roles for the black pastor in preventive medicine

7/30/2019 Roles for the Black Pastor in Preventive Medicine

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R o l e s f o r t h e B l a c k P a s t o r i n P r e v e n t i v e M e d i c i n eJef fr ey S . Lev in , M.P.H.

Un iv e r s i t y a t T e x a s M e d ic a l B r a n c h , Ga lv e sto n , T X

A B S T R A C T : In recent years, a new role for Black pastors has emerged. As agents ofhealth-related social and behavioral change, Black ministers have taken active rolesin preventive medicine at t he tertiary, secondary, and primary levels of prevention,succeeding despite resistance by some physicians. The literature detailing these newhealth- related pastoral roles is reviewed, with special reference to the place of the BlackChurch in health care and to the place of the Black pastor in the Black experience. It isconcluded that Black ministers are ideal people to take part in planning, promoting, anddelivering preventive health care in the Black community.

BackgroundT h e B l a c k C h u r c h i n H e a l t h C a r e

A r e c e n t r e v i e w o f c h u r c h - b a s e d p r e v e n t i v e m e d i c i n e a c t i v i t i e sa s s e r t e d t h e r e l e v a n c e o f b a s i n g s u c h p r o g r a m s w i t h i n t h e B l a c kC h u r c h . 1 F o u r r e a s o n s w e r e g i v e n s u p p o r t i v e o f t h e B l a c k C h u r c h a s al o c u s f or c o m m u n i t y - w i d e h e a l t h p r o g r a m s : f ir st , t h e B l a c k C h u r c h i st h e s i n g l e m o s t i m p o r t a n t s o ci al i n s t i t u t i o n i n t h e B l a c k c o m m u n i t y ,a n d i s t h e c o n s e r v a t o r o f t h e B l a c k e t h o s ; s e co n d , t h e e t h i c o f s e r v i c e t of e ll o w h u m a n b e i n g s i n h e r e n t i n t h i s e t h o s i s q u i t e c o n v e r g e n t w i t ht h e " c o m m u n i t a r i a n e t h i c ''2 o f p u b l i c h e a l t h ; t h i r d , t h e r e i s h i s t o r i c a lp r e c e d e n t f o r a c k n o w l e d g i n g t h e B l a c k C h u r c h a s a n a g e n c y o f s o ci alw e l f a r e s e r v i c e s d e l i v e ry ; a n d , f o u r th , B l a c k A m e r i c a n s a r e , m e d i c a l ly -s p e a k i n g , b o t h s i g n i f ic a n t l y a t - r i sk a n d u n d e r s e r v e d r e l a t i v e to t h ed o m i n a n t m a j o r i t y p o p u la t io n . I t w a s t h e n p o i n t e d o u t t h a t B l a c kC h u r c h - b a s e d p r e v e n t i o n h a s i n d e e d s e e m e d to h a v e c a u g h t o n in c er -t a i n r e s p e c t s, a s p r o g r a m s h a v e e x i s t e d f o r s e v e r a l y e a r s i n th e a r e a s o fp r i m a r y c a r e d e l iv e r y , c o m m u n i t y m e n t a l h e a l th , h e a l t h p r o m o t i o na n d d i s e a s e p r e v e n t i o n , a n d h e a l t h p o l ic y .

Address correspondence to Jeffrey S. Levin, M.P.H., Divis ion of Seciomedical Sciences,Department of Preventive Medicine and Community Health, The University of TexasMedical Branch, Galveston, Texas 77550-2777.The au thor wishes to acknowledge Dr. John W. Hatch of the Univers ity of North Caro-lina School of Public Health, who supervised the preparation of an annotated bibliogra-phy upon which this paper is based.

Pastoral Psychology, Vol. 35(2), Winter 19869 4 9 1986 Huma n Sciences Press


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J e f f r e y S . L e v i n 95

This article seeks to expand the discourse on Black Church-basedprevention by engaging consideration of the roles, both current andemergent , of Black pastors in prevention-related heal th activities. Inparticular, three issues are addressed. First, the t raditional historicalrole of the Black ministe r is discussed, with emphasis upon his impor-tance both to the Black Church proper and to the community-at-large.Second, some consideration will be given to an emergent role for Blackpastors: tha t of agent of health-rela ted change. Finally, an overviewwill be provided of cur ren t and potential roles for Black pastors at eachof the three levels of prevention: tertia ry, secondary, and primary, thelatte r divisible further into specific prevention and health promotion.

T h e B l a c k P a s t o r in th e B l a c k E x p e r i e n c eAs "the unifier of its people, '3 the Black Church t radi tionally hasbeen the center of the Black community--histo rically, the primary (orPerhaps only) tru ly autonomous social institution, as well as the con-servator of the norms, values, folkways, and mores of the Black experi-ence. The Church has filled many roles: communi ty center; social wel-fare agency; training school in self-government, in financial matters,

and in business management; patron of schools; the list is probablyendless. 4 As the ti tul ar head of the Black Church, the Black pastor hashad important leadership roles in the development and maintenance ofeach of these Church roles. Where the Black Church has filled theneeds of Black Americans, the Black pastor has directed these efforts,and by his example has paved the way for his constituency--theCh ur ch -- to become further involved in developing and filling newerroles.In addition to these Church-based role expectations, which the Blackpastor fulfills within the confines of the cu l t u s , he has been a key fig-ure in the Black community-at-large. As the Black Church is at itscenter, Black pastors "have traditionally been the leaders in the blackcommunity, '5 and have worked for advancement of the status ofBlacks in all avenues of life. Hamilton describes the vast array ofcommunity-wide roles occupied by the Black pastor as ranging fromcultural leader, linking "the old with the new, the familiar with theunfamilia r, t radition wi th moderni ty, '~ to social activist and politicalleader, to community organizer and agent of economic change. Inshort, at the ir best, Black pastors have sought the emancipation of theBlack community and, in a certain sense, have fostered a model of self-help as the most effective path to this end. Indeed, Mitchell stressesthis pastoral role as facilitator of lay empowerment when he claimsth at the "most obvious need" for the Black clergy is to mount a "mas-


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9 6 P a s t o r a l P s y c h o l o g y

s iv e a s s a u l t o n t h e p r a c t ic a l l i m i t a t i o n s o f t h e B l a c k l a i t y , s o t h a t t h e ya r e e n a b l e d t o t a k e p a r t i n a b r o a d r a n g e o f p r a c t ic a l e f fo r ts o n t h e i ro w n b e h a l f . ''7

T h e B l a c k P a s t o r a s a n A g e n t o f H e a l t h - R e l a t e d C h a n g eC o n s i s t e n t w i t h t h e B l a c k C h u r c h ' s r o l e s i n p r e v e n t i v e m e d i c in e ,

a n d w i t h t h e B l a c k p a s t o r ' s r ol e in th e B l a c k C h u r c h a s w e l l a s int h e l a r g e r B l a c k c o m m u n i t y , a n e w B l a c k p a s t o r a l r o le r e c e n t l y h a se m e r g e d : m i n i s t e r s a s a g e n t s o f h e a l t h - r e l a t e d s o ci al a n d b e h a v i o r a lc h a n g e . A s in s t i t u t i o n a l c h i e f t a in o f t h e p r e e m i n e n t s o ci a l i n s t i t u t i o ni n th e B l a c k c o m m u n i t y , t h e B l a c k p a s t o r i s e s p e c i a ll y p r e p a r e d t o re -s p o n d t o t h e c r i t i c a l n e e d s o f h i s c o n s t i t u e n t s . I n d e e d , a c c o r d i n g t oH i c k s , t h e l i t e r a t u r e s u g g e s t s t h a t o v e r h a l f o f c h u r c h g o i n g B l a c k s" a g r e e t h a t i n a c r i s i s s i tu a t i o n , t h e y m i g h t t u r n t o t h e B l a c k p r e a c h e rfo r ad v ice . ''8

B y v i r t u e o f t h e i r a p o s to l ic a u t h o r i t y a n d t h e i r c e n t r a l p l a c e i n th ecultus, B l a c k p a s t o r s a r e i d e a l f o lk s t o c o n v e y h e a l t h - r e l a t e d i n fo r m a -t i o n , a n d , i n t h e b r o a d e r s e n s e , t o e f f e c t health-related behavioralchange. N o t s u r p r is i n g l y , w h e n h e a l t h e d u c a t i o n a n d o t h e r p r e v e n t i v em e d i c i n e a c t i v i t i e s a r e l o c a t e d w i t h i n B l a c k c h u r c h e s , t h e e n t h u s i a s t i cp a r t i c i p a t i o n o f p a s t o r s i s a b s o l u t e l y c r i ti c a l t o t h e s u c c e s s o f t h e s e e n -d e a v o r s ? A m a j o r r e a s o n f o r t h is m a y b e t h a t f e l lo w c h u r c h m e m b e r sa n d c h u r c h l e a d e rs , e s p e c i a l ly t h e c le r gy , r e p r e s e n t t h e m o s t im p o r -t a n t s o u r c e o f n o n - k i n g r o u p s u p p o r t , a s t h e c u l t f e ll o w s h ip m a y i t s e l fr e s e m b l e a la r g e e x t e n d e d f a m i l y n e t w o r k (o r, i n s o m e s m a l l r u r a lc o m m u n i t i e s , a c t u a l l y be a f a m i l y n e tw o r k ) . A s S a u n d e r s a n d K o n gn o t e , w i t h r e s p e c t t o a t e n - c i t y c h u r c h - b a s e d h y p e r t e n s i o n p r o g r a m ," I n d iv i d u a ls w h o m a y r e je c t o r m i s u n d e r s t a n d i n f o rm a t i o n a n d a d v i c ef ro m h e a l t h p r o fe s s i o n a ls m a y t r u s t a n d a c c e p t t h e r e c o m m e n d a t i o n so f t h e i r p e e r s . ''9

B r o a d e r s ti ll , t h e s e s a m e c o n t i n g e n c i e s a p p e a r s u p p o r t i v e o f ahealth-related social change r o l e f o r B l a c k p a s t o r s . I t w a s p o i n t e d o u te a r l i e r t h a t t h e B l a c k c l e rg y h a s b e e n a t ra d i t i o n a l l y r ic h s o u r c e o fB l a c k s o c ia l c h a n g e a g e n t s , a n d , g i v e n t h e b a r r i e r t o h e a l t h c a r e - se e k -i n g m e n t i o n e d b y S a u n d e r s a n d K o n g , m a n y B l a c k p a s t o r s h a v e b e -c o m e in v o l v e d i n h e a l t h - r e l a t e d c h a n g e a t s u p r a - i n d i v i d u a l l e v e ls e n -c o m p a s s i n g a g e n d a s b e y o n d f os t er in g h e a l t h y b e h a v io r s . E x a m p l e s o ft h i s i n c l u d e B l a c k p a s t o r s w h o h a v e f il le d t h e r o l e s o f p o l i c y m a k e r , i n -s t i t u t i o n a l c h a n g e a g e n t , p r o g r a m d e v e l o pe r , a n d e n v i r o n m e n t a l i s t ,a l l i n h e a l t h - r e l a t e d c o n te x t s. A s in t e r e s t i n g a s t h e b e h a v i o r a l c h a n g ea g e n t r o l e fo r c l e rg y m a y b e - - e s p e c i a l l y w h e n c o n s id e r i n g t h e p o ss i-b i l i ty o f t h e h o m i l e ti c s u b - ro l e a s a n a v e n u e o f c o n v e y i n g h e a l t h - r e -


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lated inf ormati on- -th e real potential for clergy-facilitated change liesin social change agency.

A n O v e r v i e w o f P a s t o r a l R o l e s i n P r e v e n t i v e M e d i c i n e

In the fifteen or so years tha t there have been organized programsfor preventive medical care based in or affiliated with the BlackChurch, 1 Black clergymen have demonstra ted ample ability to func-tion as agents of health-rel ated change, both behavioral and social.At every level of preven tion-- te rt ia ry (i.e., rehabilitation,) secondary(i.e., screening and treatment), and primary (including both specificprotection and heal th promotion)l~ pastors have successfullyengaged in health-related activities in a variety of settings and con-texts. Many of these preventive medicine roles will now be examined,and the literature reporting on pastoral accomplishments in this areawill be reviewed.Ter tiary Prevention

Several te rti ary preventive roles for the clergy are identifiable. Pas-tors can serve as liaisons between hospitalized patients and their fami-lies. 1 This pastoral role involves serving as a communication link be-tween both parties and, in the end, helping the latter to prepare for thetime when the former returns to the family setting. In other words,pastors can help loved ones plan for the patient's rehabilitative period,much of which may involve a lengthy stay at home.A similar role, yet one oriented to a very different situation, is thatof working with terminal ly ill patients. 12 In this case, the uni t of prac-

tice is not primarily the patient's family, but, rather, the patient. Thisis a very promising Black pastoral role, as the sort of care and counsel-ing here entai led may be inaccessible to most Black Americans.Another possibility for ministers is in providing family counselingand forming self-help groups for troubled families or those with mem-bers who suffer from menta l illness. 13 Indeed, the ent ire field of com-mun ity menta l health has witnessed considerable pastoral activity, al-though primarily at the level of secondary prevention. However, at thetertiary level, the provision of counseling and social support is quiteconsistent with the mission of the Church. The nurt uri ng na ture ofcultic fellowship is quite analogous to the therapeut ic sequelae of self-help, and the encouragement of church-based support as a vehicle formedically-oriented self-help represents a promising path of pastoralaction for the future.


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Secondary PreventionA t t h e l e v e l o f s e c o n d a r y p r e v e n t i o n , a w i d e r a n g e o f p a s t o r a l r o le s

h a s p r o v e n v i a b l e i n r e c e n t y e a r s . O n e o f t h e m o s t v i s ib l e a n d s u c ce s s-f u l o f s u c h r o l e s h a s b e e n t h a t o f d i a g n o s t i c i a n . A c o u p l e o f a r t i c l e s r e -p o r t t h e v a l u e o f u s i n g a p p r o p r i a t e l y t r a i n e d m i n i s t e r s a s h i s to r y -t a k e r s a n d d i a g n o s t i c i a n s i n p r i m a r y c a r e s e t t i n g s , 14-~ a n d o t h e r sr e p o r t o n a p a s t o r a l r o le i n th e d i a g n o s i s o f m e n t a l a n d e m o t i o n a l d is -o rd e r s , a s w e l l 2 3'~6

T h i s d i a g n o s t i c r o l e f o r p a s t o r s i s o f e s p e c i a l l y s a l i e n t r e l e v a n c e t oB l a c k s w i t h r e s p e c t to h y p e r t e n s i o n . H i g h b l o o d p r e s s u r e i s a m a j o rs o u r c e o f m o r b i d i t y i n B l a c k A m e r i c a n s , a n d t h e d i a g n o s t ic c o n t r i b u -t i o n s o f B l a c k m i n i s t e r s c o u ld b e o f t h e u t m o s t v a l u e i n th e b a t t l e t o in -s u r e e a r l y d e t e c t i o n o f h y p e r t e n s i o n . S e v e r a l p r o j e c t s, in f a ct , h a v e a l -r e a d y r e c o g n i z e d t h i s p o t e n t i a l , a n d t h r o u g h o u t t h e U n i t e d S t a t e sB l a c k p a s t o r s a n d B l a c k C h u r c h c o n g r e g a n t s a r e a l r e a d y b e in gt r a i n e d a n d c e r t i fi e d i n l a r g e n u m b e r s a s h y p e r t e n s i o n d e t e c t i o ns p e c ia li s ts . 9,17-22

O t h e r v a l u a b l e s e c o n d a r y p r e v e n t i v e r o le s f o r p a s t o r s a r e a s a ll i e dh e a l t h p r o f e s s io n a l s o p e r a t i n g a s a g e n t s o f e n t r e e f o r t h e i r c o n g r e -ga n t s , 23 as r e f e r r a l ag en t s , 13'16'24-~ an d co un se lo r s o f b o t h o t h e rc l e r g y 24 a n d p a t i e n t s . ~6'25 S t i l l a n o t h e r r o l e i n v o l v e s u s i n g e n t i r ec h u r c h e s - - n o t j u s t p a s t o r s - - a s p r o v id e r s o f p r i m a r y c ar e. T h a t i s , t h ea c t u a l c h u r c h f a c i l i t i e s m a y s e r v e a s lo c i f o r p r o g r a m o p e r a t i o n . P r o -g r a m s c a n r a n g e f ro m m e n t a l h e a l t h i n te r v e n ti o n s , ~ t o h y p e r t e n s i o nd e t e c t i o n , 19 t o o u t p a t i e n t c l in i c s a n d " w e l l n e s s c e n t e r s " w i t h p h y s i -c i a n s ' o f fi c es l o c a t e d o n c h u r c h g r o u n d s . ~Primary Prevention

I n d e f i n i n g p r i m a r y p r e v e n t i o n , L e a v e l l a n d C l a r k 1~ d i s t i n g u i s h b e -t w e e n " sp e ci fi c p r o t e c t i o n " - - p r e v e n t i o n i n t h e c o n v e n t i o n a l s e n se o f" m e a s u r e s a p p l i c a b l e t o a p a r t i c u l a r d i s e a s e o r g r o u p o f d i s e a s e s i n o r-d e r t o i n te r c e p t t h e c a u s e o f d i s e a se b e fo r e t h e y i n v o l v e m a n " - - a n d" h e a l th p r o m o t i o n " - - m e a s u r e s e m p l o y ed i n p r o m o t i n g h e a l th w h i c h" a r e n o t d i r e c t e d a t a n y p a r t i c u l a r d i s e a s e o r d i s o r d e r b u t s e r v e to f u r-t h e r g e n e r a l h e a l t h a n d w e l l- b e in g . " I n o t h e r w o r d s , t o m a k e a r o u g hd i s ti n c t io n , t h e f o r m e r t y p e o f p r i m a r y p r e v e n t i o n i s d i r e c t e d a t p o p u-l a t io n s a t - ri s k , w h i l e t h e l a t t e r t a r g e t s r e l a t i v e l y h e a l t h y p o p u l a t io n s .T h i s d i s t i n c t i o n i s u s e f u l i n a h e u r i s t i c s e n s e , a n d w i l l b e a p p l i e d h e r e .Specific Protection. T h e l i t e r a t u r e o n p a s t o r a l r o le s i n p r i m a r y p r e v e n -t i o n i d e n t i f i e s s e v e r a l a v e n u e s o f c l e r g y a c t i v i t y i n s p e c i fi c p r o t e c t io n .F i r s t , p a s t o r s h a v e s e r v e d a s p r o g r a m d e v e l o p e r s f o r b o t h c o m m u n i t y


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J e f f r e y S . L e v i n 9 9

m e n t a l h e a l t h a n d h e a l t h e d u c a t i o n i n t e r v e n t i o n s . ~4 I n t h i s r o l e , p a s -t o rs h a v e i n s u r e d t h a t p r o g r a m s r e m a i n s o c io c u l tu r a ll y r e l e v a n t a n dt h a t t h e y m e e t t h e n e e d s o f t h e i r c o n g r e g a n t s . S e c on d , B l a c k p a s t o r sa n d B l a c k C h u r c h e s h a v e p r o v i d e d b o t h in f o rm a t i o n a n d o t h e r m o r eg e n e r a l h e a l t h e d u c a t i o n w i t h i n t h e c o n t e x t o f h y p e r t e n s i o n p r e v e n -t i o n p r o g r a m s ? '17-18 F i n a l l y , s u c h B l a c k C h u r c h p r o g r a m s h a v e e v e ns o u g h t t o m o d i f y p a t t e r n s o f h e a l t h - s e e k i n g b e h a v i o r , ~7 a r o l e q u i t ec o n s i s t e n t w i t h t h e s e c o n d a r y p r e v e n t i v e r o le o f p a s t o r s a s r e f e r r a la g e n t s m e n t i o n e d e a r li e r.Health Promotion. O f a l l t h e l e v e ls o f p r e v e n t i o n t h u s f a r d i s c us s e d ,h e a l t h p r o m o t i o n m a y r e p r e s e n t t h e m o s t e x ci t i n g d o m a i n o f h e a l t h -r e l a t e d s o c ia l a n d b e h a v i o r a l c h a n g e f or B l a c k m i n i s te r s . N u m e r o u sp a s t o r a l r o l e s a t t h i s l e v e l h a v e p r o v e n e f f e c t i v e i n t h e p a s t , a n d w i t ht h e c u r r e n t f ed e ra l e m p h a s i s - - p e r h a p s o v e r - e m p h a s i s - - u p o n h e a l t hp r o m o t i o n a s a m e a n s o f i m p r o v i n g t h e h e a l t h o f p o p u l a t io n s , t h e m i n -i s t e r a s a p r o m o t e r o f h e a l t h s h o u l d c o n t i n u e p l a y i n g a n e c e s s a r y a n d ap o l i t ic a l l y s a n c t i o n e d h e a l t h - r e l a t e d p a s t o r a l r o le fo r y e a r s t o co m e .

C l e r g y m e n c a n a l s o s e r v e a s c o n s u l t a n t s t o a n d e d u c a t o r s o f l a y-p e o pl e. T h e y m a y a s s u m e t h e r o le o f p u b l i c h e a l t h e d u c a t o r o r c om m u -n i t y p s y c h o l o g i s t a n d h e l p r e d u c e " p s y c h o l o g i c a l d i s t a n c e s i n s o c i -e t y . '13 T h i s r o l e i s g e a r e d t o s t r e n g t h e n t h e f e l lo w s h i p n e t w o r k sa l r e a d y p r e s e n t w i t h i n t h e C h u r c h .B l a c k c l e r g y m a y e v e n b e c o m e d i r e c t ly i n v o l v e d i n th e p r o m o t i o n o fh e a l t h - r e l a t e d b e h a v i o r a l c h a n g e a n d r i s k r e d u c t i o n . 1'19 B y s a n c -t i o n i n g t h e u s e o f t h e i r c h u r c h e s a s h e a l t h p r o m o t i o n s i te s a n d b y e n-c o u r a g i n g t h e i r p a r i s h i o n e r s t o li v e r i g h t a n d m a i n t a i n t h e i r b o d i e s a st e m p l e s o f G o d, o n e m i g h t e v e n o p t i m i s t ic a l l y e n v i s i o n p a s t o r s h e l p i n gt o a c h i e v e m a n y o f t h e b e h a v i o r a l o b j e c ti v e s f or h e a l t h p r o m o t i o n s e tb y t h e S u r g e o n G e n e r a l . 28

A n o t h e r h e a l t h p r o m o t i o n r o l e fo r p a s t o r s i s i n s e r v i n g a s a l i a is o nb e t w e e n c o m m u n i t y h e a l t h e d u c a t i o n p r o g r a m s a n d c o n g r e ga n t s . I no t h e r w o r d s , a p a s t o r c a n o p e r a t e a s a b r i d g e o f r e c r u i t m e n t b e t w e e na l r e a d y e s t a b l i s h e d p u b l i c h e a l t h i n t e r v e n t i o n a n d h i s o r h e r f lo c k.B r u d e r o u t l i n e s t h i s a n d s e v e r a l o t h e r s i m i l a r r o l e s i n a n e x c e l l e n tp ie c e on c l e r g y c o n t r i b u t io n s t o c o m m u n i t y m e n t a l h e a l t h y 4

B r u d e r a l s o d e t a i l s y e t a n o t h e r h e a l t h p r o m o t i o n r o le f or t h e c l e rg y :t h a t o f s o ci al c h a n g e a g e n t . I n t h i s c a p a c i t y , p a s t o r s c a n e n c o u r a g et h e i r c o n g r e g a t i o n s t o g e t i n v o l v e d i n p r o m o t i n g a n d i n s u r i n g t h e i ro w n h e a l t h , a n d a t l e v e l s b e y o n d t h e i r o w n i n d i v i d u a l w e l l- b e in g . T ow i t , a B l a c k C h u r c h - b a s e d h e a l t h p r o m o t i o n p r o g r a m i n t h e S o u t h TMs e t a b o u t t o t r a n s f o r m s c o re s o f l oc a l c h u r c h e s i n to c e n t e r s o f h y p e r t e n -s i o n d e t e c t i o n a n d r e f e r r a l a n d l a y a d v i c e - g i v i n g . I n t h e c h u r c h w i t hp e r h a p s t h e m o s t s u c c e s sf u l ly i n s t i tu t i o n a l i z e d p r o g r a m , t h e p a s t o r


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and ma ny of the trai ned laypeople, as well as man y other churchgoers,became involved in a toxic waste dumping controversy. Sit-ins werestaged and the story eventua lly made the evening news. The pastor be-lieved that the initial health education project had contributed in away to the heig htene d health-directedness of his congregation.Finally , Black pastors can become directly involved in he al th policy-maki ng, ei ther at the level of plann ing programs or at a community,state, or federal level. For example, a few years ago, a Black UnitedMethodist Heal th Care Policy Consultation drafted a healt h care pol-icy sta tem ent which addressed a numb er of heal th care concerns ofBlack Amer icans withi n th e context of providing a "wholistic minis-try. '~9

In consider ing all of these pastora l roles as a whole, what is most ira-mediately apparent is that this listing of current and potential ave-nues of Black health- rela ted mini steri al ac tivity is probably identicalto any enu merati on of wha t goes on in preventive medicine. In short--and this is the primary thesis which has been advanced--Blackmin ist ers are ideal and completely competent folks to engage in activi-ties designed to plan, promote, and deliver preventive he alth care. Atall levels of prevent ion, Black pastors have succeeded in the past, aresucceeding now, and should continue to succeed in the future.

C o n c l u s i o n sProfessor C. Eric Lincoln, America's foremost scholar of the Black

experience in religion, once remarked:A society or a community that is religiously alert will invariably react towhatever may be perceived as a religious innovation because whateveris new is perceived as an implied threat or contradiction to what has al-ready been settled by history and confirmed by tradition?~

Or, in other words, "religious innovation" presents a severe threat tothe entire social order. If we ma y tak e the liberty of projecting down tothe muc h more "micro" social cosmos of Modern Medicine, then Lin-coln's warning suggests the possibility of serious conflict resultingfrom the expansion of clergy roles into the medical domain. Add to thisthe potential for additional conflict between the pastor and the physi-c i a n - t h e High Priest of his own Medical Church, as Mendelsohn hasclaimed31- -and the odds of acceptance of this pastoral role declinesfurther yet. Finally, add, too, the discordant territorial disputes be-tween curative allopathy and preventive medicine--even betweenpreventive medicine and public he al th - -a nd throw in the likelihood of


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racial tensions resulting from the encroachment upon the space ofWhite physicians by Black pastors, and it is easy to see why the Blackpastoral role of heal th-re lated agen t of change is such a potentiallythre aten ing development.This potential for clergy-physician conflict is borne out in a ra therstrident article extremely critical of a pastoral role in medicine22 Theauthor suggests that clergymen are dangerous to patients because ofthe ir "inability to respond adequate ly when confronted with a hospitalstress situation." In addition, certain acute problems (e.g., attemptedsuicide) may "affront their orthodoxy." Furthermore, states the au-thor, such acute situations could be exacerbated by ministers wast ingtheir time engaged in lengthy prayer in lieu of summoning a physi-cian. Clearly, the assumptions posited here- - the emotional fragility ofclergymen, the intellectua l primacy of physicians, the subordination oftradit ional religious insight into well-being to current medical beliefs--are dubious, to say the least. However, such attitudes may remainpersistent even with the expanding visibility of successful pastoral ac-tivity in hea lth care.Despite the pessimistic scenario painted above and evinced by thenarrow-minded opinion just cited, there nonetheless are reasons for op-timism that the Black pastoral role of health-rela ted change agent willprosper.First, and most important, thi s article has detailed the exciting ex-periences of pas tor s-- man y of them Black pas tors --in health-relatedactivities at the tert iary, secondary, and primary levels of prevention.In other words, the major reason for optimism is simply the continuedexistence and growth of Church-based prevention. As these programsexpand; as evaluative resea rch demonstrates their effectiveness; and,as interventions become methodologically more sophisticated with theincreasing prevalence of liaisons between churches or religious denom-inations and academic schools of medicine and public health, th is pas-toral role should continue to gain professional acceptance by govern-ment funding agencies, private foundations, and, eventually, by themedical establishment.Second, as this particular pastoral role becomes increasingly ac-cepted by laypeople--both religiously and medically-speaking--andas ministers themselves come to view pastoral activity focused abouthealth-related concerns as a legitimate "calling," religious denomi-nations may begin to institutionalize this health-oriented role withinthe curricula of seminaries. Many divinity schools already offer grad-uate degrees in counseling or psychology, and perhaps courses onhealth-related topics will eventually find their way into M.Div. andB.D. programs, or at least into the Christian Education curricula of de-nominat ions sponsoring health projects.


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I n c o n c l u s io n , t h e r e a r e m a n y o p p o r t u n i t ie s f o r B l a c k p a s t o rs i n p r e -v e n t i v e m e d i c i n e . A t t h e t e r t ia r y , s e c o n d a r y , a n d p r i m a r y l e v e l s o fp r e v e n t i o n , m i n i s t e r s h a v e f u l f i l le d t h e r o l e s o f c o u n s e l o r , p r o vi d e r,h e a l t h p r o m o t e r, r e f e rr a l a g e n t , p o l i c y m a k e r a n d p la n n e r , h o s p i t a l li -a i s o n , a l l ie d h e a l t h p r o f e s si o n a l, a n d s o c ia l a n d b e h a v i o r a l c h a n g ea g e n t , t o n a m e j u s t a f e w . W i t h s u f f ic i e n t s up p o r t a n d e n t h u s i a s m , t h i sl i s t o f B l a c k p a s t o r a l r o l es i n p r e v e n t i v e m e d i c i n e s h o u l d c o n t i n u e t oe x p a n d .

R e f e r e n c e s

1. J.S. Levin, "The role of the Black Church in community medicine," J o u r n a l o f th eN a t io n a l M e d ic a l A s s o c ia tio n , 7 6, (1984), 477-482.2. J.L. Forster, "A communitar ian ethical model for public heal th interventions: an al-ternat ive to behavior change strategies," J o u r n a l o f P u b l i c He a l th P o l ic y , 3 , (1982),150-163.3. J.R. Bryant, The Black Church as unif ier of the Black community. In L.S. Yearwood,ed., B la c k Or g a n i z a tio n s : I s s u e s o n S u r v iv a l T e c h n iq u e s , (Washington, D.C.: Univer-sity Press of America, 1980), p. 6.4. B. Quarles, T h e N e g r o i n t h e M a k i n g o f A m e r i c a , (New York: Collier Books, 1964), p.162.5. S. Carmichael and C.V. Hamilton, B la c k P o w e r : T h e P o l i t ic s o f L ib e r a tio n in A m e r -ica, (New York: Vintage Books, 1967), p. 102.6. C.V. Hamilton, T h e B l a c k P r e a c h e r i n A m e r i c a , (New York: William Morrow andCompany, Inc., 1972), p. 35.7. H.H. Mitchell, B la c k P r e a c h in g , (New York: Harper and Row, Publishers, 1979), p.215.8. H.B. Hicks, Jr., I m a g e s o f t h e B l a c k P r e a ch e r: T h e M a n N o b o d y K n o w s , (ValleyForge, PA: Judson Press, 1977), p. 135.9. Saunders, E., and Kong, B.W., "A rote for churches in hypertension management."Ur b a n He a l th , 1 3 (7), (1983), 49-55.10. H.R. Leavell and E.G. Clark, P r e v e n t i v e Me d ic in e fo r th e Do c to r in H is C o m mu n i t y :A n E p id e m io lo g ic A p p r o a c h , 2nd ed., (New York: McGraw-Hill Book Company, Inc.,1958), pp. 20-29. \,11. S.M. Aronson, "Conversations between the clergy and practicing physicians,"R h o d eIs la n d Me d ic a l J o u r n a l , 5 8, (1975), 329-330.12. P.K. Quinn and K. Talley, "A clergy training program in a mental heal th center,"H o s p i t a l a n d C o m m u n i t y P s y c h ia t r y, 2 5 , (1974), 472-473.13. K.C. Haugk, "Unique contr ibutions of churches and clergy to community mentalhealth," C o m m u n i t y M e n t a l H e a l t h J o u rn a l , 1 2 , (1976), 20-28.14. G.E. Westberg, "Can the clergy help overworked physicians?" P o s tg r a d u a te Me d i -cine, 53, (1973), 165-169.15. C. Marwick, "Religion and medicine draw closer," Me d ic a l W o r ld N e w s , 1 9 , (1978),26-33.16. W.K. Bentz, "The clergyman's role in community mental health," J o u r n a l o f R e l i -g io n a n d H e a l th , 9, (1970), 7-15.17. B.W. Kong, J.M. Miller, R.T. Smoot, "Churches as high blood pressure control cen-ters," A m e r i c a n J o u r n a l o f P u b l i c H e a lt h , 7 1, (1981), 1173.18. E.J. Perry and B.J. Williams, "Memphis TN: the Memphis church-based high bloodpressure program," Ur b a n He a l th , 1 0, (1981), 69-70.19. J.W. Hatch, and C. Jackson, "North Carolina Baptist church program," Ur b a nHeal th , 10 , (1981), 70-71 .20. J.W. Hatch, A.E. Callan, E. Eng, C. Jackson, "The General Baptist State Conven-tion Health and Human Services Project," Contact, 77, (1984), 1-7.


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Jeff rey S. L e v i n 1 03

21. J.W. Hatch and K.A. Lovelace, "Involving the southern rural church and students ofthe health professions in health education," P u b l i c H e a l th R e p o r t s , 9 5 , (1981), 23-25.22. "Health and Human Services Project, Raleigh, North Carolina," Focal Po in ts , 2 ,(1984) 6 -7 . Division of Health Education, Center for Health Promotion and Educa-tion, CDC, PHS, DHHS, Atlanta, GA.23. J.A. Smith, The role of the Black clergy as allied health care professionals in work-ing with Black patients. In D. Luckraft, ed., B l a c k A w a r e n e ss , (New York: AmericanJourna l of Nursing, 1976).24. E.E. Bruder, "The clergyman's contribut ions to community mental h e a l t h . " H o s p i t a la n d C o m m u n i t y P s y c h ia t r y, 2 2 , (1971), 207-210.25. C.M. Kaseman and R.G. Anderson, "Clergy consultation as a community menta lhealth program," C o m m u n i t y M e n t a l H e a l th J o u r n a l, 1 3, (1977), 84-91.26. G.E. Westberg, "Churches are joining the health care team," Ur b a n He a l th , 1 3 (9),(1984), 34-36.27. E. Eng, J.W. Hatch, C. Jackson, R. Young, B. Dixon, Social support in the BlackChurch as a health promotion intervention (Paper presented at the annual meetingof the Amer ican Public Heal th Association, Dallas, November 1983).28. P r o m o t in g He a l th /P r e v e n t in g D is e a se : O b je ct iv e s fo r th e N a t io n . PHS, DHHS (Wash-ington, DC: U.S. Government Prin ting Office, 1980).29. L. Ranck, "Upgrading the Black health care s ta tu s , " E n g a g e /S o c ia lA c t io n , 8 , (1980),6-8, 41-42.30. C.E. Lincoln, T h e B l a c k C h u r c h S i n c e F r a z i e r , (New York: Schocken Books, 1974), p.105.31. R.S. Mendelsohn, Confess ions o f a M edica l Here t ic , (New York: Warren Books,1979), p. 185.32. D. Kasanof, "Clergymen can be bad medicine," Me d ic a l E c o n o mic s , March 2, (1970),211-215.

roles for the black pastor in preventive medicine

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