Faithful Families and More: Expanding Faith Community Partnerships in North Carolina

In this issue of AJPH, Hardison-Moody and Yao (p. 363) describe Faithful Families, the long-standing faith-based health education and promotion program, and highlight their long history of and lessons learned during more than a decade of work with mostly Black faith communities in North Carolina. Their work follows in the path first blazed in the 1980s by John Hatch, the General Baptists of North Carolina, and his team at University of North Carolina, Chapel Hill.¹

FAITHFUL FAMILIES

Faithful Families strongly emphasizes how “building strong relationships with faith communities . . . takes time, patience and a respect for the congregation’s priorities,” an essential guideline for building strong faith community partnerships also highlighted by others.² This was illustrated in Faithful Families’ best practice of “listening” to respondents and culturally adjusting language. Faithful Families shifted from focusing on language of “weight loss” or “body size” in their target African American population to discussing “better health” to decrease participants’ stigma around a singular focus on, and celebrate even small decreases in, weight. Developing the capacity of local leaders to continue the teaching or training in a participatory manner also is best practice in faith community partnerships, particularly in terms of program sustainability, representing a key aspect of community-based participatory research.³ Faithful Families is to be commended for humbly acknowledging the critical need for multilevel and multisectoral partnerships and a desire to not set an end date for programming but stay connected for the long run in the community, particularly in times of shrinking research funding. Faithful Families’ best practices offer ways for current partners wishing to partner well with faith communities to expedite both the efficiency and the efficacy of their efforts.

Faithful Families’ review also shares some of the more nuanced aspects and challenges of faith community partnership work that often cannot be described in depth within limited journal article formats. These include how public health practitioners or researchers sometimes are perceived as, or actually may be, inadvertently instrumentalizing or “using” faith communities; have difficulties in obtaining consistent measurement while growing and implementing a program⁴; reconcile the often discordant values that exist between members of faith communities and academic partners; and face the difficulty in avoiding quality drift and maintaining program fidelity in terms of program implementation in the broader community over time.

HEALTH–FAITH PARTNERSHIPS

Health systems now are beginning to practice with the social determinants of health, following in public health’s long history. Wake Forest Baptist Medical Center’s The North Carolina Way expands beyond health education and promotion to community-based caregiving, triaging, and connecting and now includes that health system plus seven others, working with more than 300 congregations in 27 North Carolina counties.⁵ The North Carolina Way also partners with Faithful Families, Community Cares Network, and numerous other agencies; is being written into regional Medicaid pilot programs; and continues to be informed by John Hatch and Anita Holmes,¹ who are serving as an informal mentor and a consultant, respectively. Current health system practice is most comfortable with the material, if nonmedical, resources a family or neighborhood needs for health. Hospitals are now integrating these into the electronic medical record and developing new referral patterns to ensure that their patients have the full array of things thought necessary for health. Public health has a more expansive view, thinking in terms of entire neighborhoods and social-political choices affecting the availability and promotion of dangerous food or preventable environmental factors. These, too, could be seen as shaped by public-scale dynamics of culture, including religious aspects that are not entirely negative. If understood, public health might find currents within the traditions and practices of social-scale faith helpful.

Public health remains far more comfortable with the highly inconvenient complexity of humans than does traditional medicine. But nowhere is this more challenging for public health than in one of the most endemic variables of human social phenomenon—faith. No culture recognizable as human is without practices of faith with different patterns of ritual, inclusion, shame, and compassion, all of which have implications for understanding patterns of social vectors that favor the spread of pathological agents and behaviors, as well as positive ones. This was seen clearly in the language around weight loss stigma in Black church members noted by Faithful Families. We hope that our field could come to understand the dynamics of faith within the public well enough for it to be an asset, an active ally in the design and operation of programs rooted in science but necessarily integrated into local life and culture.

Almost every religious tradition regards life and health as benevolent phenomena expressive of a loving creator or positive force. Public health practitioners rarely speak of our practice that way, even if some of our most iconic scientific breakthroughs, such as John Snow’s meticulous maps that led to the Broad Street Pump removal, were done in tandem with clergy (in that case, an assistant rector).⁶ Those who succeed in winning the trust of the public and sustain themselves in a long career of public practice do more than follow the data.⁷ They love the thing called public and find it worthy of giving it our most respectful study, including its most durable, if intangible, quality—faith. Faithful Families and others suggest ways of approaching that study with intellectual clarity sufficient to guide our hands into modern partnerships relevant to some of the most vexing conditions our society now faces.