CCIH 2012 Conference, Plenary 2, Jonathan Quick, Janneke Quick, Chronic Disease, Biblical Wisdom, Longevity

Chronic Diseases, Biblical Wisdom, Longevity:
The Epidemiology, The Word, The Evidence

The pool at Bethesda, John 5:2-8

Jonathan D. Quick, MD,MPH, President, Management Sciences for Health
Janneke C. Quick, Community Wellness Director, Live Well Winona
CCIH Annual Conference, June, 2012

CCIH Biblical Wisdom for Global Health Series

2008: Lessons from God's 1st Century Leadership Team for 21st
Century Christian Health Organizations - Teams that lead:
1. Are aligned around a compelling vision and shared values.
2. Are strengthened through diversity in skills and backgrounds.
3. Grow by embracing challenges.
2009: Biblical Wisdom for Digital Living – Wired for Technology,
Instructions Not Included
1. God has blessed us with boundless capacity to create technologies
2. Too often technologies separate, create inequalities, dehumanize
3. Scriptural wisdom can guide responsible use of technologies
2010: Injustice, Impact, Inspiration: Women, the MDGs, and Faith
1. Worldwide, women face stunning injustices in all areas of life
2. Women have dramatic positive impacts on human development
3. Faith inspires and empowers those combating injustice against women

Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 2

Chronic Diseases, Biblical Wisdom, Longevity

1. Chronic NCDs: The Epidemic

2. Biblical Wisdom: The Word

3. Longevity: The Evidence


Dominic Chavez

Epidemic of staggering proportions –
Already leading cause of death in all but
poorest countries
Deaths in millions (2008) In low and middle income
20 19.3 countries:
Injuries
• 28 million chronic NCD deaths
Communicable, maternal, perin • Among children, youth, working
15
atal, nutritional age adults – 8 million preventable
Chronic NCD NCD deaths
10 • 6 million from AIDS, TB, malaria
7.9 8
5.8 5.4
5 3.1
1.5
0.5
0
High Upper middle Lower middle Lower
income income

Source: WHO 2008

Stunning human impact of NCDs in low and
middle income countries (LMICs)
The NCD divide between rich and poor countries is deadly
• Death from breast & cervical cancer = pregnancy & childbirth
• A young diabetic will live 20 years with insulin – just 6 -18 months without
On current trends the problem will get worse before it gets better
• On the rise in LMICs, smoking will kill 1 billion people this century
• Urbanization in Africa has doubled overweight/obesity in reproductive age women
The human impact is huge – and so is the economic impact.
• Total worldwide cost of chronic NCDs > U.S. $6 trillion in 2010.
Potential impact of action is affordable and dramatic
• Just 2%/year  in NCD deaths would save 36 million lives over a decade
• Annual cost < $2 per person for 5 ―best buy‖ interventions targeting tobacco,
salt, inactivity, alcohol, obesity, cardiovascular risks

Adapted from: XXXXX


An integrated, holistic response is require to
combat the rise in chronic non-communicable
diseases
Number of Deaths for low income countries
(each silhouette = 1 million annual deaths)

2004 2030 (projected)
Chronic diseases
(NCDs)
HIV, TB, malaria,
other
communicable
Maternal, perinata
l, related
Accidents and
injuries

Chart based on WHO Global Burden of Disease, 2004, figure 15


Is there a role for religion in combating chronic
NCDs? A web of risk factors and complex
treatment
Physical
Age activity Cancer
Diabetes
Type 2
Gender Nutrition

Blood Ischemic
Education Overweight lipids Heart Disease
Chronic
Income
Alcohol Respiratory
Blood
Disease
Environ- pressure
ment Smoking
Mental
Illness
Stress
Adapted from: WHO, Global Health Risks, 2009


Jim Williamson – Healthy Vessels: A Christian
Guide for to edit Master title style
Click a Healthy Lifestyle

Motivation:
Good
biblical principles
Health

Recovery

Deterioration


The battle of our health and happiness is a
struggle of the „flesh‟ that can be won by living
Click„spirit‟edit Master title style
in the to
Importance of caring for your body
Therefore, I urge you, brothers and sisters, in view of God‟s mercy, to
offer your bodies as a living sacrifice, holy and pleasing to God—this
is your true and proper worship. Romans 12:1

Do you not know that your bodies are temples of the Holy Spirit, who
is in you, whom you have received from God? Therefore honor God
with your bodies.
1 Corinthians 6:19-20

So whether you eat or drink, or whatever you do, do it all for the glory
of God.
1 Corinthians 10:31


An abundant life - Biblical wisdom for healthy
living
I came that they may have life, and have it
abundantly.*
1. Moderation
For the drunkard and the glutton shall come to poverty.
Proverbs 23:21

But the Holy Spirit produces this kind of fruit in our lives: love, joy,
peace, patience, kindness, goodness, faithfulness, gentleness, and
self-control.
Galatians 5:22

Do you not know that in a race all the runners run, but only one gets the
prize?
Run in such a way as to get the prize. Everyone who competes in the
games goes into strict training. They do it to get a crown that will not
last, but we do it to get a crown that will last forever.
1 Corinthians 9:24-25

Click to edit Master title style
living

2. Nutrition
And God said, “Behold, I have given you every plant yielding seed
that is on the face of all the earth, and every tree with seed in its fruit.
You shall have them for food.”
Genesis 1:29

The fat of an animal found dead or torn by wild animals may be used
for any other purpose, but you must not eat it.
Leviticus 7:24

These are the regulations concerning animals, birds, every living thing
that moves about in the water and every creature that moves along the
ground. You must distinguish between the unclean and the clean,
between living creatures that may be eaten and those that may not be
eaten.
Leviticus 11:46-47

Daniel said ―no thanks‖ to a royal diet style
Click to edit Master title
Daniel & King Nebuchadnezzar

At the end of the ten days they looked
healthier and better nourished than
any of the young men who ate the
royal food.
So the guard took away their choice
food and the wine they were to drink
and gave them vegetables instead.

Daniel 1:15-16


The Daniel Plan – Rick Warren’s purpose-
driven lifestyle plan (www.danielplan.com)


living

3. Physical Activity

Physical training is good.
1 Timothy 4:8

To this you were called, because
Christ suffered for you, leaving you
an example, that you should follow
in his steps.
1 Peter 2:21


living

4. Rest

Six days you shall labor and do all your
work, but the seventh day is a sabbath to
the Lord your God. On it you shall not do
any work. For in six days the Lord made
the heavens and the earth, the sea, and all
that is in them, but he rested on the
seventh day.
Exodus 20:9-11
Come to me, all you who are weary and
burdened, and I will give you rest.
Matthew 11:28


living

5. Healing

A man with leprosy came and knelt before him and said, “Lord, if you
are willing, you can make me clean.” Jesus reached out his hand and
touched the man. “I am willing,” he said. “Be clean!” Immediately he
was cleansed of his leprosy.
Matthew 8:2-3
When Jesus had entered Capernaum, a centurion came to him, asking
for help. “Lord,” he said, “my servant lies at home paralyzed, suffering
terribly.”
. . . Jesus said to him, “Shall I come and heal him?” The centurion
replied, “Lord, I do not deserve to have you come under my roof. But
just say the word, and my servant will be healed.”
. . . Then Jesus said to the centurion, “Go! Let it be done just as you
believed it would.” And his servant was healed at that moment.

A promise of edit health
Click to good Master title style
He said, “If you listen carefully to the
LORD your God and do what is right in his An abundant life
eyes, if you pay attention to his 1.Moderation
commands and keep all his decrees, I will
not bring on you any of the diseases I 2.Nutrition
brought on the Egyptians, for I am the 3.Physical activity
LORD, who heals you.”
4.Rest
Exodus 15:26
5. Healing
Godly people find life; evil people find
death.
Proverbs 11:19


Do the Faithful live longer? Ask the Blue
Zones centenarians, 258/263 of who were
people of faith

Marge Jetton Marion Westermeyer Eleftheria Gaglia
Loma Linda, USA Greece

Nicoya
Costa Rica

Ishigaki Family
Okinawa,Japan
Church Festival, Sardinia
Source: D Buettner, The Blue Zones, 2009

Blue Zone video clip


Longevity and Faith – What is the state of
evidence, science, practice, and public
expectation?
A steadily growing scientific evidence base
 2001: 850 publications, 70% positive results, 60% quality methods
 2012: 1200 publications, 80% positive results, 72% quality
methods.
Increasing professional interest
 1992: 3 medical schools offered religion/spirituality courses
 2006: over100 of 141 U.S. and Canadian medical offered courses
Mismatch between needs, expectations and practice
 70 to 80% of doctors believe spiritual factors influence a patient’s
health
 72% of advanced cancer patients said spiritual needs not met
 10% of U.S. physicians report routinely talking to patients on
spirituality Source:s HG Koenig et al, Handbook of Religion and Health, 2012;
 <20% of patients report that a physicianReligion, and Health,spiritual 23-25
HG Koenig, Medicine, ever ask about 2008, pp.

“Market Share” – How commonly do people
from different faiths use religion for health?
United States – 42% overall, 62% cancer survivors use ―prayer for my own
health‖
Canada – Religious practice ranked fourth among six coping mechanisms for
terminal cancer patients, AIDS patients, and general population
UAE – 100% of 38 parents with cancer in a child turned to their religion
Morocco – 95% non-practicing believers among cancer patients started
practicing
Mexico – 70% of 2097 doctors felt religious beliefs were important
Taiwan – Of 1031 hospital patients & family visitors, 76% prayed to their god/s,
45% to Buddha, 24% to Chinese folklore gods
Japan – Among 305 cancer patients 17% believers, 17% unsure, 55% non-
believers
Europe – Daily prayer highest in Greece, Italy (54; 49%) lowest in Denmark,
Sweden (21; 14%)
Switzerland – 61-73% of children 10-12 yrs with health problems coped with
religion

What’s the evidence? Regular religious
service attenders have 30 to 40% increased
survival rates
Six-year survival and religious attendance
in 3,968 persons, ≥ 65 years

100
Probability of Survival

Once per week or more
90

80
Less than once per week
70

60
0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400
1986 1992
Days of Follow-Up
Source: HG Koenig, J. Gerontology, 1999

Cost-effectiveness – religious attendance
better than statins (And after-effects that last
forever!)
Cost per life-year
Intervention Additional life-years
gained
Weekly religious 2 to 3 $3000 - $ 10,000
attendance (a)
Statin-type medications 2½ to 3½ $4000 to $ 14,000
for blood lipids (b)
Regular physical 3 to 5 $2000 to $6000
exercise (c)

Cost based on:
(a) Average per capita contributions to religious institutions = $ 516
(b) Average yearly cost statin-type therapy = $836
(c) Annual cost of local gym membership = $500
Source: DE Hall, JABFM, 2006

Mechanism of Action – How do religious practices
increase longevity – especially from chronic NCDs?
Personal factors
 Source of social support – including church attendance (dose
effect)
 Relaxation response – prayer
 Modifier of behavior – reduced risk behavior, increased positive
behavior
 Prosocial agent – altruism and volunteering
Reduction in risk factors
 Smoking
 Alcohol consumption
 Exercise/fitness
 Nutrition/diet
Increase in treatment effectiveness
 Cancer treatment
 Cardiac treatment
Sources: HG Koenig et al, Handbook of Religion and Health, 2012;
 Diabetes treatment HG Koenig, Medicine, Religion, and Health, 2008

“Dose effect” – Frequency of church
attendance and reduced risk / mortality
Regular attendance at religious services versus
selected baseline risk factors
Never <weekly weekly >weekly
prevalence (%)

60
Age-adjusted

50
50
40
31
30 24 25
21
20 14 17
9
10
0
Current smoking lcohol in past month physical activity social support
A Low Low

Source: RF Gillum, AEP, 2008. longitudinal study 8450 Americans,
≥ 40 years, 1988-1994, 8.5 years average follow-up.

Adverse Effects – Can some religious beliefs or over-
reliance on prayer be harmful?

Source:


A role for religion in prevention and treatment of
chronic NCDs – tackling the web of risk factors

Physical
Age activity Cancer
Diabetes
Type 2
Gender Nutrition

Blood Ischemic
Education Overweight lipids Heart Disease
Chronic
Income
Alcohol Respiratory
Blood
Disease
Environ- pressure
ment Smoking
Mental
Illness
Stress
Adapted from: WHO, Global Health Risks, 2009


Lucy
The
Epidemiology Jim
The
Word

Simona
The
Evidence


Thank you
Stronger health systems. Greater health impact.

Saving lives and improving the health
of the world‟s poorest and most vulnerable people
by closing the gap between knowledge and action in public
health.


Faith and Health

 Have you seen faith in action for healthy living? In whom?
 Was Paul right::
I do not understand what I do. For what I want to do I do not
do, but what I hate I do. Romans 7: 15-16
 How should this evidence drive/guide our programming
decisions?
 What are some specific strategies or interventions that could
effectively address the risk factors of NCDs?
 How can faith/religion/the church support a campaign to
reduce NCD risk factors (alcohol, inactivity/obesity, smoking)?


Resources on Religion and Health

Web Resources
//healthy-vessels.com/
//travel.nationalgeographic.com/travel/happiest-places/
www.bluezones.com/
www.tomorrowsworld.org/magazines/2001/may-jun/bible-principles-of-health
www.tomorrowsworld.org/magazines/2001/mar-apr/are-you-walking-in-the-
footsteps-of-christ

Books
 Medicine, Religion, and Health, HG Koenig, 2008
 Healthy Vessels: A Christian Guide for a Healthy Lifestyle, J
Williamson, 2009
 Handbook of Religion and Health, HG Koenig et al, 2012


Acknowledgements

Harold Koenig, Duke University
Laura van Vuuren, President, CCIH
Henry Moseley, Johns Hopkins
Jim Longhurst, Medway Village Church
Fred Harburg, Harburg Consulting, Human Performance Institute
Carol Meyer, Winona, MN
Kelsey Nagel, Management Sciences for Health
Barbara Ayotte, Management Sciences for Health
Kate Onyejekwe, Management Sciences for Health


CCIH 2012 Conference, Plenary 2, Jonathan Quick, Janneke Quick, Chronic Disease, Biblical Wisdom, Longevity

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