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Posted September 19, 2007
A Survey of Health Services given by Churchesconducted by the National Council of Churches USA (NCC) with support from the Robert Wood Johnson FoundationIt shows that a majority of churches are ministering to their communities by providing health care ministries. As the number of uninsured Americans reaches 47 million people, congregations are supplying health education and direct health care services. Many are advocating on behalf of public policy issues related to health care. Please read in particular “Casting A Wide Net.” It contains success stories that need dulplication. What Can We Learn From This Survey? The Congregational Health Ministry Survey constitutes a pioneering study in the field of health activities and congregations. The results of this study: — Document the very large amount of congregational activity addressing health issues. — Portray the range and distribution of the health-related activities in congregations. — Suggest the characteristics of congregations that are most involved in the provision of health services. The 6,037 congregations who responded to the survey and their collective 2.5 million members, have responded to the needs of their communities though programs of education, direct services and advocacy. While this initial survey leaves undocumented much of the congregational landscape of the United States it does provide an important basis upon which future studies might build. Used within appropriate constraints the findings of this study do much to advance our knowledge of congregational responses to health care needs within their communities and their capacity to address those needs. What Patterns of Health Care Ministries Were Reported Only 6.4% of the respondents reported that their congregations offered no programs of any kind in health care ministries. It should be noted that this figure is probably lower in all churches as some recipients of this survey may have chosen not to complete it since, in their perception the survey was not for them” because they provide no such services. The sample of the 6,037 responding congregations report a staggering total of 78,907 programs of health ministries or an average of 13.07 health-related activities per congregation. The three program areas which served as the foci of this survey were: 1) health education 2) direct provision of health services, and 3) advocacy of public policies related to health care. In order to isolate these three types of health care ministries from more typical volunteer services routinely offered by congregations and from one time “health events” which are not necessarily sustained programs, separate responses were also recorded for volunteer services and health events. Table 4 reports the frequency of report in each of the five areas of programming. Within the congregations, provision of volunteer services routinely takes place independent of other health care ministries. These volunteer services are often hallmarks of the sense of community established by congregations as they reach out to each other as members of a given congregation. Fully 87% of the congregations reported their participation in such activities as visitation to the sick, provision of meals and transportation to medical appointments and assistance with health related paperwork. Even congregations that have not established health care ministries are apt to provide such services. Health-related events, such as use of the church facilities for blood donor drives or health fairs, are by definition limited-time events rather than on-going programs and therefore require less structure, staffing and budget to accomplish. The impetus for health events, such as a blood drive, may originate outside of the congregation. Indeed congregations may simply permit the use of their facilities for such events that are actually planned, initiated and conducted by community health agencies. These events organized by outside organizations might provide Table 4 — Program Frequencies
hearing and vision screening, or flu shots, for example. Such health events may be “portal” events for congregations, introducing members of the church to problems they may not have been aware of in their community, pointing to new and interesting programming possibilities, and suggesting new or broader ministries to their membership and/or communities. Such events may serve to sensitize congregations to largely unspoken health concerns that are not adequately addressed by existing systems. As these needs become better understood within the congregation a decision may be made to develop an on-going response through some form of sustained program. 57% of the respondents reported hosting health events within their congregations. Health Education More than 65% of the respondents report offering health education programs within their community. With a median of four programs per congregation more than 24,000 health education programs were offered by the sample as a whole. Table 5 lists the kinds and frequency of the content of these educational programs. Congregations that run at least one education program are likely to run several. While 35% of the congregations in the sample run no education programs, of those that do, more than 80% run multiple education programs. More than 30% of all congregations in the sample ran five or more education programs. These data were analyzed to better understand which congregational characteristics (e.g. race composition, location, size, etc.) best predict the operation of education programs. Holding all other factors constant, African American congregations as well as suburban and urban downtown congregations ran disproportionately more education programs than other congregations in the sample. The best predictor of the operation of numerous health education programs was average attendance; clearly, larger congregations run more programs than smaller congregations. For every additional 250 people in attendance, one more educational program was run. No significant findings with regard to denomination or region were found. Direct Service Surprisingly, more congregations in the sample engage in the provision of direct health services (70%), than provide educational health programs (65%). Direct services are understood to mean provision of medical care provided directly to individuals, usually by someone specifically trained to do so. However, a lower total number of direct service programs (13,033) are offered than total educational programs (24,072). This is probably explained by the greater need for organization, financial resources and personnel required to sustain direct service programs. Only a quarter of congregations provide three or more direct service programs. The array and frequency of direct service programs offered is reported in Table 6. Health screening were by far the most common form of direct service Table 5 – Respondents Reporting Health Education Activities
provision with 27% of all congregations providing some form of screening. Thirty-seven percent of congregations provided at least one service exclusively to their own congregation, while 31% of congregations provide at least one service exclusively to the community. Over fifty percent of congregations provide direct service to both. This table illustrates that, with the exception of the services of a parish nurse, all direct services are more frequently offered to both congregation and community than as a service to congregational members. A statistical analysis was performed to better understand which congregational characteristics best predict direct health care service provision. Once again, larger congregations (higher average attendance) predicted provision of greater numbers of direct service programs. Controlling for all other factors, suburban and urban downtown congregations provided significantly more direct service programs. Rural congregations offered fewer such programs. In the case of rural communities, the existence of both larger congregations and direct service provision may be in inverse relation to need. Neither denominational affiliation nor the predominant race of the congregation had a significant effect. Who Receives the Direct Services? The survey explored the balance between the provision of direct service to “congregation only” or to the community. An attempt was made to assess the congregational characteristics that best predict a “congregation only” orientation. Again, larger congregations were less likely to emphasize “congregation only” services. Downtown urban congregations were also significantly less likely to emphasize “congregation only” services as they were to offer programs for the wider community. Rural congregations had more direct services for the “congregation only” as opposed to services provided to the wider community. No significant effects of race, denomination or region were observed. Table 7 displays the pattern by which congregations offer a variety of direct services to congregation members exclusively or to community members at large. The most significant finding is that services offered to both the broader community as well as congregation members is the most common practice of congregations offering direct services. The only exceptions to this pattern is with regard to the services of the parish nurse (and in the few cases in which a health minister, his/her services tend to be restricted to congregation members). This restriction is likely due to the practicability of limiting the work load of parish nurses and/or health ministers. Casting A Broad Net The 6,037 congregations reporting through the Congregational Health Ministry Survey do indeed cast a broad net in providing programs that meet local need. They include a tiny parish in upstate New York with two retired lawyers who volunteer to assist the elderly and migrant workers in completing health insurance and Medicaid forms to three Alabama congregations, which sponsor a free health clinic. Thousands of churches offer screening for diabetes, hypertension, vision, hearing and referrals to appropriate health facilities for follow-up care. Robust education programs assist homeowners in retrofitting homes to accommodate new physical restrictions, inform participants about blood and organ donation provisions, and a host of topics geared to meet the needs of parents of young children in safety-proofing homes, counseling teens regarding drug and alcohol use, and providing nutrition and exercise classes for senior citizens. Working with community agencies churches recruit, train and sponsor volunteers for hospitals, nursing homes and in home respite care. Large congregations in Chicago, Cleveland and Atlanta provide health care screening, dental clinics and referrals for clients at soup kitchens, homeless shelters and in drop in centers. Parish nurses educate, co-ordinate and enable congregational members and community residents in making lifestyle changes and in securing the medical and mental health services they need. In California and elsewhere church committees organize, petition, and invite governmental officials to public meetings to discuss gaps in the health care system and to explore ways to close such gaps through policy reform. Churches reach out to hospitals, build their own clinics and offer financial assistance to the uninsured facing medical calamity. In local communities large and small congregations are engaged in vibrant, innovative approaches to health care education, direct service provision and public policy advocacy. Drawing on congregational, community and denominational resources congregations in service to the wider community continue to cast a broad net in ministry to those in need. Counseling (Referrals) 32% 12-Step Program 32% Screening 27% Emergency Medical Funding 25% Exercise 23% Counseling (mental health) 22% Clinic 20% Counseling (provide service) 20% Support Group 20% Parish Nurse 18% Referrals 16% Daycare Health 8% Health Minister 5% Table 6 — Direct Services Taken as a whole, the patterns of service to congregation and community underscores the extent to which congregational involvement in health services is viewed by congregations as a ministry within the broader community rather than an intramural benefit of church membership. Advocacy As might have been expected, public policy advocacy was a far less common practice, although among the congregations who practice health care advocacy, there is a wide array of approaches to this activity. Advocacy can be understood as efforts to inform and/or urge action on health policies and practices on a systemic level, usually involving public officials. The variety and frequency of these advocacy activities is shown in Table 16. About a quarter of all congregations engaged in any form of advocacy. Of these, 60% of congregations (15% of all congregations) participated in two or more forms of advocacy. When hearing sermons on advocacy issues is included, fully 35% of congregations have one or more advocacy practices. A health advocacy scale was produced incorporating all advocacy activities except “hearing a health advocacy sermon”. Controlling for other characteristics, larger congregations, African American congregations, as well as suburban and downtown congregations were significantly more likely to engage in advocacy. White and rural congregations engaged in significantly less advocacy. Similarly some denominational differences in response were observed. Incorporation of whether or not the congregation heard sermons on health advocacy issues went hand in hand with an additional 17% of increase in congregational advocacy by itself. Furthermore, it eliminated the predictive significance of being an African American or suburban congregation. That is, African American congregations, or suburban congregations, are simply more likely to have heard sermons on advocacy, which we observed occurs together more often than expected with more advocacy activities. African American churches without a pastor who advocates are no more likely than Hispanic or Asian congregations to engage in advocacy. White congregations, even allowing for the effect of advocacy sermons, engaged in less advocacy. Larger congregations and downtown congregations engaged in significantly more advocacy activities, controlling for the role of sermons. In general regional patterns were not observable with the exception of California. At the time of the survey California was engaged in a statewide reform effort with regard to health care coverage. This timing may account for the finding that the California churches in the sample engaged in advocacy substantially more than the sample as a whole. This performance was 11% above the mean in the sample as a whole. Why Do Some Congregations Engage in Health Care Ministries and Others Do Not? As has been suggested by several of the findings above, size of congregation has been shown to be a significant factor in predicting congregational engagement in education, direct service or advocacy activities related to health care. But size alone is not sufficient to predict broad and multifaceted embrace of health care as a field of ministry activity. Our reflection on both the statistical analysis and the substantial anecdotal information that was received with the returned surveys suggests a more complex confluence of factors. These factors, taken together might be described as capacity, leadership and opportunity. Capacity often comes with size especially as relates to organizational coherence, financial and human resources and a congregational orientation toward active programming in addition to the worship activities of the congregation. Capacity is also measured in terms of the stature of the congregation within the community and whether it is looked to within Table 16 - Advocacy Heard Sermons 19% Discuss Policy 11% Voter Education 10% Communicate with Government 10% Meeting with Health Institutions 10% Letters 7% Petition 6% Internet 5% Rallies 3% Other 3% None 44% the community as a source of community service and programming in relation to issues such as child care, feeding programs or homeless shelter. Congregational literature often emphasizes the “200 mark” of membership above which programming becomes not only expected but critical to institutional membership. While there are considerable and notable exceptions to this rule of thumb, these data corroborate this tendency especially in provision of direct services beyond the congregational membership. Finally, capacity may be understood in terms of congregational self perception of having skills and or services sufficient to address needs within the complex world of health care. Even small congregations with members willing and able to assist others in completing complex insurance forms or schedule transportation to a series of medical treatments, is in possession of considerable capacity. Leadership appears to be a critical element in congregational provision of education, direct service and policy advocacy activities. The study strongly suggests the importance of pastoral leadership in enabling congregational participation in policy advocacy. With regard to health education and direct service provision as well as advocacy activities, a number of other sources of leadership were noted in the anecdotal material. Parish nurses, and far less commonly, health ministers too, provide crucial leadership in forming and maintaining health initiatives within congregations. A surprising number of other sources of leadership for congregations in their pursuit of health care activities were identified. Denominational staff or coordinators specifically focused on health ministries were commonly recognized as resources. While there is by no means such a role identified in each denomination, in those instances in which there are such persons, local congregations look to them for assistance and leadership. That leadership comes in both print and electronic materials, conferences and especially in identification of experience- based or “best practice” models. Leadership is also sometimes available from local ecumenical agencies focused on health care and operates across denominational lines often in relation to local or state councils of churches. Finally, leadership comes from key lay persons within the congregation with specialized health care knowledge. Numerous comments within returned surveys highlighted the leadership roles of retired doctors, nurses, medical technicians and social workers initiating and staffing various programs of education and direct service. The role of key lay leaders in making health ministry happen in congregations, how laypersons interact with the pastor, how voluntary involvement translates into programming, are undoubtedly fruitful areas for further research. Opportunity might express a final critical element in relation to congregational provision of health care programs of education, direct service and advocacy. This matter of opportunity is related to leadership but is also closely related to awareness of health needs in the specific community surrounding the congregation. Opportunity seems to present itself through a variety of means judging from the anecdotal responses from the sample. Health events initiated by a municipal office or neighboring hospital may serve to quicken a congregation’s awareness of the need for greater education about diabetes or hypertension, for example. Cover the Uninsured Week has been instrumental in calling the FUNDING HEALTH CARE MINISTRIES Respondents were asked to identify the sources of financial support for their various health ministries. This portion of the survey was not designed to match specific funding sources with particular health ministries. Rather, we sought to have respondents identify all sources of support for their health care ministries. This approach resulted in rich anecdotal evidence rather than a statistical analysis. Congregations appear to have a rather entrepreneurial spirit developing the financial support they need to underwrite the particular health ministries. In addition to the congregational budget; “special offerings,” donor givings, community funding sources were reported as sources of support. Frequently “state sources” of funding were identified with a wide array of specific programs noted such as state office for older adults, Title XX (related to child care health programs), recovery monies (from Gulf Coast state referring to Katrina recovery efforts, alcohol and drug programs offered by the states was also reported. Support for congregational programs comes also through in-kind contributions. This may take the form of printed materials or professional services. Such in-kind contributions congregations report receiving from local and state health offices, American Red Cross, local hospitals, medical and dental schools and donated transportation from a local bus company. Of particular mention were electronic and print resources as well as encouragement and technical assistance from their respective denominational offices. In short, local congregations tap a number of diverse sources to garner the financial support they need to establish and minister their health care ministries. In doing so, the congregations form partnerships with governmental educational and charitable organizations within their communities as well as obtaining contributions of funds or material from their respective denominational sources. What are the implications of this study? The rich fabric of congregational involvement in health education, direct service and public policy advocacy hold numerous implications for institutions related to congregational ministry and/or to health care. Our purpose in reporting these data fully as represented in the tables is to enable these groups to examine the data and draw their own conclusions. The National Council of Churches and its member communions recognize in the findings of the study considerable confirmation that local faith based organizations can and do play an important role within the complex picture of health care in America. The study confirms, as well, the reality that congregations look to national denominational and ecumenical structures for a variety of institutional supports related to these ministries. National denominations and ecumenical agencies will likely wish to review and strengthen their respective relationships with congregational health ministries in a number of ways which may include: .... Creation and/or maintenance of networks of congregations engaged in health ministries. .... Establish or strengthen national staff structures which relate to health-engaged congregations. .... Development of electronic communications and print and electronic resource materials. .... Consider incentives to congregations to explore involvement in health care ministries through time limited “health events.” .... Sponsor conferences, perhaps ecumenically, to advance training, provide resources and to nurture these ministries. .... Prepare and disseminate sermon resources related to the health care system and policy reform. .... As health care public policy debates arise in the national agenda, denominations working together, will want to draw from the lived experiences of local congregations in providing testimony regarding the unmet health care needs of the communities they serve. .... Denominations will likely wish to reason together about the ways to celebrate, augment and extend to more congregations the kinds of health care efforts reported in this study. .... National church agencies will surely want to learn more about congregations that did not respond and what prevents them from engagements in health care ministries within their communities. .... A related inquiry may address the question of what types of local planning and coordination bodies (committee, deacons, pastor alone, etc.) best address the kinds of decision-making that results in effective health programming. .... Acting together denominational agencies will want to learn more about the kinds and types of organizations which partner with congregations on the local level and, as may be appropriate, explore the nature of the relationship at the national level between such organizations. Attention of congregations to the needs of those--within both congregation and community--who skip medical appointments or fail to have prescriptions filled when they lack insurance coverage. Sponsoring or serving as volunteers at homeless shelters often awakens congregational awareness of chronic physical and mental health needs among that population. This awareness, in fact, becomes opportunity for service as congregational members seek to find ways to address unmet needs. It is not uncommon for congregations to discover holes in the fabric of the health care system and seek to address such needs directly through preventative education, medical services or advocacy. Within congregational life then, capacity, leadership and opportunity, it seems form a kind of “fire triangle” which best explains the combustion that results in congregational initiation of health care ministries of education, direct service and advocacy. The form which that initiative takes is unique to the community and to the congregation. The patterns of activity that were reported in this sample are highly differentiated and conform to few norms. Health ministries are undertaken by congregations alone, with other congregations or in partnership with secular organizations in relation to a dizzying array of health issues and needs. Some are directed primarily to meet the needs of congregational members and others are offered without cost to any in need. Some are complex and expensive operations, which require extensive financial support garnered often from sources outside the congregation. Other programs are operated entirely within the modest budgets of the church. While no questions on the survey addressed the longevity of congregationally based health care programs, anecdotal information suggests that such programs are expanding in size and moreover, that the number of congregations finding health care services as a part of their own sense of mission is growing. Local and state health departments may see within the findings of this study potential for working in partnership with local congregations to reach underserved populations. Congregations themselves may draw some satisfaction from the multifaceted health ministries highlighted by this study and may adapt or expand their own practices. Policy advocates should be heartened to discover the willingness and capacity of local congregations for advocacy activities and may want to ask how this capacity can be maximized within state and national public policy debates. Researchers might well find in this study a rough mapping of the terrain of health care among diverse congregations and seek to further explore matters such as how the programs began and how they are maintained, as well as the number of persons served and approximations of the aggregated financial value of such programs within the national health care economy. High priority should be given to the development and application of research which might effectively explore minority and marginalized communities where health disparities are acute. Too, they may wish to inquire as to the training, record keeping and substance of the advocacy activities in congregations. In the present national moment it is likely that adequate health care policies will only be established through a thorough and well framed national debate. Communities of faith bring with them not only years of experience in meeting health needs locally but a commitment to the common good. The findings of this modest study might well make a contribution in heightening awareness, providing evidence of the kinds of needs that have not been met under current policies and especially in identifying thousands of congregations and tens of thousands of volunteers who daily step forward in acts of kindness to secure a better future for others. To the degree this study has provided them with a voice in this important societal debate, we are grateful. Table 1 — Number of responses, by Denomination Denomination Name Number of Returned Surveys The United Methodist Church* 2516 Presbyterian Church (U.S.A.)* 1240 Evangelical Lutheran Church in America* 956 United Church of Christ* 743 Episcopal Church* 172 Missing, Ambiguous, or Unknown Group 164 American Baptist Churches in the U.S.A.* 43 Progressive National Baptist Convention, Inc.* 39 Church of God (Anderson, Indiana) 38 The Church of God in Christ 37 Others 217 |
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