Talk like a health promoter

Chronic condition — a long-lasting medical condition that requires ongoing care

Congregation — a group of people who gather for religious worship

Demographics — the make-up of a population, including age, gender and socioeconomic status

Health disparities — differences in health between groups of people, often caused by factors such as unequal access to care, leading some groups to have worse health outcomes than others

Health equity — when everyone has the opportunity to achieve their best health outcomes

Health promotion — efforts to improve health and prevent disease through education, community involvement, and interventions that encourage healthy behaviours

African Americans experience higher rates of chronic conditions, such as heart disease and diabetes, and have shorter life expectancies than other populations in the US. These health disparities are not random – they are rooted in a long history of systemic racism, unequal access to quality healthcare, and generations of mistrust in medical institutions. The result is a serious public health crisis that continues to affect millions of African Americans today.

While health education can improve health outcomes, how can it be delivered to those who do not trust healthcare organisations? Dr TanYa Gwathmey, a researcher at the Maya Angelou Center for Health Equity at Wake Forest University School of Medicine, believes the answer lies within the communities themselves – when faith leaders oversee the health education their congregations receive, community members trust the information.

Why is mistrust in healthcare common among African American communities?

“Throughout history, African Americans have not been treated fairly or humanely, especially regarding healthcare and medicine,” says TanYa. “In the past, researchers experimented on African Americans to examine health conditions or test drugs.” One of the most infamous examples of this mistreatment is the Tuskegee Syphilis Study. For over 40 years, hundreds of African American men with syphilis were deceived by researchers who withheld treatment from them. The men believed they were receiving proper medical care, but in reality, they were being used to observe the natural progression of the disease.

“Cases such as the Tuskegee Syphilis Study have caused many African Americans to lose trust in the healthcare system,” explains TanYa. As a result, many African Americans are hesitant to seek medical help when they need it, and they often avoid participating in research studies that could lead to new treatments and better understanding of medical conditions. This has serious consequences, contributing to the fact that African Americans have the lowest life expectancies and worst health outcomes for many diseases compared to other racial groups.

How can faith communities promote health education?

The Triad Pastors Network (TPN) is a partnership between the Maya Angelou Center for Health Equity and Christian faith leaders from African American communities in North Carolina. The goal of the TPN is to improve the health of these communities by addressing their specific needs through trusted local churches. “Through our partnerships with churches, we ensure that health information is shared in a way that is easily understood by everyone, even if they don’t know very much about science or medicine,” says TanYa. “We identify ways to apply this information so that community members can develop and maintain healthy behaviours in ways that fit with their needs and lifestyles.”

The churches involved in the TPN vary in location (rural, urban and suburban), size, congregation demographics, and style of worship. A key strength of the TPN is that health education is adapted to the unique health needs of each community it serves. “Each faith leader tells us the specific needs of their church and the health conditions that are most prominent in their community,” explains TanYa. “We use this to develop educational resources about different health conditions and activities to help churches to share the information with their congregations.”

The TPN takes a community-driven approach to health promotion by empowering local church members to become health leaders. Each church designates one or two individuals to serve as health ambassadors. “The health ambassadors attend a year-long programme that helps them develop a health ministry within their church,” explains TanYa. “They share health information with their fellow church members through various health promotion activities, including workshops, seminars with expert speakers, health fairs, and groups that emphasise healthy behaviours, such as walking, dancing, and nutritious cooking.”

In addition to faith leaders and church members delivering tailored health education to congregations, the TPN also conducts surveys to understand the wider healthcare needs of African Americans in North Carolina. “For example, our surveys indicated that women were much more likely to get vaccinated against COVID-19 than men, and young adults tended to have more hesitancy regarding vaccination due to lower levels of trust in public agencies,” says TanYa. “These results highlight that the healthcare community must spend more time and effort developing trust with African American young adults and men of all ages in order to encourage future vaccinations.”

Why are churches more effective than healthcare settings?

Churches hold a unique position of trust within many African American communities, making them an ideal setting for delivering health education. Unlike healthcare centres, which have historically been associated with mistrust, churches are seen as safe spaces where people seek guidance, not only for their spiritual well-being but also for their physical and mental health. People are much more likely to accept information that is delivered by trusted faith leaders or fellow church members than by faceless government healthcare organisations.

The success of the TPN offers hope that similar faith-based partnerships across the country could help rebuild trust between healthcare systems and African American communities. By developing these relationships, health education delivered by faith leaders and community members will hopefully increase access to healthcare, reduce health disparities, and ultimately, achieve health equity for African Americans.

Dr TanYa Gwathmey
Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, USA

Fields of research: Health promotion, health education, health disparities, cardiovascular health

Research project: Working with churches to deliver health education to African American communities

Funders: The Duke Endowment; US National Institutes of Health (National Institute of Aging, National Institute of Diabetes and Digestive and Kidney Disease, National Institute of Child Health and Human Development, National Institute of General Medical Sciences)