Why Map Religion?

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Religions in the United States.  Source:  http://www.britannica.com/topic/classification-of-religions/Conclusion

 

Currently, managed care programs are struggling trying to make the best of of the available electronic medical records data.  One of the most helpful series of insights into population health comes from a study of the religious background of your patients.  This is because the amount of adherence your patients demonstrate to your program has a direct correlation to the religious background of the patient, his or her upbringing and family beliefs about health and the role of the physicians, and the official religious concept that your faith system holds belief-wise, in terms of how much to belief in the teachings of your faith, the meaning of the lessons contained within its historical background and reliance upon spiritual and “higher” forms of healing, and how the physician is placed in the paradigm that a someone’s religious leaders follow when it comes to medical school and allied health or experiential medical training beliefs and attitudes.

Reviewing a part of the east coast religious background, for nearly thirty years I knew I was researching a region of the U.S. with quite a long and varied religious background, history, philosophy and combined spiritual and extremely positivist (scientific proofs only are accepted) practices and belief systems.  In the past I taught classes and produced essays and maps demonstrating that the heart of religious diversity is New York.  This is because the other big urban center developing during the first decades were guided by one particular culture–for Philadelphia and Boston it was the United Kingdom and British  philosophy for governing and leadership, with Quakerism contributing to the establishment of the colony in general for Philadelphia, but defining very little of the ruling theocracy for that time, and for Boston, the British and later Irish influences that prevailed, in part to keep the French forces both governmental and of a church-defined nature away from the ruling classes of the British societies forming in the New Britain, New Scotland (Nova Scotia), New England and upper New York parts of these pre-United States colonies.

Between these two British New World countries were the combined belongings of Sweden and the United Netherlands, what we refer to today as the temporary New Sweden settlement followed by the more successful rulership dominated by the Netherlands Dutch families, with their own unique interpretations of the role of the church in a very multi-ethnic, non-Anglican dominated society.  It is the Dutch who allowed unique minority groups with their own religions and religio-medical beliefs to dominate this narrow part of the New World.  With its multiethnic neighborhoods and multiethnic rulers located on the adjacent lands, the ability of this region to remain diverse in its people and belief systems is what made New York , at first, the site where many new religions and medical beliefs could be generated and propagated like the pages of a new version of the Bible.  Even with the diminishment of this alternative thinking in health, religion and medicine, through repeated attempts to define medicine as a predominantly allopathic field throughout the nineteenth and early twentieth centuries, religious groups remained diverse, and due to the diversity of these groups, within the multiethnic society that the Dutch colonists helped to form, we find the most ethnically diverse forms of public health related medical practices evident throughout this part of the United States.

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From one of my several pages reviewing GIS, medicine, surveillance, and/or Foreign Born Disease patterns.

The database I am working with to understand this unique multiethnic population, with its  unique racially and ethnically diverse population, where plain “white” or causasians anglo-saxon borne protestants do not constitute the majority.  This population consists of 7.5M patients for the region being analyzed.  Their history and EMR stretch over a 20 to 25 year time frame.  Naturally, the richness of religious data indicating familiar and individualistic religious background provided for mo one of the first opportunities to evaluate the value of religious data in EMRs, for any problems or possible errors that might exist in these data.

The following are my preliminary conclusions to what a 7.5 year dataset of 160 religions tells us, and can be used to design the method for studying religion and health as it pertains to the health planning and administrative process, not the value of religion in eliciting the cure, assisting the patient, or creating the miracle that is needed.

Researchers need to understand the following when trying to understand and map the religion of their area.  The following findings that were made have a significant impact on how I will deal with a dataset when evaluating its people for religious background, from this point on, regardless of community size and type.

First, the amount of data obtained for a patient’s or patient’s family’s religious commitment can be scarce.

It would be no surprise to find that some databases provide as little as 30% of the patients’ data on religious practices and commitment. To substitute for EMR void of religious data, it is necessary to develop a survey to fill in for this missing data, to set guidelines or write up policies that make it essential than we maintain better records about the religion of our patients, providing them with the opportunity to refuse to answer this question if so inclined.  The cultural make up of the community, in particular its churches and religious program that define the area, play an important role in obtaining further insight into your institutional potential and actual patient loads.

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Noma, from my page at https://brianaltonenmph.com/gis/population-health-surveillance/production-examples/528-1-noma/

For a study I did 5 years ago on religion and unique foreign born forms of disease in parts of the U.S., I found that missionary organizations played a role in introducing cases of foreign or rare diseases to the U.S. EMR databases, but not necessarily in any attempt to result in further propagation or spread.  The severe malnutrition case discussed on another of my web pages for another blog, Noma, provides and excellent example of how a cluster of extremely severe cases may be generated and discovered through foreign borne disease mapping. [See https://brianaltonenmph.com/gis/population-health-surveillance/production-examples/528-1-noma/ ]

Second, there is an exceptionally large variety of types of religions that can be entered into an EMR, on the old fashioned paper copies of EMRs, documented as part of the first visit, or enrollment application for a new  program.  The lack of data is a problem with older datasets, and is one of the toughest issues to resolve when researching religion and health based upon EMR data.  Most of the time, a patient doesn’t require the institution to know or act upon the institution’s interpretation of religion.  And twenty years ago, many institutions had a history of supporting a particular religious group or two, but many are now in compliance with the federal standards stating that no preferred social group devoted to religion should be favorably promoted by a facility, at the most basic level of providing medical support for all patients.

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A large number of different types of religions may now be found in EMRs developed by some of the more successful programs engaged in detailed record keeping.  Since the point of this study is to focus on how the interaction of religious faith, its influence on our personal lifestyle, and the way cultural beliefs influence our reaction to practitioners’ decision making processes, it is important to be able to relate the various faiths to the most basic health or public health related decision that are made.  There are very specific cultural beliefs and practices that could influence the care that is provided, or the likelihood a person may develop and illness.  These include specific dietary practices, the approval or lack of approval for certain child healthcare procedures, or what the mores and taboos about sex and relationships might be in terms of educating or consultation experiences involving a child.  Religion may influence  the way in which family medicine doctors cater to the need of a maturing adolescent, or provide medical information for a young adult pondering marriage and child raising plans.  The needs of the spouse and older parents regarding health care, the type and amount of support we or the practitioner should provide to elders and possible end-of-life stage patients, are also influenced by cultural beliefs and expectations.

AfricanDiseaseChalkboard

Third, religion is a personal attribute that may or may not have the support of patients for sharing this part of the personal history information to the facility they are visiting.  In general, when patients are in the hospital, for one or more overnight stays, or for a surgical procedure, the community and social part of a patient’s life experience often provides that patient with the contacts he/she needs to get that important care of others for being in the hospital.  Similarly, non-denominational religious supporters are common to many hospital settings.  They are there to provide the support a patient needs before the operation or important procedure is to commence.  They play an important role in the mental health of the patient before such a procedure, and reinforce cultural beliefs regarding the interactions between family and patients, sometimes critical to the quality of a patients subsequent experience and/or outcome.

StemCellresearchJudaica

Source: Crane, J. K. (2016). Stem Cell Research and Judaism. Religions: A Scholarly Journal, (2014), 13.  Accessed at http://www.qscience.com/doi/pdfplus/10.5339/rels.2014.science.13

Fourth, the option of filling out the religious background in you medical record can lead to diverse entries, many more than expected by an institution.  Generally speaking, we think of just a few major groups of religions when thinking about how the population’s different faiths distribute across the numbers at hand.  Knowing the practices common to a patient’s community may help with some patients, but provided a very small amount of critical information when this data is due because of its usefulness.  We need to know specific patients and their attachments to specific religious, because that religious faith they admit to and document in their records, provided the medical profession with very valuable insights, assuming the institution’s social scientists, ethnologists, social workers and psychologists/psychiatrists, are familiar with this important piece of demographic information, and its usefulness.

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Recently, I had to construct a way to interpret a population of 7.5 million patients, who laying claim to practicing more than 160 different religions.    The response rate for this groups was about 50%, meaning about 50% had a well defined religious group contained in their EMR data.

Even though this data represented about 50% of the total patient population over the past two plus decades, it still provides the insights needed to determine how to analyze religion as a contributor to certain aspects about the quality of care provided to patients within this heavily populated setting.  The types of care they ask for or are against being provided are determined by their background, but especially their race, ethnicity, culture, and religious background.  Of these four possible demographic metrics for any given patient or population, we tend to just pay attention to the first two.

Religion also impacts the special requests people might have about particular parts of the healthcare services normally provided.  It is not unusual for patients to be against certain forms of care, treatment or preventive health measures.

Also playing an important role are the unique types of.ICDs that each population might have entered into the EMR, including ICDs for culturally-bound disease and behavior patterns, culturally linked conditions with some sort of physical science related entity, such as genetics or developmental related illness causes and patterns, and documented race-culture linked traditional ICDs focused on particular medical conditions and health behaviors, such as dietary, domestic living style, and stress management behaviors.

On another page posted at another site, I noted the 10 religious groups or classes I developed for interpreting religion in a population.   Each group presumably shared important features in the average lifestyle that are determined by the social and cultural expectations of that individual and family, based on the individual’s family-related and personal religious background.

The first six of these religious groups make sense:

  1. Catholic
  2. Christian
  3. Christian-derived or related
  4. Judaic
  5. Islamic
  6. Unique Cult or Sect (various titles have been given to this group)

These six have culturally defined church practice activities, church related social pressures put upon families and individuals by their place of worship, and certain practices–such as child upbringing expectations, child health education procedures or programs, recreational allowances, work and social commitment requirements, foodways and drug and alcohol consumption expectations, and beliefs about violence and criminal behaviors in the community setting.  Each of these has particular ICDs, V-codes and E-codes attached to them, which can be assessed in the EMR.

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A Pentecostal “healing”, September 1954

The remaining groups are tougher to define, but two of them stand out, and surprising have similar belief-behavior relationships enabling hem to be categorized together.

Atheism and agnosticism both share the general lack in belief in a God or Creator concept as they are defined by the above groups.  Some of the traditional classes do have sections of followers that are essentially focused on the social setting and behave atheist or agnostic as well.  Modern Judaic followers who do not pay attention to the Torah per se, most often fit into this particular group.

Whereas Atheists believe in no God at all, essentially living live as a non-theological, purely nihilistic experience (nothing more matters once you’v departed), agnostics have that uncertainty in their philosophy, enough to “believe in a god, perhaps” but not so certain as to follow a particular faith or belief system due to this ideology.

The scientists are directly related to a belief system referred to as positivism–the proof must exist for something to be consider a proven statement or claim.  The counter believe to positive is relativism, which claims that relationships exist, but not necessary indisputable proofs of the cause for these relationships–also referred to as post-positivists, existential proof may be all that is needed.  The existence of something is proof enough of its value or worth.

This loosely linked, fairly uncoordinated and socially detached groups of followers (no major friends or support system for their exact cause exists), result in a pair of believe systems, that can be lumped together as a combined Modern/Postmodern group of patients.

Between the agnostics and the transcendentalists and/or experientialists is another group, which I refer to as the “natural philosophers”.  This group includes those who see a creator or God entity as existing but as part of the universe in general.

ThreeHealersHudsonValley

Three “healers” from the Hudson Valley, N.Y., ca. 1820 +/- 15 yrs.  Andrew Jackson Davis (left) was a self-proclaimed mystic who developed a world follow, as a product of Quimbyism and Mary Baker Eddyism travelling the New York Hudson Valley Circuit during the Transcendental movement; he was an early experientialist or possibilist.  First or Second generation Mahican descendant Mannessah (either Metis through the missions or Algonkin-Mahican) was a “Christian Indian” who revitalized the Native American healing philosophy and faith around 1790-1840, continuing it decades later in Ohio (left); we could consider he a natural theologian with religious minded experientialist and possibilist influences.  Samuel Mitchell was a NY Congressman and Benjamin Rush’s adversary in New York; he was a realist, actualist, and/or positivist who was broadly trained and highly respected for this scientific approach to interpreting most of disease and medicine, including the geographic perspective that he made famous.

The Quakers for example believe in a “Universal God” that is essentially an energetic thing, a”being”, or causative factor  for what we can experience. The happenstance that defines someone’s life is a result of the existence of this “power”, but its recognition may be missed or not noticed, based upon personal reaction and experience.

The Shakers communicated with this energy when it was founded, and viewed the people who were most gifted in performing these communications as the “most gifted” of worshippers, typically considering them valuable social leaders of “the faith.”  Mary Ann, the founder of Shakers, is certainly one of the better example of these gifted leaders.

The Aesculapians are natural healing, multigod energy worshippers, and view nature and energy/power as important to their natural philosophy faith.

Many Native American “faiths” may fall into this category as well.  The “Manitou” concept is akin to the Shaker’s form of God.

Likewise, the Moravians, actually best considered a Christian religious sect offshoot, are of this type, but due to their much stronger discipline and following as defined by Christian writings, have parts of their faiths overlap with indigenous belief systems, but at the expense of remaining traditional Christian in nature (Group 2 or 3 above, depending upon how you define each).

The Mormons and Seventh Day Adventists are certainly followers of the the Group 3, Christian derived faiths.  They have leaders who are gifted, but still retain some of the older traditions focused on previous gifted leaders, namely the Christ, or Moses, or Mohammed.

Mary Baker Eddy’s Christian Science group places more of the responsibility of utilizing their universal energy on the individual.  They are detached more from the God concept that the Quakers (who aren’t really detached), and almost as detached as energy energy believers who approach atheism or agnosticism, leaving open the option of communicating with that higher entity, energy or being in some way, shape or form.  Native American Manitou-related shamanism may be more natural theological in nature than the faith of a “Christian Scientist.”

ActualismvsPossibilism

Link: https://www.google.com/search?q=actualism&num=20&espv=2&source=lnms&tbm=isch&sa=X&ved=0ahUKEwipiPDO9YHNAhVJ8z4KHYu2BwAQ_AUICCgC&biw=1366&bih=623#imgrc=Q1RFwTgWESouqM%3A

This leaves us with a group of religions that are superficial and mostly personally and socially driven agnostic, atheism and purely physical world focused.  Their followers play a role as a social support group.  They have unique energy concepts or interpretations quite often. Examples include Scientology and the non-denominational churches that serve mostly as social gathering for the young to middle age.

The last group is the unstated or unknown religious group.  Those who provided no answer to the clinician when asked this question.

The remaining groups are as follows:

  1. Cultural (Buddhist, Hindu, Sikh, Baha’i, etc.)
  2. Natural Theological or Natural Philosophy
  3. “Contemporary” (Scientologists, Unity, etc.) [aka Modern/Postmodern]
  4. Other, Unknown

(More on this to come.)

Other classification systems paid attention to the natural philosophy aspects of the tradition, enabling some of the groups devoted to mysticism to have their own “transcendentalist” group.

The Encyclopedia Britannica website at http://www.britannica.com/topic/classification-of-religions/Conclusion offers several historical interpretations of how scholar classified religion during the past two centuries.  The most influential interpreters of the last, with philosophical concepts relative to today’s allopathic interpretation of religious faith and medicine, with a focus on the works of Cornelius Petrus Tiele and William James.

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Epitaph to a German Lutheran Gravestone, ca. 1802 mortality, probably due to “consumption” or tuberculosis, or alternatively, rheumatism.  

 

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