In many communities churches are a primary partner in community health. By uniting the best practices of public health and congregational-based principles emphasizing wellness, wholeness, prevention, and education, churches can influence people's values and life choices, and enable them to assume responsibility for their own health. A survey conducted by the Congregational Health ReSource, in partnership with the Virginia Department of Health Office of Minority Health and Public Health Policy, will report the findings from four rural communities that participated in a pilot congregational health assessment.

1. Changing Times, Changing Strategies
Working together to strengthen the Safety Net
Advocacy & Community Outreach
Churches as Primary Partners in
Community Health
November 16, 2009
Reverend Andrea Lomboy

2. The Congregational Health ReSource, LLC (CHR) is a Judeo-Christian
company and ministry devoted to improving health awareness from
the perspective of “body, soul (mind, will, and emotions), and spirit”
from a BIBLICAL approach.
“Our desire is to bring together the promise of
medicine with the power of faith to lessen the gap
between the secular and the sacred, increasing
synergies and infusing the potential to build
healthier communities.”

3. Congregational Health
Congregational health brings together the best practices of
public health and faith-based principles and is a key
resource in advancing public health.
Over one half of Virginia’s population attends church. By
leveraging the Commonwealth’s 7,000+ congregations (and
nearly 3.8M members) as a force multiplier, the reach of
public health can be much more extensive and effective.
Churches have the distinct power to influence people’s
values and personal life choices—and enable them to
assume responsibility for their health.
Your organization has an opportunity to maximize the
capacity of public health efforts and help close the gap by
supporting congregational health efforts.

4. Definition
Congregational health is the focus of a congregation—an assembly of
people who meet for worship and religious instruction in a designated
locale—that is dedicated to being sound in body, soul, and spirit and to
experiencing freedom from physical disease or pain.
Congregational health unites the best practices of:
1. Public health–Protecting and improving community health through such
means as applying preventive medicine, providing health education,
controlling communicable diseases, and monitoring environmental hazards.
2. Faith-based principles–Relying on the belief that God is the Great
Physician who has the ultimate power to heal and cure with or without the
use of medical practices; using wisdom (applied knowledge) to make
consensual and informed treatment decisions; turning to God-given
resources such as health care providers, pharmaceuticals, hospital treatment
services, and clinics as needed; and leveraging the network and support
offered within the faith community.
By understanding these best practices, we can improve the health of individuals
and, ultimately, the community at large. Why?

5. Introduction
“The church is the only community-based organization
that is found in virtually every community in this country.
It is able to reach people of all ages, races, and economic
backgrounds and it can strongly influence people’s values and
personal life choices. Because the church is generally more
integrated into the life of individuals and communities than
our modern medical establishment, it can better enable people
to assume responsibility for their own health.”
- Health and Welfare Ministries
General Board of Global Ministries
The United Methodist Church
New York, New York

6. Office of Faith-based & Neighborhood Partnerships
In 2001, then-President George W. Bush issued an
Executive Order to help the federal government
coordinate a national effort to expand opportunities
for faith-based and other community organizations
and to strengthen their capacity to better meet social
needs in America’s communities. The top two goals
identified focused on living a longer, healthy life with
equality of access throughout the population mix. In
the current administration, the program has been
broaden and renamed as the Office of Faith-based
and Neighborhood Partnerships.

7. “The particular faith that motivates each of us can
promote a greater good for all of us. Instead of driving
us apart, our varied beliefs can bring us together to feed
the hungry and comfort the afflicted; to make peace where
there is strife and rebuild what has broken;
to lift up those who have fallen on hard times.”
– President Barack Obama

8. Your Health
Health – defined by Webster as:
• the condition of being sound in body, mind, or spirit;
especially: freedom from physical disease or pain: the
general condition of the body
• flourishing condition: well-being
The World Health Organization states that "health is a
state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity"
including the ability to lead a "socially and economically
productive life."

9. Simply put, these determinants affect the health of every
member of your congregation. Each determinant should be
considered as an “opportunity” to show the love of Christ and
minister to the needs of your community.
http://www.vdh.state.va.us/healthpolicy/2008report.htm

10. Minority Populations
5 federally recognized minority populations in Virginia:
African American/Black (19.44%)
Hispanic/Latino (4.66%)
Asian American (3.66%)
Native Hawaiian or
other Pacific Islander (.05%)
American Indian and
Alaskan Native (.26%)
70% White Non-Hispanic
make up the majority
population. This group
includes: whites with origins
in any of the original peoples
of Europe, the Middle East,
or North Africa as
determined by the U.S.
Census Bureau.

11. Leading Causes of Death
Are similar for every race,
but not necessarily in the
same order…
1. Heart Disease
2. Cancer U
3. Stroke
4. Diabetes
5. Unintentional injuries
6. Homicide
7. HIV/AIDS
8. Chronic lower respiratory
disease
9. Nephritis, Nephrotic
syndrome, Nephrosis
10. Septicemia
Source: Health, U.S., 2004, Table 31. Source: Unequal Health Access Across the
Commonwealth, Virginia Health Equity Report, 20008.

12. Your Faith
Faith Section - defined by Webster as:
• allegiance to duty or a person : loyalty, fidelity to one's
promises and sincerity of intentions
• belief and trust in and loyalty to God and belief in the
traditional doctrines of a religion, as well as, the firm belief
in something for which there is no proof: complete trust
• something that is believed especially with strong
conviction: synonymous to BELIEF. It is without question.
Hebrews 11:1 NKJ - Now faith is the substance of
things hoped for, the evidence of things not seen.

13. Your Faith–Body, Soul & Spirit
Body (physical dwelling)
1 Corinthians 3:16 - Don't you know that you yourselves are God's
temple and that God's Spirit lives in you?
1 Corinthians 6:19 - Or do you not know that your body is the
temple of the Holy Spirit who is in you, whom you have from God,
and you are not your own?
We were created in God’s image and we are a physical dwelling
place for Him in lieu of the Holy of Holies as described in David’s
Tabernacle.
We should, therefore, honor and respect that which was given to
us by God by caring for it in a way that expresses our love for
Him.

14. Your Faith
Soul - (mind, will and emotions)
The O.T. Hebrew word is rendered as nepes. It appears 755
times in the Old Testament. KJV uses 42 different English terms
to translate it. The two most common renderings are "soul" (428
times) and "life" (117 times).
It is chiefly defined as a principle or living being
The N.T. counterpart to nepes is psyche [yuchv] six hundred
times in the Septuagint).
Psyche, as its Old Testament counterpart, can indicate the
person (Acts 2:41; 27:37). It also serves as the reflexive
pronoun designating the “self” Luke 12:19. Expresses emotions
such as grief (Matt 26:38, ; Mark 14:34), anguish (John 12:27),
exultation (Luke 1:46), and pleasure (Matt 12:18).

15. Your Faith
Spirit (inner man)
The O.T. Hebrew word for "spirit" is ruah essentially meaning
“breath or wind.” It is the breath of life that gave us the ability to
live physically and spiritually. (Isa. 42:5)
The N.T. Pneuma [pneu’ma] is the New Testament counterpart to
the Old Testament ruah. While it occasionally means wind (John
3:8) and breath (Matt 27:50; 2 Thes 2:8), it is most generally
translates "spirit“ an incorporeal, feeling, and intelligent being.
(Luke 1:47, 2:40, John 11:33, Acts 18:25, 2 Cor 2:13, Matt 5:3)
Ruah can also refer to a person’s will. Ezr 1:5, Num 14:24, Psalm
51:10.
In the New Testament spirit is also seen as that dimension of
human personality whereby relationship with God is possible
(Mark 2:8; Acts 7:59; Rom 1:9; 8:16; 1 Cor 5:3-5).

16. Religion, Spirituality & Public Health
Harold M. Koenig, MD., Professor of Psychiatry
& Behavioral Sciences, Associate Professor of
Medicine, Duke University Medical Center
Religion, Spirituality & Public Health Testimony
to US House of Representatives, September
2008.
Examines relationships between religion/spirituality
and the health of individuals and populations.

17. Religion, Spirituality & Public Health
FACTS to ponder:
The US is a very religious nation:
93% of Americans believe in God
89% of Americans report affiliation with a religious
organization
83% of Americans say religion is fairly or very
important to them
62% of Americans say that they are members of a
church or synagogue
58% of Americans pray every day (and 75%
weekly)
42% of Americans attend religious services weekly
or almost weekly (and 55% at least monthly)

18. Religion, Spirituality & Public Health
“If the religious congregations in America all had health
programs, then two-thirds of the U.S. population would be
exposed to disease detection, disease prevention, and health promotion
efforts. Since persons of all ages participate regularly in religious
congregations, this means that health education efforts would occur at
all ages, from the young (focused on substance abuse prevention and
character development) to the middle aged (focused on healthy eating,
exercise, stress-reduction, etc.) to the elderly (focused on volunteering,
mentoring and generative types of activities).”
–Harold M. Koenig, MD

19. Religion, Spirituality & Public Health
There is every reason to suggest that religious
involvement is related to better health.
Religious beliefs, practices, and rituals are
shown to improve health.
Some research has suggested that communities
where high portions of the population are
members of religious groups have better health
in general, even the non-religious people who
live in those communities.

20. 268,240 documented congregations
with 176,477,348 adherents in a US
population of over 300M
**Estimated total including non-reporting congregations.
*The data in these reports come from the Religious Congregations and Membership
Study which is collected by the Association of Statisticians of American Religious Bodies
(www.asarb.org). They collect these data by asking denominations to submit counts at
the county level of congregations and membership. Some denominations choose not to
participate while others simply do not have the data required to participate. The latter is
the case with most African-American denominations.

21. Virginia Statistics for Congregations and Memberships
The Association of
Religion Data Archives,
www.thearda.com
Congregations Members

22. 45 Churches in Essex County
These statistics are only for reporting churches.

23. Purpose
The purpose of the congregational health assessments
is to advance the congregational approach to health by:
1. Identifying Community-based Leaders
• Develop health/faith public-private relationships and/or partnerships
2. Identify Community-based Assets
• Uncover existing programs and assets within the community from
materials to services
• Educate the public about overall health issues while increasing
awareness of prevention and treatment options
3. Developing a Community-wide Congregational Health Assessment
• 5 survey tools were developed (civic, clergy, education, government and
medical)
• Illuminate root causes of existing health inequities, promoting social
justice that could influence changes in funding policies
• Use the pilot as a framework that can be replicated in other communities

24. Selection Process
The following four counties were selected because of need and access to care
challenges. They also were identified as having one or more of the following:
• Virginia Medically Underserved Area (VMUA)
• Mental Health Professional Shortage (MHPSA)
• Primary Care Health Professional Shortage (HPSA)
• Dental Health Professional Shortage (DHPSA)
3 Critical Access Hospitals (CAH) in Virginia (out of 7)
• Bath Community Hospital, Hot Springs - Bath County
• ValleyHealth Shenandoah County Hospital, Woodstock - Shenandoah
County
• ValleyHealth Page Memorial Hospital, Luray - Page County
1 SHIP Hospital (out of 24) was selected:
• Riverside Tappahannock Hospital, Essex County

25. Federal Designations
CAHs meeting the following requirements to receive the designator:
• Located in a state that has a State Flex Program
• Located in a rural area
• Furnish 24-hour emergency care services
• Provide no more than 25 inpatient or swing bed services
• Have an average length of stay 96 hours or less
• Located > 35 mi. from nearest hospital or > 15 mi. in areas mountainous
terrain or only secondary roads
SHIPs General acute care hospitals:
• with fewer than 49 eligible beds and
• that are located outside a metropolitan statistical area (MSA) or
• located in a rural census tract

28. Surveys
Five categories of community leaders were addressed:
1. Civic–local associations and business community
leaders
2. Government–local mayor, county medical director,
county executives
3. Medical and health services–hospitals, clinics, health
departments, private-public doctors, and other health
practitioners including psychiatrists and social
workers
4. Education–principals, school counselors, school
superintendents, and boards of education
5. Faith–pastors, clergy, lay leaders, congregational
members

29. Methodology
• Development of congregational health assessment tools was necessary
and developed online through SurveyMonkey.com
• 5 databases were developed for each survey type
• A tremendous amount of effort was involved in the survey!
• Methods of contact included:
1. Phone
2. Email
3. Door-to-Door Delivery
4. Direct to Community Leader
5. Leader to Leader
6. US Mail
7. Fax

30. Preliminary Survey Findings Final Survey Findings
Essex Luray, Page
45 churches total: 30 churches total:
7 - Civic 2 - Civic
16 - Clergy 6 - Clergy
3 - Education 0 - Education
3 - Government 0 - Government
6 - Medical 2 - Medical
*35 Completed Surveys 10 Completed Surveys
Bath Woodstock, Shenandoah
30 churches total: 24 churches total:
9 - Civic 2 - Civic
9 - Clergy 9 - Clergy
4 - Education 0 - Education
4 - Government 3 - Government
6 - Medical 7 - Medical
*32 Completed Surveys 23 Completed Surveys
*Survey submission to be completed by 11/30/09
136 Counties, 7,736 reporting congregations

31. Non-Clergy Findings
Sampled secular organizations said that they could provide the
following resources to local churches:
Funding Teachers (including volunteers)
Medical Personnel Facilities
Media & Advertising Partnerships
Mailings Referrals
Space Policy & Systems Change
Programs & Services Medical Equipment
Health Fairs Counseling
Training Reduced Rates

32. Barriers
The top barriers secular organizations face in providing products and/or
services to congregations includes the following:
• Lack of information about the needs
• Lack of staff and volunteers to provide services
• Lack of funding
• Fear of violating separation of church and state laws
Assistance
In order to assist congregations, these organizations said they would
need the following information in order to provide products and/or
services:
• Identifying information about the congregation
• A list of needs
• A clear, measurable plan to show the value of their contribution

33. Clergy Findings
Every Clergy survey completed indicated that they “believed there is
a connection between physical, emotional, and spiritual health.”
The clergy also overwhelmingly felt that “religious institutions should
play a role in helping its congregations be physically healthy.”
Nearly 80% of those who felt that way said it was, “appropriate to
offer health education and health services to their
congregations.”
Based on this response, the clergy were asked if they felt their
congregations would use a “combination of both spiritual and medical
resources to maintain and improve their health.” The same 80% “felt
that they would use the resources.”
Despite these findings, just over 10% said they have an active health
ministry.
*For the purposes of the survey, an “active” health ministry was defined as, “A
ministry of a faith-based organization that provides health care services
and/or health educational classes more than once a year.”

34. Clergy Findings
The following list are ways in which the various
congregations currently support the health of its members:
Go with member’s to doctor’s Transportation to medical appointments
appointments
Help with health-related paperwork Prayer
Provide meals Visit members who are sick
Phone calls Run a health food store
Pastoral care Pay for medical bills
Health and preventative education Support local free clinics (time & finances)
Anoint with oil Lay hands on the sick
Use the Word of God to bring Fellowship nights that can be used to
encouragement and comfort address health-related issues

35. Clergy Findings
Top health concerns that “your” congregation is facing:
• aging
• heart disease
• cancer
• diabetes
• high costs of medications
• lack of insurance
• obesity
• affordable health care
These concerns are not surprising and are consistent with
major causes of death in Virginia.

36. Barriers
The top barriers faith-based organizations face in providing
products and/or services to congregations includes the
following:
• #1 response - Uncertain how to start one (48.3%)
• #2 response - Lack of finances and resources
- Lack of volunteers and/or leaders
• #3 response - Lack of time
• Lack of health care expertise
• Lack of community partnerships
The top cultural barriers that people face within their community
are:
1. Racial biases
2. Fear of mistreatment or unequal treatment
3. Language barriers (cultural or linguistic)
4. Cultural beliefs
5. Perception of unequal treatment of persons

37. Barriers
The top health care barriers that people face in their community:
• #1 response - Lack of adequate and affordable insurance
• #2 response - Lack of knowledge of resources that are available
• #3 response - Lack of access to free clinics
The top socioeconomic barriers that people face in their community are:
1. Lack of sufficient income to afford basic necessities
2. Lack of transportation (public and private)
3. Unemployment
4. Lack of vocational training
The top social environmental barriers that people face in their community are:
1. Drug abuse
2. Poor social support network from within the community
3. Housing (non-availability, non-permissive cost, low-quality)

38. Rural Congregations
In our broad-brushed analysis of the four counties in the pilot, the
demographics reflect the following trend:
• Membership average of 150
• Primarily composed of senior adults with a much smaller
representation of youth and children
• A predominant female majority of members
• Have been in existence for more than 50 years
• Have a single, salaried leadership staff
• Significantly segregated
• Few churches have “active” health ministries
• Nearly all of the churches felt they play a role in helping its
members be healthy
• All of the churches actively support the health of its members
in one way or another

39. How can you utilize the local church as a public health partner?
According to VDH, a medium-level pandemic in Virginia could cause:
• 2,700 to 6,300 deaths
• 12,000 to 28,500 hospitalizations
• 575,000 to 1.35 million outpatient visits
• 1.08 million to 2.52 million people becoming sick

40. http://www.flu.gov/professional/community/cfboguidance.html

41. Recommendations & Next Steps
• Development of a model health ministry program at a statewide
level
• Health ministry toolkit/manual for congregations
• Individual church member survey
• Pilot model rural health ministry programs for congregations
• Conduct further research
Engaging the faith community in these recommendations
is essential to program success. And, the development of
persistent, sustained relationships with congregations are
absolutely necessary.

42. By leveraging the strength of the faith
community as a force multiplier in public
health, community capacity can be
significantly increased extending its
reach, impact and value.
Rev. Andrea Lomboy
Alomboy@faithbasedhealth.com
703/581-4323