Spiritual practices and beliefs as a social determinant of health: When will the profession of pharmacy address the whole body-mind-spirit triad?

In the foreword to Cultural and Religious Sensitivity: A Pocket Guide for Health Care Professionals, Michael S. Woods, MD, writes “It’s undeniable that understanding a patient’s cultural practices and spiritual beliefs influences not only the delivery of health care in our global society, but also the individual’s outcome and satisfaction. . . . If a patient, because of a cultural or spiritual ‘disconnect,’ can’t appreciate what is being prescribed or why it’s necessary, or if the information is delivered in a way that inadvertently frightens, offends, or confuses the patient, how can we fulfill our mission as health care providers?”1 The value of spiritual care in wellness has been studied for decades.2 Most studies evaluating the effects of religious activities on healthcare outcomes have found that patients experience better mental health, adapt more successfully to stress, and are physically healthier, which decreases the number of health services utilized.3 The World Health Organization defines social determinants of health (SDOH) as the nonmedical factors that influence health outcomes and include the conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life.4 Recent research on SDOH has concentrated on socioeconomic status; spiritual practices and beliefs are additional nonmedical factors that can influence health outcomes. As patients age, they encounter more health challenges and may begin to confront their mortality.5 This confrontation with mortality seems to be associated with a focus on religiosity (the extent to which an individual believes, follows, and practices a religion), which may be an extension of spirituality (the personal quest for answers to ultimate questions about life, about meaning, and about the relationship to the sacred or transcendent).6 One study revealed that the individual factors that people identified as providing meaning to their life changed with age. While younger persons mentioned “friends,” “partnership,” or “work” as decisive factors, “spirituality/religion” and “nature experiences/animals” were most important to patients aged 70 or older.7 When respondents in the US were asked whether they consider themselves to be a religious person on the World Values Survey (2010-2014), significantly more people 60 years of age and older (77.6%) gave affirmative responses compared to people under 60 years of age (64.7%).8