Mass as Medicine?

Studies have linked participation in religious activities with long lives, but not everyone stands convinced.

Pray for a healthy life, and you just might get your wish--if you do your praying in church, anyway. At least that's the conclusion of a growing number of studies that suggest people who regularly attend religious services enjoy better health than their more secular peers. Hundreds of studies have examined the link between religion and wellness, and the correlation between the two looks stronger than ever, says Harold Koenig, a psychiatrist at Duke University Medical Center in Durham, North Carolina. But critics charge that the apparent medical benefits of religion probably stem from factors that have nothing to do with faith.

So many studies have linked religion to payoffs such as improved psychological well-being, decreased risk of depression, reduced stress, and rosier overall health that Koenig filled his 2001 book The Handbook of Religion and Health with summaries of more than 1000 of them. More provocative still, recent investigations suggest that churchgoers live longer than those who eschew the pews do. For instance, in a study published in the Journal of Gerontology this year, sociologist Terrence Hill and his colleagues at the University of Texas, Austin, found that the mortality rate of people age 65 or older who went to church once a week was 32% lower than that of those who skipped services. "We controlled for health, behavior, and cognitive impairment, and the link didn't go away," says Hill. The result confirms a 2003 review of longevity and religion that, after taking into account social support, mental health, and behaviors such as smoking, found about a 25% reduction in mortality among people who attended religious services once per week or more.

Despite this abundance of evidence, "the devil is in the details," says Neal Krause, a sociologist at the University of Michigan, Ann Arbor. "The real trick is to find out what is it about religion that's good for health." It's virtually impossible to separate religion from other factors that might be responsible for the lift in well-being seen in the faithful, such as social support for a healthy lifestyle that shuns smoking, drugs, and sexual promiscuity, says psychologist Richard Sloan of Columbia University Medical Center.

What's more, he says, religion resists easy measurement: Some studies look at church attendance; others ask people to rate their religiousness. Thus researchers can't know for certain that different studies are tracking the same thing. "Religion is not one thing; it's a name we use to describe all kinds of stuff," says Krause. In an effort to pin down the helpful aspects of devotion, researchers have tried to carve out different aspects of religion to see which factors promote benefits.

The social interactions members gain at church provide one obvious explanation. People with strong friendship networks enjoy better health than those with weaker support systems, says Krause. He has examined the role of interpersonal interactions by investigating whether social networks at church could protect people from the adverse health consequences that accompany financial strain. The results indicated that when it comes to support, it's better to give than to receive. Among older churchgoers who were facing severe money problems, offering emotional support to other members reduced the odds of dying by about 13% compared to the less altruistic. Krause is now looking into whether volunteering assistance in a secular setting produces similar payoffs.

But the support people receive at their place of worship might go beyond what they can acquire at their bridge club or bingo group, says Koenig. In addition to trading comfort and encouragement, spending time with other religious followers can serve as affirmation of a belief system that gives coherence to their lives. Krause says that religion provides its followers some sense of control. "It's a god-mediated control," he says. But it allows followers to feel that someone is in charge and life is not meaningless and random. That belief could help, says Krause, because "people with a strong sense of control generally have better health than those who believe that the world is a random place that they cannot control." Feelings of control decline with age, and some people cope by turning to a higher being, he says. Such a strategy might explain why elderly people describe themselves as religious more commonly than younger people do.

For retirees, participation in religious services could enhance well-being by lifting self-esteem, says Hill. "They're not working anymore, but they can take on leadership roles and enjoy status at a church if they're regular attenders." The sermons themselves might also provide a lift for elderly members by providing an hour or two each week of contemplation of weighty philosophical ideas. "Any activity that's mentally stimulating is great for people in late life," says Hill.

Such theories, says Sloan, remain difficult to prove--in large part because the studies are all observational (see "Proving Grounds"). "You can't divide groups in half and ask some of them to be religious and others not. So you have to rely on preexisting differences and then look at the health correlates of that," says Sloan. But religious individuals might also differ from their secular counterparts in other crucial ways. For example, some psychologists have suggested that the same character traits that make people more likely to attend church might also leave them naturally more prone to adopting healthy habits, says Hill. These studies cannot rule out the possibility that some as-yet-to-be-identified variable could be driving the observed boost in health or longevity, says Sloan.

Sloan suspects that much of the research in the field proceeds with an underlying motive to promote religion. Hill admits that some religious and conservative groups have funded studies and have used them to endorse their organizations but says that is not researchers' intent. "We try to stay away from saying that religion is good," he says. Church services are just one activity that older people can participate in to improve their well-being, says Hill: "We're trying to describe patterns in health. We're not trying to prescribe religion."

That's why the studies have little practical value, says Sloan. At the end of the day, they don't offer clinicians concrete advice that they can give to patients. "My critique has nothing to do with the value of religion," Sloan says. No one disputes that religion plays an important role in some people's lives and helps guide them through difficult times. But until researchers can verify exactly how--and whether--religion boosts health, even the most faithful followers would be well advised to continue leading a healthy, low-sin lifestyle.

Christie Aschwanden is a freelance writer in Colorado who likes to ponder weighty philosophical ideas.