A paper on determinants of health seen as a theological issue presented at the Roehampton University Research Group in Religion Theology and Practice

1. Are social determinants of
health a theological issue?
Health, Flourishing and the Common Good
Jim McManus
2nd February 2020
Jim.mcmanus@hertfordshire.gov.uk mcmanusj@Roehampton.ac.uk

2. The problem of defining terms: “Health” as a
major cultural preoccupation
“health” as a major current concern
◦ What is Health
◦ WHO Definition of Flourishing
◦ Functional Health – Satisfactory adjustment to lived reality
Even the definitions become problematic
Is it or is it not the same as Flourishing?
An issue which spans disciplines
Rise of medical humanities
Rise of theological contributions
dialoguing the contribution of theology and science

3. Inequalities in “Health”
The World Health Organization (WHO) defines health inequalities as follows:
‘The differences in health status or in the distribution of health determinants between different
population groups.’
In the UK, the population groups showing differences in health and health chances are based
on:
•Social class
•Gender
•Ethnicity
•Region
These are not, of course, mutually exclusive — e.g. working-class people tend to live in more
deprived areas.

4. Determinants of inequalities? What really
determines health outcomes beyond biology?
Health Systems – Inverse
Care Law
Genetics
Biology
Early Years
Environment
Education
Employment
“Allostatic Load”

5. Impact on our
health outcomes
Source: Robert Wood
Johnson Foundation, 2014

6. Example: Health inequalities and COVID-19
6
PHE’s
(2020)Disparities in
the risks and
outcomes of COVID-
19 confirms that
COVID 19 has
replicated existing
health inequalities
and, in some cases,
has increased them.
This reinforces the
need for targeted
action.
Age-standardised COVID-19 mortality rates (March to May
2020, England and Wales) – geographical representation Age-standardised mortality rates, all deaths and deaths involving COVID-19,
Index of Multiple Deprivation, England, deaths occurring between 1 March and 31
May 2020
Source: ONS
Source: Public Health England

7. COVID-19 Ethnicity
death rates
Rate of COVID-19 death by ethnic group
and sex relative to the White population,
England and Wales, 2 March to 15 May
2020
7
PHE’s disparities report and other emerging evidence
has also demonstrated a disproportionate impact on
BAME communities:
• Critical care admission was 28% more likely in South
Asian and 36% more likely in Black ethnic groups,
compared to the White group (after taking into account
age, sex, location, deprivation and comorbidities)
• Risk of death was between 10-50% higher amongst
BAME communities compared to people of White British
ethnicity after accounting for the effect of age, sex, age,
deprivation and region
Source: Public Health England

8. Ethnicity (Skip)
All positive cases with specimen dates up to 19 September 2020
8
Cumulative number and rate of Pillar 1 and Pillar 2 COVID-19 cases (per 100,000) by ethnicity (n=339,901)*
Number of people tested under Pillar 1 and 2, and percentage (%) by ethnic group and week
Ethnic group Count Population Rate 95% Cl
White 230,451 47,010,723.6 490.2 488.2- 492.2
Indian (Asian or Asian British) 15,596 1,532,380.8 1,017.8 1,002.0-1,033.8
Pakistani (Asian or Asian British) 19,380 1,303,426.3 1,486.9 1,466.2-1,507.8
Other Asian / Asian British 13,692 1,850,400.1 739.9 727.7- 752.4
Black / African / Caribbean / Black British 14,953 2,104,814.3 710.4 699.2- 721.9
Mixed / Multiple ethnic groups 4,701 1,550,543.4 303.2 294.7- 312.0
Other ethnic group 10,856 624,889.4 1,737.3 1,705.2-1,770.0
Unknown 30,272 - - -
Total 339,901
Rates exclude 30,272
COVID-19 cases for
whom ethnicity is to be
confirmed
Data for ethnicity were
available for 91.5% Pillar
1 cases and 90.7% Pillar
2 cases
Ethnic group
Week - number (%)
33 34 35 36 37 38
White 3,481 (54.5) 3,912 (61.0) 4,945 (65.5) 9,979 (68.3) 12,551 (69.1) 8,096 (71.0)
Indian (Asian or Asian British) 524 ( 8.2) 459 ( 7.2) 423 ( 5.6) 757 ( 5.2) 1,060 ( 5.8) 669 ( 5.9)
Pakistani (Asian or Asian British) 1,078 (16.9) 833 (13.0) 897 (11.9) 1,487 (10.2) 1,943 (10.7) 1,212 (10.6)
Other Asian / Asian British 451 ( 7.1) 343 ( 5.4) 370 ( 4.9) 763 ( 5.2) 918 ( 5.1) 531 ( 4.7)
Black / African / Caribbean / Black British 413 ( 6.5) 432 ( 6.7) 396 ( 5.2) 728 ( 5.0) 775 ( 4.3) 360 ( 3.2)
Mixed / Multiple ethnic groups 170 ( 2.7) 160 ( 2.5) 171 ( 2.3) 337 ( 2.3) 365 ( 2.0) 240 ( 2.1)
Other ethnic group 272 ( 4.3) 269 ( 4.2) 348 ( 4.6) 550 ( 3.8) 559 ( 3.1) 287 ( 2.5)
Source: ONS

9. Ethnicity cases by week
All positive cases with specimen dates up to 19 September 2020
9 Source: Public Health England

10. COVID-19 and
BAME
Populations
Social, cultural
and structural
determinants
10 Source: Public Health England

11. COVID-19 in Black, Asian and Minority Ethnic
populations: An evidence review and
recommendations from SAHF (2020).
Available at: https://www.sahf.org.uk/covid19

12. Research on Faith and Health : Public
Health Discourse
◦ Rise of public health discourse
on Faith and social
determinants
◦ Attempting to place religion as
a social determinant of health
in same way housing,
education and employment
work
◦ (Idler, 2014)

13. So what does the science tell us?
Inequalities in Life Expectancy have a social gradiant
Inequalities in Health outcomes (early disability, life limiting illness)
too
Social, economic and racial patterning
Covid is a perfect example of these
◦ Vaccine Inequalities – BAME populations half the uptake of White in
some areas
◦ Health and the access to health are essentials for human living
BUT – is this a theological issue?

14. A word
about the
lens
Deliberately NOT looking in the obvious places
- Liberation Theology, Dorothy Day, Social
Gospel
Why on earth would you do that?
A hermeneutic of suspicion applied from some
commentators to anything that isn’t manifestly
patristic, scriptural or magisterial – narrowly
defined
needs intersectional lens, just for starters ,
otherwise we risk just incarnating the social
gradient into theological discourse

15. What about theological principles?
Privatised religion in a Covid-19 World
DISCOURSE 1
It is my OBLIGATION to attend Church
come what may
I will not Mask
I will never take the vaccine
My access to sacraments and
sanctification
DISCOURSE 2
The Common Good
Solidarity
Scientifically – epidemiology shows we are not
Islands
Theologically- what principles when Bioethics
seems focused on individuals?

16. Dominant
Theological
Discourses on
Health
the social and public
dimensions often missing, but
need to hold the value from
tradition too – how can you
affirm “good health” is good
and people can flourish with
long term conditions - HIV
1. “Suffering” has value and is not redundant
2. Formal Sacramental “Healing” – Reconciliation as much as
Sacrament of the Sick
3. Self-Care (Temple of Holy Spirit)
4. Popular Piety/ Prayer for Healing/Rites/Healing Ministry
5. Flourishing more than absence of disease – Living and Thriving
with HIV as an example (Orthodox theology, Vincent, Yetunde)
6. Vocation to Health Care

17. Example: Vocation to Health
Care in the Charter for Health
Care Workers (1995)
T H E TAI ZE I CO N O F M E RCY – T HE G O O D SA MARITAN
Conceptualised as Individual response to
calling of Christ
Individual participation in Ministry of Christ
Individual Response to Individual Suffering
(Pontifical Council, 1995)

18. Patristric readings of Scripture
God is active in human history
Covenant relationship
God – Humankind - Creation
Community – social elements, justice
Anawim -- "the widows, orphans and
aliens”
Challenge of the prophets when Israel fails
in its obligations
The example of Jesus – reign of God,
healing
“Health is Social, Teleological (aligned to
our creatureliness ) and structural, not just
individual” [Pennington, 2015]

19. John Paul II – Ecology of Human
Flourishing and Human Health
Centesimus Annus 1991
Contended that the term “ecology” had become almost
exclusively applied to the natural environment in debates
about conservation.
“not only has God given the earth to humanity, who must use
it with respect for the original good purpose for which it was
given to them, but humanity too is God’s gift to
humankind.”[ii]
a balanced view of ecology begins with a correct
understanding of the ecology of the human person.

20. Benedict XVI developed this
•Idea of Integral Development: development of each person and the
whole person - scientific and theological hooks here
•Concentration on adequate anthropology
•The role of truth (social capital?)
•The Social and the individual in dynamic tension are needed for Integral
Development
•Ecological – Social – Personal development for flourishing important
•Access to the means to flourish – Access as a theological principle
Thought Experiment: Read this while thinking about access to Covid
Vaccines

21. Social dimension of Mission
in Health(care) in revised Charter
Those involved in health care policy…have a
responsibility not only to their specific fields, but
also towards society and the sick.
It is up to them, in particular, to defend and promote
the common good, performing the duty of justice,
according to the principles of solidarity and
subsidiarity, in developing…policies aimed at the
authentic development of peoples
(Pontifical Council, 2016; Para 7.)

22. Developing a Theological Perspective on
Determinants of Health using Catholic Social
Teaching
SOCIAL TEACHING CORE PRINCIPLES
1. The Dignity of the Human
Person
2. The Common Good
3. Solidarity
4. Subsidiarity
5. Social/Structural Sin
6. Preferential option to the Poor
7. Care for Creation
SOCIAL DETERMINANTS OF HEALTH
1. Poorly Articulated?
2. Good Health as common good
3. Lack of explicit narrative
4. “Social Capital “crucial for good health
5. Inequity in access, inequality in outcomes
6. Focus on most marginalised
7. Ecology as a fundamental public health
challenge

23. Some
Conclusions
It's a
theological
issue because
determinants of
health affect in
multiple ways
how fully we
live,flourish and
die.
Theological Perspectives on Flourishing chime with scientific
perspectives : Integral Development (Person, Environment, Society)
Life in Right Relationship and Balance
Societal and individual levels are equally important (eg suffering and
social justice)
Social as important corrective to the individual-only focus
Grounding in Scripture and Patristic readings
Significant unfolding corpus in the Tradition
A theological anthropology of health: persons in relationship ;
ecology of human flourishing

24. Supplementary material follows
Supplementary Background Slides Follows

25. Background
Explore theological and biblical discourses on health and human flourishing in social and
scientific context
Work through the lens of Catholic Social Teaching
Strong Biblical and Early Church Themes on Social Theology and Health

26. Theology of
Human
Flourishing –
social,
teleological and
structural not
just the individual
(Pennington, 2015)
Shalom - wholeness results in wellbeing
Ashre– wise living / wisdom / orientation to
God
Barak - Blessedness and Happiness
Tamim – (complete, wholeness with God) the
means to achieve God directed wholeness

27. Faith and Health Research

28. Research on Faith and Health
◦ Cross-disciplinary
◦ Focuses very much on individual aspects
◦ Link between health and faith outcomes strong and
take various directions
◦ Biopsychosocial model
◦ Salutogenic impact of faith based interventions for
those of faith
◦ Salutogenic impact of discussing issues of ultimate
meaning for those not necessarily of faith
◦ (Koenig, 2012;)

29. Thank You
“Christ commanded us to Heal and to
make disciples? Why has the
institutional Church separated the two?”
Flourishing and wellbeing is a mission
issue ?
Still feels a bit “dead white men” – could
do with a greater intersectional lens
If it affects our ability to be fully human,
it’s a theological issue