This session, chaired by Katherine Marshall, spent most of its time discussing two clear challenges. The first is to try to maximise the opportunities revealed by the COVID crisis to realise just and equitable healthcare in the future. The second is to highlight the oft-neglected role that religious communities can play in doing so.
How people and countries have responded to the pandemic has been to a great extent determined by their situation before COVID. Vinya Ariyaratne, President of Sri Lanka’s Sarvodaya Shramadana Movement, described a country recovering from protracted war and still suffering deep divisions between ethnic groups. When the pandemic hit, these resurfaced. A first lesson, then, might be to anticipate pre-existing divisions and stresses, whatever they are; as far as possible, prevent them from surfacing; and, if they do, emphasize and harness the positive aspects of community in facing major stresses like pandemics. Sarvodaya Shramadana did this by taking elements of doctrine from the teachings of all major religions in Sri Lanka, relating them to the dynamics of COVID transmission, and mobilising religious leaders to use that information in their sermons. This helped make health promotion messages more relatable.
A second lesson was the value of giving religions and congregations and their leaders different channels to express themselves when important religious practices are constrained or stopped by public health measures. In Sri Lanka this included the creation of digital channels to engage leaders, who could then address mis- and disinformation by passing correct messages to the public—an important and valuable role. A third, connected lesson was revealed by difficulties around sensitive issues such as burial practices, and the need to balance public demand for ritual that was unsafe in the pandemic. Many people hold great, and psychologically valuable, faith in the protective qualities of religious practice. We need ways to help them feel they can continue those practices safely.
A final lesson from Sri Lanka was the crucial importance of harnessing trust in different contexts. In many ways society is disintegrating during the pandemic: education is interrupted and violence is rising in homes, whether gender based or violence against children. There is a huge and increasing number of pressing problems and religious leaders can play critical roles in the solutions. There is huge work to be done, for example, in mental health, or the protection of worldwide gains in child mortality and development. Some places in the world are approaching 400 days of school closure, and many of the world’s most vulnerable children are finding themselves subject to multiple compounding depravations.
Agus Samsudin, its chairman, outlined some of the lessons that have emerged from the work of Muhammadiyah in Indonesia, where religious leaders are important figures. Sadly, some such leaders still believe that COVID-19 is a conspiracy and vaccines are bad, and have ended up fighting actively against the pandemic response. Efforts to counter misinformation have not been helped by the ongoing inconsistency of government economic and health policies. In such an unstable context, difficulties with preventative measures are compounded by cultural factors that impede uptake of measures like social distancing: for example, physical closeness and togetherness within society are important in Indonesia; distance is alien to the culture. The impact of the pandemic on social, economic and psychological wellbeing has been immense. People on lockdowns are bored at home; they want to go out, meet each other, pray outside. Religious leaders are all the more important for all this: they need to fight very hard for more innovative ways to practise faith, finding innovative responses to the potential harm these problems can cause. Some such measures have already been taken – for example, with Muslim leaders allowing Friday prayers at home rather than at the mosque.
COVID-19 is an ever-changing, evolving experience wherever you are. Peter Yeboah, Executive Director of the Christian Health Association of Ghana, shared some thoughts on how the pandemic has deepened the appreciation of the role religious leaders and institutions can play in protecting health and global health security. In Ghana, the church was a victim of the pandemic in some ways, closing places of worship and seeing congregations were dispossessed of income and office; but in others, the church became a valuable advocate for pandemic management, influencing government policy and behaviour in the community. The president convened leaders for national prayer, elevating and recognising the vital role of religion. Churches donated their infrastructure as isolation centres and quarantine centres, helped distribute food and relief during lockdown, and promoted compliance with COVID protocols. There has been pandemic denial and fatigue, of course, and some churches have fallen prey to disinformation; but on the whole great examples have been set. Religious leaders were the first public figures to receive vaccines, to address hesitancy and cynicism. Churches have provided important counselling services and risk communication, and helped people navigate the health system.
Having started down this road, there are now prospects for a more profound engagement of the religious community in health policy. Religion affects everybody; deeper engagement with governments is necessary. The UHC agenda is now recognised by politicians as a universal public good, and for the first time, the government in Ghana – and around the world – openly recognises the need to invest in holistic health. Advances in digital and technological approaches have opened up vital new avenues for innovation that faith organisations can foster, creating an atmosphere of social investment in health as a matter of national security that requires partnership and cooperation with all stakeholders. Finally, in a paradox of pandemic management, lockdowns and distancing have emphasised the value society places on congregating – highlighting the longer-term need for congregations to come together, fraternise and share lessons.
In India, the pandemic is in the middle of a second wave. Hospitals are full and communities are filled with quarantining families. Vinu Aram, Director, explained how Shanti Ashram and other faith organisations have responded as the pandemic made religious bodies into
partners able and willing to sit at the table with the government. In the past, HIV showed how faith inspired organisations can work in this way, and some of the institutional memory survives; but faith organisations were unprepared for the intensity of COVID. Many were not even prepared for their main duty to meet people’s spiritual needs. But they have shown a willingness to learn that has been valuable, issuing declarations in support of science and health policy, closing places of worship while continuing to provide crucial services, and recognising the need to be a positive partner – and the dangers of finger pointing.
Decision making capacity at every level is important. Local leaders have had to make decisions on the spot, communicating, absorbing scientific evidence and taking localised decisions in response. Religious communities have stepped up, offering spiritual support, buildings, meals and care for the vulnerable. They have accompanied people through deep uncertainty, empowering local dispensaries and hospitals and keeping educational institutions open. Somewhere between the first and second waves they became able to present not just a sense of ethics, but also a pragmatic overview of what they were seeing and hearing – a picture of shrinking incomes, women losing disproportionate numbers of jobs, a lack of contraceptives, rising violence and a reproductive health crisis. Having that closeness to communities at the same time as the seat at the top table meant faith organisations have become communications channels, contributing substantively to conversations about social cohesion. Healthcare providers are beginning to pay more than lip service to the four pillars of health: the physical, the mental, the social and the spiritual. With only a tiny fraction of a huge population vaccinated, all these elements will be important in the efforts to come.
Religion has, and has had, much to do with the current crisis, both good and bad; and it can play a huge role in emerging from it in the right way. The future will also be shaped greatly by large multilateral organisations like WHO. Sarah Hess, from the Health Emergencies Programme at the World Health Organization, provided some insight into efforts that have taken place in WHO over the last year to share that task with faith communities, describing the need to do so as one of WHO’s greatest learnings of the pandemic. Faith communities represent complex systems – not only social systems, but also systems for health service delivery, infrastructure and education. WHO is working to understand that complexity and figure out how best to support the existing work of these organisations. Communication will be crucial. In all communities at every level, trusted voices or leaders have huge power, if they are willing to accept it, to speak with clarity and address the concerns of organisations like Shanti Ashram and the communities they serve.
Inequity is severe and increasing, exacerbated by the pandemic: the capacities to respond to COVID and the tools available for that response are not equitably distributed. Where countries are in crisis, it is because of this, and because of the insularity, resentment and nationalism that bubble up in response. The faith values of equity, giving, helping and sharing are critical to driving the conversations around equity. WHO is examining how best to amplify their voices and support their efforts, and begin to see faith communities and systems as critical partners in achieving universal health coverage. The WHO Director General has said that he wants this partnership strengthened in the years to come.
These discussions emphasise the need for global solidarity as we distribute vaccines. Andrew Serazin, President of the Templeton World Charity Foundation, described his organisation’s attempts to make meaning, purpose and truth central to human development, in 200 projects in over 50 countries that apply scientific rigour to things that originate or are inspired by spiritual traditions around the world, to understand how they work and how to spread them. One example is spreading the science of forgiveness: while we hope to eliminate the virus and the disease, we will never eradicate the interpersonal hurt or trauma that came with it. Forgiveness is a profound psychological concept, but it also has deep theological roots and religious significance. The Foundation has been leading efforts to understand the process of forgiveness for decades, quantifying how it works, what individuals can do to access it, and its benefits. Over 50 studies have shown that after a traumatic event, once safety is achieved, forgiveness is one of the most beneficial things possible for survivors’ mental health – and there is strong evidence for its positive effects on stress and cardiovascular health as well.
Arguably, all conversations around global health and development are to some extent spiritual. Ninety per cent of the world exists outside Western, educated, industrial, rich, democratic communities. In the pandemic context, research is needed to see exactly what attributes religious organisations provide in the provision of services; and on the individual level, what distinctive attributes religious humans have, and which of those are positively associated with strong responses to coronavirus. In terms of a theoretical framing, religiosity and religious institutions have the most comprehensive holistic approaches to what it means to be human today, and have evolved them over many centuries of thinking about belonging and about the beyond. Religious individuals therefore potentially have the most holistic framing for wellbeing, for physical, mental, social and spiritual health. Can spiritual principles like compassion or forgiveness be linked to those frameworks, through rigorous research, to achieve greater efficacy and efficiency of health service delivery? Does the inclusion of contextually appropriate spiritual principles in health worker training enable better services, as reflected in metrics like vaccination rates and maternal mortality? This crisis can be used to learn how, at an institutional level, solidarity is created through spiritual principles. These are potential gains that Western models of wellbeing miss through excessive focus on the individual, and they are fascinating research questions. Human beings are fundamentally spiritual beings. All of life, including delivery of health services, should acknowledge and understand that.
Pandemics tend to be turning points in history. Sometimes they bring out the best in people and societies; sometimes the worst. COVID and its control measures forcing re-examination of what is essential in life. The mental health crisis that may follow this pandemic – referred to by the WHO Director general as a masked catastrophe and a scarring of the mind – will be of a scale impregnable to regular models of mental health services. Dealing with this will require religious communities and scientists to work together to understand the problems and the multidimensional responses they require. In a resolution at the recently concluded World Health Assembly, WHO Member States adopted a 10-year global action plan on mental health—shockingly, the first ever Assembly resolution on mental health. There is huge work to be done, but the pandemic could be a positive turning point. Religious assets are spiritual assets, and there is good longitudinal data to suggest that certain measures of spirituality or religiosity are protective against some common mental health conditions. Shifting the conversation about mental health to prevention as opposed to treatment has to include spirituality and religious institutions.
For the first time in many countries, there are strong interfaces between faith, science, communities and governments; religious leaders are complying with science-informed policies; and the non-physical aspects of health are being acknowledged by policy makers. The conversations are there to be had about how to leverage religious assets in service of UHC. The pandemic has been complicated and worsened by an infodemic: an overabundance of information that makes it hard for people to take the right decisions to protect their health. The sheer volume of information is daunting, and the fact that much of it is either mis- or disinformation makes the problem worse. Religious leaders will have big roles to play in fighting the infodemic, one of the most surprising and damaging aspects of the pandemic. Digital strategies offer huge opportunities to share values, knowledge, experience and compassion for the public good. Power is being redistributed: big multilateral institutions and governments have found themselves unable to go the last mile, to reach people on the ground. This could be a time to rebalance, reframe and recalibrate the dynamics of power to reach communities—which, under pressure, have shown themselves to be refuges and repositories of resources for healing, sharing and wellbeing.
To achieve all this, many societies and policy-making spaces may need to demystify the word “religion.” A global health partnership that included investors, governments, communities, religious organisations and leaders along with the diagnostic, pharmaceutical and vaccine industries could achieve magnificent things.
To that end, the World Faiths Development Dialogue and others will be very engaged in this year’s G20 meetings on the topic of religion, faith and health. The world has a long way to go to achieve the necessary thoughtful, nuanced understanding of the complex world of religion. The current spotlight is on how religious roles can support global vaccine targets and delivery, but in the long term they should be addressing pandemic preparedness, the gross inequities in healthcare, and the crucial challenge of universal health coverage.