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CCIH 2012 Conference, Plenary 2, Jonathan Quick, Janneke Quick, Chronic Disease, Biblical Wisdom, Longevity
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CCIH 2012 Conference, Plenary 2, Jonathan Quick, Janneke Quick, Chronic Disease, Biblical Wisdom, Longevity

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Dr. Jonathan Quick and Janneke Quick discuss the growing epidemic of non-communicable diseases and the Biblical wisdom behind developing healthy habits.

Dr. Jonathan Quick and Janneke Quick discuss the growing epidemic of non-communicable diseases and the Biblical wisdom behind developing healthy habits.

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  • ABSTRACTChronic Diseases, Biblical Wisdom, Longevity: The Epidemiology, The Word, The Evidence. This session will weave together three inter-dependent realties: the magnitude of the accelerating chronic non-communicable diseases epidemic in low and middle income countries (LMIC), wisdom on healthy living that dates to the opening books of the Bible, and the growing body of evidence linking faith and longevity. The chronic diseases epidemic in LMIC is of staggering proportions, the NCD divide between rich and poor countries is deadly, on current trends the problem will get worse before it gets better, and the economic impact rivals the human impact is huge. The web of risk factors and often complex treatments requires a fundamentally different global health approach. Biblical wisdom from Moses’ 3500 year old preventive health instructions, to Christ’s numerous healing miracles, to Paul’s recognition of self-control as one of the fruits of the spirit provides lessons that speak as clearly to use today on the value of personal health and importance of healthy living. Evidence on faith and longevity provides practical insights for global health. We pray, attend church, perform acts of service and practice other habits of faith. But do we live healthier or longer lives as a result? We will look at now voluminous scientific evidence linking faith, chronic disease risk factors, emergence of clinical disease, and longevity. Together these three stands provide a pragmatic spiritual basis for tackling the most daunting challenge to date for global health.
  • The chronic diseases epidemicin LMIC is of staggering proportionsthe NCD divide between rich and poor countries is deadlyon current trends the problem will get worse before it gets betterthe economic impact rivals the human impact is hugeweb of risk factors and often complex treatments requires a fundamentally different global health approachCan faith helpBiblical wisdom from Moses’ 3500 year old preventive health instructions to Christ’s numerous healing miracles, to Paul’s recognition of self-control as one of the fruits of the spirit the Bible provides lessons that speak as clearly to us today on the value of personal health and importance of healthy living. Evidence on faith and longevity provides practical insights for global health We pray, attend church, read our Bible, perform acts of service and practice other habits of faith But do we live healthier or longer lives as a result? We will look at now voluminous scientific evidence linking faith, chronic disease risk factors, emergence of clinical disease, and longevity.
  • Let me take us to southern Africa for a moment.  To Salima, Malawi, not far from the expansive Lake Malawi – or more properly Lake Nyasa. For three years, our colleague Lucy Sakala has helped counsel people seeking HIV tests at the District Hospital. She was employed by MSH as part of our efforts to support the government’s health system. Sakala is 28, married and the mother of an 8 year old girl.  She loves her job, but a year ago she was diagnosed with uterine cancer. She has had chemotherapy and surgery, which have sapped her energy and at times been painful. In the counseling sessions for people who have tested positive for AIDS, she sometimes tells people about her illness. “I tell them they should live positively,” she says. “There are things worse serious than HIV – like some cancers.” And I tell them I have cancer, and it’s difficult. But I live positively.  Even as she speaks she is thinking of the yesterday’s seven-hour round-trip to the nearest city to see her doctor. He says she needs more chemotherapy and advised her to go Zambia to receive radiation therapy. Sakala doesn’t have the money for either.  It seems a cruel paradox that those caring for patients with AIDS – for whom so much has been done in the last decade – should themselves suffer and die from diseases that have been around far longer than AIDS – and that may be entirely curable. In a very real way, this paradox lies at the heart of this week’s UN High Level Meeting on Non-Communicable Diseases.
  • ‘Big 4’ chronic diseases = heart, lung, cancer, diabetes‘Big 4’ risk factors account for 8 million annual premature (<age 60) deaths in LMCs (tobacco, diet, alcohol, inactivity) (vs 6 million from AIDS, TB, malaria)
  • Urbanization in Africa has doubled overweight/obesity in reproductive age women in Ethiopia, Benin, Kenya, Ghana and reaching over 40% in NigeriaThese interventions would reap enormous economic and human benefitsDespite this, NCDs receive only 0.9% of health official development assistance
  • 2004 2030NCDs 10 M 17 M nearly doubleHIV, TB, 10 M 5 M cut in halfmalaria, other communicable Maternal, 4 M 3 MperinatalAccidents 2 M 4 MinjuriesWill require a very different approach
  • PLEASE ADD to Rest slide (slide 16): The Lord is my shepherd, I lack nothing. He makes me lie down in green pastures,he leads me beside quiet waters, he refreshes my soul.  Psalm 23: 1-3 PLEASE ADD to Moderation slide (slide 12):I came that they may have life, and have it abundantly.  John 10:10
  • From this coming Monday’s Time Magazine (June 11, 2012)What is The Daniel Plan?So whether you eat or drink, or whatever you do, do it all for the glory of God. 1 Corinthians 10:31 The Daniel Plan is not just another "diet". It’s a lifestyle based on the biblical story of Daniel, who forsook the king's rich food in order to honor God's best for him and his friends. The Daniel Plan focuses on "The Simple Six" Core Principles, including the following: CONNECT for Success - Get in touch with your health and with others!RELY on God's Power - Willpower is not enough. You need God's power.EAT Delicious Whole Foods - Imagine the Garden of Eden as your food source.MOVE Your Way to Health - Get going. The more exercise, the more energy!THINK Sharper and Smarter - Better brain health = better life!HEAL for Life - Make a game plan for permanent changes that heal.The Daniel Plan includes guidance from three world-class medical authorities and other wellness professionals, including:Functional medicine specialist Dr. Mark HymanBrain health expert Dr. Daniel AmenHeart surgeon Dr. Mehmet Oz
  • Sabbath rest is about not working, but also about the fellowship of coming together for worship and community events. “A change is a rest.”The Lord is my shepherd, I lack nothing. He makes me lie down in green pastures,he leads me beside quiet waters, he refreshes my soul.  Psalm 23: 1-3
  • 27 of Jesus’ 37 miracles were healing (23) or raising from the dead (3)In Matthew and Mark, a healing was the first reported miracle
  • 98% of the 263 centenarian interviewed by the National Geographic team Faith - Community – Belonging - Sabbath restClockwise from upper left:Faith and Purpose - When she turned 100, Marge Jetton renewed her driver’s license for another five years. But what truly keeps her going, she says, is her Christian faith. The church encourages and provides opportunities for its members to volunteer. Centenarians like Jetton stay active, find sense of purpose, and stave off depression by focusing on helping others.Daily exercise – Here, 94-year-old Marion Westermeyer emerges from his daily swim in Loma Linda. “I've always needed exercise," says the Seventh-day Adventist. Regular, low-intensity exercise like daily walks appears to reduce the chances of having heart disease and certain cancers. Maintaining a healthy body mass index (BMI) is also important. Adventists with healthy BMIs who keep active and eat meat sparingly, if at all, have lower blood pressure, lower blood cholesterol, and less cardiovascular disease than heavier Americans with higher BMIs.Lifestyle for longevity/Greece – The lifestyle of Ikaríans like Eleftheria Gaglia (above) has helped them become some of the longest-lived people in the world. Even the tradition of the afternoon nap may contribute to such longevity. Daily naps have been shown to lower the risk of heart disease and the likelihood of depression—and to increase happiness.Sense of Purpose /Costa Rica – A senior Nicoyan woman relaxes for a portrait. After waking up at 4 a.m., she bakes tortillas for a couple of hours and walks five miles to the village to sell them. In addition to keeping hard at work, successful centenarians have a strong sense of purpose—a plan de vida for the Nicoyans. They feel needed and want to contribute to a greater good.Family / Sardinia – Women gather at a church during a festival. In Sardinia, elders are celebrated and family is revered. Grandparents can provide love, child care, financial help, wisdom, and expectations and motivation to perpetuate traditions and push children to succeed in their lives. By turn, elders feel a sense of belonging in their families and communities. They live at home, where they’re likely to receive better care and remain more engaged than they would in a nursing home or assisted-living facility.Paying Respects – The ritual of daily offerings to ancestors is a cornerstone of spiritual life on Okinawa. Here, the Ishigaki family worships their ancestors at the family tomb on the Okinawan island of Taketomi. Once a year, families on Taketomi gather to worship their ancestors with a feast for the living as well as the dead.“All but five of the 263 centenarians we interviewed belonged to some faith-based community.  It doesn’t matter if you’re Christian, Buddhist, Muslim, Jewish or some other religion that meets as a community.  Research shows that weekly attendance at faith-based services will add 4-14 years of life expectancy.” Buettner, Dan (21 April 2009) [2008]. The Blue Zones: Lessons for Living Longer From the People Who've Lived the Longest National Geographic.
  • Blue Zones Costa Rica Quest Day 7 - What role does religion play in longevity? Juan and Simona Guevarra of Nicoya, Costa Rica help us explore the complex link between longevity and faith.
  • In 70% of the 2/3 of medical schools offering courses, they were required
  • In US: Most commonly used form of complementary and alternative medicine (CAM). 2002 National Health Interview Survey.United Arab Emirates (UAE) Afghanistan – For community-dwelling seekers of emotional support in a war zone, 98% turned to Allah, 81% to family
  • D.E. Hall, "Religious Attendance: More Cost-Effective Than Lipitor?" JournaJ of the American Board of Family Medicine 19 (2006): 103-9.DE Hall, JABFM, 2006
  • Note the dose effect of attendance on risk factors.Definitions matter Religion = system of beliefs and practices observed by community, supported by rituals that acknowledge, worship, communicate with, or approach a Higher Power. Relies scriptures/teachings and a moral code.Spirituality = the individual connection with the transcendent or supernatural and search for ultimate meaning through religion, family, naturalism, rationalism, humanism, or the arts. HG Koenig, Medicine, Religion, and Health, 2008
  • Those attending more than weekly had 30% reduced mortality risk.Those attending weekly had nearly 20% reduced mortality risk.Reduced risk was explained in part by reduced risk factors associated Never <weekly weekly >weekly Female 46.6 51.7 60.3 60.0 OBJECTIVE: Few nationally representative cohort studies have appeared on frequency of attendance at religious services and mortality. We test the hypothesis that O weekly attendance compared with nonattendance at religious services is associated with lower probability of future mortality in such a study.METHODS: Data were analyzed from a longitudinal follow-up study of 8450 American men and women age 40 years and older who were examined from 1988 to 1994 and followed an average of 8.5 years. Measurements at baseline included self-reported frequency of attendance at religious services, sociodemographics, and health, physical and biochemical measurements.RESULTS: Death during follow-up occurred in 2058. After adjusting for confounding by baseline sociodemographics and health status, the hazards ratios (95% confidence limits) were never 1.00 (reference); <weekly 0.89 (0.75–1.04), p Z 0.15; weekly 0.82 (0.71–0.94) p Z 0.005; and O weekly attenders 0.70 (0.59–0.83), p ! 0.001. Mediators, including health behaviors and inflammation, explained part of the association.CONCLUSIONS: In a nationwide cohort ofAmericans, predominantly Christians, analyses demonstrated a lower risk of death independent of confounders among those reporting religious attendance at least weekly compared to never. The association was substantially mediated by health behaviors and other risk factors.R.F. GILLUM, MD, MS, DANA E. KING, MD, MS, THOMAS O. OBISESAN, MD, MPH, AND HAROLD G. KOENIG, MD, MHS. Ann Epidemiol 2008;18:124–129.
  • 12.15pm GMTJehovah's Witness mother dies after refusing blood transfusionShare 14EmailFred Attewillguardian.co.uk, Monday 5 November 2007 14.17 EST A 22-year-old mother died just hours after giving birth to twins because doctors were forbidden from giving her a blood transfusion as a Jehovah's Witness. Emma Gough's family, including her Jehovah's Witness husband, Anthony, 24, refused to overrule her wishes and she died after losing blood.In Child Deaths, a Test for Christian ScienceBy DAVID MARGOLICKPublished: August 06, 1990David and Ginger Twitchell, a Christian Science couple from Massachusetts who relied on prayer rather than on doctors as their young son lay dying from an obstructed bowel, were convicted of involuntary manslaughter last month. It was a stunning verdict, coming as it did in the very shadow of the Mother Church in Boston.But the death of 2-year-old Robyn Twitchell and the conviction that followed was only the latest of a number of successful prosecutions of Christian Scientists whose children died agonizing deaths after spiritual healing failed.The prosecutions, like many historic constitutional cases, represent a clash of apparent absolutes: of religious liberty and parental autonomy on the one hand and the right of the states to protect children - and the rights of the children themselves - on the other.
  • The magnitude of the growing chronic NCD epidemic in low income countries is stragering – Lucy Sakala is but one of millions of examples of that’s at stake for people in these countries. The Biblical wisdom on our bodies, our health and healthy living from Moses,the prophets, Christ, and Paul is more relevent than ever – and as powewrful as it has always been as evidenced by the life of Jim Williamson. What is The Daniel Plan?So whether you eat or drink, or whatever you do, do it all for the glory of God. 1 Corinthians 10:31 The Daniel Plan is not just another "diet". It’s a lifestyle based on the biblical story of Daniel, who forsook the king's rich food in order to honor God's best for him and his friends. The Daniel Plan focuses on "The Simple Six" Core Principles, including the following: CONNECT for Success - Get in touch with your health and with others!RELY on God's Power - Willpower is not enough. You need God's power.EAT Delicious Whole Foods - Imagine the Garden of Eden as your food source.MOVE Your Way to Health - Get going. The more exercise, the more energy!THINK Sharper and Smarter - Better brain health = better life!HEAL for Life - Make a game plan for permanent changes that heal. Three decades of research and over 1000 scientific studies confirm what National Geographic’s Dan Buettner has found in Simona’s town of Nicoya Costa Rica and the other “Blue Zones”: the evidence is growing that faith not only heals, but also lengths our healthy life span. While the practice of Faith – including regular church attendance – may be nearly as effective as exercise or lipid-lowering medicines, there will be many, many skeptics. Our role is not to be simply people of faith – but also people willing to share and use the knowledge that faith is a powerful force for healthy living and longevity.THANK YOU

Transcript

  • 1. Chronic Diseases, Biblical Wisdom, Longevity: The Epidemiology, The Word, The Evidence The pool at Bethesda, John 5:2-8Jonathan D. Quick, MD,MPH, President, Management Sciences for HealthJanneke C. Quick, Community Wellness Director, Live Well WinonaCCIH Annual Conference, June, 2012
  • 2. CCIH Biblical Wisdom for Global Health Series 2008: Lessons from Gods 1st Century Leadership Team for 21st Century Christian Health Organizations - Teams that lead: 1. Are aligned around a compelling vision and shared values. 2. Are strengthened through diversity in skills and backgrounds. 3. Grow by embracing challenges. 2009: Biblical Wisdom for Digital Living – Wired for Technology, Instructions Not Included 1. God has blessed us with boundless capacity to create technologies 2. Too often technologies separate, create inequalities, dehumanize 3. Scriptural wisdom can guide responsible use of technologies 2010: Injustice, Impact, Inspiration: Women, the MDGs, and Faith 1. Worldwide, women face stunning injustices in all areas of life 2. Women have dramatic positive impacts on human development 3. Faith inspires and empowers those combating injustice against womenManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 2
  • 3. Chronic Diseases, Biblical Wisdom, Longevity 1. Chronic NCDs: The Epidemic 2. Biblical Wisdom: The Word 3. Longevity: The EvidenceManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 3
  • 4. Dominic ChavezManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 4
  • 5. Epidemic of staggering proportions – Already leading cause of death in all but poorest countries Deaths in millions (2008) In low and middle income20 19.3 countries: Injuries • 28 million chronic NCD deaths Communicable, maternal, perin • Among children, youth, working15 atal, nutritional age adults – 8 million preventable Chronic NCD NCD deaths10 • 6 million from AIDS, TB, malaria 7.9 8 5.8 5.45 3.1 1.5 0.50 High Upper middle Lower middle Lower income income Source: WHO 2008 Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 5
  • 6. Stunning human impact of NCDs in low and middle income countries (LMICs) The NCD divide between rich and poor countries is deadly • Death from breast & cervical cancer = pregnancy & childbirth • A young diabetic will live 20 years with insulin – just 6 -18 months without On current trends the problem will get worse before it gets better • On the rise in LMICs, smoking will kill 1 billion people this century • Urbanization in Africa has doubled overweight/obesity in reproductive age women The human impact is huge – and so is the economic impact. • Total worldwide cost of chronic NCDs > U.S. $6 trillion in 2010. Potential impact of action is affordable and dramatic • Just 2%/year  in NCD deaths would save 36 million lives over a decade • Annual cost < $2 per person for 5 ―best buy‖ interventions targeting tobacco, salt, inactivity, alcohol, obesity, cardiovascular risks Adapted from: XXXXXManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 6
  • 7. An integrated, holistic response is require to combat the rise in chronic non-communicable diseases Number of Deaths for low income countries (each silhouette = 1 million annual deaths) 2004 2030 (projected)Chronic diseases(NCDs)HIV, TB, malaria,othercommunicableMaternal, perinatal, relatedAccidents andinjuries Chart based on WHO Global Burden of Disease, 2004, figure 15 Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 7
  • 8. Is there a role for religion in combating chronicNCDs? A web of risk factors and complextreatment Physical Age activity Cancer Diabetes Type 2 Gender Nutrition Blood Ischemic Education Overweight lipids Heart Disease Chronic Income Alcohol Respiratory Blood Disease Environ- pressure ment Smoking Mental Illness Stress Adapted from: WHO, Global Health Risks, 2009 Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 8
  • 9. Chronic Diseases, Biblical Wisdom, Longevity 1. Chronic NCDs: The Epidemic 2. Biblical Wisdom: The Word 3. Longevity: The EvidenceManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 9
  • 10. Jim Williamson – Healthy Vessels: A ChristianGuide for to edit Master title style Click a Healthy Lifestyle Motivation: Good biblical principles Health Recovery DeteriorationManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 10
  • 11. The battle of our health and happiness is a struggle of the „flesh‟ that can be won by living Click„spirit‟edit Master title style in the to Importance of caring for your body Therefore, I urge you, brothers and sisters, in view of God‟s mercy, to offer your bodies as a living sacrifice, holy and pleasing to God—this is your true and proper worship. Romans 12:1 Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? Therefore honor God with your bodies. 1 Corinthians 6:19-20 So whether you eat or drink, or whatever you do, do it all for the glory of God. 1 Corinthians 10:31Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 11
  • 12. An abundant life - Biblical wisdom for healthy living I came that they may have life, and have it abundantly.* 1. Moderation For the drunkard and the glutton shall come to poverty. Proverbs 23:21 But the Holy Spirit produces this kind of fruit in our lives: love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control. Galatians 5:22 Do you not know that in a race all the runners run, but only one gets the prize? Run in such a way as to get the prize. Everyone who competes in the games goes into strict training. They do it to get a crown that will not last, but we do it to get a crown that will last forever. 1 Corinthians 9:24-25Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 12
  • 13. An abundant life - Biblical wisdom for healthy Click to edit Master title style living 2. Nutrition And God said, “Behold, I have given you every plant yielding seed that is on the face of all the earth, and every tree with seed in its fruit. You shall have them for food.” Genesis 1:29 The fat of an animal found dead or torn by wild animals may be used for any other purpose, but you must not eat it. Leviticus 7:24 These are the regulations concerning animals, birds, every living thing that moves about in the water and every creature that moves along the ground. You must distinguish between the unclean and the clean, between living creatures that may be eaten and those that may not be eaten. Leviticus 11:46-47Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 13
  • 14. Daniel said ―no thanks‖ to a royal diet styleClick to edit Master title Daniel & King Nebuchadnezzar At the end of the ten days they looked healthier and better nourished than any of the young men who ate the royal food. So the guard took away their choice food and the wine they were to drink and gave them vegetables instead. Daniel 1:15-16Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 14
  • 15. The Daniel Plan – Rick Warren’s purpose- driven lifestyle plan (www.danielplan.com)Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 15
  • 16. An abundant life - Biblical wisdom for healthy Click to edit Master title style living 3. Physical Activity Physical training is good. 1 Timothy 4:8 To this you were called, because Christ suffered for you, leaving you an example, that you should follow in his steps. 1 Peter 2:21Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 16
  • 17. An abundant life - Biblical wisdom for healthy Click to edit Master title style living 4. Rest Six days you shall labor and do all your work, but the seventh day is a sabbath to the Lord your God. On it you shall not do any work. For in six days the Lord made the heavens and the earth, the sea, and all that is in them, but he rested on the seventh day. Exodus 20:9-11 Come to me, all you who are weary and burdened, and I will give you rest. Matthew 11:28Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 17
  • 18. An abundant life - Biblical wisdom for healthy Click to edit Master title style living 5. Healing A man with leprosy came and knelt before him and said, “Lord, if you are willing, you can make me clean.” Jesus reached out his hand and touched the man. “I am willing,” he said. “Be clean!” Immediately he was cleansed of his leprosy. Matthew 8:2-3 When Jesus had entered Capernaum, a centurion came to him, asking for help. “Lord,” he said, “my servant lies at home paralyzed, suffering terribly.” . . . Jesus said to him, “Shall I come and heal him?” The centurion replied, “Lord, I do not deserve to have you come under my roof. But just say the word, and my servant will be healed.” . . . Then Jesus said to the centurion, “Go! Let it be done just as you believed it would.” And his servant was healed at that moment.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 18
  • 19. A promise of edit healthClick to good Master title style He said, “If you listen carefully to the LORD your God and do what is right in his An abundant life eyes, if you pay attention to his 1.Moderation commands and keep all his decrees, I will not bring on you any of the diseases I 2.Nutrition brought on the Egyptians, for I am the 3.Physical activity LORD, who heals you.” 4.Rest Exodus 15:26 5. Healing Godly people find life; evil people find death. Proverbs 11:19Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 19
  • 20. Chronic Diseases, Biblical Wisdom, Longevity 1. Chronic NCDs: The Epidemic 2. Biblical Wisdom: The Word 3. Longevity: The EvidenceManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 20
  • 21. Do the Faithful live longer? Ask the Blue Zones centenarians, 258/263 of who were people of faithMarge Jetton Marion Westermeyer Eleftheria Gaglia Loma Linda, USA Greece Nicoya Costa Rica Ishigaki Family Okinawa,Japan Church Festival, Sardinia Source: D Buettner, The Blue Zones, 2009Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 21
  • 22. Blue Zone video clipManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 22
  • 23. Longevity and Faith – What is the state of evidence, science, practice, and public expectation? A steadily growing scientific evidence base  2001: 850 publications, 70% positive results, 60% quality methods  2012: 1200 publications, 80% positive results, 72% quality methods. Increasing professional interest  1992: 3 medical schools offered religion/spirituality courses  2006: over100 of 141 U.S. and Canadian medical offered courses Mismatch between needs, expectations and practice  70 to 80% of doctors believe spiritual factors influence a patient’s health  72% of advanced cancer patients said spiritual needs not met  10% of U.S. physicians report routinely talking to patients on spirituality Source:s HG Koenig et al, Handbook of Religion and Health, 2012;  <20% of patients report that a physicianReligion, and Health,spiritual 23-25 HG Koenig, Medicine, ever ask about 2008, pp.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 23
  • 24. “Market Share” – How commonly do peoplefrom different faiths use religion for health?United States – 42% overall, 62% cancer survivors use ―prayer for my own health‖Canada – Religious practice ranked fourth among six coping mechanisms for terminal cancer patients, AIDS patients, and general populationUAE – 100% of 38 parents with cancer in a child turned to their religionMorocco – 95% non-practicing believers among cancer patients started practicingMexico – 70% of 2097 doctors felt religious beliefs were importantTaiwan – Of 1031 hospital patients & family visitors, 76% prayed to their god/s, 45% to Buddha, 24% to Chinese folklore godsJapan – Among 305 cancer patients 17% believers, 17% unsure, 55% non- believersEurope – Daily prayer highest in Greece, Italy (54; 49%) lowest in Denmark, Sweden (21; 14%) Switzerland – 61-73% of children 10-12 yrs with health problems coped with religionManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 24
  • 25. What’s the evidence? Regular religious service attenders have 30 to 40% increased survival rates Six-year survival and religious attendance in 3,968 persons, ≥ 65 years 100Probability of Survival Once per week or more 90 80 Less than once per week 70 60 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 1986 1992 Days of Follow-Up Source: HG Koenig, J. Gerontology, 1999Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 25
  • 26. Cost-effectiveness – religious attendance better than statins (And after-effects that last forever!) Cost per life-year Intervention Additional life-years gained Weekly religious 2 to 3 $3000 - $ 10,000 attendance (a) Statin-type medications 2½ to 3½ $4000 to $ 14,000 for blood lipids (b) Regular physical 3 to 5 $2000 to $6000 exercise (c) Cost based on: (a) Average per capita contributions to religious institutions = $ 516 (b) Average yearly cost statin-type therapy = $836 (c) Annual cost of local gym membership = $500 Source: DE Hall, JABFM, 2006Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 26
  • 27. Mechanism of Action – How do religious practices increase longevity – especially from chronic NCDs? Personal factors  Source of social support – including church attendance (dose effect)  Relaxation response – prayer  Modifier of behavior – reduced risk behavior, increased positive behavior  Prosocial agent – altruism and volunteering Reduction in risk factors  Smoking  Alcohol consumption  Exercise/fitness  Nutrition/diet Increase in treatment effectiveness  Cancer treatment  Cardiac treatment Sources: HG Koenig et al, Handbook of Religion and Health, 2012;  Diabetes treatment HG Koenig, Medicine, Religion, and Health, 2008Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 27
  • 28. “Dose effect” – Frequency of church attendance and reduced risk / mortality Regular attendance at religious services versus selected baseline risk factors Never <weekly weekly >weekly prevalence (%) 60 Age-adjusted 50 50 40 31 30 24 25 21 20 14 17 9 10 0 Current smoking lcohol in past month physical activity social support A Low Low Source: RF Gillum, AEP, 2008. longitudinal study 8450 Americans, ≥ 40 years, 1988-1994, 8.5 years average follow-up.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 28
  • 29. Adverse Effects – Can some religious beliefs or over- reliance on prayer be harmful? Source:Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 29
  • 30. A role for religion in prevention and treatment ofchronic NCDs – tackling the web of risk factors Physical Age activity Cancer Diabetes Type 2 Gender Nutrition Blood Ischemic Education Overweight lipids Heart Disease Chronic Income Alcohol Respiratory Blood Disease Environ- pressure ment Smoking Mental Illness Stress Adapted from: WHO, Global Health Risks, 2009 Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 30
  • 31. Lucy The Epidemiology Jim The Word Simona The EvidenceManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 31
  • 32. Thank you Stronger health systems. Greater health impact. Saving lives and improving the health of the world‟s poorest and most vulnerable people by closing the gap between knowledge and action in public health.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 32
  • 33. Faith and Health  Have you seen faith in action for healthy living? In whom?  Was Paul right:: I do not understand what I do. For what I want to do I do not do, but what I hate I do. Romans 7: 15-16  How should this evidence drive/guide our programming decisions?  What are some specific strategies or interventions that could effectively address the risk factors of NCDs?  How can faith/religion/the church support a campaign to reduce NCD risk factors (alcohol, inactivity/obesity, smoking)?Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 33
  • 34. Resources on Religion and Health Web Resources //healthy-vessels.com/ //travel.nationalgeographic.com/travel/happiest-places/ www.bluezones.com/ www.tomorrowsworld.org/magazines/2001/may-jun/bible-principles-of-health www.tomorrowsworld.org/magazines/2001/mar-apr/are-you-walking-in-the- footsteps-of-christ Books  Medicine, Religion, and Health, HG Koenig, 2008  Healthy Vessels: A Christian Guide for a Healthy Lifestyle, J Williamson, 2009  Handbook of Religion and Health, HG Koenig et al, 2012Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 34
  • 35. Acknowledgements Harold Koenig, Duke University Laura van Vuuren, President, CCIH Henry Moseley, Johns Hopkins Jim Longhurst, Medway Village Church Fred Harburg, Harburg Consulting, Human Performance Institute Carol Meyer, Winona, MN Kelsey Nagel, Management Sciences for Health Barbara Ayotte, Management Sciences for Health Kate Onyejekwe, Management Sciences for HealthManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 35