During the National Center for Complimentary and Integrative Health (NCCIH) Advisory Council Meeting on September 19, 2025, the Director announced that they have decided to add a Spiritual domain to their whole person health model!

Discussion about the decision to add the spiritual domain to their model can be viewed at the 26:05 mark in the video cast at the following link –  NCCIH Adds a Spiritual Domain to Their Whole Persona Health Model.

This National Institute of Health (NIH) agency has been deliberating this issue for almost three years! This is an important milestone because one would expect that more research monies will now be made available to study the relationship between spirituality and health. Also, as NCCIH creates its next 5 year strategic plan, studying the spiritual component of health will be part of that plan. As well, other NIH agencies who are inclined to address whole person health will adopt the NCCIH model that now includes a spiritual domain. Resources that are made available to the public will eventually address the significance of spirituality as it impacts a person’s health and wellbeing.

The diagram below is what their model would look like if the spiritual domain was included. The diagram links to a post about this consideration written by the Director of NCCIH.

During the NCCIH Advisory Council Meeting on July 1, 2025 (video cast), a Working Group on Spiritual Health presented a Final Report on this issue to the Advisory Council. (That report begins at the 1:34:10 mark in the video. See screenshots of many of the slides at this link – NCCIH Spirituality and Health Working Group Report – 7 1 25.)

After almost two years of study, they reported that “Well designed research is needed to evaluate the role of spiritual health/wellbeing to justify its inclusion as a domain of whole person health.”

So, NCCIH still will not recognize that a spiritual domain belongs in its Whole Person Health Model.

This exclusion of the spiritual dimension not only impacts negatively on all aspects of personal wellbeing, but on the public health of our nation such as chronic diseases and deaths of despair and their related plaguing social issues such as poverty, homelessness, substance abuse, unemployment, crime, violence, and suicide.

It will also impact negatively on the funding of research in the field of spirituality and health.

In this post I will challenge some information that the Working Group presented and again make a case for the inclusion of a Spiritual domain to their model.

Justification to Include the Spiritual Domain to the NCCIH Whole Person Health Model

In 2022 I wrote a detailed ‘white paper’ type of post titled Spirituality and Health in the Federal Government. The concern I addressed is that spirituality as a component of health and wellbeing is not generally recognized by the health agencies of our U.S. government. I pointed out at that time that the NCCIH model of Whole Person Health did not include a spiritual domain. In 2023 I wrote another post specifically related to their Whole Person Health Model. In both instances, I sent communications to the Director of NCCIH urging her agency to implement the recommendations I made in the posts.

The information I am presenting below is new and additional justification for the inclusion of a Spiritual domain to the NCCIH Whole Person Health Model.

A. NIH Agencies Indicate that the Care of the Spirit is Important.

1. A page of the NCCIH’s own website recognizes that a human’s spirit is a part of one’s whole person with the following text: “The word holistic (sometimes spelled wholistic) often refers to the treatment of the whole person—body, mind, emotions, and spirit – to achieve wellness and good health.” This recognition appeared on the NCCIH website well before they developed their model. So, some staff at NCCIH have previously recognized that the human spirit is part of the whole person!
2. The National Cancer Institute  (Another National Institute of Health agency) recognizes that there is a spiritual aspect of a person’s health. This statement is on their website: An Integrative medicine approach to medical care “often stresses the patient’s preferences, and it attempts to address the mental, physical, and spiritual aspects of health.” This NIH agency understands that there is a spiritual component to a person’s health.

B. U.S. Adults Say It’s Important

1. 1. In 2022, NCCIH held a Request For Information (RFI) to the public to identify a Set of Determinants for Whole Person Health. They asked the public to assist them in compiling a list of major determinants of health that encompass the full continuum of biological, behavioral, social, and environmental domains. Their instructions to respondents did not ask them to consider a spiritual domain. Results of the RFI were that 19% of respondents indicated that spirituality/religion was a determinant of health. This factor was the fourth most frequently identified determinant even though respondents were asked to consider only the biological, behavioral, social, and environmental domains of health. (A request for more complete data of the results of the RFI was made to NCCIH but denied.)
   2. The greatest majority of US adults recognize that there is a spiritual aspect to their being and that caring for it is an important aspect of health.

  a. The Pew Research Center’s Religious Landscape Study of U.S. Adults conducted in 2023-2024 found the following pertinent data:

1. 1. • • 86% of American adults believe that humans have a soul or spirit in addition to their physical bodies.
        • 83% of American adults believe in God or a universal spirit.
        • 75%  of American adults acknowledge having a sense of spiritual peace and wellbeing at some time during the year.

  b. 75% of Americans attend to their vital spiritual needs by choosing to affiliate with a specific religion. 69% of this group identify as Christian. (Gallup 2021 Poll on Religion in America) This is relevant because people align with various religions, and engage in practices of those religions, to attend to their deep spiritual nature and needs. This is how they live out their spirituality.

 c. A Mayo Clinic Proceedings publication reports that a survey found that 94% of patients regard their spiritual health and their physical health as equally important.

d. The same Mayo Clinic publication reports that another survey of family physicians found that 96% of patients believe spiritual well-being is an important factor in health.

e. Prayer is one of the most common spiritual practices by individuals in the United States, regardless of spiritual or religious orientation. A 2024 Pew Research Center report indicated that 45% of adults in the United States pray daily. Research on the impact of religion and spirituality (R/S) and health demonstrates that practices such as prayer generally impact favorably on wellbeing. Yet, prayer was removed as a form of complementary and alternative medicine (CAM) by NCCIH in the 2007 timeframe. Read this post – Prayer is Excluded as a Form of Complementary and Alternative Medicine by Our Federal Government.

Since adults in the U.S. report that their spiritual wellbeing is an important facet of their health, NCCIH should recognize that a ‘patient-centered’ approach to caring for individuals should include the spiritual domain.

C. The Research on the Connection Between Spirituality/Religion and Health

The Working Group statement that “Well designed research is needed to evaluate the role of spiritual health/wellbeing to justify its inclusion as a domain of whole person health” is unmerited.

The spirituality/religion (S/R) and health research in the scientific literature has demonstrated a clear and strong relationship between many factors of S/R and well-being and health.  

1. 1. 1. A prominent researcher in the field, Harold Koenig, MD writes, “There is overwhelming, rigorous, objective evidence being published by some of the world’s top public health institutions that religious faith and practice influence mental, social, behavioral, and physical health (Koenig et al., 2024)” Koenig, H.G., VanderWeele, T.J., & Peteet, J.R. (2024).  Handbook of Religion and Health, 3rd ed.  NY, NY: Oxford University Press.
      2. In a related journal article this statement was written by 12 distinguished researchers in the field:  “The growing body of robust, empirical research strongly links spiritual beliefs, states of being, communal practices, and private rituals to a range of beneficial health out- comes including lower all-cause mortality.” This was written in the 2024 Health Affairs journal article titled – Spirituality As A Determinant Of Health: Emerging Policies, Practices, And Systems, Long, K, et. al.
      3. In a study (published in a 2020 issue of JAMA Psychiatry) of 66,492 female registered nurses and 43,141 male health care professionals in the US, attendance at religious services at least once per week was associated with a 68% lower hazard of death from despair (deaths related to suicide, drug use, and alcohol poisoning) among women and a 33% lower hazard among men compared with never attendance.
      4. “Participating in spiritual practices during childhood and adolescence may be a protective factor for a range of health and well-being outcomes in early adulthood, according to a study from Harvard T.H. Chan School of Public Health, published in the September 13, 2018 issue of the American Journal of Epidemiology.
   2. 
   3.      5. See paragraph 8 in this blog post – Spirituality and Health in Our Federal Government – for a more detailed listing of the scientific research in this area.

D. The Spiritual Dimension of Wellbeing is Recognized by Leading Institutions

The NCCIH Working Group Report includes a statement as follows: ‘Spiritual Health/Well-being is currently not routinely incorporated as a separate factor of whole person health.’  This statement is not valid as evidenced by the following:

1. 1. 1. The organizations listed below promote the inclusion of a spiritual domain to their Whole Person Health initiatives/models, or to the spiritual dimension as part of ‘whole person’ care:
      • National Institute for Whole Health
      • George Washington University Wellness Model
      • The George Washington University Institute for Spirituality and Health (GWish)
      • Georgetown University
      • Harvard University’s Initiative on Health, Religion, and Spirituality
      • University of Michigan Medical School’s Program on Health, Spirituality and Religion – (a LINK to their model)
      • Veterans Health Administration
      • Department of Defense – Total Force Fitness
      • US Army – Holistic Health and Fitness
      • Academy of Integrative Health & Medicine (AIHM)
      • American Holistic Nurses Association
      • National Wellness Institute
      • Substance Abuse and Mental Health Services Administration (SAMHSA)(an agency within the U.S. Department of Health and Human Services)
      • Southern California University of Health Sciences
      • University of Maryland
      • University of California Davis
      • Yale Program For Medicine, Spirituality and Religion
      • University of New Hampshire
      • University of Miami Miller School of Medicine
      • Columbia University’s Spirituality Mind Body Institute
      • Duke University Wheel of Health
      • Duke University Center for Spirituality, Theology and Health
      • Rocky Mountain University of Health Professions
      • National Cancer Institute  (A National Institute of Health Agency) This statement is on their website: An Integrative medicine approach to medical care “often stresses the patient’s preferences, and it attempts to address the mental, physical, and spiritual aspects of health.”
      • The American Medical Association recognizes the importance of individual patient spirituality and its impact on health and encourages patient access to spiritual care services.

2. In a 2023 article published in the International Journal of Wellbeing, Assessing the Structures and Domains of Wellness Models: A Systematic Review, the authors write – “Based on this review the most commonly occurring domains of wellness are related to “Physical”, “Psychological”, “Social”, “Emotional”, “Spiritual”, and “Environmental” themes.”

3. In another article published on March 7, 2025 in the International Journal of Women’s Health, The Evolution of Wellness Models: Implications for Women’s Health and Well-Being, the authors identified 12 Wellness/Holistic/Whole Person Health models. Spiritual Wellness was included in the majority (7) of those models and the authors write, “Spiritual wellness was a notable dimension in several models, including the Wheel of Wellness, Perceived Wellness, and Whole-Person Wellness, reflecting its importance in a holistic view of wellness.”

The above references support the fact that Spiritual Health/Well-being is currently routinely incorporated as a separate factor of whole person health.

E. Spiritual Health Should be Included in the Measurement of Whole Person Health

Authors of recent peer-reviewed journal articles do recommend the inclusion of the spiritual dimension when measuring whole person health.

1. 1. 1. In a 2025 peer-reviewed journal article titled Measuring Whole Person Health: A Scoping Review –  the authors write the following in their results section: “Our search identified six WPH (Whole Person Health) measures. All six WPH measures included assessments of the biological/physical, behavioral/mental, social, and spiritual domains.” This was their conclusion:  “The results of this scoping review provide a greater understanding of the domains involved in WPH as a multidimensional construct. Although no existing WPH measures are suitable for broad use, their structural commonalities imply that WPH measure development efforts should consider the assessment of physical, mental, social, spiritual (my emphasis), and individual domains.” Measuring Whole Person Health: A Scoping Review. Journal of Alternative and Complementary Medicine, April 3, 2025 (This very recent research was funded by NCCIH.)
      2. In the book, Measuring Well-Being there is a chapter titled Tradition-Specific Measures of Spiritual Well-Being, authored by Tyler J. VanderWeele, Katelyn N. G. Long, and Michael J. Balboni of Harvard University. They write – “The neglect of spiritual well-being is thus an important omission in most assessments of well-being,” and also, “Since it is indeed the case that so much of the world’s population views religion and spiritual well-being as central, it would seem that any holistic assessment of well-being would arguably allow space for assessments of spiritual well-being as well.”

F. Spirituality is Recognized as a Determinant of Health

As part of their rationale for not including spirituality as a domain of whole person health, the Working Group reported that Social and Environmental factors are accepted as ‘determinants of health.’ They imply that spiritual factors are not accepted or recognized as a determinant of health.

1. 1. 1. 12 leading researchers in the field of spirituality and health do recognize that spirituality is a determinant of health as pointed out in this June, 2024 Health Affairs journal article – Spirituality As A Determinant Of Health: Emerging Policies, Practices, And Systems. In the article they state, “Reimagining public health’s future should include explicitly considering spirituality as a social determinant of health that is linked to human goods and is deeply valued by people and their communities.” They also state, “As empirical scholarship increasingly illuminates these connections, public health systems must seek additional ways to recognize spiritual determinants of health as a vital dimension, and extension, of whole person, whole-community well-being.” These recommendations emerged from their systematic review of empirical evidence on spirituality, serious illness, and population health published between 2000 and 2022.
      2. In a 2023 council meeting, the NIH’s National Institute on Minority Health and Health Disparities approved “spirituality and religiosity as psychosocial determinants of health” as a research concept.
      3. In paragraph B 1 above, read that in a public request for information, spirituality was the fourth ranked determinant of health identified by respondents.

During the July 1, 2025 Council meeting referenced above, the NCCIH Director, Dr. Helene Langevin indicated that the NCCIH has been ‘dancing around’ this topic of spirituality for quite some time. They continue to ‘dance around’ this issue by not recognizing that there is a spiritual domain to one’s whole person health and by not adding this as a domain to their Whole Person Health Model.

NCCIH’s position is that more studies and research on the connection between spiritual well-being and health is still required to justify the inclusion of the spiritual domain in its model. At their current pace of studying this issue, it could likely be many more years before NCCIH might make a decision to recognize that spiritual well-being is a relevant and important facet of whole person health.

Spiritual distress and poor spiritual health are at the root of many chronic diseases and social issues. Delaying the addition of a spiritual domain to their model continues to contribute to the poor health and well-being of our country’s citizens.  This negatively impacts many chronic diseases, deaths of despair, and related social issues such as poor mental health, poverty, homelessness, substance abuse, unemployment, crime, violence, and suicide.

Other federal agencies, including Health and Human Services agencies, are beginning to use the NCCIH model of whole person health for their policies, programs, educational materials and research. The continued use of the existing model, which excludes a spiritual domain, by other federal agencies further contributes to the poor health of our country’s citizens.

NCCIH has a robust 5 Year (2021-2025) Strategic Plan to guide their research. If the next version of this strategic plan were to be developed with a model of Whole Person Health that excludes the spiritual domain of health, it would further impact negatively on the public health of our country.

With the above in mind, I have provided compelling rationale for the NCCIH to recognize that spirituality is an important, seperate component of integrative health care, and for the immediate inclusion of the spiritual domain to the NCCIH whole person health model.

Recommendations:

1. 1. 1. That members of the NCCIH Working Group on Spiritual Health review the contents of this post and reconsider their decision to not add a spiritual domain to the NCCIH Whole Person Health Model.
      2. That the members of National Advisory Council for Complementary and Integrative Health (NACCIH) review this post and recommend to the leadership of NCCIH that the Spiritual domain of individual health be added to its Whole Person Health Model.
      3. That the staff of NCCIH make a decision to add the Spiritual domain of individual health to its Whole Person Health Model.
      4. That in any future NCCIH workshop to explore spiritual health, people of faith representing the most prevalent religions in the U.S. be included.
      5. That NCCIH recognize prayer as a form of CAM and that it be added back to future National Health Interview Surveys related to complementary and alternative medicine. (Read this more complete blog post concerning this issue.)
      6. That each recommendation made in the paper – Spirituality As A Determinant Of Health: Emerging Policies, Practices, And Systems – be implemented.
      7. That the recommendations I made in an earlier post concerning Spirituality and the Federal Government be implemented as well.
      8. That further research in the field of spirituality/religion and health include the study of sacred texts to learn of principles and interventions related to spiritual wellbeing that have been provided to us by our Creator.

Call to Action:

1. 1. 1. Contact NCCIH to inform them that you support the recommendations that I have made above.  Do this by sending an email to nccih-info@mail.nih.gov.
      2. Contact your state’s members of congress to make them aware of this important matter and ask that they become an advocate for this issue. (Senate Committee on Health. House of Representative Subcommittee on Health. (scroll to the bottom to view members.))
      3. Contact a local or national news agency, or an influencer on social media, and suggest that they run a story on this issue.
      4. Share this blog post with others in your network, or on your distribution list, so that they can become informed and be an advocate.
      5. For the White House Faith Office to actively advocate for this issue and support these recommendations.
      6. For the Christian Medical and Dental Associations, representing the medical profession of the largest religion in America, to be an advocate and address this as an issue of concern.
      7. For members of the NIH Religion, Spirituality, and Health Scientific Interest Group to support this matter.
      8. For the leadership of the Health and Human Services Center for Faith to be an advocate for including the spiritual domain of health to NCCIH’s model.

I invite and encourage you comments to what I’ve written!  Where it might be helpful, share your credentials and the name of your organization.

What other recommendations or calls to actions would you add?

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 2, The Holy Bible

Prayer is one of the most common spiritual practices by individuals in the United States, regardless of spiritual or religious orientation. A 2024 Pew Research Center report indicated that 45% of adults in the United States pray daily. Research on the impact of religion and spirituality (R/S) and health demonstrates that practices such as prayer generally impact favorably on wellbeing.

As of the date of this post, the NCCIH website, which was last updated in April 2021, indicates on this image depicted below that Spiritual Practices are a form of Psychological complementary medicine that falls in the category of Mind and Body Practices, yet it fails to acknowledge that prayer is one of those practices and therefore does not measure its use as a CAM practice by Americans.

Examples of complementary health approaches – NCCIH

In 2004, the CDC reported that prayer was the most common form of complementary and alternative medicine (CAM) used by adults in the U.S.  The data is from the 2002 National Health Interview Survey (NHIS) in which NCCIH sponsored questions about the use of various CAM therapies, including prayer. Of those adults who reported using any CAM therapy, 43% indicated they prayed for their own health and 24% reported that they prayed for other’s health. The next highest frequency of any form of CAM therapy reported in this 2004 CDC report was the use of natural products by 19% of adults. Of the 27 types of CAM studied, prayer for health reasons was the most frequently used! (See Graph Below)

CDC Advance Data Number 343 May 27, 2004

Beginning in 2007, and since that time, the NHIS Survey has not included questions about the use of prayer as a CAM as the NCCIH stopped requesting that prayer be included in the survey. Instead of measuring the use of prayer, the survey began to measure the use of “spiritual meditation.”

In a communications to me by the NCCIH Clearinghouse, I was informed that “the literature” (see this one paper they referred to – Is Prayer CAM? ) was an influencing factor in removing prayer from the 2012 NHIS Survey) To me, this paper does not make a good case for excluding prayer as a form of CAM.

Terms and language are important. I contend that most people who align themselves with any religion place a very high value on their practice of prayer to connect with and relate to the God of their religion. Christians, for example, are instructed and encouraged by their sacred text, the Bible, to pray to God and to pray for one another.  By so doing, they are attending to their own spiritual, mental, emotional and physical wellbeing and to the wellbeing of others. Christians do not regard their personal prayer practice as ‘spiritual meditation.’

So, might the exclusion of prayer as a form of CAM by the NCCIH be considered a form of religious discrimination?

It seems preposterous to me that the NCCIH does not recognize prayer as a form of complementary and alternative medicine (CAM)! Their own website indicates that spiritual practices are a form of CAM, and prayer is certainly a spiritual practice. And the 2004 CDC report referenced above demonstrated that prayer was by far the most frequently used form of CAM in the U.S. at that time.

Prayer is a spiritual practice that should be considered as a form of CAM by the NCCIH and it should specifically be listed as such, and it should be added back to future National Health Interview Surveys related to complementary and alternative medicine.

Additionally, the spiritual dimension should be added as a domain of individual wellbeing in the NCCIH’s model of Whole Person Health. It currently is excluded. (Read this post: Is Spirituality a Domain of Whole Person Health?) To exclude it suggests that the spiritual nature of a person does not exist. This exclusion of the spiritual domain of Whole Person Health could also be considered a form of religious discrimination to those who recognize that humans are spiritual beings who live in a physical body.

What are your thoughts? Please share them in the Comment section below.

I also encouraged my readers to submit a comment to NCCIH to that affect.

I’m happy to announce that on August 18, 2023 the Director of NCCIH posted a message on her Director’s Page stating that “I hope to get a conversation started about how we may thoughtfully include spirituality as one of the domains of research on whole person health.”  Doctor Langevin also wrote, “We’ll need to answer a core question. What are the elements of spiritual health that would be most amenable to research and would interconnect with the biological, behavioral, social, and environmental domains that we study?”

The draft diagram above was offered by Doctor Langevin as a suggestion as to how the spiritual domain might fit in their Whole Person Health model.

I commend the NCCIH staff for being open to including the Spiritual domain of health to their model. I also pray that as they explore this issue further that they make a decision to add the spiritual dimension as the research clearly shows that spirituality is an important component of mental and physical health.

I encourage you to read Doctor Langevin’s message. And, if you agree that there is a spiritual domain to health, then I also encourage you to send a comment to the NCCIH staff to that effect. (NCCIHStrategicPlan@mail.nih.gov)  Her message includes instructions on how to do this.

“Now may the God of peace himself sanctify you completely, and may your whole spirit and soul and body be kept blameless at the coming of our Lord Jesus Christ.” 1 Thessalonians 5:23

On Friday, May 12th, 2023 at 12 PM Eastern Time, their Advisory Council will be meeting (open to the public virtually) to approve a concept of the NCCIH research initiative. Read about the meeting here – Whole Person Health research concept meeting.

The NCCIH Whole Person Health Model does not include a spiritual domain, only these four domains: biological, behavioral,  environmental and social. This is concerning as research demonstrates that numerous factors related to an individual’s spiritual wellbeing clearly affects one’s physical, emotional and mental health.

At the above link for the May 12, 2023 meeting, the public is invited to submit comments regarding this Whole Person Health research initiative. I have submitted the following as a comment.  If you are also troubled by the fact that the NCCIH model of Whole Person Health does not include a spiritual domain, I encourage you to also submit a comment by May 27th, 2023. (visit the meeting link for instructions.)

Whole Person Health Research Concept at NCCIH – A Comment on Spiritual Health

This comment was provided to NCCIH regarding the concept for an initiative for Whole Person Health Research that will be presented to the NACCIH on May 12, 2023:

On a page of the NCCIH website that defines terms, your agency recognizes that one’s spirit is a part of one’s whole person with the following text: “The word holistic (sometimes spelled wholistic) often refers to the treatment of the whole person—body, mind, emotions, and spirit—to achieve wellness and good health.

Yet, the NCCIH framework for Whole Person Health (WPH) does not recognize the Spiritual domain of an individual.

If the concept for the WPH Research Initiative does not include the exploration of whether the spiritual domain should be included as part of the ‘whole person’ framework and considered just as important as the biological, behavioral, social and environmental domains, why is that?

A ‘white paper’ – Spirituality and Health in Our Federal Government – provides rationale, with referenced research, for including the spiritual domain in the NCCIH’s framework of WPH. This paper names several prestigious institutions of higher learning in the US that research this field and have documented the connection between spirituality and health. This research in the scientific literature has shown that incorporating spirituality into personal self-care and into the healthcare of patients can have positive effects on physical, emotional, mental, and psychological well-being.

Doctor Langevin’s blog post of 3/28/23 on a Whole Person Approach to Lift the Burden of Pain refers to the effectiveness of the VA’s Model of Whole Health, which has a spiritual dimension. Medical professionals who helped develop the DOD’s version of Whole Person Health, Total Force Fitness, deemed fit to include the spiritual domain in their framework. Both the VA’s and DOD’s frameworks are referenced by NCCIH as examples of systems that are using whole person health in health care.

This page of the NCCIH website states “In the context of whole person health, (research) topics should focus on exploring the fundamental science of interconnected systems…” Available research does demonstrate that the spiritual aspect of a person is a unique and important ‘system’ that is connected to an individual’s biological, psychological, emotional, and nervous systems.

Yet, the Executive Summary of the NCCIH Strategic Plan FY 2021–⁠2025 Mapping a Pathway to Research on Whole Person Health and your website’s definition of Whole Person health excludes the spiritual domain stating that whole health has ‘multiple interconnected domains: biological, behavioral, social, and environmental.’

The slight mention of Spiritual Practices on the venn Diagram on Complementary Health Approaches, or the identification of Spirituality, Meaning and Purpose as one of 11 Factors or Determinants of Whole Person Health, does not properly represent the magnitude of the multitude of spiritual factors that impact positively on health. Spiritual practices, beliefs, attitudes, thinking patterns, and a relationship with a higher power tend to improve coping skills and social support, foster feelings of optimism and hope, promote healthy behavior, reduce feelings of depression and anxiety, and encourage a sense of relaxation. Spiritual factors like faith, hope, forgiveness, and prayer have a positive effect on health and healing. By alleviating stress and promoting healing, spirituality can positively influence one’s immune, cardiovascular, hormonal, and nervous systems.

In the 2022 NCCIH RFI to the public to identify determinants of Whole Person Health, 19% of respondents indicated that spirituality/religion was an important factor. This factor was the fourth in frequency mentioned even though respondents were asked to consider only the biological, behavioral, social, and environmental domains of health. This is another representation of the importance of adding a spiritual domain to your WPH model.

The spiritual nature of an individual and it’s numerous and various corresponding factors play a significant role in an individual’s health and wellbeing. NCIHH is the most appropriate governmental health agency to recognize spirituality’s significance and to include it prominently in its WPH framework and to recognize it as a complementary approach to health.

As included in the above mentioned ‘white paper’ I propose that the spiritual component/domain of health be incorporated into the NCCIH framework for whole person health as a separate domain and into the 2021-2025 Strategic Plan.  As a precursor to this, I recommend the NCCIH conduct a roundtable with a goal of advancing research in the area of spiritual wellbeing to better understanding its role in improving health. (Such a roundtable on emotional wellbeing was conducted in 2018.)

Thank you for your consideration.

Dale Fletcher, M.S.

Whole Person Health – Why a Spiritual Domain Should Be Included

The following is a concise rationale of why the NCCIH Model of Whole Person Health should include a Spiritual domain of Individual Health:

1. Humans have an immaterial part of themselves that many recognize as a soul or spirit. Read this page on my website – Spirit, Soul and Body – How God Designed Us.
2. The greatest majority of Americans (75%) attend to their vital spiritual needs by choosing to affiliate with a specific religion. 69% of this group identify as Christian. (Gallup 2021 Polls on Religion in America)
3. The spirituality or religion (S/R) and health research in the scientific literature has demonstrated a clear and strong relationship between many factors of S/R and well-being and health.
4. Our federal health agencies exist to serve the various demographics of our nation’s citizens. Their research should focus on what matters most to our citizens.

I encourage you to attend the virtual meeting on May 12th to become informed and to submit a comment regarding this research initiative.   The more this field of the connection between spirituality and health is researched, the clearer it will be documented that many spiritual factors positively affect health and wellbeing. This should result in more focus on this area, better whole person health care to people, a better informed public, and ultimately will lead to improved wellbeing of our nation’s citizens.

Spiritual health is not recognized as a component of individual wellbeing by our federal government.

This exclusion of the spiritual dimension not only impacts negatively on all aspects of personal wellbeing, but on the public health of our nation and its related plaguing social issues such as poverty, homelessness, substance abuse, unemployment, crime, violence, and suicide.

This blog post is a sort of ‘white paper’ that addresses this very important issue and its impact.  It also provides rationale for the recommendations that are offered. Included are suggested actions that you as an individual can take to make a difference.

I believe that a group of resolved people can cause a change to occur. In that light, I invite you to prayerfully read through this as you consider how it affects the wellbeing of the people of our country and the collective health of our nation.

Terms

Spirituality.  The deepest beliefs, values, and practices, often informed by sacred texts, by which a person seeks to be in communion and harmony with the transcendent/God, to love themselves and others, and gives one a sense of right and wrong, meaning and life purpose which enables him/her to achieve their fullest human potential.

Spiritual Health. Caring for one’s spirit by living out their spirituality. Care for the health and wellbeing of a person must include care for the whole person, his/her physical/material nature as well as his/her immaterial nature – the soul/spirit – as the soul/spirit and body are intricately interwoven. Science demonstrates that ‘sicknesses’ of the soul/spirit such as worry/fear, bitterness/unforgiveness, shame/guilt and despair can be the underlying cause of many psychosomatic physical illnesses. A robust spiritual health enables a person to better recover from such ‘spiritual sicknesses’ and to meet their deepest spiritual needs to feel loved, accepted and valued.  Spiritual wellbeing also enables a person to better cope with stress, be more resilient, better manage negative emotions, and prevent trauma and heal from past trauma. It can provide hope, inner peace, and forgiveness, and creates an inner environment that promotes improved emotional, mental, social, and physical health.

The Issue/Concern

Spirituality as a component of health and wellbeing is not generally recognized by leading health-related agencies of our U.S. government.

In exhaustive research of the primary health-related websites of our government such as Health and Human Services (HHS), Office of Disease Prevention and Health Promotion – Health.gov (ODPHP), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA), Indian Health Services (IHS), National Center for Complementary and Integrative Health (NCCIH) and the National Cancer Institute (NCI), I found but a handful of instances where the term spiritual or spirituality was used in relationship to its significance in health and wellbeing:

1. The impact of Trauma on Spiritual Wellbeing and Creating a Healthier Life – A Step by Step Guide to Wellness. (The Wellness Initiative is no longer an active program) (SAMHSA)

2. An integrative medicine approach to care includes the spiritual aspect of health. (NCI)

3. The mission of the IHS is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. (IHS)

4. A brief article on How to Improve Mental Health on the MedlinePlus area of the NIH website states that exploring spirituality may help a person find meaning and purpose in life.

Most of the prominent federal health-related agencies and their efforts, resources, and the websites they maintain, do not include the spiritual dimension of wellbeing. Here are a few examples:

1. This definition of Whole Person Health by the National Center for Complementary and Integrative Health( NCCIH), a component of NIH, is an example:

“Whole person health refers to helping individuals, families, communities, and populations improve and restore their health in multiple interconnected domains—biological, behavioral, social, environmental—rather than just treating disease. Research on whole person health includes expanding the understanding of the connections between these various aspects of health, including connections between organs and body systems.”

In her article, Moving Complementary and Integrative Health Research Field Toward Whole Person Health, Helene M. Langevin, MD, the Director of NCCIH, excludes the vitally important spiritual domain in their whole person approach to health and framework.

UPDATE: On August 18, 2023 the Director of NCCIH posted a message on her Director’s Page stating that “I hope to get a conversation started about how we may thoughtfully include spirituality as one of the domains of research on whole person health.”  Doctor Langevin also wrote, “We’ll need to answer a core question. What are the elements of spiritual health that would be most amenable to research and would interconnect with the biological, behavioral, social, and environmental domains that we study?”

I’m hopeful that the team that looks at this will make a favorable decision on this issue and that the spiritual domain of individual health will be added to their model of Whole Person Health.

2. Similarly, the CDC also excludes spirituality as a factor in wellbeing. The following is from a page on their website – Well-Being Concepts.

How is well-being defined? There is no consensus around a single definition of well-being, but there is general agreement that at minimum, well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning. In simple terms, well-being can be described as judging life positively and feeling good. For public health purposes, physical well-being (e.g., feeling very healthy and full of energy) is also viewed as critical to overall well-being. Researchers from different disciplines have examined different aspects of well-being that include the following:

• • Physical well-being.
  • Economic well-being.
  • Social well-being.
  • Development and activity.
  • Emotional well-being.
  • Psychological well-being.
  • Life satisfaction.
  • Domain specific satisfaction.
  • Engaging activities and work.

3. The Health and Human Services agency makes no mention about the importance of caring for one’s spirit as it relates to health prevention and wellness.

4. The Wellness and Lifestyle page of the MedlinePlus website of NIH makes no mention of spiritual health.

5. The Healthy People 2030 Framework on the ODPHP website excludes the spiritual dimension of wellbeing. A stated Foundational Principle of the Framework is: “Promoting health and well-being and preventing disease are linked efforts that encompass physical, mental, and social health dimensions.”

Why This is Significant. The Impact.

1. A robust spirituality or spiritual health is a protective factor for many physical, emotional, and mental illnesses. By not addressing this important dimension of health, the rate of these various illnesses is not impacted in a positive manner.
2. The absence of spiritual-related components of health on our government’s health-related websites means that health-promoting spiritual-related recommendations and resources are not made available to individuals in our nation.
3. Because there is limited federally funded research where spirituality is the central focus of wellbeing and in which well-designed intervention trials are included, advancement in the field of spirituality and health is stymied.
4. Ultimately, the health and wellbeing of our nation’s citizens is adversely impacted because the important component of spiritual wellbeing is not properly addressed within our federal government. This also impacts adversely on homelessness, the rate of poverty, the rate of suicide, the incidence of crime, and acts of violence.

The Facts and Research

The following is provided to support the case for including spiritual health as a component of overall health and wellbeing in our federal health agencies. It is not meant to be a comprehensive review but is representative of the facts that make a case for the link between spirituality and other well-accepted facets of wellbeing.

1. As of June, 2022, a Gallup Poll found that 81% of US citizens believe in God. Belief in God is a core aspect of spirituality.
2. A 2017 Pew Research Center report found that 81% of Americans consider themselves either spiritual or religious.
3. Many prestigious institutions of higher learning recognize the role that spirituality plays in wellbeing and health. Several dedicate monies for research and programming.
   1. Stanford University – Be Well – Spirituality and Health
   2. Harvard University – Initiative on Health, Spirituality and Religion and this Spirituality and Health Review Article.
   3. Duke University – Center for Spirituality, Theology and Health, including a section on the latest research on this topic.
   4. Baylor University – Program on Religion and Population Health
   5. George Washington University – GW Institute for Spirituality and Health (GWISH)
   6. Columbia University – Spirituality Mind Body Institute
   7. University of Florida – Center for Spirituality and Health

4.  Paul Reed, MD, Deputy Assistant Secretary for Health and Director, Office of Disease Prevention and Health Promotion mentions that spirituality is a factor in facets of health and wellbeing as he addresses this in various blog posts on health.gov. He indicates that one’s spirituality plays a role in diabetes, and wellbeing, and that conversations among health professions about healthy aging should include spirituality. Reed also states that spiritual organizations should be included in conversations about improving Social Determinants of Health (SDOH).

5. The Department of Defense (DOD) includes spirituality in their care for our nation’s soldiers and their families:

1. 1. Spiritual Wellness
   2. Department of the Army Holistic Health and Fitness
   3. Department of the Army Spiritual Readiness. Holistic Health and Fitness

6. The Department of Veterans Affairs (VA) recognizes that the spiritual aspect of a person’s life is important for wellbeing – Treatment for PTSD in veterans. It also recognizes that Spirit and Soul are an aspect of the Circle of Health.
7. The Indian Health Service (IHS) recognizes the significance of a person’s spiritual health. Their stated mission is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

8. Recent scientific research, peer-reviewed journal articles, and articles by leading academic institutions demonstrate a positive association between religion/spirituality (R/S) and health and wellbeing. Just a few references are listed here:

1. 1. Religion, Spirituality and Health: A Review and Update, Harold G. Koenig, Adv Mind Body Med. 2015 Summer;29(3):19-26.
   2. Religion, Spirituality, and Health: The Research and Clinical Implications, Harold G. Koenig, ISRN Psychiatry.2012; 2012: 278730
   3. Spiritual Health as an Integral Component of Human Wellbeing, Juskiene Vaineta, Applied Research In Health And Social Sciences: Interface And Interaction, Vol. 13, No. 1, 2016
   4. Spirituality and Health, Harvard Medical School Primary Care Review, May 14, 2021
   5. Religion and Mental health: Evidence for an Association, Harold G. Koenig and David B. Larson, International Review of Psychiatry (2001), 13, 67–78
   6. Religiosity/Spirituality and Cardiovascular Health, LaPrincess C. Brewer, MD, MPH, Journal of the American Heart Association. 2022;11:e024974
   7. Religion, Spirituality and Cardiovascular Disease, Lucchese, Fernando A. and Koenig, Harold G, Brazilian Journal of Cardiovascular Surgery [online]. 2013, v. 28
   8. Handbook of Religion, Spirituality and Health, 3^rd Edition, (to be released in 2022) John Peteet, Harold Koenig and Tyler VanderWeele
   9. Spirituality in Serious Injury and Health, Tracy Balboni, MD, MPH, et al, JAMA July 12, 2022 Volume 328, Number 2. Based on her findings, Balboni recommends the following: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation.

9. In 2008, Harold Koenig, MD, one of the world’s most prominent researchers in this field, made a presentation with recommendations concerning public health policy and programs and further research to a US Congress sub-committee on Research and Science Education related to spirituality and health and the Role of Behavioral and Social Sciences in Public Health.
10. On December 14, 2021, Harold Koenig, MD, made a presentation to the NIH religion, Spirituality and Health Scientific Group. He recommended to the NIH staff that religious and spiritual variables be included in projects that NIH funds, given that over 85% of Americans are involved in some kind of religion, and that existing research supports that spirituality and the practice of religion is associated with many aspects of mental health, health-promoting behavior and physical health.
11. The Constitution of the World Health Organization (WHO) (1946, Article 80) provides a commonly used definition of health that does not, at present, include spirituality. In 1998, two changes were proposed to the definition of health, adding in the word “dynamic” and including a fourth domain of health – spirituality. It would then have read: “Health is a dynamic state of complete physical, mental, spiritual, and social well-being and not merely the absence of disease and infirmity”. The Executive Board at first adopted this revised definition, but then a committee of the World Assembly in May 1999 decided not to consider proposed amendments to the Constitution.

In a 2016 Journal of Health and Social Sciences article – Spiritual Wellbeing in the 21^st Century: It is time to review the WHO’s health definition – Francesco Chirico makes a case that spiritual wellbeing should be added to the current WHO’s definition of health. I concur.

The WHO does, however, include spirituality in their definition of wellness in their Health Promotion Glossary of Terms: “Wellness is the optimal state of health of individuals and groups. There are two focal concerns: the realization of the fullest potential of an individual physically, psychologically, socially, spiritually and economically, and the fulfilment of one’s role expectations in the family, community, place of worship, workplace and other settings.”

12. The National Wellness Institute includes spiritual as one of its Six Dimensions of Wellness.
13. A recent Gallup report, Religion and Wellbeing in the United States, February 4, 2022, makes the case that spirituality/religion and wellbeing are connected.
14. Prayer is one of the most common spiritual practices by individuals, regardless of spiritual or religious orientation. In 2004, the CDC reported that prayer was the most common form of complementary and alternative medicine (CAM) used by adults in the U.S., according to data from the 2002 NHIS Survey. Of those who used a CAM therapy, 43% of adults indicated they prayed for their own health. Yet, for the 2012 NHIS Survey, prayer was dropped from the CAM Questionnaire of the instrument. Why?

Recommendations

The information provided above is rationale for the recommendations that follow.

1. That all federal agencies that have a mission to improve the wellbeing of our nation’s citizens include spirituality as a component of health and provide appropriate resources, services and funding for research.

2. To gain a deeper insight into the existing research on the role of emotional wellbeing in health and the implications for public understanding, the National Center for Complementary and Integrative Health (NCCIH) and the Office of Behavioral and Social Sciences Research (OBSSR), in collaboration with other National Institutes of Health (NIH) organizations, co-sponsored a roundtable discussion April 3-4, 2018 with the goal of advancing research in the area of emotional wellbeing. Its focus was on issues in developing, testing, and implementing intervention strategies to promote emotional well-being. The report generated – Emotional Well-Being: Emerging Insights and Questions for Future Research – provided recommendations for future governmental efforts.

I recommend a similar roundtable, and resulting report, be conducted on the role that spirituality and religion play in health and wellbeing. This effort should include a decision as to whether the spiritual dimension of wellbeing should be included in appropriate federal health-related efforts and on their websites.

3. Healthy People 2030. That the US Government’s model of Social Determinants of Health be modified to include a spiritual component as a domain. The Healthy People 2030 website gives the following definition: “Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” However, the spiritual component of wellbeing or the environment of ‘where people worship’ is not addressed within their five domains, even though the care of a person’s spirit does have a major impact on their health, well-being, and quality of life.

That the stated principles and overarching goals of Healthy People 2030 be revised to include the spiritual dimension of wellbeing:

• • Foundational Principle: Promoting health and well-being and preventing disease are linked efforts that encompass physical, mental, (include spiritual), and social health dimensions.
  • Overarching Goal: Create social, physical, (include spiritual), and economic environments that promote attaining the full potential for health and well-being for all.

The soon to be released Federal Plan for Equitable Long-Term Recovery and Resilience (Federal Plan for ELTRR) plans to use the Vital Conditions for Health and Wellbeing Framework that is intended to address “all the facets of our lives that favor health and well-being, enhance resilience, and enable thriving for all.” However, none of these Seven Vital Conditions address the spiritual component of wellbeing which is indeed a hugely important facet of life that favors wellbeing. I recommend that those responsible for this initiative formally review the appropriateness of incorporating spirituality in this new federal plan.

4. That consideration be made to create a Center for Spiritual Health and Wellbeing within Health and Human Services for research, education, and program development.

5. The National Cancer Institute website has a page on the topic of Spirituality and Health as it relates to coping with cancer. In that the research demonstrates that spirituality is a protective factor for heart disease (the leading cause of death in the United States) I recommend that Medline Plus and the websites of other federal agencies related to heart disease such as the National Heart, Lung, and Blood Institute, include appropriate resources on the topic of spirituality and health.

6. That federal agencies begin to provide more funding for research in the area of spirituality and health where spirituality/religion is the central focus. More frequent and better research in this area would result in resources and programming in this arena that is ‘evidenced-based.’

7. That, if HHS does not willingly incorporate spirituality as an aspect of health and increase research funding in this area, members of Congress enact a bill that requires the Department of Health and Human Services to review the appropriateness of adding spiritual health as a dimension of health and wellbeing and then resource its agencies accordingly to offer programs and services and funding for research.

8. That the spiritual domain become part of the Whole Person Health Framework that the National Center for Complementary and Integrative Health (NCCIH) is researching. That various spiritual practices be recognized as forms of complementary therapy. That the spiritual component of health be incorporated into their 2021-2025 Strategic Plan.

Also, that “Prayer for One’s Own Health” be recognized as a form of complementary medicine by NCCIH and be added back into the CAM Questionnaire portion of the next NHIS Survey.

9. That the following research objectives be added to the respective areas of Healthy People 2030. This recommendation is associated with the Public Open Comment Period announcement of October 24, 2022. (A listing of current objectives by topic can be found at this link – Healthy People 2030 Objectives.)

1. 1. Heart Disease and Stroke: Explore the impact of spirituality/religiosity on heart disease.
   2. Drug and Alcohol Use: Understand spiritual factors that are protective to drug and alcohol use.
   3. Mental Health and Mental Disorders: Explore the impact of spirituality/religiosity on individuals who display symptoms of trauma from Adverse Childhood Experiences (ACES).
   4. Physical Activity: Explore the impact of spirituality/religiosity on physical activity.
   5. Mental Health and Mental Disorders: Understand whether aspects of spirituality/religiosity are protective against suicide.
   6. Social Determinants of Health: Explore whether spirituality and religiosity should be added as a social determinant of health.
   7. Mental Health and Mental Disorders: Understand the underlying spiritual factors (create a spiritual profile) that cause people to conduct gun violence, and in particular, mass shootings. Learn more – Mass Shootings and ACES. Spiritual Issues Require Spiritual Solutions.

An Invitation to Others

Be an advocate for this issue and an agent of change by becoming engaged in the following. Collectively, we can make a difference!

1. Pray about how you can contribute to this effort.

2. Make a comment on this blog post if you support this initiative or if you have a recommendation for enhancing it.

3. Share the link to this blog post with your colleagues and others in your network and encourage them to support this effort.

4. Participate during periods of Open Public Comment that the federal health agencies occasionally have and provide comments/input like what is addressed in this blog post.

A current Open Comment Period for the Healthy People 2030 initiative is from October 24 to December 2, 2022. Recommend one or more of the research objectives that I have noted in paragraph 9 above be added as a Research Objective.

An Example of A Comment: Copy and paste what follows in the body of an email:  I recommend that the following research objective be added to Healthy People 2030 – Mental Health and Mental Disorders: Understand whether aspects of spirituality/religiosity are protective against suicide.  Send the email to this address: HP2030Comment@hhs.gov

(Learn more and how to make a comment at this link – Healthy People 2030 Seeks Public Input.)

5. Correspond directly with leadership of the federal health agencies with your concerns. In your correspondence you might refer to this blog post with a link or offer your own rationale. Key leaders are as follows:

Admiral Rachel Levine, MD, Assistant Secretary for Health – ash@hhs.gov

Rear Admiral Paul Reed, MD, Deputy Assistant Secretary for Health – paul.reed@hhs.gov

Leith States, MD, MPH, Chief Medical Officer, Health and Human Services – leith.states@hhs.gov

Carter Blakey, Deputy Director, Office of Disease Prevention and Health Promotion – carter.blakey@hhs.gov

Lawrence Tabak, D.D.S., Ph.D., Director, National Institutes of Health – lawrence.tabak@nih.gov

Helene M. Langevin, MD, Director, National Center for Complementary and Integrative Health – helene.langevin@nih.gov

6. Contact members of congress that might be able to use their influence on this matter and ask them to help.

Senate Committee on Health, Education Labor and Pensions Members

House Committee on Labor, Health and Human Services and Related Agencies Members

House Committee on Energy and Commerce Health Subcommittee Members

7. Contact me to discuss how you might be able to contribute to this effort in other meaningful ways.

Acknowledgement

Thank you to the following individuals who provided direction and comments on this effort: Carter Blakey, Leith States, MD, MPH; Walt Larimore, MD; Jeff Levin, PhD; Harold Koenig, MD; Bill and Debby France

I welcome the opportunity to discuss this issue with the leaders of the Department of Health and Human Services and their various agencies.

This is a lengthy post, yet I felt that it needed to include all its content to make a solid case for change.

I hope that you’ll join me in this worthwhile cause.

Here is a link to a PDF document of this post – Spirituality and Health in the Federal Government