What do we know about the effectiveness of faith-based health programs?

"Some needs and hurts are so deep they will only respond to a mentor's touch or a pastor's prayer," said President George W. Bush in his first inaugural address in January 2001. (1) "Church and charity, synagogue and mosque lend our communities their humanity, and they will have an honored place in our plans and in our laws." (1) With these words President Bush introduced Americans to his plan to provide federal funding to faith-based organizations; later that month, the President signed an Executive Order creating the White House Office of Faith-Based and Community Initiatives. (2)

There is a long tradition of church-based and synagogue-based social programs in the United States, (3,4) and many of these have been devoted to helping minorities, the elderly, and other underserved populations. Church-based programs are particularly widespread and play an important role in the black community.

Well before the President's 2001 initiative, there were a number of faith-based organizations that operated a range of social service programs separate from religious congregations within a community. Among these, some of the largest are the Salvation Army, Catholic Charities, and Lutheran Social Services. These programs were secularized in accordance with federal regulations that were then in effect. (2)

A study in the current issue of the Southern Medical Journal explores the relationship between faith-based health centers and local churches in their catchment areas. (5) The findings indicate that collaboration between the churches and the health centers is hampered by the differing visions of the two groups. The faith-based centers envision multichurch programs organized around the centers, whereas church leaders want more activities within their own congregations. The results raise the concern that lack of cooperation and coordination could undermine the effectiveness of faith-based initiatives.

In his 2005 State of the Union Address, (6) President Bush told the nation he intended to reduce or eliminate "government programs that are not getting results." "The principle is clear," he said, "Taxpayer dollars should be spent wisely, or not at all." (6)

In light of the President's statements, we ask: How effective are faith-based programs? A 2002 study conducted by the University of Pennsylvania's Center for Research on Religion and Urban Civil Society attempted to answer this question with respect to social service programs. Given the paucity of studies on the topic that were published in professional journals at that time, the researchers combed through unpublished resources and various types of electronic databases as well as contacting faith-based organizations directly for information. "Unfortunately," these researchers note, "the majority of these nationally recognizable social service faith-based organizations have neither produced or requested that empirical studies be conducted to quantify the effectiveness of the social programs they provide." (2)

Their extensive literature search produced only 25 studies that examined the effectiveness of faith-based programs, and only 12 of these were sufficiently sound, methodologically, to draw meaningful conclusions. Five studies examined prison recidivism and five were published reports on a single 30-church screening program for breast cancer that was conducted in Los Angeles in 1996 to 1998. One of the five articles reported that screening rates for this church-based program was higher than that for other community-based programs. The remaining two studies evaluated the effectiveness of a teenage drug treatment program, but they did not compare its success to that of secular programs.

Our own search of PubMed, using the search phrase "faith-based or church-based" identified almost 150 journal articles. Most of these were not directly relevant, others were merely program descriptions, and some were program evaluations. However, none of them compared the effectiveness of faith-based and secular programs with respect to health outcomes.

Given concerns about cost-effectiveness in the federal government and the healthcare field, it would be valuable to examine the comparative effectiveness of faith-based and secular health and social programs receiving taxpayer money. Furthermore, it would be wise that funding for such programs contain provisions that require scientifically valid evaluations of their effectiveness.

References

1. President George W. Bush's Inaugural Address, January 20, 2001. Available at: http://www.whitehouse.gov/news/print/inaugural-address.html. Accessed.

2. Johnson BR. Objective hope: Assessing the effectiveness of faith-based organizations: A review of the literature. Center for Research on Religion and Urban Civil Society, University of Pennsylvania, Philadelphia, 2002.

3. Modesto K, Weaver AJ, Flannelly KJ. Motive and method: A systematic review of empirical research on religion in six social work journals. Social Work and Christianity (in press).

4. Flannelly KJ, Stern S, Costa KG, et al. Rabbis and health: A half-century review of the mental and physical health care literature. Pastoral Psychology (in press).

5. Gee L, Smucker D, Chin MH, et al. Partnering together? Relationships between faith-based community health centers and neighborhood congregations. South Med J 2005;98:13-18.

6. State of the Union: The President's Address, The New York Times February 3 2005, A22.

Kevin J. Flannelly, PHD, Andrew J. Weaver, MTH, PHD, and Helen P. Tannenbaum, MBA, MLIS 

From The HealthCare Chaplaincy, New York, NY; Zion's Herald. Boston Wesleyan Society, Boston, MA; and The HealthCare Chaplaincy, New York, NY.

Reprint requests to Kevin J. Flannelly, PhD, The HealthCare Chaplaincy, 307 East 60th Street, New York, NY 10022. Email: [e-mail]

Accepted March 23, 2005.