Gallup estimated that 118 million Americans went to church last weekend. The Hartford Institute identified ~350k religious congregations across the United States. Notwithstanding that level of activity, the country has clearly turned more secular; 2020 was the first year when less than half of all Americans (47%) identified as a member of a church, synagogue or mosque. In 1999, that number was 70% and had been consistently above that threshold for the prior 60 years.
This religious “shoulder season” between year-end holidays and Easter offers an interesting window to reflect on the role of religion in healthcare. The obvious societal crosscurrents and turbulence arguably have further polarized an already fractured country. Fewer Americans identify as Christian, now standing at 63%, while 29% of U.S. adults claim to have no religious affiliation. More than 40% are Protestant and 21% are Catholic. Other religions continue to be a relatively modest yet important slice of the overall population, according to Pew Research Center data. In large measure due to the pandemic, in-person attendance has declined between 30-50% according to the Barna Group, which studies religion in the U.S., and yet it is believed that 45% of Americans still pray daily (which is admittedly down from 58% in 2007).
Reproduced from Pew Research Center. Chart: Axios Visuals
Religion is also a big business. According to Cause IQ data, religious organizations employ 321k people and generated $46 billion in revenues and have cumulative assets of $133 billion. Many religious organizations have essential healthcare affiliations or have endowed important healthcare organizations, providing critical healthcare services. These are often found in communities that struggle with issues of access and quality. Religious organizations often serve as society’s safety net and play a profound role in coordinating with public health infrastructure. Over the centuries, clergy were known to provide healthcare services, in part, to supplement income earned from the church.
So, do those with religious affiliations have better health outcomes? Baylor University researcher and Pulitzer Prize nominee, Rodney Stark, identified $115.5 billion in healthcare savings for those who practice a religion (2012). Quite clearly, the deeply religious find emotional and psychological comfort in spirituality. Religious practice is thought to reduce depression, improve interpersonal relationships, and enhance a deeper sense of self-esteem, which are all shown to improve physical well-being. A pivotal Mayo Clinic study in 2019 concluded that “Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide.”
Notwithstanding this study, the connection of spirituality and physical well-being are still somewhat indirect, and showing causality is still elusive. Most religions emphasize the importance of physical health, and in fact, many identify smoking, alcohol, poor diet, and unsafe sexual behavior as anathema to core principles. Such religions advocate abstinence, often encouraging meditation, which likely does have important physical benefits. Clearly, increased levels of depression or emotional problems directly contributes to poor physical conditions, likely leading to increased mortality and reduced quality of life. Increased sense of meaning and purpose afforded by religious practices can improve one’s ability to manage stress and depression.
Notably, a 2018 Forbes study identified a significant gap between providers and patients and whether they believe that God or a higher power exists. It was estimated that 64% of clinicians held such beliefs while more than 90% of their patients did. Importantly, the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) requires that providers demonstrate respect for patients’ cultural and personal values, beliefs, and preferences (including religious or spiritual beliefs). It is estimated that 25% of providers expressed uncertainty in their religious beliefs. Over 75% of patients felt that providers should consider their spiritual needs when providing care.
Interestingly, against a backdrop of reduced stated religious affiliations but arguably a more energized and vocal religious community, investment in religious facilities has dropped significantly. A recent Axios analysis identified a precipitous decline starting a dozen years ago, further accelerated by the pandemic. According to U.S. Census Bureau data, twenty years ago construction spending on religious facilities averaged approximately $9 billion annually; analysts estimates are that there was only $3 billion invested in 2021.
As a point of comparison, the level of construction spending in healthcare has been relatively consistent over the past decade or so, running between $40 – $45 billion with a marked increase over the past few years, heading towards $50 billion in part due to needs exposed by the pandemic as well as an incredibly favorable financing environment. Curiously, construction spending for recreational facilities was nearly $11 billion in 2021, perhaps reflecting how society weighs the need to be entertained given the extraordinary pandemic pressures.
Have venture capitalists seen the light? According to Pitchbook, $175.3 million was invested in faith-based apps in 2021, which is rapturously greater than the $6.1 million invested a mere five years ago. It is most likely too convenient to conclude that the reduction in physical religious infrastructure is being replaced with virtual infrastructure (akin to ecommerce replacing Main Street retail) but many congregants have turned to virtual solace when lockdown during the pandemic. The YouVersion Bible app claims to have been downloaded over 500 million times.
Setting aside the obvious tension surrounding for-profit religious apps, and whether they can be deemed exploitive, there were a handful of notable venture financings in 2021. Glorify, which is a subscription “well-being” app offering meditation and Christian content, closed a $40 million round with Andreesen Horowitz and SoftBank as lead investors. Not to be outdone, Hallow, claiming to be the #1 Catholic app, also raised a $40 million round with Drive Capital as the lead investor. Pray.com closed on a $34 million round, while Ministry Brands (a provider of software and services for faith-based organizations, which had been acquired for $1.4 billion by Insight Partners in 2016), sold a majority stake to Reverence Capital Partners. Published interviews with these companies’ founders consistently reference the potential to build robust social networks and dating tools with their members, sort of “monetizing the flock.”
Gloo, launched by the founders of Blockbuster Video and Boston Market, provides software to 30k church clients that identifies and markets to potential new members based on sophisticated algorithms that profile individuals based on thousands of data points.
Undeniably, the sense of community is powerful, even therapeutic. Much of the promise for digital health tools involves engagement, activation, navigation, and providing information to its users. Perhaps digital religious tools will provide similar utility.
Of course, all of this risks going too far. The quest for palingenesis can be tricky. The “Way of the Future” was considered the first AI church, developed by Anthony Levandowski, who achieved some notoriety after being convicted for stealing autonomous vehicle trade secrets from Google when he was hired by Uber (and subsequently pardoned by Trump). This “religion” envisioned a future for humankind that is to be overseen by benevolent algorithms. What the…?