Intended for healthcare professionals


Religion as a social force in health: complexities and contradictions

BMJ 2023; 382 doi: (Published 18 July 2023) Cite this as: BMJ 2023;382:e076817
  1. Ellen Idler, professor1,
  2. Mohamed F Jalloh, country director2,
  3. James Cochrane, emeritus professor3,
  4. John Blevins, professor1
  1. 1Emory University, Atlanta, Georgia, USA
  2. 2US Centers for Disease Control and Prevention, Cameroon
  3. 3University of Cape Town, Cape Town, South Africa
  1. Correspondence to: E Idler eidler{at}

Ellen Idler and colleagues argue that durable partnerships with religious bodies can contribute to better population health outcomes

The relationship between religion and public health regularly makes headlines in the press, with both conflict and cooperation as themes. Recent examples include: “Battling covid when religion and public health collide,”1 “Churches and mosques educate on Ebola,”2 “Uganda: HIV-positive teens choose religion over ARV.”3 In some cases, religious institutions protect and support public health measures; in others, the opposite occurs.

Religion is a set of spiritual beliefs and practices that manifest not only at individual level but at institutional levels through congregations of organised religions and faith based, charitable organisations. At the individual level religion may manifest as public participation in worship services of a congregation, as private practices such as prayer or meditation, or as private beliefs in the tenets of a faith or identifying as a religious person. Alongside education, income, ethnicity, and gender, religion has a quantifiable, demonstrable effect on population health.4 However, religion is different from other socioeconomic determinants of health; its unique complexities can produce both harmful and protective health effects. It therefore warrants a different conceptualisation as a social determinant of health, both to mitigate its harmful effects and to realise its protective and generative impact.

Not all tensions between public health and religious institutions are reconcilable, but engagement between public health actors and religious actors is essential because religion’s health effects are real, contradictory, and complex. These effects are relevant not only at the level of personal religiousness and individual health outcomes but also at the institutional and national levels.

Religion has a largely protective effect for individuals

Globally, many people see their health through a religious or spiritual lens, even in countries where there is little public participation in religious services. Religion shapes people’s “healthworlds”—their complex ways of …

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