Spirituality, Religion, and Human Health: connecting the empirical and the profound at the intersection of science and religion
Tobias Anker Stripp, Center for Science and Faith, University of Copenhagen
Even though the discourse of modern biomedical healthcare appears to render little attention to questions of spirituality or religion, the relationship between spirituality, religion and human health has always been intricate and entangled. Prior to our era, the priest and medical doctor occupied one role: the shaman. With universal tropes in all global theologies, exemplified by the story of the Good Samaritan, the spiritual life of humans has always been linked to health and care for the ill (Gill, 2006; Stripp, 2023). The field of “religion and health” has emerged from the fringes of academic discourse to become a vibrant, albeit complex, field of inquiry. While not traditionally a “science and religion” field in the way cosmology or evolutionary biology have been, its increasing relevance is undeniable. While the field represents not only descriptive research on how spirituality and religion are experienced or associated with other e,g, health outcomes, either through phenomenological or epidemiological approaches, numerous theological and philosophical questions arise and various recent examples of “theologies of health” have been made (Balboni & Balboni, 2019; VanderWeele, 2024) placing the field firmly in (health) science and religion (theology). At the horizon are important epistemological, metaphysical, ethical, and theoretical questions of how, precisely, spirituality affects human health and what we should do about it?
Navigating the definitional quagmire and other limitations
The importance of the spiritual dimension of health, though historically conceptually challenging for the World Health Organization (WHO) (Cour, 2025; Peng-Keller et al., 2022), is underscored by the development of measurement instruments, such as the WHOQOL-SRPB (Organization, 2002), and various examples of “bio-psycho-socio-spiritual/existential” models of health (Cour, 2025; Engel, 1977; Sulmasy, 2002). Over the past decades, several major professional organizations, including the WHO (in palliative care) and the World Organizations of Family Doctors (in primary care), have integrated spiritual issues as essential components of clinical practice. For example, a Lancet Commission Report on palliative care treated spiritual suffering and pain as equally significant to physical, psychological, and social pain (Sallnow et al., 2022). While legitimate concerns exist regarding research bias in favor of religion’s role in healthcare (Sloan et al., 1999), a large body of evidence support that spirituality is relevant in both illness and health (Balboni et al., 2022). But how can one define such a concept as “spirituality”, being a notoriously amorphous construct, seemingly encompassing everything from a belief in a transcendent being, a sense of purpose and connection to nature to something as mundane as a “candlelight” (la Cour et al., 2012)?
Indeed, one of the most persistent hurdles in the field is the challenge of defining words and their relationships, and a consensus will probably never emerge (not, however, unlike most academic fields!). Multiple constructs are used to describe this ineffable matrix of the “spiritual dimension”. Such words can be, but are not limited to: meaningfulness, purpose, coherence, religion, existential or ultimate concerns, hope, love, trust, faith, significance and more. This plenitude of associated and related constructs often leads to ambiguity and conceptual muddiness and limits the generalizability of findings. One of the most prominent attempts to reach a consensus definition was by Puchalski et al. in 2014:
“Spirituality is the dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices” (Puchalski et al., 2014).
Although expansive, it provides a value starting point with a broad yet inclusive framework, acknowledging both religious (transcendent and theistic orientations) and non-religious (secular existential meaning-making (la Cour & Hvidt, 2010), nature, generativity) expressions of spirituality, which is crucial for interdisciplinary research. A plethora of validated questionnaires tapping various related constructs are available and have been reviewed by the author and colleagues for adults (Damberg Nissen et al., 2020; Nissen et al., 2021) and children/adolescents (Sebastian Boesgaard Bloch et al., 2025). Three tools could probably be highlighted for particular use in (post)-secular multicultural settings: the Meaning and Purpose Scales by Schnell and Danbolt (S. B. Bloch et al., 2025; Schnell & Danbolt, 2023), the Spiritual Needs Questionnaire by Büssing (Büssing et al., 2010; Stripp et al., 2022), and the Human Flourishing Index by VanderWeele (the latter is a broad measure with a particular dimension tapping meaning and purpose) (Stripp et al., 2024; VanderWeele, 2017). All three questionnaires are void of specific cultural or religious content (such as only focusing on Christianity), making them suitable for multicultural contexts.
Beyond definitional issues, the field has grappled with methodological design limitations, which researchers have now fundamentally improved. Many earlier studies were cross-sectional, making it difficult to establish causality (Koenig, 2008). Did spirituality improve health, or were healthier individuals more spiritual? The risk of tautological inferences is also present; if spirituality is defined in terms of well-being, then studies showing a link between spirituality and well-being merely confirm the definition. Furthermore, securing funding for studies on spirituality can be challenging, often seen as less “hard science” than biomedical research, and navigating publication issues in mainstream medical journals can be an uphill battle against ingrained biases. However, with papers and perspectives on spirituality and health now being published in top-tier journal groups such as JAMA (Balboni et al., 2022), Nature (Stripp & Sangild, 2025), or the Lancet (Stripp et al., 2023), the field is firmly establishing itself as a rigorous and highly scientific study.
The Rise of Empirical Rigor
Despite these limitations, the field has continued to grow, propelled by significant advancements in epidemiological tools (Hernan & Robinson, 2023; VanderWeele et al., 2020) and access to large datasets. This has enabled researchers to identify nuanced correlations and control for confounding variables with greater precision than ever before. By now the evidence for spirituality on health is quite overwhelming, most impressively as presented in the 3rd edition of the Handbook of Religion and Health (Koenig et al., 2023). There is longitudinal evidence with tens of thousands of individuals that meaning and purpose as well as spiritual practice (most often measured as religious attendance) are associated with multiple health-associated outcomes and most prominently with lower mortality (Chen et al., 2021; Chen et al., 2020; Czekierda et al., 2017; Roepke et al., 2013). Some studies even find a positive dose-response association between religious attendance and mortality; i.e. mortality decreases when attendance increases (Li et al., 2016). Even in a highly secular culture such as Denmark (Andersen et al., 2019; Habermas, 2008; Stripp et al., 2023) – characterized by the paradoxical situation of a very high membership proportion of a national church (~75%) but very low attendance to religious services (~ 2%) (Stripp, 2023) – religious service attendance is associated with lower mortality (Ahrenfeldt et al., 2023). Additionally, mediation analyses (controlling baseline variables in longitudinal designs) attempting to identify the contributing factors to the reduced mortality have yet to clearly explain the effect (Kim & VanderWeele, 2019; Li et al., 2016). Numerous expected factors contribute to the effect e.g. mental health, life style (diet, smoking etc.), and social factors – but these put together have yet to explain the full picture. While reverse causation is difficult to ever entirely rule out in observational research, factors such as education and income are simple to control for and does not explain the effect. Factors such as parental warmth during upbringing, internal religiosity (i.e. the faith that service attendance is used as proxy for), private prayer etc. are much more difficult factors to capture and will probably continue to serve as potential unmeasured confounders for a long time. It should be remembered, however, that “extraordinary” claims don’t necessarily require extraordinary evidence – an old issue, and a lingering misunderstanding of Hume’s. The effect of smoking on lung cancer has never been tested in an RCT but is still widely held as true, despite being based on similar observational evidence.
Charting the Path Forward: Evidence to Implementation
Given this accumulating evidence, the critical question becomes: What should we do with it? Can and should spirituality be implemented for public health improvements or in routine clinical care and by whom (Stripp, 2023)? It seems clear that both patients and health care professional are concerned with spiritual aspects of health and illness (Hvidt et al., 2020). A recent paper published in the Lancet Regional Health Europe found that 81.9% of ~27.000 randomly selected adult Danes reported a strong or very strong spiritual need within the previous month (Stripp et al., 2023). Such needs are elevated in the first 6-12 months following a cancer diagnosis (Stripp et al., 2025). But we do not know to what degree individuals reporting spiritual needs want spiritual care. Furthermore, we immediately encounter significant ethical and practical considerations. How do we harness the positive aspects of meaningfulness and spirituality without crossing into proselytization or imposing beliefs and practices? The inherent difficulty lies in “prescribing spirituality” and the enormous challenges of testing such interventions in a randomized controlled trial (RCT). Spirituality is deeply personal, multifaceted, and often resistant to reductionist, measurable interventions typical of medical trials. How do you standardize a spiritual practice? How do you create a control group for spiritual well-being? Currently, such efforts are being undertaken with the highest possible scientific rigor in the Templeton founded ISSR research project discussed by Wiseman in the June 2025 blog (https://www.issr.org.uk/blog/june-2025-blog/) and we are eagerly awaiting results.
Ultimately, while the scientific pursuit of understanding spirituality’s role in health is vital, we must also acknowledge the limits of empirical inquiry. Perhaps, not every aspect of human experience can or should be reduced to quantifiable data. There will always be elements of mystery that remain, aspects of spirituality that resist full scientific dissection. This serves as a reminder that while we strive for empirical understanding, we must also cultivate an openness to truths that transcend our current scientific paradigms. The journey of integrating spirituality and health is not merely about accumulating data; it is about embracing a holistic view of human flourishing, one that honors both the measurable and the immeasurable, the known and the profound mystery that lies beyond. As a Hasidic prayer wisely states, “May I never use my reason against truth.”
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