Religion and Spirituality as Social Determinants of Health Over the Life Course

In this presentation we review the evidence for including religion among the social determinants of health, now the dominant paradigm in public health. It is widely accepted that social, economic, and political conditions are the fundamental influences on population health indicators such as morbidity and mortality. We contend that the social determinants literature has been limited by its exclusion of the social sphere of religion, to which most world populations have wide exposure. This oversight is ironic because one of the key insights of the social determinants approach is that early life influences often have lifelong consequences on health.  Many rituals and practices of the world's leading faith traditions map directly onto daily, weekly, annual, and life course transition events that are encountered as individuals age.

We review the population-based research literature on religion/spirituality and health outcomes using a life course approach. We summarize findings from available studies of mortality and identify gaps in the literature. There are extremely few studies of the effects of religion on the health of infants and children. Most research on religion/spirituality and health has been limited to surveys; the inclusion of (non-self-report) infant and child outcomes is an important area for future research. For adolescents, there are many more studies, but physical health outcomes are still relatively rare; such research more frequently examines mental health outcomes and health practices. Most of the thousands of studies of religion/spirituality and health outcomes have been performed with adults and elderly persons; we summarize the mortality findings from these studies with a graphical approach, differentiating group-level from individual-level studies, and public religious involvement measures from private/subjective measures. We conclude that a) the evidence for an association between religion/spirituality and health is incomplete; b) the available evidence suggests that public/social but not private/subjective religiousness is related to lower mortality risks in adulthood; and c) a life course approach is necessary for future research on religion/spirituality and health outcomes.  Overall, the evidence suggests that religious involvement represents a social influence, or determinant, of health that should be included in the framework of the social determinants of health.