Healing in the Spaces Between: Realizing Spiritual Determinants of Health for the Future of Medicine and Public Health
Kate Long, Harvard University, Cambridge; Xavier Symons, Harvard University, Cambridge; Tracy Balboni, MD, MPH, Harvard University, Cambridge; and Howard Koh, Harvard University, Cambridge
Healing in the spaces between requires imagination and a willingness to engage deeply in interdisciplinary work that attends to the whole person and to whole communities. In the fall of 2023, members of this panel were invited by a leading health policy journal to write a paper focused on reimagining the public health system in the United States. In this session, panelists will discuss this paper and our claim that reimagining the future of medicine and public health should reintegrate explicit consideration of spiritual determinants of health, including ultimate meaning, purpose, transcendence and connectedness – human goods that are deeply valued by both patients and communities.
Panelists will begin by describing key findings of their systematic review of the most rigorous empirical evidence on spirituality, serious illness, and population health between 2000-2022 (Balboni et al., JAMA 2022)[1]. This review and evidence synthesis, iteratively assessed by an interdisciplinary, expert Delphi panel, resulted in six evidence-based recommendations to advance spiritual health within medicine and public health. Examples include the need to: recognize spirituality as a social factor associated with health in research, community assessments, and program implementation; include specialty practitioners of spiritual care (e.g., chaplains) in the care of patients with serious illness; and, reintegrate patient-centered, evidenced-based approaches regarding the beneficial associations of religious/spiritual community participation.
Panelists will then spend time on each recommendation, reviewing policies and practices at federal, state, and local levels and discussing ways that future health policies might be more inclusive and attentive to spiritual factors. The panel will feature examples of how each recommendation works in practice, highlighting opportunities for application and scale in diverse settings. Exemplars include durable institutional collaborations between public health and faith communities that promote population health; medical systems that meaningfully integrate chaplaincy programs to provide tailored care for patients and healthcare practitioners; and training programs that help health providers better understand the complex interplay of a person’s spirituality with their experience of serious illness and health. Panelists will describe how effective approaches encompass and respect the spiritual diversity of the United States, including traditional religious and growing spiritual/non-religious forms, as well as remaining attentive to potential harms of religion.
The panelists will end the session by describing how the consequential lessons of Covid-19 reinforce the need to recognize spirituality as a critical component of future comprehensive medical and public health strategies, and that a reimagined clinical and public health system will routinely consider spiritual factors in the formation of patient-centered and community-centered policy and practice.
[1] Balboni TA, VanderWeele TJ, Doan-Soares SD, Long KNG, Ferrell BR, Fitchett G, Koenig HG, Bain PA, Puchalski C, Steinhauser KE, Sulmasy DP, Koh HK. Spirituality in Serious Illness and Health. JAMA. 2022;328(2):184-197. doi:10.1001/jama.2022.11086
Panelists will begin by describing key findings of their systematic review of the most rigorous empirical evidence on spirituality, serious illness, and population health between 2000-2022 (Balboni et al., JAMA 2022)[1]. This review and evidence synthesis, iteratively assessed by an interdisciplinary, expert Delphi panel, resulted in six evidence-based recommendations to advance spiritual health within medicine and public health. Examples include the need to: recognize spirituality as a social factor associated with health in research, community assessments, and program implementation; include specialty practitioners of spiritual care (e.g., chaplains) in the care of patients with serious illness; and, reintegrate patient-centered, evidenced-based approaches regarding the beneficial associations of religious/spiritual community participation.
Panelists will then spend time on each recommendation, reviewing policies and practices at federal, state, and local levels and discussing ways that future health policies might be more inclusive and attentive to spiritual factors. The panel will feature examples of how each recommendation works in practice, highlighting opportunities for application and scale in diverse settings. Exemplars include durable institutional collaborations between public health and faith communities that promote population health; medical systems that meaningfully integrate chaplaincy programs to provide tailored care for patients and healthcare practitioners; and training programs that help health providers better understand the complex interplay of a person’s spirituality with their experience of serious illness and health. Panelists will describe how effective approaches encompass and respect the spiritual diversity of the United States, including traditional religious and growing spiritual/non-religious forms, as well as remaining attentive to potential harms of religion.
The panelists will end the session by describing how the consequential lessons of Covid-19 reinforce the need to recognize spirituality as a critical component of future comprehensive medical and public health strategies, and that a reimagined clinical and public health system will routinely consider spiritual factors in the formation of patient-centered and community-centered policy and practice.
[1] Balboni TA, VanderWeele TJ, Doan-Soares SD, Long KNG, Ferrell BR, Fitchett G, Koenig HG, Bain PA, Puchalski C, Steinhauser KE, Sulmasy DP, Koh HK. Spirituality in Serious Illness and Health. JAMA. 2022;328(2):184-197. doi:10.1001/jama.2022.11086