Making the Religion-Health Research Foundation Even Stronger

We essentially all long for that which is of ultimate significance, that which can imbue meaning, and that which gives us a sense of connectedness. Many long for what is transcendent, or for a truth, beauty, and goodness that extends beyond everyday experience. In such longings, we effectively have an at least implicit spirituality as we seek what transcends beyond ordinary life. That longing for the transcendent has found various forms of communal expression as well, within the various world religions. Systems of beliefs and practices unite people together in a community with a shared vision for the experience of, or union with, the divine or transcendent. And that effectively is what constitutes religion.

Decades of prior research has indicated that such religious participation is also associated with a wide range of temporal health and well-being outcomes. In building upon and contributing to that research, in collaboration with the Human Flourishing Program at Harvard, we are pleased to announce the release of Koenig et al.’s 3^rd edition of the Handbook of Religion and Health. The Handbook constitutes the most comprehensive treatment of the role of religion in shaping health and well-being to date, and draws upon, synthesizes, summarizes, and weighs the evidence, of over 10,000 studies on this topic.

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Building Knowledge of Religion and Health Over Time

Our understanding of the relationship between religion and health has gradually expanded year after year. While some of the earlier studies on the topic were less rigorous, and had often employed cross-sectional data, making causal inference almost impossible, over the past couple of decades the research has become increasingly rigorous. Large longitudinal studies with extensive confounding control and sensitivity analysis, have provided evidence for effects of religious service attendance on numerous health and well-being outcomes including, for example, all-cause mortality, depression, suicide, and many others. By 2009, a meta-analysis of numerous more rigorous longitudinal studies indicated a 27% reduction in all-cause mortality for those attending religious services regularly vs. not. By 2021, a similar meta-analysis, restricted to longitudinal studies, provided evidence for powerful effects on mental health, most notably depression. In 2022, researchers at the Human Flourishing Program and the Initiative on Health, Religion, and Spirituality at Harvard, under the leadership of our colleague Dr. Tracy Balboni published a systematic review of large longitudinal studies of religion and health indicating effects of religious participation on longevity, depression, suicide, smoking, drug use, alcohol abuse and various aspects of quality of life and well-being.

The handbook supplements that prior work yet further by synthesizing the evidence not only from the largest and most rigorous studies, but also the weaker or smaller studies, summarizing the state of research even when evidence is more limited so as to help guide and direct future research efforts to learn more. While for some outcomes such as longevity, depression, substance use, and social support, the existing evidence is arguably now quite definitive, for others we still in fact know relatively little (e.g. schizophrenia) or the emerging picture is complex (e.g. pain). Beyond these other outcomes, we also have a lot to learn on aspects of religion and spirituality beyond service attendance, and also on the role of spirituality and religion in other non-Western contexts and countries, and how this varies across the world religions. We very much hope that our Global Flourishing Study, the first wave of which will be released early next year, will help in this endeavor.

Beyond new studies, work also remains to be done on evidence synthesis. While numerous meta-analyses have been carried out, along with other books summarizing these, to the best of our knowledge, only the two meta-analyses mentioned above, on longevity and depression, have restricted attention to more rigorous longitudinal studies. We have recently received support from the Templeton Religion Trust to expand this more rigorous evidence synthesis further to carry out longitudinal meta-analyses for outcomes extending beyond mortality and depression, and including suicide, cardiovascular outcomes, alcohol, smoking, drug use and life satisfaction, and to examine the sensitivity or robustness of these meta-analyses to potential unmeasured confounding. Further evidence to be integrated includes quasi-experimental studies from economics suggesting effects of religious participation on depression and on death of despair, along with studies on mediators or mechanisms for the effects of religion on health.

From Research to Population Health

Considerable work also remains to be done on the translation of research into policy and practice to improve population health. The handbook covers this as well with numerous sections on clinical implications and case vignettes and chapters on public health, health policy, and human flourishing. These matters are not always adequately taken into account in clinical and public health discussion. Major reviews of determinants of mental health and suicide often completely neglect discussion of religion as a social determinant of health, despite evidence that declining participation may explain about 40% of the increased rates of suicide and 28% of increased rates of depression.

As discussed elsewhere also, the implication of this research are in no way straightforward. But sensitive ethical evidence-based approaches of taking a brief 2-question or 4-question spiritual history in clinical settings, or encouraging religious community participation for those who positively self-identify with a religious tradition and other form of community participation for those who do not, has the potential to powerful enhance health and well-being. Much has thus been accomplished but much more needs to be done both with regard to research and with regard to moving from research to practice, and we encourage interested readers to examine the Handbook further.

As the holidays approach, many turn away from the busyness of life to spend time with friends and family. Many seek to reflect on, remember, seek out, and celebrate, the transcendent. Many turn to, and draw upon, those communal celebrations offered by religious communities. Christians all over the world commemorate the birth of one whose life brings light, who is celebrated as the Prince of Peace, who has shaped human history, with, across the globe, two billion people seeking the transcendent in his presence. As we pursue that which gives us ultimate meaning, significance, and connection, let us work together in seeking that peace, that truth, that goodness which our inherent spiritual longings prompt us towards.