behavior, 25(6), 778-189.

11. C.E. Lincoln and L.H. Mamiya, L. H., The Black church in the African American experience. (Durham, NC: Duke University Press, 1990) and M. Marty, Healthy People 2000: A Role for Americas Religious Base (1990)

12. H.A. Washington, Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to present. (New York: Doubleday, 2006).