Healthcare workers are ministers of a God who loves life

Health workers are ministers for a God who loves life

By Professor Jim McManus

Catholics have a long history of working in health and social care. From the examples of the saints who have founded orders to the history of hospitals, to the work done today, the evidence is all around us.

Indeed, the Catholic Church worldwide today remains one of the biggest providers of health and social care globally, and is the single biggest provider of HIV and Aids care.

So why are we so interested in health and social care? Simply and solely because we see it as a commitment to human dignity and wholeness, and that in itself stems from the mission of Christ.

The fact is the Catholic Church’s position is and has been consistent for some time. Human beings are precious because they are precious to God. So we should cherish life, however weakened and disabled. It is precious. We should support people to achieve best health. But the Church has always balanced that by saying we should embrace natural death when it comes.

That means participation in this mission of health and healing is important to the Church because of what it sees as its participation in the mission of Christ. And workers who participate in this mission of health and healing – indeed, have a vocation to this – are important because they are doing something – paid or unpaid – that the Church sees as valuable and in many ways is central to its mission.

The Church has produced a range of consistent teaching for many years on this. What it hasn’t done terribly well is codify this or always make it readily accessible for us. St John Paul II created a Pontifical Council for Health Care Workers, and in his Apostolic Constitution Dolentium Hominum taught us much about suffering and our understanding of it.

Many would say he taught us even more by his bearing of it personally. In creating the Pontifical Council for Health Care Workers, he gave us a range of resources including a Charter for Health Care Workers which, sadly, have not received the coverage they should have. The council was recently, after 30 years, subsumed into the new papal organisation for Integral Human Development. Some see this as a retrograde step.

I disagree. Health and health care have to be about integral human development across the whole life course. And this gives us some new opportunities to articulate what being healthy means across our whole life.

Within the last month, a document which I believe needs a much wider audience was produced by the Vatican. Entitled A New Charter for Health Care Workers, this document – as yet, only available in Italian – represents nothing less than a major opportunity for us. I’ve already received invitations to lecture and teach on this. I hope an official English version will be made available soon. For the present, I am on my fourth reading of this document and it is nothing less than inspirational.

So why is this document important? I would like to advance a few reasons. First, it is a document which does joined up thinking. Health is hugely important to us as a human good, and it was important to Christ. That means that the ministry of healing, and the work of health and social care, is an important part of the Church’s ministry. This document rings that message out loud and clear. If you are a carer – paid or unpaid – you live the Church’s mission by encountering people in pain and need.

The document begins with a rather beautiful ‘ministry of health’ introduction and a preface re-iterating the teaching of St John Paul II. It frames the whole discussion of health and healthcare as part of the Church’s mission.

…the health care worker is ‘the minister of that God who in scripture is presented as “a lover of life”’ (Wisdom 11:26). To serve life is to serve God in the person: it is to become ‘a collaborator with God in restoring health to the sick body’ and to give praise and glory to God in the loving acceptance of life, especially if it is weak and ill.

The therapeutic ministry of health care workers is a sharing in the pastoral and evangelising work of the Church. Service to life becomes a ministry of salvation that is a message that implements the redeeming love of Christ. Doctors, nurses, other health care workers and voluntary assistants are called to be the living image of Christ and of his Church in loving the sick and the suffering: witnesses to “the gospel of life”.

Second, the document sets the whole journey of human life, and the issues of health and suffering, within the context of integral human development.

Third, the document links Catholic Social Teaching to issues of health quite explicitly. There is a framing of rights people have to health and healthcare within the duty of justice. The document frames healthcare quality within the context of justice too, and this theme of justice continues throughout. People have a right to the means to health (education, employment, food etc) and to good quality healthcare.

Fourth, the document takes a whole life course approach. The text is divided into sections on procreation, living and dying so there is a bioethical theme running through it (which sometimes dominates) but if you read closely the social justice for all theme is strongly there.

Fifth, and here I think very profoundly, the document attempts to join up an understanding of health, health care and the mystery of suffering. Health is a ‘good’ to enjoy. Suffering in some senses is something to avoid and so healing when we can cure is a participation in Christ’s healing ministry. But suffering is not valueless. It has a redemptive quality. We can offer it to God and unite ourselves with Christ in his suffering. We can learn through our pain – and I say that personally here.

Finally, I personally feel it says something profound about the nature of health. If people who suffer, or are disabled, are precious to God, health cannot be the perfect state of everything being wonderful that the aspirational 1948 World Health Organisation definition suggests. Health needs to be seen as an orientation to be the best we can be, for God, for self and for others, given our physical and psychological limitations. We need not be physically perfect. We must be realistic. But through it all we remain precious to God and the Church’s position on valuing all human life seen in this light is entirely consistent. Those we cannot cure we can support, sustain and learn from.

There is a wonderful section on death and dying which you would think was almost written as a development of some of the recent work on end-of-life care policy nationally. It says: ‘In the last days of life the dignity of the person should be understood as the right to die with greatest possible serenity, and with that human and Christian dignity which is their due.’ There’s a call to mission for Catholics if ever there was one.

It goes on to remind us of the importance of spiritual care at end of life. ‘The spiritual crisis which comes as death approaches, compels the Church to bear the light of hope to the dying person and their loved ones, a light which only faith can shed on the mystery of dying.’

Seen in this light, the Art of Dying Well website www.artofdyingwell.org is a clear attempt to communicate these riches of the Church’s understanding to a society which really needs them.

This document gives us some major opportunities. And it comes at the right time as in all of the four health systems of the UK, we see some significant changes being wrought.

The diocese of Westminster has already spurred a season – Called to Serve the Sick – which is intended to be a practical continuation of the Year of Mercy. This new charter lands right in the middle of that season.

A series of roadshows, championed by Bishop Paul McAleenan, will discuss a Catholic understanding of health and social care, why Catholics should feel a particular vocation to health and social care, and what parishes can do about it. “It is fitting that this season comes as a continuation of the Year of Mercy, giving us the opportunity to practise that most important act of Christian love, care for our neighbour,” says Bishop Paul. “Good health, poor health, disability and ultimately our death, are integral aspects of what it means to be humans precious to God, and so they are of huge importance to us as Catholics.”

To register and for more information and resources go to www.rcdow.org.uk/called-to-serve-the-sick

He added: “The Church has a special place of value for those who are sick, those with disabilities and those who work with and for them. Cardinal Vincent and I very much want priests, deacons, religious and lay faithful to understand that working with the sick is part of their core ministry and mission”.

At the same time, new resources are being published by CTS. A Priest’s Guide to Hospital Ministry and a Catholic Patient’s Guide to Being in Hospital are available from www.ctsbooks.org

Professor Jim McManus is director of public health for Hertfordshire, and a consultant to the Art of Dying Well.
For more, see www.artofdyingwell.org

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Linking Health and Faith: re-learning old lessons

One of my scientific and theological interests has, for some time, been dialoguing scientific evidence on health and medicine with faith.  I believe dialogue between health and faith needs to be scientifically, theologically and epistemologically rigorous in equal measure.  A growing body of robust scientific research is remembering what people of faith seem to have not quite forgotten, than people mediate their understanding of health, and their coping and living strategies, at least in part through their belief systems. That has profound implications for our health and wellbeing.

 

 

Some practical examples

Less than a month from now, in October 2017 a new series of videos, and in November a website Positive Faith will be launched as one embodiment of this. This will be series of videos and resources by, about and for people living with and affected by HIV. This exercise has been funded by Public Health England, and led by Catholics for AIDS Prevention and Support.  The resource privileges the voices of People with HIV over professionals of any kind. People with HIV explicitly address these issues of health and belief.

The FaithAction health and faith portal remains, for me, one of the great things to come out of Public Health England’s partnerships with the community sector because it works at applying these lessons and collates practical examples.  There are many more. I have been privileged to work with  FaithAction for some time. Their report contextualising the evidence on faith and health for UK commissioners and policymakers is important reading.   Their work on mental health and dementia friendly places of worship has much to offer a prevention and community engagement agenda.  FaithAction have created a series of resources for commissioners, practitioners and faith communities to use together.

A series of Catholic mental health demonstration projects has been delivered.  A mental health access pack for Churches – written by professionals and experts by experience – has been created by a charity whose values commit them to work on disability and health. You can read my invited blog on why I endorse the pack, here.

The University of Leeds with Leeds Public Health team has explored the links and barriers between religion and public health in some really exciting work on mental health.

I don’t claim any of what I say here makes people of faith better or more special than those of no faith in the world of health and care. I merely say that we have legitimate and understandable motivations and values to be in that world, and we have a contribution to make every bit as valuable as anyone else.  And our values inform that. We can no more leave our values or identity at the door that anyone else.

Faith cannot be the one “protected characteristic” that is private when every other one is recognised to be part and parcel of the person. But that’s for another blog.

The scientific evidence behind this

Most of you who know me well know this is an area of interest. I do my job because of my value base.  Early next year my review article on some of the best recent publications in health and faith will make its appearance in Reviews in Religion and Theology

In the process of entertaining this interest I have amassed a smallish library of 200 volumes in several languages, including volumes which stand out like Ellen Idler’s (the polymath Epidemiologist and Sociologist) recent and rather excellent Public Health volume on Religion as a social determinant of public health , the brilliant theological/philosophical work Flourishing by one of my theological heroes Neil Messer  and a range of materials on psychology, psychopathology and religion.  I’m preparing this collection (well the stuff in English anyway) for donation to a library where people will get easier access to it.

Faith still relevant to our population

Some of you may think Faith – especially explicitly religious faith – is a minority interest. Well you may be right, but that minority is still between 37% and 43% of the population depending on who you speak to.  We wouldn’t now be so discriminatory as to dismiss LGBT populations because they’re 2% – 3% of the population depending on who you read, would we?   So let’s recognise that our value bases inform who we are, and most of us are part of some minority. It’s inclusion of every minority’s best offerings which makes social life vibrant.

Prof Stephen Bullivant a sociologist at St Mary’s University has undertaken analysis of ONS data (I believe as yet unpublished) which suggests that, for example, Catholics are present in the health and care field in numbers around eight times more than they would be if they were just present in the same proportion as their presence in the general population.  Incidentally, Stephen Bullivant’s recent report on the “No Religion” population is a good read for anyone in public policy.

People still understand and filter their health experiences, beliefs, behaviours and life choices (including the choice to serve) through their religious belief.  NICE guidance recognises that and has stated there is a strong evidential case for its salience in care.  It is folly not to engage with this. My invited paper to the Equality and Human Rights Commission on what this means for healthcare employers in terms of workforce strategy, service quality and equality and diversity law explores the practical and organisational implications of this further.  The growth of non-religious spiritual and pastoral care in our hospitals, recognising that humanists and others who describe themselves as non-theist and non religious, have spiritual needs too, is welcome and valuable alongside care for those who do have religious faith.

The Guild of Health and St Raphael

A short while ago, I was approached by the Guild of Health and St Raphael to become their president, a role which I shortly take on, after a bit of reflection and dithering on my part. I look forward to this immensely.  It came, to me at any rate, as something of a shock. I did the “why on earth would they want me, couldn’t they find anyone better?” And “why  on earth would they want a Catholic? ”  thing. I then thought of suggesting Archbishop Justin Welby before realising he’s a patron already.  And then I thought of Lord Rowan Williams, who’s a patron of something else they do already. Whoops!

In discussing this with a good colleague , she reminded me that she calls me “the health and faith babel fish”. By which she means I seem to be good at translating the field of health to the field of faith. She asked me “do you think the Guild does important things?” “Yes”, I answered. “Does it have a sound theology?”  “Yes”.  Have they got people who are scientifically credible?”  Again, “yes”. Just for starters, the Director, Gillian Straine is a PhD qualified Scientist and an ordained Anglican priest.  “Does it resonate with your desire to make clear the links between health and faith?” “Yes, vey much so.” “Well, then in your own words -get on with it.”   And so, with that kick up the motivations, here begins a journey.

Formed in 1904 to bring together members of the clergy and medical professions to study and promote the healing ministry of the Church, it claims to be the oldest organisation in the UK working in the field of Christian health.  Anglican in heritage it is now ecumenical in outlook. The two Anglican Archbishops of York and Canterbury are Patrons along with the Methodist Church’s President, and now the Guild has let in a – rather stumbling – Catholic President! (What were they thinking, I hear you ask?)  An academic journal is coming. And practical resources. We have plans!

Academic community of interest

The academic community interested in the crossover between health and faith in the UK is growing. From Professor Chris Cook (psychiatry and psychology) at Durham, to the Guild’s newly launched Raphael Institute collaboration with epidemiologists, scientists, medics and psychologists, through to the work of Professor Michael King at UCL and many others I could mention, a body of work is beginning to be pumped out in a UK context examining the links between health and faith.  Similar communities in German medical schools, Swiss Universities,  Italy and, of course, the United States are creating work of use and value to the public health community.

Putting effort where my mouth is

There are a number of reasons why I am delighted to take on the role of President. First, Health and Faith, and the links between it, are an enduring interest.  My paid professional role as a Director of Public Health seeks to improve and protect the health of a population, something to me which resonates deeply with the call I believe all faiths – including the humanists I am lucky to know and learn from – have to improve human life and hold in good stewardship our earth.  I have written elsewhere, in The Universe about the vocational aspect of this.   And I guess as part of that I need to play my part in dialoguing the health and faith world constructively and rigorously to help us find what mitigates for maximum human flourishing – for those of all faiths and none.  That doesn’t mean those of us of faith leave our values at the door of the office, by the way.

The second is that participation in the work of ensuring people are as healthy as possible, in all dimensions, is a direct participation in one of the ultimate purposes of what most people of faiths do – the cherishing of and service to the human. Visit a Sikh or Jewish social service centre if you haven’t ever done so. You’ll be amazed.

The third is that because of this insight, people of faith have much to offer from “all our best traditions” as the hymn goes to the world of healthcare, and to the whole issue of what health means.  In fact, we were here first. Long before the NHS, before organised health care, we were there.  And people like the Historian of Science Gary Ferngren and others are writing the history of that engagement.

Christian Social Teaching as a Health Inequalities Manifesto

A further reason is that this provides a much needed opportunity to explicitly link Catholic Social Teaching (sometimes called the Catholic Church’s best kept secret) and its seven principles embodying Justice, dignity of the person and so on to issues of health.  Read any book on inequalities in health and a book catholic social teaching side by side and they say very similar things.  People have a right to health, and the means to health including good , healthcare, education and so much else and this is part of doing justice to our world. Good quality healthcare is framed as an exercise in justice and love in such teaching. I can find that link implicitly or explicitly everywhere I look. The founder of the Science of Healthcare Quality and Healthcare Improvement, who was not a Catholic, explicitly defined Quality Improvement in Healthcare as an exercise in love.  The links are significant. For more on the seven principles of Catholic Social Teaching, read here. Recent changes over the past fifteen years in US health care policy have generated a significant body of Catholic thought on Just Health Care policy including a whole body of thought on access. I’ll be discussing my take on what Public Health and Catholic Social Teaching agree on with regard to access, equity, justice and commissioning policy at an International conference on mental health in Oxford in summer 2018.

The fourth reason is that now, explicitly in the policy frameworks of all of the four devolved administrations of the UK, there is the recognition that health has many social dimensions, and needs social actors. This is a Kairos moment – an auspicious time when we can speak into the agenda of what it means to be healthy, and what health and social care is about. We have things to say.  And that means re-energising communities about what they can do on their health.  Faith communities can be a part of this. And examples of good practice here abound, from dementia friendly places of worship to social inclusion programmes and projects for people with long term conditions.

The riches of tradition informs the progress of today

The fifth reason is that while each of us can offer things from our own tradition – I have a particular tradition which feeds my commitment to improve and protect the heath of the population.  I don’t claim it’s better, I just claim it has enduring relevance. Catholics founded religious orders dedicated to health and healing, for example. Countless people we call saints have been engaged in health.  The St Vincent de Paul Society is a Catholic charity providing help from white goods to holiday breaks to clothing to utility crisis payments and has a bigger volunteer workforce than CAB last time I looked.  Entirely funded by Catholics.  Mary Aikenhead, founded the order which created the hospice of which I am a trustee. Her values of advocacy for and inclusion of the most excluded (and said in those words) are a constant reminder to me not to become complacent in a public health system where it would be easy just not to try  to find a way through the cuts being imposed on us.

Those Catholic religious orders still run health and care services across the World and the UK (and over 150 centres from hospices to refuges for victims of human trafficking in England today).  One of those orders is the biggest non-governmental emergency aid agency in the world, among whose volunteers I am proud to count myself. My tradition is supposed to roll up its sleeves, include and serve. (and it often needs a good kick to remind it of that.) Moreover, my tradition attests to the fact that health is social as much as it is individual.  These must go together. No human being is anything other than precious.  Justice, Love and Hope are the hinges on which we embody that insight.

Institutions sometimes get decadent and fail people. That happens in the NHS and public sector as much as it happens in the churches. The point is that continual renewing of our purpose – maximum human flourishing. Every faith which has a sense of the divine is at its best committed to human flourish and justice – even if at its worst we shamefully can and do at times betray and sully that commitment – because we believe that’s what God wants for God’s world.

The whole person

The sixth reason I am keen to do this is because the scientific evidence supports these insights as much as it informs them. We are becoming increasingly aware that health includes the whole person, and especially for those who cannot be cured, health is about making a good response to the realities we face. Like the Guild’s Director, Gillian, I am a cancer survivor, lucky to be alive after a Grade IVB lymphoma. Like Gillian, that experience has shaped how I am rediscovering the riches of the Christian tradition to speak to today’s world on health. Her book Cancer: a pilgrim companion is a brilliant read.

For those with long term conditions or disabilities, those with long term mental health challenges, those who are dying, the World Health Organization’s definition of health as a complete state of psychological, physical, spiritual wellbeing is hopelessly optimistic, and unreal. It implies they are less than fully human, and with that comes the risk they become devalued.  That is not a Christian view. Suffering, limitations and disabilities are not valueless.  It is also not a view that sits with the science of health inequalities, otherwise why bother with the discourse of tertiary prevention?

The World Health Organisation’s vision is valuable, but its valuable because of where it points us. It is future rather than present, a hope for the future. That means we have to revisit what health means here and now. And I would argue that the science and our theology are mutually affirming on this, and the Guild is ideally placed to do that work from the academic work at one end of the spectrum to the work of caring, praying and doing at the other.

Called to serve

Earlier this year, The RC Diocese of Westminster led a season of events entitled Called to Serve the Sick. I hate the term “the sick” but that’s for another time.  The series was intended to be a practical continuation of Catholics being recalled by Pope Francis in 2016 to serve and welcome, when we sometimes exclude too easily.  A series of roadshows, which I was privileged to present at, discussed a Catholic Understanding of Health and Social Care, why Catholics should feel a particular importance of committing to health, social justice and social care, and what local communities can do about it. We had an audience of health and care workers, and people struggling with health issues. And people of all faiths and none. We’ve been asked to do more. There is a demand for this work. And a useful reflection on why should Catholics be interested in healthcare is here

The Bishop who led this season, Bishop Paul McAleenan said that “It is fitting that this season comes as a continuation of the Year of Mercy, giving us the opportunity to practice that most important act of Christian love, care for our neighbour. Good health, poor health, disability and ultimately our death, are integral aspects of what it means to be humans precious to God, and so they are of huge importance to us as people of faith.

On this, I hope, people of all faiths and none can make common cause.

Catholic Volunteers in Health and Social Care

The Church Teaches: Voluntary Work in Healthcare

Cardinal Javier Lorenzo Barragan

Cardinal Barragan, a Mexican, was President of the Pontifical Council for Health Care Workers at the Vatican. He has been auxiliary Bishop of Mexico City, then Bishop of Zacatecas.  This reflection was given during a gathering one of the International Health Care Conferences in Rome, before Cardinal Barragan retired. Translated from the Italian by Jim McManus.

There are people and associations that have chosen to work for the improvement of the quality of our history and for the development of civilisation – voluntary workers.

They have embraced the banner of mercy. There are very ancient and glorious associations – some even have that name – and they seek to hear the voice of those in need, those without speech, and the cry of the land in order to find an answer ‘as long as this is possible’.

Hands-up

Interpreting the commandment of Christ to love one’s neighbour, voluntary workers have decided to place their own lives at the service of other people in order to construct a ‘civilisation of love’.

Moved by religious faith or because they believe that a more civilised world is possible, they want to literally give their hands to others. Whether they begin in the parish – that creative unit from which so much voluntary work stems – or pushed forward by organized humanitarian movements; voluntary workers struggle against the consequences of racial discrimination, fight against social exclusion linked to a multiplicity of forms of poverty and deprivation, and promote campaigns to respect human dignity in every historical and geographical context.

Following the Christian vision of life, many are concerned with the ‘least’ and the ‘last’, who Jesus tells us are  to be the privileged of the kingdom of God.

The Church throughout history has seen the force present in the voluntary work movement as a bearer of civilisation in care for older people, children, the chronically ill, disabled people, homeless people and immigrants. This is a presence that wants to create conditions of life that are more human, out of respect for God, and God’s creation.

When we reflect on the varying activities promoted by voluntary workers we feel a sense of admiration, but also a certain anxiety because one asks oneself how voluntary workers can carry out the tasks which society entrusts to them today. The Church, which has created and nourishes many associations, points to the promotion of Christian values as the inescapable point of reference and the inspiration of every social activity. This much can be seen in the encyclicals Centesimus Annus and Evangelium Vitae of Pope John Paul II.

Strong because they belong to and are formed by this solid inner structure, Catholic voluntary workers through their action can give a soul to the civilisation of the third millennium and encourage the advance of everyone without us falling into the brutal dehumanisation to which so many wars have borne witness. We should not  yield to pessimism because, as we can happily see, today voluntary workers exist in their thousands, and they have even been defined as the ‘flower in the buttonhole’ of the church’s efforts in the new millennium.

The Church looks with hope to voluntary work – the soul of solidarity – and must be involved in spiritually guiding so many Christians by supporting their organisation, forming their consciences, and encouraging the exercise of free-giving in favour of one’s neighbour.