Examining the Spiritual Determinant of Health

By Stephen P. Kliewer, MS, DMin, LPC

I will never forget the moment, when, walking down the hallway of a large university hospital I heard two “white coats” refer to the “liver in room 10”.  It had never occurred to me, until that moment, how profoundly disease-oriented healthcare divided human beings into distinct “pieces” or dimensions, thereby rendering them less human.

At that point we were just beginning to study, and promote, an approach to health care that not only sought to be wholistic in nature, taking into account such things as spirituality, but also sought to be contextual, recognizing that such things as the social context in which a person lived each day had a profound impact on wellness.

Today, social determinants of health are taken seriously, and it is understood that no approach to health care would be complete without addressing those factors.  We know that such things as food security, adequate housing, and transportation have a profound impact on a person’s physical and mental health.

Another important shift means that now, instead of thinking simply in terms of “cure”, the eradication of a disease, we think in terms of wellness.  Wellness, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) “concerns maintaining an overall quality of life and the pursuit of optimal emotional, mental, and physical health” (http://www.samhsa.gov/wellness). It is not just the absence of disease, it is the “presence of purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, and happiness (SAMHSA).”

How can you talk about wellness without including spirituality is part of the equation?  Spirituality can be defined in many ways. Many simply see it as a search for “the Sacred” or even a search for meaning and purpose.  It is considered distinct from “religion” which is often the manner in which people attempt to pursue spirituality – using specific sets of teachings and rituals. I like to think of spirituality as the act of connecting with something larger than myself.  This is echoed by Kaiser who suggests that spirituality “refers to a broad set of principles that transcend all religions. Spirituality is about the relationship between ourselves and something larger. That something can be the good of the community or the people who are served by your agency or school or with energies greater than ourselves. Spirituality means being in the right relationship with all that is. It is a stance of harmlessness toward all living beings and an understanding of their mutual interdependence” (Kaiser 2000).

The focus on wellness rather than cure has led SAMHSA to promote what they call the “eight dimensions” of health.  There are emotional, environmental, financial, intellectual, the occupational, physical, social, and spiritual dimensions (http://www.samhsa.gov/wellness-initiative/eight-dimensions-wellness)

These dimensions are now considered as critical as the traditional social determinants of health, and open new opportunities for working with patients in meaningful ways.  We can now add a new layer of richness to the traditional concept of social determinants, which include economic stability, education, social and community context, health and health care and neighborhood.

This is a very exciting development which will allow physicians, nurses, mental health professionals, and other service providers to move more deeply into those factors that impact health.  We have much to learn about how to apply this new agenda to actual care, but this new emphasis is likely to have a profound impact on the art of healing.

Stephen P. Kliewer, MS, DMin, LPC, is the executive director of Wallowa Valley Center for Wellness in Oregon. He has written Creative Use of Diversity in the Local Church, and was the primary author of Healthcare and Spirituality, a basic text for health care providers. He will speak on “Spirituality as a Social Determinant of Health,” at the 2015 Interfaith Health & Hope Coalition Prayer Event, Sept. 24. Contact Ron Beford at rbeford@yahoo.com or 810-923-6940 for information.