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

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

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

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

Dominic ChavezManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 4

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blue Zone video clipManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 22

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

“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

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

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

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

“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

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

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

Lucy The Epidemiology Jim The Word Simona The EvidenceManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 31

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

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

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

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

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 Presentation Transcript