To many Master of Public Health graduates entering the field, the methodology and pathways to a healthier society may seem simple: Take scientifically verified data, synthesize it into public health solutions and work to implement these solutions to achieve more positive health outcomes.
The reality, however, is rarely so simple. Often, public health experts find themselves in direct conflict with religious doctrine or social mores when making recommendations. Certain issues — such as same-sex marriage, reproductive rights and sexual education — may run up against religious beliefs, while others — like gun control, socialized healthcare and the legalization of substances like marijuana — are often the subject of cultural conceptions. Given the profound foothold that religious teachings and societal beliefs have even in the most modern and secular societies, this can prove to be a challenge that public health officials must learn to meet head on.
The Prevalence of Religion
Religion is something that filters into nearly every aspect of life for the global population. In the U.S. alone, three-quarters of adults say religion is at least “somewhat” important in their lives, with over half saying it is “very” important. More than that, Americans, on the whole, have distinctly cold or negative attitudes toward the non-religious community compared to religious groups: According to a 2017 survey by the Pew Research Council, atheists on average scored lower in positive feelings compared to other religious groups, coming in at a middling 50 out of 100 on the “feeling thermometer”.
For those in the public health community, this explicit religious preference within American society can be a struggle, as science and religion are popularly viewed as being at odds. While not all scientists are atheists, the scientific and healthcare community in the U.S. tends to be less religious than the community at large, as established by a recent study by researchers at Rice University. And, as Ellen Idler writes in her book, “Religion as a Social Determinant of Public Health,” this means that many of the social leaders and policy gatekeepers that public health experts must work with have associations with the religious community.
“There are few if any communities in the world where there is no religious institution at all, and in many communities, particularly the most vulnerable, religious institutions may be the most important, vital, and functional social institutions in the lives of community members.”
The Conflict between Public Health and Religion
While the religious and public health communities aren’t innately at odds, there have been several significant conflicts throughout the years. One of the most recent and prominent examples of this was the recent cases of Burwell v Hobby Lobby Stores, Inc. and Conestoga Wood Specialties Corp. v. Burwell. These cases involved a business contesting the “contraceptive mandate” of the Affordable Care Act on explicitly religious grounds, stating that being forced to offer employees’ health insurance that covers all means of federally-approved contraception violates deeply held religious beliefs — claiming specifically the company’s owners felt it was a form of abortion. The case was ultimately decided by the Supreme Court, with the Justices siding with the businesses in what many hailed as a “victory for religious liberty.”
While abortion access and family planning — which the CDC continues to recommend as a positive force in public health — has always been a hot-button issue, the particular line of argument used by the defense may have seemed puzzling to those in public health. Data cited by Reuters shows that access to contraception decreases unwanted pregnancy, which in turn lowers abortion rates. The inability to reach a consensus on both what constitutes abortion and how to lower abortion rates makes this a fundamental roadblock within public health.
In general, restrictive religious attitudes toward sexual agency and education have proved trying for public health officials. Consensus within the public health community holds that sexual and reproductive health education should be part of any comprehensive health program. The American Public Health Association cites in particular that “abstinence-only” sexual education — a form of sex education preferred by many religious groups — result in populations with high STI and pregnancy rates.
“Evidence suggests that abstinence-only approaches do not lead to behavioral changes and result in critical health information being inappropriately withheld,” APHA writes in “Sexuality Education as Part of a Comprehensive Health Education Program in K to 12 Schools.”
This points to a direct path where public health officials can make some headway in the debate. With education such a vital component of sexual health, pushing to make comprehensive, scientifically backed sexual education programs available in schools could help bridge the gap and give young people secular and scientific context.
Yet, in spite of this public health consensus, implementing policy has proven difficult. Prior to 2016, Congress had built into its budget nearly $2 billion over the course of 25 years for “abstinence-until-marriage” educational programs. While President Obama removed all funding for abstinence-only education in his 2017 federal budget, the Trump Administration has consistently made overtures to the conservative religious community, positively signaling the return of such funding.
Meanwhile, public health often finds itself in conflict with social attitudes rather than faith-based ones. One example is that of vaccines: Vaccines have been overwhelming accepted by the scientific community as a boon for public health, with a Pew Research survey showing that 86 percent of scientists with the American Association for the Advancement of Science think childhood vaccines should be mandatory. This is echoed in the 73 percent of Americans cited in a separate Pew study who see vaccines like the MMR as a benefit to society.
Meanwhile, a growing number of parents have expressed a desire to choose whether or not to vaccinate their children. Pew pointed to the fact that 17 percent of Americans say parents should be able to decide not to vaccinate, all amid growing concern about the supposed “dangers” of vaccines — dangers that tend to be backed by conjecture and societal bias rather than scientific fact.
While organizations like the CDC have taken pains to underscore the importance of vaccines, the personal freedom to choose touted by anti-vaccination groups makes the debate complicated. The push to make vaccination “opt-in” actually poses a threat to herd immunity — the ability for large populations to be functionally resistant to virulent strains of diseases, by virtue of most of the population being vaccinated. Herd immunity is a vital public health concept and has recently been seen in action as the incidence rate of human papillomavirus in Australian men both vaccinated and unvaccinated have fallen following the deployment of the vaccine.
In this case, the concept of social liberty rubs up against the interests of public health. In the same way that the Hobby Lobby verdict could be interpreted as a victory for religious liberty, so too could the ability to choose whether or not to vaccinate a child for personal liberty. Yet when failing to do so could expose populations to outbreaks of infectious diseases — as was the case in 2016, when 33 counties in Arkansas experienced nearly 3,000 cases of the mumps — how can public health officials navigate the tightrope of personal liberty while putting overall public health first?
The Public Health Course
Ultimately, public health officials have an uphill battle when attempting to convince people to question their deeply held religious or social beliefs — particularly in an era of increased partisanship. Yet perhaps one of the most important things that the public health community can do is not position science as innately at odds with cultural traditions.
“No one today can deny that there is a popular ‘warfare’ framing between science and religion,” said the Rice University study’s principal investigator, Elaine Howard Ecklund, founding director of Rice University’s Religion and Public Life Program.
“Science is a global endeavor,” Ecklund added. “And as long as science is global, then we need to recognize that the borders between science and religion are more permeable than most people think.”
One useful framing device for public health officials is focusing on the historical religious traditions that have put a premium on public health and happiness. This works to bridge the gap between science and faith, emphasizing social justice and tending to the poor and sick. The Christian and Islamic faith, in particular, have long legacies of emphasizing social service, with the field of public health stemming from traditions related to caring for vulnerable populations. In this way, public health experts entering the field may benefit from focusing not on the ways those ideas and methodologies differ from religious communities, but on the ways they are the same.
Alternatively, the public health community could stand to learn lessons from the success and prevalence of faith-based communities and initiatives. Faith’s ability to reach struggling communities represents a teachable moment: Why do people with restricted access to education and economic development opportunities respond to faith leaders more than public health officials? Are there opportunities to intervene directly in vulnerable communities or work with local ministries to show that the relationship is not combative?
Finally, there is a value in being able to filter scientific insights to the benefit of public health through a cultural and faith-based lens. With some of the public perception that scientific innovation may come at the expense of ethical concerns, public health could apply some of the checks and balances that these traditions emphasize. This could not just make the research more rigorous, but also help connect the dots as to why this research is important to a diverse assortment of groups.