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Which Way to Clergy Health?

Prompted by rising health care costs and looming clergy shortages, the church is recognizing health as an important issue.

Dr. Gwen Halaas, a family physician in Kenosha, Wis., is concerned about a patient, a middle-aged professional whose case has drawn all her time and attention. She describes the case in the same concise format she learned years ago at Harvard medical school:

A 51-year-old male with symptoms of depression, the patient has high blood pressure and is overweight, presenting a heightened risk of heart disease and other illnesses. He works 60-70 hours a week in a sedentary job, does not currently engage in any physical exercise, and reports considerable work-related stress. Patient is married, with three children, one of whom expresses interest in following patient's career path. Patient expresses little enthusiasm for encouraging child to do so.

While the case history may sound routine, Dr. Halaas and her patient are, in fact, remarkable - perhaps even historic. That's because the patient is not a specific individual, but a statistically based overview of the typical Lutheran pastor. And Halaas is the project director of the Ministerial Health and Wellness Program, a major new initiative by the Evangelical Lutheran Church in America to improve the health of Lutheran pastors and other church leaders.

What makes her work especially significant, however, is that her patient's condition does not differ substantially from that of clergy in just about every Christian denomination today. Doctrinal and theological differences aside, North American churches have in common not only the Cross and a love of Christ, but also a pastorate whose health is fast becoming cause for concern.

Prompted by rising health care costs and looming clergy shortages, some denominations are recognizing health as an important issue. A few - most notably the ELCA, the American Baptists, and the General Synod of the Anglican Church of Canada - have launched efforts within the past year to improve clergy health. Others, including the United Methodist Church, are following the issue with great interest.

"Certainly this is a big-time problem," says Steve Weston, assistant plan manager for HealthFlex, a managed-care health plan offered by the UMC's General Board of Pension and Health Benefits. "I see the utilization data every month, and definitely, we're overweight, we have high blood pressure, and we have stress levels and depression levels that are higher than the general population. The General Board and HealthFlex are aggressively looking at the issue, and I would imagine there will be discussion about it at General Conference within the next couple of years."

If you're imagining thousands of jogging-suit-clad pastors pounding the pavement, relax and take a deep breath. At its heart, this new movement to improve clergy health is about much more than just strapping on the Nikes. It is about creating and cultivating within the church a wholistic approach to health that addresses wellness in all its physical, emotional, social, spiritual, and intellectual dimensions. At its best, observers say, this emphasis on clergy health raises important theological issues with the potential for reclaiming Christian practices about care of the self and one another. At the same time, it's challenging both clergy and laity to rethink and re-envision the entire nature of ministry.

"We're not talking about continuing education or crisis management, but changing the culture of the church to be a healthy community," says Halaas. "That's what's exciting to me as a physician: the church can become a community that sets an example for the rest of America."

Although data is limited, research indicates that some of the most critical issues facing clergy appear to be in the areas of weight, mental health, heart disease and stress:

  • A national survey of more than 2,500 religious leaders conducted last year by Pulpit and Pew, a research project on pastoral leadership based at Duke Divinity School, found that 76 per cent of clergy were either overweight or obese, compared to 61 per cent of the general population.
  • The same study also found that 10 percent of those surveyed reported being depressed - about the same as the general population - while 40 percent said they were depressed at times, or worn out "some or most of the time."
  • A survey of Lutheran ministers found that 68 percent were overweight or obese, while 16 percent of male pastors and 24 percent of female pastors complained of problems with depression.

Much of the clergy health problem may be rooted in the very nature of ministry today -- what Stephanie Paulsell, a visiting lecturer on ministry at Harvard Divinity School and author of Honoring the Body, calls "the overwhelmingness" of ministry.

"When you get up in the morning, you have to make a lot of choices about how to spend your time," says Paulsell, who also serves as a member of Pulpit and Pew's Core Seminar, an advisory group of religious leaders and theological educators. "It's a job that is conducive to eating on the run and not taking time to exercise and not getting enough sleep."

Faced by overwhelming need and filled with a genuine desire to help, many pastors, consciously or not, set themselves up for problems, thanks in part to a misguided notion of ministry.

"There is a false notion that effective ministry is about the imitation of Christ," says the Rev. Pamela Cranston, chair of the Clergy Wellness Commission of the Episcopal Diocese of California. "There is the idea that ministry is about living a life dying to the self and living to other people, and that to be a true priest you have to kill yourself, to give your entire life for others. The theological problem around that is that Jesus already did it and we don't have to."

The Rev. Ivan George, chair of the Ministerial Leadership Commission of the American Baptist Church, says clergy tend to address their own needs, if at all, only after dealing with all the needs of their congregation. The commission voted earlier this year to make clergy wellness a church priority over the next five years.

"They'll take care of themselves only after they've made out the church budget, visited the sick, done all these kinds of other things, but usually time runs out before the work gets done."

But that alone doesn't explain today's clergy health problem: The world has always been filled with overwhelming need, and priests have always tried to be a healing presence. Halaas suspects that the day-to-day experience of ministry has fundamentally changed over the past 30-40 years.

In the 1950s, she says, a major study began following a large cohort of clergy. The researchers found that clergy had lower rates of disease for virtually every possible diagnosis and lived longer and healthier lives than any other professional group. Later, she says, two other studies emerged that were conducted on an entirely different and later generation of clergy. The first, published in 1983, found that Protestant clergy had the highest overall work-related stress of various religious professionals and the next-to-lowest amount of personal resources to cope with the strain.

The second, published in 1999, found that clergy have one of the highest death rates from heart disease of any occupation.

"Taken together, these three studies suggest to me that the experience of clergy has changed over the past few decades," says Halaas.

Halaas contends that today's clergy have greater demands and less support - both physical and emotional - from staff and volunteers. The same sweeping changes that have rocked American society in the past 50 years have also radically altered the nature of ministry.

With more two-income families, fewer stay-at-home spouses are available as volunteers to help carry out the day-to-day tasks of running a church. The dramatic rise of clinical pastoral education has increased the role of counseling in modern ministry - even as greater social stresses have fueled a demand for those services among laity. Meanwhile, clergy salaries have not kept pace with those of other professions, and the position is, perhaps, not as respected as it once was.

"Basically, it's become a more difficult job with fewer rewards," says Halaas. "And all those things add to stress and take a toll on health."

Herself a clergy spouse, married to a Lutheran pastor, Halaas says she is not harkening back to a long lost "Golden Age," but simply describing very real changes that have occurred in ministry and society.

"Think back to the picture of pastors we had in mind when we were kids and the image today," says Halaas. "Pastors from 40 years ago probably had spouses who worked alongside them and supported them, and they lived next door to the church and maybe they walked home for lunch and dinner. Now it's a minister who gets up in the morning and goes all day, and if they get a chance to eat at all, it's fast food, and if they're not sitting in their office, they're in the car driving somewhere."

Halaas and her group have already sketched out a broad action plan that is essentially a public health campaign aimed at communicating a message and creating coalitions to encourage healthier lifestyles. Yes, healthy diet and increased physical activity will be a big part of the prescription for better clergy health, but it's not all, or even the most important part.

For Christians, health and wellness are not just "physical" issues, but are deeply rooted theological concerns that, rightly understood, will require a change in thinking about the body, says Paulsell.

To some extent, Christians still struggle with an ambiguous legacy about the body that goes back to the very beginnings of the church, one that split the body from the spirit, elevating the work of the spirit and denigrating the physical and the material.

"There has always been this tension about the body not being important, and placing the work of the spirit over that of the body," says Paulsell. "But in fact, everything in the Gospel and in the tradition suggests that bodies matter to God and ought to matter to us."

Christians worship a God who came to them in a physical body, and who ate, drank, slept, touched and was touched, suffered, died and was raised from the dead.

"And that tells us that bodies matter to God, and through our bodies we're invited to be in deep relationship with God," says Paulsell. People today tend to think of caring for the body as an individual act and concern, but in reality, such care is a communal practice, says Paulsell. It is through the body that we learn to care for one another. Even as our physical body separates us from others, it also beckons us to be in relationship with others.

"We are all so different in so many ways, but what we all share as human beings is that we have fragile bodies," says Paulsell. "No matter how strong or healthy we are, there will be times in life, in our births and in our deaths and in between, when we will be dependent upon the care of others. And this fragility must be a sign God wants us to care for each other, because otherwise we could take care of ourselves."

The Christian tradition contains within it certain practices, some long dormant, that can be extraordinary resources in the quest for better health, contends Paulsell. In a hurried and affluent culture where eating becomes refueling and hunger pangs are never known, the rhythms of feasting and fasting, of pausing in gratitude before a meal, can help shape a radically different way not only of eating, but of being in the world.

"A way of eating that draws deeply on Christian faith would be shaped by . . . choices that honor the body - our body and the bodies of others," writes Paulsell in Honoring the Body. "Choices that delight in the bounty of creation and that respect God's intention that there be enough for all."

Fasting from junk food; eating less meat; paying attention to our hunger and eating no more than necessary to satisfy it; taking care not to waste food; never eating without saying thanks. These are all small but important practices that can make real differences in the way people live their lives by reminding them that food is God's gift.

Paulsell and others recommend Sabbath-keeping as a powerful practice that could help clergy - and others - recover a healthier way of life. Taking one day to acknowledge that our bodies need rest and that the world goes on without our labor is a profound counter-cultural practice, says Paulsell.

"It's one day a week when we pause to spend time with others in worship and rest and refuse the culture's insistence that we be producing."

With everyone else's Sabbath being their primary workday, clergy must find another day of rest. But to do so will require the support of congregations. In the Episcopal Diocese of California, church officials have established guidelines setting the expected work week for clergy at no more than 45-50 hours, with a five-day work week and two full days off. The diocese's Clergy Wellness Commission has developed sample job agreements and health agreements that set out expectations about job duties, work hours, sick leave, vacation, and the steps that clergy will take to maintain their spiritual, emotional, mental, and physical well being.

The agreements are part of a broader effort to make congregations see ministry as a shared task between clergy and laity. Rather than viewing pastors as the hired chaplain and service provider, healthy congregations should see themselves in mutual ministry with the clergy.

Paulsell acknowledges that "Clergy can't do it by themselves.

"They need to have the whole church and whole congregations behind them to say that honoring the body is important. Both clergy and laity need to understand that the body is a precious gift from God that has to be cherished."

Rather than viewing a pastor's day of rest or daily hour of exercise as time away from the care of others, clergy and their congregations need to see such measures as time spent taking care of ministry.

"People need to understand that ministry isn't done by the disembodied mind, but by the whole embodied self," says Paulsell. "We need churches to be communities where we talk about bodies and the care of bodies and what God expects from us."

It's as simple as this, says Paulsell: If people are going to do the hard work of ministry, they have to be healthy.

* * *

For more reading:

Evangelical Lutheran Church in America, Division for Ministry, Ministerial Health and Wellness website (including Ministerial Health and Wellness Report, 2002) http://www.elca.org/dm/health

Clergy Wellness Commission of the Episcopal Diocese of California website, http://www.diocal.org/cwc

The Ministerial Leadership Commission (MLC) of the American Baptist Churches USA, website, http://www.abc-mlc.org/issues

Paulsell, Stephanie, Honoring the Body: Meditations on a Christian Practice; Jossey-Bass, San Francisco, 2002.

Bass, Dorothy C., Practicing Our Faith: A Way of Life for a Searching People; Jossey-Bass, San Francisco, 1996.

Reprinted from the Fall 2002 issue of Divinity, the alumni magazine of Duke Divinity School

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The Sustaining Pastoral Excellence program is funded by Lilly Endowment Inc.