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The Role of Faith-Based Models in Community Outreach and Patient Care

Supplements and Featured PublicationsStriving Towards Cancer Health Equity Through Community Outreach: Highlights From a Cleveland Clinic Taussig Cancer Institute Symposium

In some communities, families and individuals may be more comfortable attending church than seeing health care providers for medical issues. Recognizing this disconnect from the health care community, faith-based initiatives that unite religion and medical care can help draw people in to address their health needs, especially in neighborhoods in which people lack access to resources and face barriers to optimal health care.

At a Cleveland Clinic symposium in October 2022, C. Jay Matthews I, senior pastor at Mount Sinai-Friendship United in Cleveland and a leading advocate for Cleveland Clinic’s Stopping Cancer in its Tracks (SCIIT) program, discussed how the partnership between Cleveland Clinic and faith-based organizations can address cancer disparities in the community. The initiative focuses on educating people about cancer and on preventive screenings, making them aware of resources and helping them gain agency to seek care.

According to Matthews, improving access to and utilization of health care resources is paramount for people living in underserved neighborhoods, who are typically uninsured or underinsured. This focus on patient navigation is directly linked to better health outcomes—specifically, a reduction in cancer mortality rates by enabling preventive screening and early-stage detection.

“Can you imagine how revolutionary it is to talk about stopping cancer in its tracks? The individual who hears those words for the first time from their physician [may think], ‘This idea seems impossible,’” Matthews said. “But through the work and the networking of faith organizations [working with] the SCIIT program, we are making that possible.”

Matthews noted that raising awareness of health conditions and emphasizing the need for screenings and early detection is a group effort. “We could not do this without collaboration,” he said. “If any particular faith, church, mosque, synagogue, or organization believed that they could do these things by themselves, [then] we could go to sleep and take some rest. We know that by working together we can make a difference.”

Pastors, rabbis, imams, and other faith leaders who work with SCIIT undergo training to allow them to understand the rhetoric and language that will be most impactful when speaking with congregants and members about health care. “Those training toolkits are important,” Matthews said. “They empower people who are non–health care professionals to have the skills to be able to communicate within their congregations both health messages as well as health opportunities.”

Matthews said that a health ministry is as important as Sunday school in terms of changing lifestyles and considering personal health in a different way. In his congregation, for example, he highlights different health topics each month by offering workshops open to the entire community.

According to Matthews, 65 congregations in Cleveland participate in SCIIT, a number he expects to grow over time as the initiative continues to break down barriers and enfold people of all religious denominations. “When someone is sick, it doesn’t matter what the people around them believe,” he stated. “They want to be made well.”

Gary Gunderson, MDiv, DMin, DDiv, vice president of FaithHealth at Atrium Health Wake Forest Baptist in North Carolina, also spoke during the session about the need to leverage religious and community assets to improve health. Instead of reaching out to the community in what he calls “an oppressive educational manner,” Gunderson observed, hospitals that succeed integrate into the existing fabric of the area. “We’re actually learning how to turn around, humble ourselves and…become 1 institution in a system of institutions that works in the community,” he said.

In his previous position at Methodist Le Bonheur Healthcare in Memphis, Tennessee, Gunderson was involved in growing and expanding an initiative known as the Memphis Model, a partnership between faith-based organizations and the wider community whose goal was to elevate the health and well-being of local residents. “That was a big order in Memphis,” said Teresa Cutts, PhD, an assistant professor in the Department of Social Sciences and Health Policy at Wake Forest University School of Medicine, who also was involved in the Memphis Model. “Memphis is a city of disparities.”

According to Cutts, many small- to medium-sized Black churches joined the Memphis Model, and doing so made a measurable difference in the health of their congregants. When data from the Memphis Model were analyzed, the team learned that participants decreased their gross mortality rate by almost half. Patients experienced much better all-cause hospital readmission rates (69 days later than in the premodel period), and for post–heart failure readmissions, the figure was 141 days later. Heart failure, Cutts said, is the number-1 diagnosis among older parishioners in Memphis. The population of the most impoverished zip code in the city experienced a decrease in 30-day readmission rates. “More people navigated in that network to hospice and home health,” she said. “Again, [this] was huge for a distrusting population in terms of health systems.”

One tough obstacle for the Memphis Model team was medical fatalism, according to Cutts. “A lot of folks really felt that if you got a cancer diagnosis, you’re going to die,” she said. “Many of our people who work within the congregations really had to [strive to] overcome that.”

In practical terms, an important goal was to help people access treatment and assistance for the costs of biopsies or other surgeries. The Memphis Model achieved its results with the help of funding from a variety of organizations. A grant from the Susan G. Komen Breast Cancer Foundation enabled the team to hire paid patient navigators and offer a host of safety-net screening efforts; 95% of those screened were navigated to a primary care provider. A grant from the West Cancer Center went toward diagnostics and treatment for uninsured and underinsured people in the community, and a grant from the Avon Foundation for Women allowed the organization to analyze data to elucidate disparities in health care access and treatment among women of different races.

A decade ago, Gunderson and Cutts established a faith-based outreach program at Atrium Health Wake Forest Baptist in North Carolina. Still extant, the program serves people who come from diverse walks of life; the urban counties in the hospital system’s catchment region are home to many Black patients who may delay care and find themselves with more advanced disease at diagnosis, while a large number of rural residents from impoverished counties have higher rates of lung and other cancers, as well as elevated mortality rates.

It was more difficult to build trust in North Carolina than it had been in Memphis, Gunderson and Cutts said, largely due to the state’s past practice of involuntary sterilization of people of color, which endured for decades. Faith leaders in North Carolina did not want to sign covenants indicating their participation in the program, and Gunderson and Cutts saw that tailored processes were needed to serve communities that were rural compared with those in Memphis’ urban core.

First, the team realized they would be well served by listening intently to people in the community. According to Cutts, a barrier that had to be overcome was the inability of undocumented Hispanic residents to obtain photo identificiation, especially for the purpose of claiming parentage on birth certificates or for use in the criminal justice system. To maintain ongoing ties with the Hispanic population, Gunderson and Cutts broadcast information about health education and access with the help of a local radio disc jockey who ran a Spanish-language station.

Gunderson noted that a health system’s faith-based partners, from churches and clergy to community organizations, function as a “social immune system” when there is injury or illness in the population. By putting programs and initiatives in place that create a network of help, for everything from preventive care and active treatment to follow-up, health care can become accessible to everyone.


Assistant Professor

Department of Social Sciences and Health Policy

Wake Forest University School of Medicine

Winston-Salem, NC


Vice President


Atrium Health Wake Forest Baptist

Winston-Salem, NC


Senior Pastor, Mount Sinai-Friendship United

Stopping Cancer In Its Tracks Program, Pastor Leader

Cleveland, OH

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