Moral Experiences, Religion, and Global Health Values: The View from American Pews Nancy T. Ammerman, Boston University May, 2007 As I understand the question before us, our task is to explore how people think about the value of global health and why they act as they do in pursuit of it. My own point of entry into this question is largely through my work on religion in the U.S. context, work that has explored how religion takes shape in individual lives and in local congregations. The moral philosophy I ll be describing, then, is one that is fairly close to the ground. It is also, I would argue, one that has enormous influence. The individuals in those religious communities are often the decisionmakers and service deliverers, and even when they are not, the resources they provide help to fund much of the health work around the world, and the votes they cast help to shape the policies and personnel that direct priorities and support. Knowing how people in U.S. religious congregations think about global health may be very important indeed. While I have done work across a number of religious traditions, what I will be describing in this paper is based in the Christian tradition. More than a decade ago, I was doing research on how local congregations respond to the various kinds of social disruption that immediately surround them new immigrant populations, industrial downsizing, exurban expansion, and the like. As part of that research, we interviewed about 300 individual congregational participants and asked them, among other things, to tell us how they would describe a good Christian life. The contours of those answers led us to formulate similar questions that could be asked in survey format to a much larger population, both in that study and in a subsequent project in the late 90s. Between the two projects, we have responses from about 6000 people, from over 50 congregations, spanning a range of Catholic and Protestant, liberal and conservative, black and white and hispanic. None of these were randomly selected, but together they provide a fairly representative picture of American Christian churchgoers. 1 How they describe a good Christian life can help us to map the range of religious and moral sensibility in this country, but it also tells us a good deal about how people participate in caring for their own communities. That, in turn, may give us some hints about how church-going Americans think about the larger world and the challenges of seeking health in that world. 1
What has emerged out of this research is a picture of three distinct, but overlapping orientations toward religious virtue, what I have labeled Activist, Golden Rule and Evangelical. 2 The ACTIVIST orientation is one that says good Christians ought to be actively seeking social and economic justice. Solutions to life s problems are structural, not just individual and therefore require collective action. People with an activist orientation want their churches to give high priority to supporting social action groups, they encourage their pastors to speak out on social and political issues, and they are eager to cooperate with outside groups for community betterment. One can imagine such religious people writing their representatives about support for global health initiatives, demonstrating at biotech conferences, giving to health NGOs, and perhaps supporting shareholder petitions to provide pharmaceuticals to developing nations all motivated at least in part by their basic understanding of their Christian faith. The GOLDEN RULE orientation is one that says good Christians should practice Christian values in everyday life, take care of those who are sick or needy, and share what they have with those less fortunate. They take personally the admonition to do unto others as you would have them do unto you. They tend to think in terms of family, congregation, and neighborhood, attempting to be good citizens who contribute to the well-being of the community. They say that churches should promote a strong sense of fellowship for their own members, but also provide aid and services to people in need. They don t seem to expect to change the world, but they do want to leave it a little better place than they found it. These religious people are the backbone of international charitable efforts of all sorts, and one can imagine them rallying to appeals to assist sick people in developing nations. Show them a picture of the needy person or tell them a story of disease that can be prevented or suffering eased, and they will write a check or maybe even go on a volunteer mission trip. The EVANGELICAL orientation is one that says a good Christian life starts with the heart. The most fundamental duty is to orient one s life toward God and try to bring others to faith in Christ. A good church, then, should have a strong evangelism program and support mission efforts in the nation and the world. In addition, this orientation emphasizes personal piety, saying that good Christians should spend time reading and studying the Bible, as well as in prayer and meditation, while also avoiding worldly vices (something they also want their churches to help them do). 3 It is not as immediately apparent, then, how this orientation might 2
affect action in behalf of global health. As I will argue, however, the evangelical orientation is not nearly so otherworldly as it might first appear. (Table 1 will provide frequency distributions on the 3 orientations) It is important to note that these orientations are not mutually exclusive. Individuals tend to value one set of virtues more than the other two to have a dominant mode -- but their valuing of each way of orienting their lives tells us something about how they engage in religious action in the world. All three scripts are available to people within the Christian tradition, and individuals may draw more or less on each of the three. While very few of our respondents would completely reject any of the three as valid descriptions of Christian living, some are more likely to be endorsed than others. Only a minority place activism at the center of their understanding of the faith, making it their dominant mode, but strong majorities include evangelical or Golden Rule orientations (or both) in their expectations about how life should be led. For the most part, in fact, people are drawing on all three narratives, even if they see one as more important than the others. Their first discourse, for instance, may be to say that faith is about personally caring for others, but they recognize that a more activist story can legitimately be told or that evangelical virtues are important, as well. In what follows, we will look for the ways each of these orientations is linked both to the public narratives of congregations and to the actions of the individuals who carry and enact them. (Table 2 about here) It is also important to note that these orientations are not perfectly correlated with particular denominations or religious traditions (see Table 2, which will give a breakdown by conservative Protestant, mainline Protestant, African American Protestant, and Catholic congregations). People in conservative Protestant churches are more likely to have an evangelical orientation than are, say Catholics or people in liberal Protestant churches; but the Golden Rule orientation is the normative center across churches of all sorts. The real difference is whether it is combined with a minority of Activists or with a minority of Evangelicals. Mapping out these distinctions gives us, I think, perhaps a more fruitful way to think about the differences we see than simply arraying the population on a liberal-conservative continuum. The differences include both questions of priority salvation of soul v salvation of 3
body, but also of strategy personal caring v structural change. Each, in its own way may shape how people think about pursuing the health of the world. Orientation and Action: Doing Good in the World But does this mapping actually tell us anything more? In our late 1990s research, we were interested in how congregations are connected to the work of caring for their communities and the larger world. 4 In addition to focusing on the organizational issues, we again surveyed individual churchgoers, this time including questions about how they enact the public dimension of their faith. We asked people to report how often they participate in SERVICE ORGANIZATIONS in the community and how often they offer INFORMAL HELP to people in need. The first was intended to identify activity that was not directly sponsored by the church but that did have a formally-organized base. The second was intended to capture activities like providing transportation, meals, childcare, respite care, and the like work that might or might not be officially organized and might or might not be connected to the church. 5 Finally, we asked attenders to tell us how much they gave in 1997 to SECULAR CHARITY. 6 While nearly eighty percent of churchgoers claim that they provide informal assistance at least occasionally, only fifty-nine percent do so through organized community service organizations, and less than half gave more than $100 to organized charities. 7 [I ll add comparisons to the general population on these measures.] Controlling for key demographic factors -- education, income, age, presence of children, and rural v urban residence -- actions in service to the community are indeed related to different orientations toward how Christians should live. Activists are simply more likely to engage in all three forms of service engagement. Understanding Christian virtue in terms of seeking social justice is a way of thinking about religious life that is linked to participation in organized service agencies and giving to secular charities, but includes informal assistance, as well. People who strongly endorse Activist accounts of Christian living are people who think they should be making a difference in the world and seem to appreciate the way community organizations make that possible. There is also a positive link between a Golden Rule orientation and organized volunteerism, secular charitable giving, but especially with informal caring. Whether more or less educated, rural or urban, more or less well off, young or old, parent or not, those most 4
committed to this Golden Rule account of virtuous living are more likely to report regular participation in doing just what that account says they should do person-to-person caring for others. 8 The Evangelical orientation presents a much more complicated picture. Here too there is a link to informal caring, but it is not so clear that the most evangelical Christians are committed to organized volunteerism or to secular charity. This finding parallels many other studies that show conservative Protestants more engaged in building up bonding social capital within their own communities than in building bridging capital through links with secular organizations. Taking both income and overall generosity into account, the stronger the person s commitment to Evangelical virtues, the less likely they are to be a generous giver to non-church-based charity. To fully understand how service and giving are linked to the Evangelical orientation it is necessary to bring a new set of considerations into the picture. It is not enough simply to take into account the sorts of demographic differences represented by education and income and place of residence. For all our respondents, the link between orientation and action is mediated by institutions. Narratives about good Christian living exist in a particular interactional context, so we need to know how community service activities are situated in relationship to networks of membership and participation in the church and beyond. By virtue of completing our survey, we know that these people at least occasionally attend worship services, but there was a great deal of variation among them in what other connections they have to their congregation and beyond. We asked them to tell us how often they participate in church-based Sunday school or religious education, in parish fellowship activities, and in church-based mission groups and service activities, as well as in various other church groups beyond Sunday School. More than any other factor we have yet examined, level of church participation is a key to understanding community service activities. It tells us nothing about the amount of money a person is likely to contribute to secular charities, but it tells us a great deal about whether community service organizations and informal forms of helping are included in a person s pattern of activity. 9 People who make time to go to Sunday school or to show up at church picnics or to participate in a church mission group are also likely to make time to deliver meals to a sick neighbor or volunteer at the town soup kitchen. Being part of various small groups in the community whether spiritual or secular has similar, if smaller effects. People who participate in one thing are simply more likely to participate in other things as well. 5
That strong connection between church participation and community service is the key to understanding how the Evangelical orientation is related to public engagement. The people who are most likely to be highly active church participants are those with an Evangelical orientation toward life, and their sheer levels of participation increase the likelihood that both informal assistance and organized community service will result. In other words, there are two countervailing forces at work for Evangelicals. On the one hand, an Evangelical life narrative, with its emphasis on personal piety and otherworldly salvation, does not contain the obvious emphasis on this-worldly community service that an Activist or Golden Rule orientation may contain; and when other demographic factors are taken out of the picture, the orientation itself seems to be a negative force. On the other hand, that same Evangelical narrative strongly encourages active participation in a local congregation through which wider participation in the community may be both expected and facilitated. Because people committed to an Evangelical orientation are the most active participants in churches, the net result is more informal help and at least marginally more community volunteerism beyond the church itself in spite of the negative impact the orientation itself might have. 10 Across all three types of community engagement formal, informal, and financial differing ways of accounting for a good Christian life create narrative expectations about the value of engagement in service. Golden Rule narratives of mutual care evolve especially into informal assistance in the community, but also unfold in organized volunteering and giving. Activist narratives of seeking justice and change evolve into organizational participation and financial support for agencies serving the world. Evangelical narratives of eternal salvation and personal piety are unlikely to include such worldly engagement at all, but mediating and facilitating these individual narratives are the religious cultures of the congregations in which people are involved. Sheer participation in any religious community seems to engender practices of caring and organizational connections that make it more possible that persons will be invited into the networks through which service and advocacy happen. Knowing about these individual orientations and practices provides, then, a picture of how American Christians may respond to appeals on behalf of the health of the world. Some, albeit a minority, may eagerly bring their faith into the policy arena, speaking as easily of empowerment, justice, and peace as of wholeness and caring (Intl mission journal article). Many others indeed the majority will respond easily to appeals to serve and assist. They recognize 6
a basic connection and obligation among human beings all are God s children. If you tell them how to help, they are likely to respond. A substantial minority, the evangelicals, may not respond directly to any of your appeals. The most ideologically committed of them may not respond at all. But even within this community, many also share golden rule inclinations, and most have been taught by the practices of their churches, if not by the teachings, that helping needy people is a virtue. Indeed, their overseas connections have always pushed them in the direction of holistic approaches that combine preaching and healing. Little wonder that some of the largest development NGOs today are heavily supported by just these evangelical believers. Organized for Action: The Continuing Legacy of the Missions Movement Indeed, understanding the moral commitments of American churchgoers to global health requires that we recognize the formidable institutional history and current activity of overseas faith-based organizations. 11 The religious impulse to reach beyond the nearby world is by no means a novel product of twenty-first century globalization. Nor is it confined to Conservative Protestant denominations. U.S. overseas missionary work began, in fact, in 1810, in Bradford, Massachusetts, when Congregationalists (successors to the Puritans and precursors to today s United Church of Christ) formed the American Board of Commissioners for Foreign Missions. A combination of Christian conversion, western education, democratic ideals, and capitalist imperialism were the complicated mix that constituted American missions throughout the nineteenth century. 12 By the early twentieth century, a debate was emerging in that movement. Should missionary activity be primarily about literally preaching the gospel, or should it be about an evangelism that includes education, health, economic development, and (eventually) human rights? In 1910, the elite leaders of the western world s mission organizations gathered in Edinburgh for a conference that would begin liberal Protestantism s movement from activist missionary preaching to the ecumenism of the later World Council of Churches (founded 1948). On the other side of the theological fence, a fundamentalist movement in America would increasingly condemn the liberal social gospel (Hutchison 1987, 125). By the 1960s and 70s, many Mainline Protestant denominations were out of the overseas missions business entirely, and most of those that remained were working in cooperation with indigenous churches. The mirror image of these declining numbers can be found in 7
denominations such as the Southern Baptists and the Assemblies of God, both of whom saw their overseas staff grow exponentially in the mid-twentieth century. In addition, hundreds of new independent mission-sending agencies have been founded and now support personnel in numbers that rival or exceed the total of missionaries supported by all American denominations combined. There are, interestingly, real ironies in the pattern of institutional strength and support. Those who speak most about saving souls sometimes spend more actual dollars in development aid than those who say they are interested in development. A comparison between the Episcopal Church and the Seventh-Day Adventists is instructive here. Both are hierarchically organized globally-based churches, but Adventists have only about half as many U.S. members as the Episcopal church. Still, Adventists support more than ten times the overseas personnel, an equivalent mission budget, and a relief and development budget that dwarfs Episcopal efforts. 13 In 2000, the Episcopal Church made about $7 million in development grants, while the Adventist agency handed out $107 million. Anglicans spend most of their overseas mission budget in support of existing Anglican churches in parts of the world that were formerly colonized. Michael Hamilton claims that in 1992, all categories of U. S. Protestant overseas ministry activity amounted to $2.27 billion dollars. Over half was raised by parachurch groups, and the largest of these are now heavily committed to humanitarian work along with evangelization (World Vision being the largest). Another third of the total overseas ministry budget came from the Conservative Protestant denominations, and as the Adventist example demonstrates, a significant portion of those budgets went to humanitarian aid, as well. Less than one sixth of all overseas ministry dollars were raised by the Mainline Protestant denominations (Hamilton 2000, 119). Even if every dollar they raised went to relief and development, Mainline churches would ironically be far outstripped by the evangelical denominations and parachurch agencies in providing overseas material aid. Whether in a conservative church or a liberal one, links to overseas ministry are likely to take on a combination of spiritual and material dimensions. Even within Mainline Protestantism, rump mission agencies, such as the Good News movement in Methodism, continued to capture the imagination of people in the pews. Indeed, more than two-thirds (69%) of the individual Mainline members we surveyed said that it was very important or extremely important to them that their congregations support mission efforts in the nation and the world. Even where denominational officials have shunned the idea of sending missionaries to convert the heathen, American churchgoers retain something of the old 8
missionary zeal not so much to convert as to share the bounty of American resources and, increasingly, to be connected ( in solidarity ) with people across cultural and economic divides. The religious impulses of the American people continue to be channeled into significant organizing on behalf of people around the world who are in need. The agencies and denominations that embody those impulses also establish critical bridges between large segments of the American public and ordinary citizens of the rest of the world. The resulting connections are, indeed, increasingly likely to have a personal face. In many congregations, the old-time practice of hearing visiting missionaries on furlough has been supplemented (or supplanted) by stories from missionary websites and e-mail correspondence that reaches the remotest mission stations. Much as World Vision and the Christian Children s Fund have personalized overseas charity by inviting people to sponsor a specific child, some denominations have created similar sponsorship programs. Connections to missions are embodied in persons and stories, and many denominations are intentional about making sure that both are widely available. Direct mission involvement of church members adds new stories to those supplied by denominational mission books and historic mission lore. Likewise, mission support activities in local churches often begin with stories told to toddlers in their weekday Bible club, but now extend to the stories brought home by adult volunteers who have seen the work firsthand. Short-term volunteer mission trips are increasingly popular across American Protestantism, accounting, as well for one sector of growth in the Catholic overseas force, as well. In the denominational churches, small and large, many of the traditional mechanisms of connection are still in place. Nineteenth century mission-minded women took inspiration from the New Testament story of the widow who gave her last mite as an offering in the Temple. In her honor, American women created mite boxes, and some denominations still use them today. These sorts of combined efforts allow even the smallest church to feel that it is part of the task of spreading the gospel a gospel that almost always includes the health and wellbeing of the recipients. Whatever we may think of the idea of sending missionaries, two important insights can be taken from this story. First, the organizational structures of American church-going are likely to facilitate awareness and connection between individuals in the U.S. and people on the ground in widely scattered parts of the world. Before anyone else knows there is trouble in the Sudan, 9
people in churches are likely to have seen an email or checked out a website or even collected money or medicine to send with a team of volunteers. Even when American schools aren t teaching geography, American churches often are. These are organizationally vital networks of connection that hold enormous potential for global health. The second insight to be taken from this is that even when the rhetoric sounds like winning souls is the only thing on people s minds, they are very likely to want people to be healthy of body, as well. That s not to say the issues are easy, but it is to say that the moral vision that dominates American religion is one that understands the search for healing and wholeness to be a Christian virtue. There is, it seems to me, enormous space for common concern and cooperative activity. Notes 1 I ll fill in more detail on the sample and representativeness. 2 These concepts are more fully developed in Nancy T. Ammerman, "Golden Rule Christianity: Lived Religion in the American Mainstream," in Lived Religion in America: Toward a History of Practice, ed. David Hall (Princeton: Princeton University Press, 1997) and Nancy T. Ammerman, "Organized Religion in a Voluntaristic Society," Sociology of Religion 58, no. 3 (1997). 3 The standardized item alphas for the three scales are.78,.76, and.84, respectively. 4 The following section on forms of community service draws from my article, "Religious Narratives, Community Service, and Everyday Public Life," in Taking Faith Seriously, ed. Mary Jo Bane, Brent Coffin, and Richard Higgins (Cambridge: Harvard University Press, 2005). 5 Responses ranged from never (0) to weekly or more (4). 6 Categories ranged from nothing (0) to $5000 or more (7). 7 The levels of community involvement we are reporting appear to be quite comparable to those being reported by a massive new study of American churchgoers. They report 38% having donated to secular charities, for instance, while our overall figure is 41%. See Evan Silverstein, Survey Finds High Rate of Turnover in the Pews [e-mail] (PCUSANEWS, 2002 [cited January 17, 2002]); available from presbynews.topic@ecunet.org. 10
8 Marc A. Musick, John Wilson, and William B. Bynum Jr, "Race and Formal Volunteering: The Differential Effects of Class and Religion," Social Forces 78, no. 4 (2000), found that people who think helping others is important in making life worth living were more likely to volunteer. Ours is a more elaborate and religiously-based measure, but their findings help to support the notion that ways of talking about what constitutes a good life are in fact linked to strategies of voluntary action. 9 Controlling for education, income, age, presence of children, and rural residence, the correlation between church participation and informal help is +.38 and between church participation and community service organization participation is +.30. 10 Differences between evangelical and mainline Protestants (using denomination as the measure) are also documented in Robert Wuthnow, "Mobilizing Civic Engagement: The Changing Impact of Religious Involvement," in Civic Engagement in American Democracy, ed. Theda Skocpol and Morris P. Fiorina (Washington, DC: Brookings Institution Press, 1999). As Becker and Dhingra point out, however, it is important not to assume therefore that evangelicals are not involved in the community. It is just that they are less likely to engage in these particular types of community activity. See Penny Edgell Becker and Pawan H. Dhingra, "Religious Involvement and Volunteering: Implications for Civil Society," Sociology of Religion 62, no. 3 (2001). McKenzie documents a similar pattern in non-electoral political participation. Those he categorizes as fundamentalists go to church services more frequently, and it is that selfselection effect that accounts for an apparent positive relationship between attendance and political activism. He curiously posits that religious orientation is the actual exogenous variable, but does not test a model so specified. See Brian D. McKenzie, "Self-Selection, Church Attendance, and Local Civic Participation," Journal for the Scientific Study of Religion 40, no. 3 (2001). 11 This section draws in part on chapter 6 in Nancy T. Ammerman, Pillars of Faith: American Congregations and Their Partners (Berkeley, Cal.: University of California Press, 2005). 12 Excellent histories of the nineteenth and early twentieth century missions movement can be found in Dana L. Robert, Women in Mission: A Social History of Their Thought and Practice (Macon, Georgia: Mercer University Press, 1997) and William R. Hutchison, Errand to the 11
World: American Protestant Thought and Foreign Missions (Chicago: University of Chicago Press, 1987). 13 These comparative accounts were compiled from information accessed 9/3/02 from www.episcopalchurch.org and www.adventist.org and http://anglican.org/domain/admin/countries.html. The Anglican Domain:Countries and Provinces accessed 9/4/02. 12