JHSH-V5n1-Spring-2015 - Tuskegee University

Volume V, Number 1 Spring 2015
Journal of Healthcare, Science
and the Humanities
and the Humanities
and the Humanities

Looking Back to Move Forward
National Center for Bioethics
in Research and Health Care
National Center for Bioethics
in Research and Health Care

Journal of Healthcare, Science and the Humanities Volume V, No. 1, 2015
Journal
of
Healthcare, Science and
the Humanities
Published by the National Center for Bioethics in Research and Health Care located at Tuskegee University.
The National Center publishes the Journal in friendship with the Smithsonian Institution.

ii Volume V, No. 1, 2015 Journal of Healthcare, Science and the Humanities
Preface
General Information
The Journal of Healthcare, Science and the Humanities is published by the National
Center for Bioethics in Research and Health Care at Tuskegee University. The Journal is
published in friendship with the Smithsonian Institution Office of Sponsored Projects. The
Journal was first published in 2009 by the former Navy Medicine Institute for the Healthcare
Humanities and Research Leadership. The Journal was transferred to the new publisher in
2012 as a private publication. The publisher today continues the mission of the Journal to
benefit international academic and professional development regarding health, health care, the
humanities, the sciences, and social justice. ISSN (print): 2159-8800. ISSN (online): 2159-8819.
Correspondence
Manuscripts are to be submitted to the Editor-in-Chief. Submission of a manuscript
is considered to be a representation that is not copyrighted, previously published, or
concurrently under consideration for publishing by any other entity in print or electronic form.
Contact the JHSH Editor-in-Chief for specific information for authors, templates, and new
material. The preferred communication is through email at jhsh@cryptyictruth.com or via
voice at + 1 (334) 724-4554.
Subscriptions
Beginning in calendar year 2016, the Journal will be available through a standard
subscription service. More information will be made available for the purchase of a yearly
subscription in calendar year 2015. For all editions of the Journal prior to the year 2016,
online copies are freely available at:Jhsh.cryptictruth.com. For more information at: Tuskegee
University National Bioethics Center in Research and Health Care, John A. Kenny Hall, 1200
W. Montgomery Rd., John A. Kenny Hall 44-107, Tuskegee Institute, AL36088.
Tel: + 1 (334) 724-4554.
Copyright Information
As a private sector publication, authors retain copyright for their articles; but grant
to the Journal an irrevocable, paid-up, worldwide license to use for any purpose, reproduce,
distribute, or modify their articles in their entirety or portions thereof. Articles prepared by
employees of the US Government as part of their official duties are not copyrighted and are
in the public domain. The Journal retains the right to grant permission to third party non-
commercial purposes only. Third party grantees, however, cannot further delegate their approved
usage to others etc. Third party usage must give credit to the Journal and the author (s). Opinions
expressed in the Journal represent the opinions of the authors and do not reflect official policy
of the institutions they may serve. Opinions in the Journal also do not reflect the opinions of the
publishers or the institutions served by members of the Journal Editorial Board.
The Journal of Healthcare, Science and the Humanities

Journal of Healthcare, Science and the Humanities Volume V, No. 1, 2015 iii
Preface
Journal Editorial Board....................................................................................3
Founders Advisory Board...............................................................................7
Contributing Authors...................................................................................... 11
From the Editor’s Desk..................................................................................17
Rueben C. Warren
Articles
Worldviews, Paradigms, and Liminal Spaces: Conflict and Compromise
in the Science and Spirituality Conversation................................................... 21
Shelley E. Brown
Health Optimism in the Face of Health Disparities: Exploring Self-Rated
Health and Chronic Disease Status among African American
Christian Congregants.....................................................................................29
Alicia L. Best, Mallory A. Bembry, Rueben C. Warren
Food Deserts in Upstate South Carolina: How Do We Both Ethically
and Sustainably Feed the Region’s Food Insecure?....................................... 37
Kenneth L. Robinson
Resilience in the Face of Injustice...................................................................53
De Fischler Herman
Public Health Injustices: “Media is the Message”............................................ 62
Joan R. Harrell
What Does One Do With a Master’s Degree in Bioethics?............................. 70
Elana Aziza, Nicole Devost, Christine McColeman, Gail A. Morris
Commemorating Legacy of Booker T. Washington................................ 83
Author Requirements.....................................................................................93
Table of Contents

Prepared by Graphic Arts and Publishing Services
at The Henry M. Jackson Foundation
for the Advancement of Military Medicine, Inc.

Journal of Healthcare, Science and the Humanities Volume V, No. 1, 2015 3
Preface
Associate Editors
Henry Findlay, EdD
Education, Cognition Science Distance
Learning
Tuskegee University
Lisa Hill, MA, PhD
American History
Tuskegee University
Moni McIntyre, PhD
Moral Theology
Duquesne University
Brendan Ozawa-de Silva, PhD, MPhil, MTS
Modern History, Philosophy, Theological Studies
Emory University
Theirmo Thiam, PhD, MA
Political Science, International Relations,
Comparative Politics
Tuskegee University
Roberta Troy, MS, PhD
Biochemistry, Molecular Biology,
Health Disparities
Tuskegee University
Malia Villegas, EdM, EdD
Culture, Community Studies, Education
National Congress of American Indians
Academic Review Committee Chair
TBA
Academic Review Committee Members
David Anderson, DDS, MDS, MA
Oral Health, Ethics & Health Policy
Pennsylvania Dental Association
David Baines, MD
Family Medicine, American Indian and
Alaska Native Health, Spirituality and Culture
Anchorage Neighborhood Health Center
University of Washington
Mill Etienne, MD
Neurology
Bon Secours Charity Health System
New York Medical College
Crystal James, JD, MPH
President/CEO
Crysalis International Consulting, LLC
Frederick Luthardt, MA, MA
Bioethics, Research Ethics,
Human Research Protections
John Hopkins University
George Nasinyama, BVM, MS, PhD
Epidemiology, Food Safey, Ecosystem Health
Makeree University
Michael Own, Med, PhD
History, Education, Human Research Ethics,
Research Integrity
University of Ontario Institute of Technology
Edward L. Robinson Jr, PhD, MA
Instructor
Fullerton College
Richard Wilkerson, PhD
Entomology
Smithsonian Institution
Executive Director
Rueben C. Warren, DDS, MPH, DrPH, MDiv
The Board of Governors
Tuskegee University Council of Deans
Interim Editor
Interim Senior Associate Editor
The Rev. Joan R. Harrell, DMIN Candidate, MDiv., M.S.
Assistant Senior Associate Editor
Wylin Wilson, PhD, MDiv. MS
Journal Editorial Board
(cont.)

4 Volume V, No. 1, 2015 Journal of Healthcare, Science and the Humanities
PrefaceJournal Editorial Board
Manuscript Editorial Committee
Members
Jere M. Boyer, PhD, CIM, CIP, CCRP
Clinical Microbiology, Molecular Biology &
Immunology, Infectious Diseases,
Tropical Medicine
Clinical Research Management, Inc.
Sydney Freeman, Jr, PhD
Higher Education Administration
Thomas C. Jefferson, MD, CIP
Pediatric Medicine, Health Care Ethics,
Literature and the Humanities
United Health Group
Copy Editing Intern
Jordan Harris
Chemical Engineering & Pre-Law
Tuskegee University

PrefaceJournal Founders Advisory Board
Mr. Ricky Allen
Dr. David Anderson
Mr. Garrett Anderson, Esq
Rev. Paul Anderson
Dr. L. Edward Antosek
Dr. Joshua Arthur
CDR Charmagne Beckett
Ms. Pamela Berkowsky
Dr. Bruce Boynton
Dr. Cedric Bright
Dr. Donna Burge
Dr. Fred Cecere
Ms. Mamie Clemons
Mr. Justin Constantine, Esq
Dr. Betty Neal Crutcher
Dr. Annette Debisette
Rev. Randall Ekstrom
Ms. Aynalem Etienne
Dr. Mill Etienne
Dr. Mohammed Fatoorechie and Family
Dr. Carol Fedor
Mr. Paul Finch
Mr. Mark Flores
Ms. Sharon Fullilove (In Memoriam)
Ms. Georgianne Ginder
Dr. Shirley Godwin
Mr. James Hanlon
Rev. Joan Harrell
Rabbinic Pastor De and Mr. Jan Herman
Dr. Elizabeth Holmes
Dr. Thomas Jefferson
Mr. George Jones
CAPT Marvin Jones
Dr. Anthony Junior
Dr. Patricia and Mr. Stephen Kelley
RDML (Ret) William Kiser
Mr. David Lash
RDML (Ret) Eleanor Valentin Larsen
Mr. Frederick Luthardt
Dr. Eric Marks
Dr. James Martin
Rev. Dr. Moni McIntyre
Dr. Adam McKee
Mr. David Mineo
LTC Craig Myatt
Rev. Andrew Ovienloba
RADM (Ret) Karen Flaherty Oxler
Dr. Steven Oxler
Dr. Brendan Ozawa-de Silva
Col Susan Perry
Dr. Clydette Powell
CDR James Rapley
Ms. Ann Marie Regan
Mr. Tony Richard
Dr. Thomas Roberts
CAPT Joel Roos
Dr. Margaret Ryan
Dr. Michaela Shafer
Dr. Jennifer Shambrook
Mr. J. Michael Slocum, Esq
Dr. William Kennedy Smith
Dr. Alexander Stojadinovic
BG (Ret) Loree Sutton
Mr. Shelby Tudor
Dr. Rueben C. Warren
Rev. Eric Wester
CAPT Moise Willis
Rev. Charles Wilson
Dr. Dorian Wilson
Mr. Daniel Winfield
Rev. Dr. Lorenzo York
Dr. Julie Zadinsky
The Founders
The Founders is a special advisory board to the Editor of the Journal of Healthcare, Science
and the Humanities. The Founders provide continual advisement to the Editor in three key
areas of development: New Areas for Publication, New Candidate Authors, and New Areas for
Mission Expansion.

Preface
Contributing Authors
Elana Aziza, MHSc Reg CASLPO, MHSc, (Bioethics) is a speech-language pathologist
practicing in oncology and acute care at University Health Network in Toronto. She practices
primarily with head and neck cancer patients, and includes assessment, support, treatment and
advocacy for patients who have communication and swallowing disorders. She is a lecturer
(status only) with the Department of Speech-Language Pathology, Faculty of Medicine,
University of Toronto.
Mallory Bembry, BS is currently a second year graduate student in the Master of Public
Health Program at Morehouse School of Medicine. She obtained her Bachelor of Science in
Plant Science Biotechnology at Fort Valley State University. She is currently completing her
Practicum Experience at HEALing Health Center, a federally qualified health center in Metro-
Atlanta. Her focus is on health education and promotion among underserved communities.
Upon graduation, Ms. Bembry plans to pursue a Doctor of Public Health degree.
Alicia Best, PhD, MPH is the Director of Research and Community Health at the HEALing
Health Center, a federally qualified health center that provides care to underserved populations
in Metropolitan Atlanta. She received postgraduate training in behavioral research with a focus
on cancer-related health disparities at the American Cancer Society and her research focuses on
understanding mechanisms through which behavioral, psychosocial, and cultural factors (e.g.
spirituality) influence health disparities among African Americans.
Shelley E. Brown, PhD, MDiv is a postdoctoral associate in the Department of Biological
Engineering at the Massachusetts Institute of Technology. Prior to MIT, Shelley received
a bachelor’s in Chemical Engineering from Stanford University, and a Masters and PhD in
Biomedical Engineering from the University of Michigan. She recently completed a Master of
Divinity from Harvard Divinity School, where she worked at the intersection of science and
religion, probing bioethical issues surrounding policy and research.
Nicole Devost MD, CCFP, FCFP, MHSc is a family physician solely practicing in Palliative
Medicine at Lakeridge Health, Oshawa, Ontario. She is an assistant professor with the adjunct
(group 1) academic staff in the Department of Family Medicine at Queen’s University for the
residency program and supervise residents for Palliative Care electives. She writes and develops
mulitple policies for the hospital in the domain of Palliative Medicine.
The Rev. Joan R. Harrell, MS, MDIV, DMin (cand) is an ordained American Baptist
clergywoman, womanist public theologian, graduate of the Columbia University Graduate
School of Journalism in New York City, award-winning broadcast journalist and television
documentary producer, and strategic external communications consultant for the National
Center for Bioethics in Research and Health Care at Tuskegee University.

Preface
De Fischler Herman is an ordained rabbi and spiritual director from the ALEPH: Alliance for
Jewish Renewal Seminary. She serves as chaplain for Capital Caring Hospice in Washington,
DC, ministering to patients, families and caregivers. She received her Clinical Pastoral
Education (CPE) certificate from Washington Hospital Center, the Level 1 Trauma Center
for the nation’s capital. Rabbinic Pastor Herman has served as distinguish faculty at four
Smithsonian Educational Ethics courses.
Christine McColeman RRT, BA, MHSc is a registered respiratory therapist working in acute
care at the Scarborough Hospital, Birchmount Division. She has been a practicing clinician for
32 years. During her years of practice she has encountered many challenging ethical dilemmas.
It was these situations that brought her to the Master of Health Sciences Program in Bioethics at
the University of Toronto. The depth and breadth of the program provided her with the ethical
framework needed to continue advocating for her patients providing the best possible care. She
functions as an “Ethics Facilitator” at her hospital and has assisted with Policy Revisions for
CPR/No CPR documents.
Gail A. Morris, BPE, MD, CCFP, MHSc (Bioethics) is a family physician in Markham,
Ontario. She is a lecturer in the Department of Family and Community Medicine with the
University of Toronto. In affiliation with the University of Toronto, she supervises and teaches
Family Medicine Residents at Markham Stouffville Hospital in Markham, Ontario. As well, she
is a member of her hospital’s Ethics Board and Research Ethics Board. She has participated in
policy development for her hospital in the areas of Research Ethics and End-of-Life Issues.
Kenneth L. Robinson, PhD is associate professor in the Department of Sociology and
Anthropology, Clemson University. He earned his Ph.D. in Development Sociology at Cornell
University, Ithaca, NY, a Master of Public Affairs from The University of Texas at Austin,
and his bachelor’s degree in Agricultural Economics and Rural Sociology from Clemson
University. He also served as a Fulbright fellow at the University of Zululand, South Africa.
His publications include Lori A. Dickes and Kenneth L. Robinson, Rural Entrepreneurship and
Chapter 30 in Rural America in a Globalizing World, edited by Conner Bailey, Leif Jensen and
Elizabeth Ransom Morganton, West Virginia: West Virginia University Press, (In-press).
Rueben C. Warren DDS, MPH, DrPH, MDiv is professor of bioethics and director, Tuskegee
National Bioethics Center in Research and Health Care. His full professor appointments are
at the following institution: the Interdenominational Theological Center, Morehouse School
of Medicine; Emory’s Rollins School of Public Health, Schools of Dentistry and Graduate
Studies, Meharry Medical College (MMC). He is the former Associate Director for Minority
Heath, Centers for Disease Control and Prevention and directed Infrastructure Development at
the National Institute for Minority Health and Health Disparities, NIH. He is Dean Emeritus,
School of Dentistry, MMC.

Preface
Message from the Interim Editor
Rueben C. Warren DDS, MPH, Dr. P.H., M.Div.
Professor and Director of the National Center
for Bioethics in Research and Health Care
Tuskegee University
Tel: (334) 724-4554
Email: warren@mytu.tuskegee.edu
The year 2015 provides an exciting array of historical and current events to celebrate the
legacy of Tuskegee University and the vision and mission of the National Center for Bioethics
Research and Health Care. Tuskegee University was founded in 1881 to provide training and
educational opportunities for Black children and adults to improve the well-being of the Black
population in the U.S. Booker T. Washington was the founding principal and president of
Tuskegee University, first known as Tuskegee Normal School, then Tuskegee Institute, and now
Tuskegee University. The National Center for Bioethics in Research and Health Care (Bioethics
Center) was mandated by President William Jefferson Clinton, as one component of the 1997
Presidential Apology for the U.S. Public Health Service Study of Untreated Syphilis in the
Negro Male at Macon County, Alabama. The U.S. Public Health Service conducted this study
at Tuskegee. The vison of the Bioethics Center is: Shaping the Future by Promoting Optimal
Health: The Future is NOW! The mission is: To enhance social justice and Optimal Health
of African American and other health disparity populations through research, education and
service in bioethics, public health ethics, health disparities and health equity. Both the vision
and mission of the Bioethics Center are 21st
Century outgrowths of the Tuskegee University.
This 2015 spring edition of the Journal of Healthcare, Science and the Humanities offers peer
reviewed articles that address public health concerns within the context of the theme, “Ethics
and Social Justice.” The articles derived from lectures that were delivered at the April 1- 4, 2014
Public Health and Ethics Intensive Course and Commemoration of the Presidential Apology
for the United States Public Health Syphilis Study.
The Journal highlights the trans-disciplinary imperative that the sciences, including health
science, must collaborate with disciplines in the humanities to address the broader issues
of individual, group and community based health and well-being. The topic areas in the
peer reviewed articles published in this edition range from resilience in the face of injustice,
food deserts in upstate South Carolina, the media and social media, spirituality and science
conversations, and health optimism in the face of health disparities. One of the articles addresses
the questions of value of the master’s degree in bioethics.
The year 2015 marks the 100th
year since the death of Booker T. Washington. One hundred
years ago in 1915, Booker T. Washington founded National Negro Health Week. Tuskegee
University is celebrating the many accomplishments of Booker T. Washington by hosting an
event each month during 2015. On April 17th
, Tuskegee University, the Centers for Disease
Control and Prevention and Morehouse School of Medicine will partner in co-sponsoring a

Preface
national forum entitled, “From Negro Health Week to Minority Health Month: 100 Years of
Public Health Progress.” The forum highlights the challenges and opportunities to improve the
health of African Americans and other health disparity populations. The vision is to move from
health disparities to health equity.
The articles in this edition should be read in the broader context of social justice through
an ethics lens. For example, 2015 is the 50th
anniversary of Bloody Sunday that occurred on
March 7th, and days later, Dr. Martin Luther King Jr. and many others marched from Selma to
Montgomery, nonviolently protesting for African Americans to have the right to vote in the Jim
Crow South. The year 2015 is also the 50th
anniversary year of the signing of the Voting Rights
Act. As we move forward to address the issues of social justice and various spheres of ethics,
the articles have expanded traditional ways health and bioethics are viewed by challenging the
reader to find common ground and synergies between the topic areas addressed in the articles.
The ethics challenges in the 21st
Century remain, however they sometimes must be researched,
investigated and critiqued within the context of a person or community’s social location such
as his or her race, ethnicity and or socio-economic class, in order to address meaningful and
long lasting resolve. Instead of focusing only on health disparities, curative care modality to
address disease, disability, dysfunction and premature death, consider a paradigm shift to health
promotion, domains of complementary and alternative medicine and health equity. Consider
physical and metaphysical constructs as complimentary, not competitive. It is important to note,
that health is one’s greatest state of aliveness; a journey, not a destination. The content of this
edition challenges the reader to embrace all dimensions of the human experience as they read
and reflect on the peer reviewed articles and resources included in this volume.

Preface

National Center for Bioethics in Research and Health Care

Public
Health
Ethics
Intensive
Course

“Ethics
and
Social
Justice”

And

Commemoration
of
the
Presidential
Apology
for
the

U.S.
Public
Health
Service
Syphilis
Study

Schedule
at
a
Glance

April
1-‐4,
2014

Tuskegee
University

Kellogg
Hotel
and
Conference
Center

TUESSDAY, APRIL 1, 2014

8:30
am

Registration
and
Continental
Breakfast

9:15
am
-‐
9:25
am

Welcome:

President
Matthew
Jenkins,
DVM

9:25
am
–
9:35
am

Mayor
Johnny
Ford

9:35
am
–
9:45
am

Chairman
Louis
Maxwell

9:45
am
–
10:00
am

Overview:

Reuben
Warren,
DDS,
MPH,
Dr.
PH,
MDiv

10:00
am
–
11:00
am

Science
and
Spirituality:
Conflict
or
Compromise?

Shelley
E.
Brown,
PhD,
MS,
MDiv

11:00
am
–
12:30
pm

Small
Group
Session

12:30
pm
–
1:30
pm

Lunch

1:30
pm
–
3:00
pm

Landscaping
Global
Public
Health
in
a
Social
Justice
Context
Beyond

Epidemiology

Bailus
Walker,
Jr.,
PhD,
MPH

3:00
pm
–
4:30
pm

Small
Group
Session

4:30
pm
–
6:00
pm

Tour

WEDNESDAY, APRIL 2, 2014


Public
Health
Ethics
Intensive
Course

“Ethics
and
Social
Justice”

And

Commemoration
of
the
Presidential
Apology
for
the

U.S.
Public
Health
Service
Syphilis
Study

Schedule
at
a
Glance

April
1-‐4,
2014

Tuskegee
University

Kellogg
Hotel
and
Conference
Center

TUESSDAY, APRIL 1, 2014

8:30
am

Registration
and
Continental
Breakfast

9:15
am
-‐
9:25
am

Welcome:

President
Matthew
Jenkins,
DVM

9:25
am
–
9:35
am

Mayor
Johnny
Ford

9:35
am
–
9:45
am

Chairman
Louis
Maxwell

9:45
am
–
10:00
am

Overview:

Reuben
Warren,
DDS,
MPH,
Dr.
PH,
MDiv

10:00
am
–
11:00
am

Science
and
Spirituality:
Conflict
or
Compromise?

Shelley
E.
Brown,
PhD,
MS,
MDiv

11:00
am
–
12:30
pm

Small
Group
Session

12:30
pm
–
1:30
pm

Lunch

1:30
pm
–
3:00
pm

Landscaping
Global
Public
Health
in
a
Social
Justice
Context
Beyond

Epidemiology

Bailus
Walker,
Jr.,
PhD,
MPH

3:00
pm
–
4:30
pm

Small
Group
Session

4:30
pm
–
6:00
pm

Tour


Preface

7:00
am
–
8:00
am

Continental
Breakfast

8:00am
–
9:00
am

Social
Justice
and
Native
Americans:
The
U.S.
Experience

David
Baines,
MD

9:00
am
–
10:30
am

Small
Group
Session

10:30
am
–
11:30
am

Interfacing
Science
and
Ethics
as
a
Social
Justice
Construct

Ralph
V.
Katz,
DMD,
MPH,
PhD

11:30
am
–
1:00
pm

Small
Group
Session

1:00
pm
–
2:00
pm

Lunch

2:00
pm
–
3:00
pm

Justice,
Food
Systems
and
the
Agricultural
Black
Belt

Ralph
Christy,
PhD

3:00
pm
–
4:30
pm

Small
Group
Session

4:30
pm
–
6:30
pm

Tour

THURSDAY, APRIL 3, 2014
8:00
am
–
9:00
am

Resilience
in
the
Face
of
Injustice

Rabbinic
Pastor
De
Herman,
RPSD

9:00
am
–
10:30
am

Small
Group
Session

10:30
am
–
12:00
pm

Social
Media
and
Social
Justice:
The
Media
is
the
Message

Joan
R.
Harrell,
MDiv,
MS,
Doctoral
Candidate

12:00
pm
-‐

1:00
pm

Lunch

COMMEMORATION ACTIVITIES
THURSDAY, APRIL 3, 2014
1:00 PM Presenter
6:00 PM Reception (By Invitation Only)
FRIDAY, APRIL 4, 2014
7:30 – 8:45 AM Breakfast (Auditorium Foyer)
9:00 – 11:30 Lecture & Panel Session (Auditorium)
COMMEMORATION KEYNOTE SPEAKER
12 NOON Luncheon (Ballroom)

Epidemiology

Bailus
Walker,
Jr.,
PhD,
MPH

3:00
pm
–
4:30
pm

Small
Group
Session

4:30
pm
–
6:00
pm

Tour


Articles
Worldviews, Paradigms, and Liminal Spaces: Conflict and
Compromise in the Science and Spirituality Conversation
Shelley E. Brown, PhD, MDiv
Massachusetts Institute of Technology
Department of Biological Engineering
77 Massachusetts Avenue
Cambridge, MA 02139
Email: sebrown@mit.edu
Author Note
The views expressed in this article are those of the author and do not reflect the official policy
or position of the faculty, staff, administration, students or any affiliated individuals with the
Massachusetts Institute of Technology or the Department of Biological Engineering. This
subject material is a collection of ideas presented in a lecture at the 2014 Tuskegee Public
Health Ethics Intensive (PHEI) Course.
Abstract
Correlative to the tremendous growth biomedical research has experienced over the past
decade, so too have theological responses and criticisms of the research proliferated within faith
communities. The history of the competing worldviews in the science and spirituality discourse
necessitates further dialogue about whether this conflict is met with compromise. As such, this
paper aims to discuss multiple perspectives from prominent scientists whom have developed
very intellectually satisfying and spiritually keen ways to overcome the conflict with compromise
by looking at the complementarity that exists. Moving forward on the ethical journey that
is biomedical research and its particular relevance to and resonance within minority faith
communities, the various worldviews and paradigms both communities uphold provide fertile
ground for interdisciplinary dialogue about scientific discovery and faith.
Keywords: Worldviews, science, spirituality, paradigm, evolution, intelligent design,
biomedical ethics
Introduction
In his book The Language of God, Dr. Francis Collins posits an important question
that frames the science and religion debate for the purposes of this paper:
“By opening the door of my mind to its [science] spiritual possibilities, had I started a war of
worldviews that would consume me, ultimately facing a take-no-prisoners victory of one or the other?”
The conflict is one that many see as a battle between ways in which people view the
world, and is ever so present at the nexus between science and spirituality. However, I believe
there are constructive ways that both communities can explore and create this liminal space
where multidisciplinary dialogue can take place in an effort to produce a paradigm shift in

Articles
the way both communities respond to each other. Does it have to be an “either-or” model,
or can we have a “both-and” paradigm? We are in need of understanding, common ground,
and reconciliation in this territory of conflict. Therefore, this paper seeks to contribute to
the efforts of rethinking and assigning new meaning to scientific and spiritual worldviews,
where faith in science and faith in God don’t have to be mutually exclusively held perspectives.
There is a delicate balance that can be struck in the liminal space between the two bodies of
thought where one does not have to be anti-scientific or anti-religious, but rather can embrace
that which is scientific and that which is spiritual. This liminal space, a threshold that we can
cross and enter into, is a place in between previously held worldviews and the possibility of
a new answer. It is the place of transition into a new mode of perceiving the natural and the
supernatural – the explainable and the unexplainable. The late Stephen Jay Gould, an American
evolutionary biologist and historian of science, coined the term “non-overlapping magisteria” to
refer to science and religion as being individually legitimate magisteria, or domains of teaching
authority. Many members of both the scientific and religious communities may hold Gould’s
worldview that the two domains are non-intersecting spheres. Where the magisterium of science
explains how the universe works, and the magisterium of religion explains why the universe and
life came about. Although there may not be one clear answer on how to develop a worldview
that is just as intellectually sharp as it is spiritually open, what is clear is that society operates
within the overlapping magisteria of science and religion. Therefore, it is of great importance
that we develop effective dialogue and carve out the liminal space that produces new paradigms
and standards for addressing the conflict and compromise within the science and spirituality
conversation. As Collins states, “we need to bring all the power of both the scientific and
spiritual perspectives to bear on understanding what is both seen and unseen”.
The unique position of being a scientist and ordained minister provides me the
opportunity to investigate this matter with the hope that society can enter into the liminal space
that exists between science and spirituality. I would like to lay the foundation for depolarizing
worldviews that position science and spirituality, which will be used interchangeably with the
term “religion”, on opposite ends of the spectrum. My intention is not to present ideological
arguments about the beginning of the universe or life on this planet; nor is it my goal to present
a case for or against specific biomedical technologies or advancements. Rather, this paper can
be read as an open invitation for all invested communities to enter into a respectful and honest
discussion over these issues. As scientists, religious leaders, ethicists, policymakers and the
public so often seem to talk past one another; I aim to present ideas from scholars that have
already begun the groundwork for developing new rules of engagement that are catalysts for
the aforementioned paradigm shift. My intention is to create a space where multiple groups
with diverse histories and perspectives can fruitfully engage with one another. I put forth
the assertion that this space is not only necessary for society as a whole, but is also within the
context of biomedical ethics, theological understanding, and social justice. In addition, I believe
it is paramount that minority faith communities need to consider the importance engaging
scientific and spiritual worldviews. With the understanding that neither the scientific nor
religious communities are monoliths, prevailing sets of beliefs upheld by both communities
will be discussed.

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BioLogos
“The need to find my own harmony of the worldviews ultimately came as the study of
genomes – our own and that of many other organisms on the planet – began to take off, providing
an incredibly rich and detailed view of how descent by modification from a common ancestor has
occurred.”
Dr. Francis Collins states this view as he addresses the topics of Darwinian evolution,
creationism, and Intelligent Design, and develops the idea of “theistic evolution”. Although
not widely referred to as such, it is the major position of scientists who are also Christians,
including Asa Gray who was a renowned 19th
century botanist and chief Darwinian supporter
and colleague. Collins goes on to suggest that a modest alteration of theistic evolution is to
rename it as “Bios through Logos”, or simply “BioLogos”. Where the Greek word for life,
bios, and the Greek word for “word”, logos, are combined to express “the belief that God is
the source of all life and that life expresses the will of God.” It is the theory that “evolution
could appear to us to be driven by chance, but from God’s perspective the outcome would be
entirely specified”. Therefore, we could take on the view that God has already orchestrated
every intricate detail and that, in fact, He is intimately involved in the formation of every living
species in the universe. If we embrace the Tillichian view that faith isn’t the opposite of doubt,
but rather doubt is an essential element of faith, then one can become more comfortable in
the uncertainties that inevitably exist in life. This is the basis upon which Collins builds the
case for science and faith in harmony. Since society historically defaults to conflict instead of
peace, the uptake of BioLogos into the lexicon of the science and spirituality discourse has
been unhurried. So how can BioLogos be seriously considered without being perceived as
committing violence to faith, science, or both? BioLogos stands to be one of those ideas results
from existing in the liminal space between worldviews, thus possibly being a catalyst for major
shifts in thinking and understanding.
Dr. Thomas S. Kuhn first published The Structure of Scientific Revolutions in 1962,
and in it he first introduced the concept of paradigm shifts in science. Then in The Road Since
Structure, a book published in 2000 that revisits a collection of essays Kuhn wrote regarding
scientific revolutions, he distinguished between two types of scientific development; normal
and revolutionary. The majority of scientific achievements build a growing body of scientific
knowledge and produce the former type of change – normal. However, “revolutionary change
is defined in part by its difference from normal change, and normal change is, as already
indicated, the sort that results in growth, accretion, and cumulative addition to what was
known before.” This type of change is inherently more problematic and jolting, and includes
scientific discoveries that cannot be accommodated within the paradigm in place. It is the type
of discovery that drastically alters the way an individual views, explains, and understands a set
of natural phenomena. Examples of these types of revolutionary changes throughout history
include: (1) The shift from the Ptolemaic geocentric cosmology to Copernicus’ heliocentric
worldview; (2) The paradigm change from Aristotelian physics, where matter is almost
dispensable, to Newtonian laws of motion and physics, where a body is constituted of particles
of matter; and lastly, (3) The introduction of evolution by Darwin.
Kuhn states “violation or distortion of a previously unproblematic scientific language
is the touchstone for revolutionary change.” These examples all inspire the altering of the
language with which the natural world is described, subsequently changing the language with

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which the scientific community explains nature. This also, at first glance, appears to challenge
the worldview of the Christian community. That is why Collins asserts that BioLogos is the
synthesis of a scientifically consistent and spiritually satisfying paradigm: one which allows for
“science and faith to fortify each other like two unshakable pillars, holding up a building called
Truth.” It does not try to impose God into the gaps in knowledge of our understanding of the
universe and the evolution of life, but rather it suggests God as the answer to the “meaning of
life”. The existentialistic questions that science was never intended to solve. Moreover, from
a faith perspective, BioLogos offers a solution to the uncertainty of interpretation of certain
Scriptural passages. It is not wise for sincere believers to rest the entirety of their worldview
on evolution solely on literal interpretation that does not allow room for uncertainty. Collins
does not believe that God, the Creator of the universe, “would expect us to deny the obvious
truths of the natural world that science has revealed to us.” The conflict between scientific
observations and religious belief, and how that relates to the human condition is one that will
not disappear into the background. Both the scientific and spiritual worldviews seek to discover
something external to ourselves. To understand the sacred and the secular overlap can prove
to be quite beneficial when trying to grasp the fullness of life and its great mysteries. Collins
asserts that while discovering a scientific truth can catapult a scientist into an experience that is
void of natural properties and causes, BioLogos can allow a person with scientific and spiritual
worldviews the opportunity to seek truth on multiple levels. However, the atheist view that is
held by many to be synonymous with the scientific worldview is that this feeling or belief in
something beyond ourselves is just an expression of joy, and is fueled by a longing to invent an
answer to our human existence that we want to be true. In contrast to this, Collins believes that
for the scientist-believer “both worshiping God and using the tools of science to uncover some
of the awesome mysteries of His creation” is vital and necessary for the synthesis of the scientific
and spiritual worldviews.
As such, Collins cautions both scientists and Christians alike. His belief is that we
are on dangerous ground when we take a hardened and steadfast position on either end of the
spectrum. Whether naturalists believe that a Creator God is an outmoded superstition, or
Christians believe that technological advances threaten the existence of God, both choices are
profoundly perilous. This points to the fact that perhaps it is time to embrace the “both-and”
paradigm; it is time to make the shift from “either-or”. Collins states that “both deny truth…
both diminish the nobility of humankind…and both are unnecessary.” The same God of the
Bible is that of the genome, and He can be worshiped in a sanctuary and in a laboratory.
Evolutionary Creationism
“This is a book written by someone who is passionate about both science and the Bible,
and I hope reading it will encourage you to believe, as I do, that the ‘Book of God’s Word’ and the
‘Book of God’s Works’ can be held firmly together in harmony.”
The above is an excerpt from Creation or Evolution: Do we Have to Choose by Dr.
Denis Alexander, in which he discusses how evolution has been “used and abused for various
ideological and political reasons” throughout the past century. In response to that he probes
questions such as: (1) In what ways can we invoke the presence and works of God when it comes
to major fundamental questions about the universe?; and (2) Have we considered the possibility
that science was never intended to be able to answer such questions about the origins of the
universe, life as we know it, or the human experience after death?

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He first begins by dispelling the myth that in the Origin of Species, Charles Darwin
“unleashed a sinister plot to subvert belief in a Creator God”. Evidence actually suggests that
Darwin was not atheist and that his personal inclinations led him to believe that “there is
grandeur in this view of life, with its several powers, having been originally breathed by the
Creator into a few forms or into the one.” Alexander also points out that later in life, Darwin
was quoted to have said that is entirely possible to be ‘an ardent Theist and an Evolutionist’.
Given the “rapid baptism of evolution into the Christian doctrine of Creation in the late 19th
and early 20th
centuries”, it is quite curious as to why a belief in evolution now demands atheism.
He suggests that ideological transformations of biology as it relates to the big theories such as
Big Bang cosmology and evolution have occurred because the public consciousness changes
the actual meaning of the label given to the theory itself changes. “Theory ‘X’ becomes socially
transformed into ‘Theory Y’ with all kinds of philosophical barnacles attached to it”. So much
so that the work it takes to remove these barnacles is continuous. Therefore, in an effort to
rectify this within the evolutionary debate, Alexander suggests that a better route was taken
by Bible-believing Christians such as B.B. Warfield and Asa Gray. Evolutionary creationism
provides the opportunity to “fully accept the authority of Scripture and the biblical doctrine
of creation, but [traces] God’s providential purposes and handiwork throughout the long
evolutionary process”. Although there may be gaps in our understanding of what God continues
to do in His creation, there are no gaps with God’s interaction with the world and human affairs.
If one were to look at the Genesis text as “an evolutionary narrative thread which describes
how God brought biological diversity into being and continues to sustain it all moment by
moment”, then evolution can be brought into the fold in our Christian worldview. This is not
a new concept, but rather a reintroduction of it by Alexander. He is careful to present this idea
with the disclaimer that he is not concluding that the adoption of “evolutionary creationism
resolves at a stroke all the problems”, but rather that “it provides a well-justified framework for
continuing to hold together the book of God’s Word and the book of God’s works in ways that
does justice [and not violence] to both.”
To further emphasize this point, it is prudent to visit the position that Dr. Owen
Gingerich, world renowned astronomer and historian of science at Harvard University,
presents on the cultural attitudes that help shape both scientific and religious worldviews. In
his book God’s Planet, he unfolds a compelling narrative that intertwines his Christian faith
and in depth knowledge of the cosmos. He addresses the conflict of the scientific and spiritual
worldviews by positing the idea that the magisterium of science alone is not independent, but in
fact overlaps with the magisteria of religion and culture. By addressing fundamental questions
about the planets and how life has evolved on Earth, he unearths the falsehood that science and
religion should be kept mutually exclusive and separate. He presented his argument on how the
magisteria have been repeatedly overlapped in the past few centuries by questioning whether
Copernicus correct in replacing the Earth with the sun at the center of the universe; whether
Charles Darwin was correct with his epoch-making book, On the Origin of Species; and whether
Fred Hoyle was correct with his steady-state cosmology that suggested continual creation with
no beginning and no end. Gingerich concludes that “the physical constants have been fine-
tuned to make intelligent life in the universe possible and that this is evidence for the planning
and intentions of a Creator God.” Furthermore, it is his scientific understanding of the fine-
tuning of physical constants in the universe that supports his theological understanding that
“the heavens declare the glory of God.” Accepting a Creator God as a final cause for “why the
universe seems so congenially designed for the existence of intelligent, self-reflective life” is not

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necessarily proof, but it propels us further into the liminal space where the explainable and the
unexplainable live in harmony. Near the conclusion of his book he states:
“And finally, I hope that in these chapters I have persuaded you that what is accepted
today as science is commonly colored by personal belief, including our religious or our
antireligious sentiments. If someone tells you that evolution is atheistic, be on guard.
If someone claims that science tells us we are here by pure chance, take care. And if
someone declares that magisteria do not overlap, just smile smugly and don’t believe it.”
With the arguments that Dr. Collins, Dr. Alexander, and Dr. Gingerich put forth,
society would be hard pressed to deny that the conflict that is present within the worldview
debate needs to be revisited, revamped, and reversed.
Conclusion:
The Critical Need for Paradigm Shifts of Worldviews
When biomedical research produces knowledge that raises new theological questions,
the religious community (and society as a whole) is challenged to develop definitive boundaries,
ethical paradigms, and theological responses to new medical treatments and information about
our natural world. As society forges pathways to partnership on a multitude of issues, instead
of letting failures and controversies drive reform, it is prudent to learn from past mistakes and
develop ways to collaborate on addressing salient bioethical, policy, and religious issues. The
recommendations for collaborative partnerships described here must be authentic, and they
must engender mutual trust between both communities. This is because there is a dire need
to understand the complexity of this debate not only for us as a society as a whole, but within
minority faith communities and populations. Congregational leaders are bombarded with
questions about health, health care, bioethics, and medicine in this modern biotechnological
world, and we must be able to have informed discussions and solutions.
Within the scientific community, there is a culture of skepticism where scientific
information is only regarded as absolute truth once a statistically significant p-value is obtained
and investigations yield repeatable results. Therefore, if one looks at the scientific community
as a producer of authoritative knowledge, the majority of the conversation about ethics takes
a very different turn from that in a religious context. Whereas, when biomedical research
produces knowledge that raises new theological questions, the religious community (and society
as a whole) is challenged to develop definitive boundaries, ethical paradigms, and theological
responses to new medical treatments and information about our natural world. As a thought
experiment, it would be interesting to introduce certain concepts into the scientific and spiritual
worldview discourse in order to raise a few thought provoking questions for secular and faith-
based ethicists alike. How might minority faith communities take to the concepts of theistic
evolution, BioLogos, and evolutionary creationism? Due in part to the fact that the authority
of science is perceived to conflict with the authority of religion, where this is no compromise, we
have to begin to shift toward the liminal space where biomedical research and faith-based ethics
intersect with and inform one another. How can we begin to close the gap between the scientific
and spiritual worldviews in such a way that they are perceived as overlapping magisteria and not
in conflict with one another? How do we forge pathways to partnership as more technological
advances are introduced into society at a very rapid rate?

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As a catalyst for a paradigm shift in worldviews, I compel both the scientific and
religious communities to push beyond their normal modes of thinking in order to enter into
the liminal space that exists between science and religion. There are common goals that both
communities share as they try to make contributions to the world. Both communities endeavor
to uplift the human condition by understanding the natural world that we live in. With the
understanding that science is ever-changing and evolving, we don’t possess all of the answers
to the mysteries of the universe, life itself, and the human body. Our modes of thinking will
continue to change and we will be constantly confronted with new knowledge and truth
claims. Therefore, as discussed in the 2013 PHEI in terms of forging pathways to partnership,
how can we look forward on this ethical journey to also heal the relationship between
spirituality and scientific research? We cannot try to reconcile the scientific and spiritual
worldviews, while perceiving such actions as committing violence against either. We should
seek harmony, not discord, when it comes to all matters. The ability to respectfully disagree is
a necessity, and the capacity to understand another’s perspective is indispensible. Eliminating
the need to disprove one’s cosmology and view of the world creates a malleable situation that
allows new ethics and viewpoints to be established. As stem cell therapy, synthetic biology,
regenerative medicine, genetic testing, and personalized medicine become more of a reality for
standard practice of care for diseases that disproportionately affect minorities, how can we be
prepared to move with this shift?
Equipping our future pastors and ministers with the ability to handle these types of
questions in an ever-advancing technological world is one solution to this complex conversation
about science and spirituality. We don’t have to fall behind our majority counterparts in this
area. As the church still remains a bulwark and structure for strength, power, and participation
in society, how can we address these topics and their relation to minority faith communities as
well? I wholeheartedly put forth the assertion that our society has made huge strides in healing
and correcting the damage and pain caused by the U.S. Public Health Service Syphilis Study
at Tuskegee. However, it is always important to note that it was announced and promoted
in churches, which serves as a prime example of why religious communities needs to be
equipped and educated such that injustices and harm are never inflicted upon uninformed
and miseducated faith communities again. We must continue to explore the relationship of
health care ethics, bioethics, and research ethics with social justice, and the needs of vulnerable
populations. The tensions and opportunities for collaborative work between these spheres of
ethics, and between the scientific and spiritual worldviews, are necessary. Faith communities
are put at risk when they adopt a purely spiritual worldview that is void of scientific discussion,
and scientific research is put at risk when it adopts a purely natural worldview that is void
of the possibility of that which is unexplainable. There are many challenges that we face as
practitioners of medicine, research, public policy, and faith – and we must be able to identify
how our work is always informed by contemporary social justice issues. All of this taken together
is further proof that one cannot regard different domains of knowledge and teaching authority
as separate. The overlapping magisteria of science, religion, and ethics must coalesce and be
brought to bear on our most pressing and challenging social issues of our time. This coupled
with a shift in worldviews, leads me to believe we are heading in the right direction.
In summary, I am astounded, the National Center for Bioethics in Research and
Health Care at Tuskegee University is intentionally working within a context of “Ethics and
Social Justice” and for framing science as a social justice construct, because it is just that.

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We must consider how to best understand and utilize biomedical knowledge within our
communities, and how to develop responsible ethics (and theological responses) about the
modern medical technologies and treatments that are made available. This begins when we call
for a cease-fire from both the scientific and religious communities, and think of new ways to
coexist. So to finally offer an answer to the question posed at the beginning of the paper: we do
not have to participate in the war of the worldviews, but can rather move away from conflict
and more toward compromise with persistence and consistence, where ethically sophisticated
scientists and scientifically educated Christians endeavor to develop new paradigms for
engagement and collaboration.
References
Alexander, D. (2008). Creation or Evolution: Do We Have to Choose?. Grand Rapids:
Monarch Books.
Collins, F. (2006). The Language of God. New York: The Free Press.
Darwin, C. (1872). The Origin of Species. London: John Murray.
Gingerich, O. (2014). God’s Planet. Cambridge: Harvard University Press.
Kuhn, T. (2000). The Road Since Structure. Chicago: The University of Chicago Press.

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Health Optimism in the Face of Health Disparities:
Exploring Self-Rated Health and Chronic Disease Status
among African American Christian Congregants
Alicia L. Best, PhD, MPH, CHES
Director, Research and Community Health
HEALing Community Center
2600 Martin Luther King, Jr. Drive SW, Suite 100
Atlanta, GA 30311
Phone: 678.704.4337
Email: aliciaLbest@gmail.com
Mallory A. Bembry, BS
Master of Public Health Student
Morehouse School of Medicine
Email: mbembry@msm.edu
Director and Professor
Tuskegee University
Email: warren@mytu.tuskegee.edu
Authors’ Note
This study was approved by the Institutional Review Board at Morehouse School of Medicine.
The authors have no financial relationships to disclose.
Abstract
The purpose of this study was to compare chronic disease status and self-rated health (SRH)
between African American adults in the general United States (U.S.) population with a sample
of African American Christian congregants. A descriptive analysis was conducted comparing
data from the 2006 Behavioral Risk Factor Surveillance System and data collected at four
national Christian conventions. SRH and self-reported prevalence of seven chronic conditions
(hypertension, diabetes, asthma, overweight/obesity, cancer, kidney disease, and HIV/AIDS)
were compared among African American adults in the general U.S. population and African
American Christian congregants. Adults in the Christian congregant sample reported a higher
prevalence of all chronic diseases assessed, except for overweight/obesity. Additionally, 80.4%
of the Christian congregant sample rated their health as excellent or good, while approximately
79% of African Americans in the general population rated their health as excellent or good.
Although African American Christian congregants reported a greater prevalence of chronic
disease, SRH was almost identical to that of the general population of U.S. African American
adults. Findings highlight the need for public health practitioners and faith leaders to work

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together to ensure that the “health optimism” displayed among Christian congregants is
balanced with sound health care decision-making.
Keywords: Self-rated health; chronic disease; Christian congregants; health optimism;
health disparities
Introduction
Among adults in the United States (U.S.), African American populations bear a
disproportionate burden of almost every chronic disease. For example, African American
adults are twice as likely as non-Hispanic white adults to be diagnosed with diabetes, and
20% more likely to have asthma than non-Hispanic white adults (DHHS, 2013). Further,
the incidence of chronic kidney disease is approximately 2.7 times higher among African
American adults compared with non-Hispanic whites (Tarver-Carr et al., 2002). These are
just a few chronic conditions that characterize racial/ethnic health disparities in the U.S adult
population. The 1985 U.S Secretary’s Task Force on Black and Minority Health report was
assembled to help eliminate health disparities (DHHS, 1985). Unfortunately, morbidity and/
or mortality gaps have widened between African Americans and non-Hispanic whites for
many chronic conditions in recent years (Gupta, Carrión-Carire, & Weiss, 2005; Pollard &
Scommegna, 2013).
In addition to poorer objective health status, African Americans tend to report poorer
subjective health status compared to their non-Hispanic White counterparts as measured by
self-rated health (SRH) (Spencer, et al., 2009; Schootman, Deshpande, Pruitt, Aft, & Jeffe,
2010). SRH is a frequently used measure of overall health status (Layes, Asada, & Kephart,
2012) and is shown to be a consistent predictor of mortality (McGhee, Liao, Cao, & Cooper,
1999). For example, a study by Shadbolt and colleagues (2002) found that among patients with
advanced cancer, SRH predicted survival far better than many clinical indicators, appetite loss,
fatigue, and health-related quality of life measures. In general, research has found that better
SRH is predictive of better objective health outcomes, including longer survival among the
terminally ill.
Spirituality and religious practice are shown to influence health beliefs, practices,
and outcomes of African Americans (Newlin, Knafl & Melkus, 2002), and have been linked to
better SRH (Daaleman, Perera, & Studenski, 2004). Numerous population-based studies have
found that African Americans consistently report higher levels of religiosity and/or spirituality
than any other racial/ethnic group in the U.S. (Hodge & Williams, 2002; Pew Research Center,
2007). Religion has been described as “society-based beliefs and practices relating to God or
a higher power commonly associated with a church or organized group” (Egbert, Mickley, &
Coeling, 2004, p. 8), while spirituality refers more to “a belief in something greater than self
and a faith that positively affirms life” (Miller, 1995, p. 257). Given the positive influence of
spirituality and religiosity on health beliefs and outcomes, it is hypothesized that individuals
with higher levels of spirituality and religiosity would report more positive SRH, regardless of
objective health status. Thus, the purpose of this study was to assess chronic disease status and
SRH between African American adults in the general U.S. population compared to a sample
of African American Christian congregants. Christian congregants in this study are defined as
individuals of Christian faith who attend religious service on a regular basis.

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Methods
Participants
Sample participants included men and women who were: 1) age 18 years and older;
and 2) self-identified as African American. Participants representing the general population
of African American U.S. adults were sampled from the Centers for Disease Control and
Prevention’s (CDC) 2006 Behavioral Risk Factor Surveillance System (BRFSS) (CDC, 2006).
BRFSS is an annual telephone survey that assesses the health status of U.S. residents. BRFSS is
the world’s largest, on-going telephone health survey system and is run through individual state
health departments. The sample size for BRFSS is currently over 400,000.
Participants representing African American Christian congregants were sampled
from four national Christian conventions between 2005 and 2006. Specifically, congregants
consisted of men and women who attended the Joint National Baptist Convention in
January of 2005 in Nashville, Tennessee; the Church of God in Christ (COGIC) Women’s
Convention in May of 2005 in Atlanta, Georgia; the General Conference of the Christian
Methodist Episcopal (CME) Church in Nashville, Tennessee in 2006; and the African
Methodist Episcopal (AME) Leadership Conference in June of 2006 in Charleston, South
Carolina. The COGIC convention focused solely on women; therefore one hundred percent
of surveys collected during this convention were women, which results in an oversampling of
women from the COGIC denomination.
Procedures
Congregant data were collected by researchers from the Institute for Faith-Health
Leadership at the Interdenominational Theological Center (ITC) in Atlanta, Georgia.
Congregant data were collected using a survey instrument containing questions about faith,
health, and health care among African American Christian congregants. The Faith, Health,
and Health Care Survey instrument contained 80 items, divided into four sections: (1)
Demographics; (2) Health/Safety; (3) Health Care; and (4) Faith, Religion, and Health.
Some items from the Health/Safety and Health Care sections were adapted from the 2004
BRFSS questionnaire, which allowed for comparisons in this study. The questions in the Faith,
Religion, and Health section were developed by a team of researchers and consultants from the
Institute for Faith-Health Leadership at the ITC. Sample size for the congregant database was
2,959, which was achieved using a convenience sampling approach. Each congregant participant
signed an informed consent prior to completing a survey. Study participants were referenced
by unique identification numbers, and no personally identifiable information was collected
(i.e. names or addresses). All hard copies of study data were stored in a secured file cabinet in a
locked office, while electronic data were stored on a password protected computer. Hard copies
of surveys were destroyed after three years. This study was approved by the Institutional Review
Board at Morehouse School of Medicine.
Measures
SRH was measured using the single item, “In general, would you say your health
is: Excellent, Good, Fair, or Poor?” The self-reported prevalence of seven different chronic

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conditions were assessed, including hypertension, diabetes, asthma, overweight/obesity, cancer,
kidney disease, and HIV/AIDS. Chronic disease status was measured using the item, “Have
you ever been told by your doctor that you have (each chronic condition was asked separately).”
Response options included “yes” or “no.” Additional variables included self-reported socio-
demographic characteristics (i.e. age, gender, Christian denomination, highest level of
education, annual household income, and health insurance status). Descriptive statistics were
analyzed using SPSS, Version 22 (IBM, 2013).
Results
Demographic characteristic of the Christian congregant sample are reported in
Table 1. More than two-thirds of congregant participants were women (69.2%). Only 6.9%
of congregants were under the age of 35 years,
while approximately one-third were age 35-54
years (34.2%), 30.3% were 55-64 years, and
26.8% were 65 years or older. Of the congregant
sample, 18.5% identified themselves as Baptist,
34.4% identified as COGIC, 5.2%% identified
as CME, and 41.9% identified as AME. The
majority of congregants had at least some college
education (78.4%), with only 6.3% reporting
less than a high school diploma. Income level
was fairly evenly distributed throughout the
congregant sample, with 16.8% reporting an
annual household income of less than $25,000;
28.4% reporting between $25,000 and $49,999;
22.7% reporting between $50,000 and $74,999;
and 21.9% reporting $75,000 or more. Finally,
almost all of congregant participants reported
having some form of health insurance to pay for
medical care (94.7%).
First, chronic disease prevalence
among U.S. adults in the general population
was compared with that of African American
Christian congregants (Figure 1). Adults in the
congregant sample had a higher prevalence of all
chronic diseases assessed except for overweight/
obesity. Specifically, the national prevalence
of hypertension among African Americans
was 34.1% and the national prevalence of
diabetes was 11.4%, while the prevalence rate
among Christian congregants was 50.4% and
20% respectively. The national prevalence of
asthma for the general population of African
Americans was 13.4%, while the prevalence rate
in the Christian congregant sample was 15.8%.
The prevalence of overweight/obesity was
Table 1. Demographic Characteristics of
Congregant Participants (N=2,959)
Notes: Due to missing data, the percentages may not add up to
100 percent; COGIC = Church of God in Christ; CME = Christian
Methodist Episcopal; AME = African Methodist Episcopal
Characteristic n (%)
Age (years)
18-34 199 (6.7)
35-54 1013 (34.2)
55-64 896 (30.3)
65+ 793 (26.8)
Gender
Female 2049 (69.2)
Denomination
Baptist 546 (18.5)
COGIC 1018 (34.4)
CME 153 (5.2)
AME 1241 (41.9)
Education Level
>High School 185 (6.3)
High School Graduate/GED 363 (12.3)
College or More 2319 (78.4)
Income (US dollars)
Less than 25,000 497 (16.8)
25,000-49,999 841 (28.4)
50,000-74,999 671 (22.7)
75,000+ 647 (21.9)
Health Insurance Status
Insured 2801 (94.7)

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Figure 2. Self-rated health of African American Christian congregants compared
o the general population of African American U.S. adults.
0
10
20
30
40
50
60
70
80
90
Excellent/Good Fair/Poor
80.4
19.6
79
21
%ofParticipants
Christian Congregants
General Population
d HIV/AIDS (30.3% versus 18.1%) compared to the general population of African Americans.
nally, SRH among Christian congregants was compared to SRH among African Americans in
e general population. Among Christian congregants, 80.4% rated their health as excellent or
ood. Similarly, 79% of African Americans in the general population rated their health as
cellent or good.
Figure 1. Self-reported chronic disease status of African American Christian
ongregants compared to the general population of African American U.S. adults
0
10
20
30
40
50
60
70
80
53.9
20 15.8
55.7
8.5
3.8
30.3
34.1
11.4 13.4
71
4.6
2.6
18.1
%ToldbyDoctorThey
HaveEachCondition
Christian Congregants
General Population
lower among the Christian congregant sample (55.8%) compared to African Americans in the
general population (71%). The prevalence rate for cancer among Christian congregants (8.5%)
was almost twice the rate of the general population of African Americans (4.6%). Christian
congregants in this study also reported a higher prevalence of kidney disease (3.8% versus
2.6%) and HIV/AIDS (30.3% versus 18.1%) compared to the general population of African
Figure 1. Self-reported chronic disease status of African American Christian congregants
compared to the general population of African American U.S. adults.
Figure 2. Self-rated health of African American Christian congregants compared to the
general population of African American U.S. adults.

Articles
Americans. Finally, SRH among Christian congregants was compared to SRH among African
Americans in the general population. Among Christian congregants, 80.4% rated their health
as excellent or good. Similarly, 79% of African Americans in the general population rated their
health as excellent or good.
Discussion
The overall goal of this study was to describe the self-reported status of seven chronic
diseases and SRH of African American Christian congregants compared to African Americans
in the general U.S. population. The sample of African American Christian congregants reported
a greater prevalence of almost every chronic condition assessed, but almost identical SRH.
Results indicate that the positive and affirming attitudes associated with religious attendance
may lead to positive SRH among African American church-goers in spite of chronic disease.
Religious instruction may cultivate the practice of “not claiming” sickness and disease.
One of the most alarming chronic disease statistics highlighted in this study is the
prevalence of HIV/AIDS among Christian congregants compared to the general population of
African American U.S. adults (30.3% versus 18.1%, respectively). The subject of sex, sexuality,
and sexual health are often avoided in the church setting. Nonetheless, the prevalence of HIV/
AIDS is nearly twice as high among Christian congregants compared to the general population
of African American adults. The avoidance of sexual health discussions and interventions
among Christian congregants may have a negative impact on sexual health outcomes among
this population.
Health optimism is described in this study as positive SRH which may disregard
objective health measures. One reason for health optimism in the congregant sample may
involve the context in which the data were collected. Congregant data were collected at faith-
based conventions, which may have prompted participants to think of health outside of the
physical realm. If data were collected in a clinical setting, it is possible that participants may
have responded based on more physical aspects of health. Health is a multifaceted phenomenon
which is comprised of physical, mental, social, and spiritual elements (Warren, 2007). Physically,
congregants had a greater proportion of chronic disease compared to African Americans in the
general population. However, consideration of other elements of health (mental, social, and
spiritual) may help explain why the congregant participants reported SRH that was comparable
to that of the general population of African Americans.
This study is strengthened by the use of such a large sample size of African American
Christian congregants (N = 2,959), which is rare within the faith-health literature. This study
is also strengthened by the sampling of participants from national Christian conventions,
which broadens the geographical and/or regional representation of study participants.
However, findings from this study must be interpreted with consideration of several important
limitations. First, the use of a nonrandom (convenience) sample limits the generalizability
of the findings of this study beyond the sample of attendees during one of the four national
Christian conventions identified. Based on self-reported income, educational level, and health
insurance status, the sample consists of a greater proportion of participants with mid to
high socioeconomic status, which is not representative of the national population of African
Americans. Also, the use of cross-sectional data limits the ability to make causal inferences
about study data.

Articles
Conclusion
Within Christian teaching, the most important component of a human being is
often cited as the spirit, or soul (Raboteau, 2004). African American slaves were taught that
their bodies were insignificant and that their souls would secure them a place in the afterlife
(Raboteau, 2004). African Americans have historically disregarded their physical health, placing
more emphasis on the human spirit. This phenomenon may also help explain the discordance
between chronic disease status and SRH among African American Christian congregants in
this study. Findings highlight the need for public health practitioners and faith leaders to work
together to ensure “health optimism” among Christian congregants is balanced with sound
health care decision-making.
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Articles
Food Deserts in Upstate South Carolina:
How Do We Both Ethically and Sustainably Feed the
Region’s Food Insecure?
Kenneth L. Robinson, PhD
Associate Professor and Extension Specialist
Department of Sociology and Anthropology
Clemson Institute for Economic and Community Development
Clemson University
132 Brackett Hall
Clemson, South Carolina 29634
Tel: (864) 656-1449
Fax: (864) 656-1252
Email: krbnsn@clemson.edu
Authors’ Note
The author is solely responsible for the contents of this article. The contents do not necessarily
reflect the policy of the U.S. Department of Agriculture. All correspondence should be directed
to Dr. Kenneth L. Robinson.
Abstract
The global food system characterized by large transnational agribusiness firms, biotech
laboratories, corporate boards and their economic advisors are “taking control of where, when,
and how food is produced, processed, and distributed” (Lyson 2004:48), with little or no regard
for the social and community level impacts on rural communities, including small farmers,
residents, workers, and even consumers, not just in the U.S., but worldwide. There is a growing
body of evidence that certain segments of the population have uneven access to healthful food
options which is associated with negative health outcomes resulting from illnesses that better
diets may delay or prevent, including high blood pressure, diabetes, and cardiovascular disease.
The goal of this paper is to shed light from a sociological perspective on the question “Can
the current food production system feed a growing population in a changing climate while
sustaining ecosystems?” and to highlight findings from a USDA sponsored research study
that seeks to support local farmers, create new food distribution and marketing channels, and
improve the quality of the food that is distributed by food assistance agencies working in local
food deserts.
Keywords: Food deserts; agriculture and Upstate South Carolina, food banks, small farmers

Articles
Introduction
The goal of this paper is to shed light from a sociological perspective on the topic
“Social Justice, Food Systems and the Agricultural Black Belt,” and to address the big question
“Can the current food production system feed a growing population in a changing climate while
sustaining ecosystems?” as posed by our plenary speaker Dr. Ralph Christy (2014).
The literature on food security and food deserts (Nord et al. 2008, Morton and
Blanchard 2007, Blanchard and Lyson 2006) suggests that food insecurity is a pervasive
problem in certain regions across the South. The regions range from portions of the Mississippi
Delta and the Black Belt to the northern portions of Appalachia. Household access to food may
be limited by a lack of money as well as by limited access to supermarkets and the large variety
of foods needed for a healthy diet, including fresh fruits and vegetables, whole grains, fresh
dairy and meat products. Despite food and nutrition assistance programs and local hunger-relief
services such as the Growing Food Locally Program (Robinson et al 2007) designed to supply
food deserts and to increase food security by providing low-income households access to food,
a healthful diet, and nutrition education, some households still experience food insecurity
and limited access to adequate food at times during the year. For many living in the South,
in addition to hunger, the outcome is major health problems such as obesity, heart disease,
hypertension, strokes and other diet-related diseases.
The Global Food System and Food Deserts
The current restructuring of the global economy toward increased corporate
integration is premised on the assumption that core firms (i.e., large national and multinational
corporations) will be the primary engines of change and development (Barber; Harrison;
McMichael 1996). Development within this framework is what Lyson (2004) calls the
corporate community model. The objective is to keep the global engine of accumulation
running. The emphasis is on economic efficiency and productivity. Communities become
places where production and consumption are concentrated, not places where citizens are
actively engaged. But as Berry (1999:2) has noted, “The ideal of the modern corporation is to be
anywhere (in terms of its own advantage) and nowhere (in terms of local accountability).”
Rural sociologist Bill Heffernan identifies a handful of what he calls “food-chain
clusters” that are taking control of the food system from the “gene to the supermarket shelf ”
(Lyson 2004:48). Cloaked in the guise of “feeding the world,” today’s mass production food
industrial complex provides abundant quantities of cheap, standardized goods. The degree of
concentration has reached the point where the 10 largest multinational food processors control
over 60 percent of the food and beverages sold in the United States. According to geographer
Philip Hart, “Size brings economic power and this is particularly significant when set against the
structure of the farming industry with its large number of relatively small producers” (as quoted
in Lyson 2004:49), including those small producers closer to home.
For Black farmers living in the agricultural Black Belt South, the situation is not
much better. In their article The Plight of Black Farmers, Racism in the US Farm Program (The
Atlanta Constitution, October 10, 2006), Jerry Pennick and Heather Gray of the Federation of
Southern Cooperatives/Land Assistance Fund, cite that Black farmers and small family farmers

Articles
in the United States depend on subsidies in an attempt to break even. They refer to a survey
conducted by the Federation of African-American cotton farmers throughout the Southeast.
The survey found that the subsidy program is essential for the survival of many Black farmers.
But when asked if subsidies would be as important if the farmers received a fair price for their
cotton, the answer was “no.”
Collectively, such evidence suggests that left to the private sector alone, we risk not
fully understanding “the high price of cheap food, or …[the] connection between a hamburger
and the price of oil, or between the vibrancy of life in the soil and the health of the plants,
animals and people eating from that soil” (Pollan 2009:1, 2). Moreover, there is a growing body
of evidence that certain segments of the population have uneven access to healthful food options
which is associated with negative health outcomes resulting from illnesses that better diets may
delay or prevent, including high blood pressure, diabetes, and cardiovascular disease. Areas
characterized by such uneven or low access are called “food deserts,” by the U.S. Department of
Agriculture and are defined as places where people have limited access to full-scale retail grocery
stores. Food deserts are generally considered urban neighborhoods and rural towns without
ready access to fresh, healthy and affordable food. Instead of supermarkets and grocery stores,
these communities are often served by fast food restaurants and convenience stores that offer
few healthy, affordable food options. According to the USDA’s Economic Research Service,
23.5 million people live in food deserts and more than half of them are low-income (Ver Ploeg
2010 and The Food Desert Locator). According to research by Blanchard and Lyson (2006),
256 of the 873 nonmetropolitan South counties are food deserts. The presence of food desert
counties in the Black Belt is especially important because of their high rates of poverty. For some
of these counties the average poverty rate is nearly 25 percent.
Grocery stores provide the most reliable access to healthy foods at the lowest cost.
Adults living in neighborhoods with grocery stores have the lowest rates of obesity at 21
percent, while adults living in areas that are void of these resources have the highest rates at
32-40 percent obesity. Adults living in food deserts are 25-46 percent less likely to have a healthy
diet than those living in close proximity to a grocery store (within one mile of their home).
Regarding obesity, studies have shown adults who have neighborhood access to stores
that sell fresh food have a 21 percent obesity rate, compared to a 32 to 40 percent obesity rate
among those without such access, according to the Robert Wood Johnson Foundation (2012).
In South Carolina alone, one million people live their lives without adequate access to grocery
stores, fresh food markets or transportation to get there, according to a recent South Carolina
Community Loan Fund study (as cited in Penso 2014). Statistically, according to a recent
study conducted by the Trust for America’s Health (2012) and the Robert Wood Johnston
Foundation (2012), South Carolina ranks 7th nationally for obesity among adults, 13th for
obesity among high schoolers, and 2nd for obesity among 10-17 year-olds.
The South Carolina Department of Health and Environmental Control (Simeon
2011) estimates more than one billion dollars is spent on obesity-related health expenditures
annually; this number is expected to increase to $5.3 billion dollars in 2018. If South Carolina
were able to halt the increase in the prevalence of obesity at today’s levels, it would save over $3
billion in five years.

Articles
The author is a member of a team of researchers at Clemson University (South
Carolina) undertaking a project supported by a multi-year grant sponsored by Agriculture and
Food Research Initiative (AFRI) that seeks to address the potential of food banks for providing
a healthier food supply to low income residents as well as creating improved small-scale farm
operations and revenues.. The research project is entitled “Using Local Food Banks to Promote
Sustainability of Small and Limited Resource Farms,” and uses the institutional intelligence
gathered in an earlier Community Food Project co-sponsored by the Lowcountry Food Bank
(LCFB) of Charleston as a benchmark on how to be an effective local food system intermediary.
In addition to returns to local farmers , findings from the LCFB project suggest that the
participating agencies changed their purchasing behaviors; increased healthy food purchases by
participating agencies; purchased fewer sweets, fats, oils than regional counterparts; provided
over twice the amount of nutrition counseling as compared regionally; and increased nutrition
training opportunities.
The current AFRI project has engaged other food banks and small scale farmers
to “scale up” the benefits of local food system participation by small farms across SC and
contiguous states. Specifically, the goals of this project are: to document the potential for
local, non-profit food system intermediaries to enhance the economic sustainability for small
and limited resource farms, and to reveal the potential for these local food systems to increase
incomes in rural communities. Lessons learned should be helpful in promoting sustainability of
small farms and proximate rural communities across the State and nation. Those lessons will be
further examined in the next section.
Method
Participants and Procedure
To evaluate the effect of one food bank’s use of local foods to blend sustainable
agriculture practices with innovative community development strategies, this paper focuses on
consumer demand, supply of locally grown foods, local networks, and local impacts.
The contingent valuation framework is used to elicit South Carolina consumer
preferences for produce with the ‘‘SC grown’’ attribute (Young 2012). We use the contingent
valuation approach because it allows us to concentrate on the ‘‘SC grown’’ characteristic
in products and measure consumer willingness to pay (WTP) for this specific attribute.
Contingent valuation methods ask respondents hypothetical questions about their willingness
to pay for products with specific attributes. Current and desired demand for locally grown
products by local residents was estimated using the results of a mail survey sent to 6,000
randomly selected households in the Upstate region of South Carolina. There were two forms
of the survey: 3,000 focused on produce (fruits and vegetables) and 3,000 focused on animal
products (meat, poultry, dairy, and eggs). The counties included in the mailing were Abbeville,
Anderson, Cherokee, Chester, Greenville, Greenwood, Lancaster, Laurens, McCormick,
Oconee, Pickens, Spartanburg, Union, and York, South Carolina. This region accounts
for roughly 36.9 percent of South Carolina’s overall population. The individuals chosen to
participate were randomly selected households.
Small and medium sized farms in the upstate region with less than $100,000 in annual
sales were then identified by county extension agents in each of the upstate counties. To analyze

JHSH-V5n1-Spring-2015 - Tuskegee University

JHSH-V5n1-Spring-2015 - Tuskegee University

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