1. Adopts the following Statement of Affirmations to guide the understanding and response of the agencies, governing bodies, and people of the church.

   A Statement of Affirmations
   The Fundamental Importance of Health. Good health—physical, mental, and spiritual—is both a God-given gift and a social good of special moral importance; one that derives its importance from our biblical and theological heritage and from its effect on the opportunities available to members of society. Good health is a basic need and an essential purpose of human and societal development.
   
   Health Has Many Determinants. Health is determined by what we are born with, how we are nurtured, living conditions, income, education, how we lead our lives, the natural and social environment, access to medical care, our spiritual and psychological state, and our relationships in the communities where we live.
   
   Personal Responsibility for Health. Each person has a moral obligation—a private and public duty—to value and care for his or her own health and the health of the community. We are stewards of God's creation. For most of us, there is ample room to adopt more healthful lifestyles.
   
   Societal Responsibility for Health. Society and its constituent public, private, and voluntary organizations have a duty—a moral obligation—to promote a healthful environment and to assure the availability of health-giving resources to all people. Free markets alone cannot provide for the adequate supply and equitable distribution of these resources. Society's institutions must always strive for the best achievable standards and the most effective performance of the health care system.
   
   Preventive Care. The indispensable foundation on which both individual and societal responsibility for health rests is a consistent major focus on health promotion and maintenance and on preventive care services, such as pre-natal care, disease control, early detection and diagnosis, mental health services, sex education, and suicide and substance-abuse counseling.
   
   Safeguards Against Unhealthy Working and Living Environments. A community's healthfulness is seriously influenced by the quality of the natural environment and by the interdependent flows of food and materials, energy, and waste products between human beings and nature. Healthy working and living environments are essential to individual and collective health. Clean air, pure water, effective sanitation, nutritious diet, adequate housing, and a safe and nontoxic workplace and living space are all essential to health.
   
   Equal Access to Appropriate and Necessary Care. Every person must have affordable, quality health services. Access should not be limited by income, ethnicity, or geography. It is the proper function of all groups of society including government in their concern for justice to ensure equal access to health services.
   
   Responsible Limits. The worship of physical perfection, no less than of worldly wealth, is idolatry. Mortality is an inevitable part of our creation and is the constant backdrop to our efforts to postpone death and overcome disease. A society is justified in placing limits beyond basics on its health care expenditures, balancing them against other needs such as housing, education, employment, and the elimination of poverty. No principle of justice entitles a patient to every conceivable form of beneficial treatment.
   
   While concerns for the costs of health care are appropriate, these concerns must continually be balanced against the objectives of access to adequate, quality care for all. The sacrifice of access and quality at the shrine of cost containment is too high a price to pay and should not be tolerated.
   
   Sustainable Resource Supplies. Because good health is a social good of special moral importance, extra care must be taken to preserve and sustain essential sources of strength in the network of health-giving resources, professions, and institutions. These resources include among others: health occupation education and training, biomedical research, and inner city and rural hospitals. Society needs to devise new ways to sustain the development of necessary resources and to assure that these resources are used effectively to achieve our full healthful potential.
   
   Health care systems and medical care delivery require good management and stewardship practices. As disciple and stewards, we are called upon to use our technological and human care skills to provide health for all the peoples of this nation and to do our share in the remainder of the world. Health, healing, and good medical care are a measure of our level of civilization as a nation. For the church, these concerns are absolutely fundamental to our mission. They are a measure of our faithfulness to the central mandate of the gospel: enabling the diving Word to dwell among us, expressing a faith that makes us whole.
   
   Reform for the Sake of Justice. The church's concern for justice, broadly shared, compels us to encourage new financing and delivery systems that better meet the needs of all people. Market strategies that serve only those able to pay are not acceptable. Health ultimately is the product of justice; and justice must be the objective of all attempts to reform the health care system in the United States. The current mal-distribution of health services must and can be rectified.

2. Reaffirms the continuing relevance and authority of the following policy statements on health adopted by previous General Assemblies and urges attention to their principles and recommendations along with the statement on Values, Choices, and Health Care of the 200th General Assembly (1988):
   • The Relation of Christian Faith to Health—172nd UPCUSA General Assembly (1960);
   • Toward a National Policy for the Organization and Delivery of Health Services—183rd UPCUSA General Assembly (1971);
   • Health Care: Perspectives on the Church's Responsibility—116th PCUS General Assembly (1976);
   • The Provision of Health Care: Obedience to Divine Purpose—195th PC(USA) General Assembly (1983).
3. Urges the agencies of the General Assembly and the intermediate governing bodies to give particular attention to three recent reports of Presbyterian agencies as planning for health ministries continues in the reunited church:
   • Health Ministries and the Church—Program Agency, UPCUSA, 1978;
   • New Directions in Health Ministries—Division of International Mission and Medical Benevolence Foundation, PCUS, 1983;
   • Report of the Health Ministries Evaluation Team—Program Agency, 1986

Personal Responsibility

Believing that each of us has been created and named by God and set in community, and that as followers of Christ we should accept responsibility for the stewardship of our own health and for the health of all, the 200th General Assembly (1988), therefore:

1. Urges each individual Presbyterian to examine his or her lifestyle and make modifications and choices in daily living which decrease the known risks of stress, illness, and premature death (such as reasonable work schedule, moderate or no use of alcohol, no tobacco, proper nutrition, regular exercise, use of seat belts, and attention to spiritual development).
2. Calls upon Presbyterians who may require the services of the medical care system to be questioning and prudent users of resources, accepting responsibility to explore with health care providers the need for and cost and benefit of proposed tests and procedures and their impact on health.
3. Encourages Presbyterians to claim responsibility for their choice to accept or refuse medical treatment, affirming the right to direct one's physician to withhold medical treatment.
4. Encourages every Presbyterian to seek ways to minister to and empower others within the congregation to attain better health and wholeness; and particularly encourages Presbyterian health professionals to explore ways to assist the congregation and its members to take informed responsibility for health, to develop programs of health promotion and prevention, and to become informed consumers of health services.
5. Calls upon all Presbyterians, as responsible citizens, to work toward elimination of environmental health risks and the enactment of public policies which guarantee full and equitable participation of all in services that promote health and provide adequate medical care.
6. Urges individual Presbyterians to pray regularly for health and wholeness embodied in the shalom of a world free from injustice, greed and the threat of nuclear annihilation.

Corporate Church Responsibility

Believing that concern for health and healing should be central dimensions of the life and witness of the church and affirming the unique role the church should play in the health of society and in societies seeking health, the 200th General Assembly (1988) challenges the congregations, governing bodies, and agencies of the Presbyterian Church (U.S.A.) to become vigorous and conscious promoters of health in all its aspects in the life of the church, active advocates and agents of health in social order, and responsible stewards of both health and health resources; and to those ends:

A. Urges Sessions and Congregations to:

1. Claim their role as communities of health and healing by:
   1. Establishing appropriate structures and processes to plan and implement an ongoing and coordinated approach to health in the life, program, worship, and witness of the congregation.
   2. Providing appropriate health promotion programs, special liturgies, liturgical resources, and faith and health exploration groups;
   3. Encouraging members to become faithful stewards of their own health and, when necessary lovingly confront them with their failure to do so;
   4. Employing health professionals as agents of congregational mission, such as parish nurses or ministers of congregational health;
   5. Establishing and nurturing organized programs of peer support which assist persons committed to reducing health risks (such as smoking cessation classes, nutrition and fitness programs, spiritual growth groups, and communal meals);
   6. Establishing and nurturing organized programs of counseling and support for families and individuals facing hospitalization or long-term institutional care or coping with serious mental illness and other long-term disabling conditions;
   7. Caring for the dying and their families through the establishment of hospices and other congregational ministries of counseling and support.
2. Utilize confidential health education and assessment tools, such as a Health Risk Assessment, to inform members of their own health risks, to encourage members to lower risks and consequent health care costs, and to assist sessions and deaconates in developing congregational programming and ministries to the community.
3. Educate all members about the responsibility of individual Christians and of church bodies in health promotion and health care, with particular attention to:
   1. Identification and reduction of health risks as an act of Christian stewardship;
   2. Ethical dilemmas facing families and professionals in modern medical care;
   3. The variety of health delivery systems in which Christians participate as providers and consumers; and
   4. Prudent use of the health care system, including limitations of health care costs.
4. Affirm the work of health professionals as a part of the mission and witness of the congregation by:
   1. Encouraging congregational members who are health professionals to understand their professions as Christian vocations and to structure their practices and inter-professional relationships as an expression of Christian discipleship;
   2. Providing opportunities for individual health professionals to use their expertise and share their gifts with the congregation and through congregational programs and mission projects;
   3. Supporting and encouraging health professionals in career, term or supplementary practice in the public health sector, church mission programs, and other voluntary, nonprofit health delivery programs serving in areas and among people of great need;
   4. Supporting personal, institutional, and public policy efforts to decrease the gaps in income, respect, freedom to practice, and opportunities for service between physicians and other health professionals
5. Evaluate congregational structures, policies and practices for their impact on the physical, spiritual, and emotional health of individual members and employees, including the relationship of these factors to stress and addictive lifestyles.
6. Establish clearly defined personnel policies which include employee assistance programs and health and pensions benefits through the Presbyterian Pension Plan or at a level commensurate with it, for all regular full-time and part-time employees.
7. Focus particular attention on the medical, social, pastoral, and spiritual challenges presented by epidemic and (or) severely disabling illnesses, such as AIDS, Alzheimer's, serious or chronic mental illness, etc.
8. Organize for effective advocacy and participation in public policy formation and implementation efforts which affect the health of surrounding communities, such as the establishment of smoke-free environments, the regulation of advertising of health-threatening substances, access to health care for poor persons, Medicaid standards, sex education programs, etc., and in national legislative proposals for improvement and reform of the health promotion and health care efforts of the United States.

B. Urges Middle Governing Bodies to:

1. Establish health ministry coordinating groups to support and encourage congregations as they pursue the recommendations above, to develop and implement a coordinated approach to the governing body's ministry and mission in health and to provide linkage with the health ministries and coordinating groups of the other governing bodies and to the Health Ministries Coordinating Group at General Assembly Council level.
2. Utilize confidential health education and assessment tools (e.g., Health Risk Assessments) to encourage lower health risk behaviors, develop health promotion programs, and reduce medical expenses.
3. Cooperate with the Board of Pensions and Church Vocations Ministry Unit in any effort to gather data on the health status and health risk assessment of church employees covered by the Presbyterian Pension Plan and in the implementation of any programs of education, health promotion, or lifestyle modification that may result in the attempt to improve the health of church employees and reduce health care costs for the church.
4. Evaluate governing body structures, policies, and practices for their impact on the physical, spiritual, and emotional health of participants and employees, including the relationship of these practices to stress and addictive lifestyles.
5. Urge units and committees which sponsor health education events and offer health assessment instruments to share learning and findings with others.
6. Sponsor educational and training events and seminars on health issues and programs in mission rallies and leadership schools and, particularly, plan and conduct consultations involving a variety of health professionals and their pastors, using the model developed by the Task Force on Health Costs/Policies.
7. Participate, in collaboration with other governing bodies and ecumenical agencies, in the prophetic witness and action of the church, seeking the reduction of environmental health risks, increased attention to health promotion and prevention programs, guaranteed access of the poor and dispossessed to quality health care, and legislation that guarantees a national health policy and health care system compatible with the values and principles adopted by the General Assembly.
8. Establish personnel policies which provide equitable benefits, including employee assistance programs and health and pension benefits for all regular full-time and part-time employees, through the Presbyterian Pension Plan or commensurate with its provisions.

C. Recognizing that a comprehensive approach to health in the life and mission of the Presbyterian Church (U.S.A.) will involve the efforts of many of the units and committees of the General Assembly, as well as the commitment of congregations and middle governing bodies, the 200th General Assembly (1988):

1. Urges the Units on Church Vocations, Education and Congregational Nurture, Global Mission, Social Justice and Peacemaking, and Theology and Worship to develop educational and programmatic resources to assist the people, congregations, and middle governing bodies of the Presbyterian Church (U.S.A.) to explore the issues and undertake the mission responsibilities outlined in this report. Particular attention should be given to congregations as center of health and wellness, to spiritual development and health, to the integration of health and healing into liturgy and worship, to responsibility for employees, and to participation in the shaping of local and national health policies and institutions to insure access by all to a healthy environment and quality health care within affordable social costs.
2. Requests the Social Justice and Peacemaking Ministry Unit to consider developing living will and other model directives to physicians concerning the right to withhold medical treatment.
3. Requests the Social Justice and Peacemaking Unit through its Washington Office to advocate for public policies based on the principles adopted in this report and the policies adopted by the 1971 and 1976 General Assemblies, and to consider including an emphasis on health and wholeness themes and on health ministries in the Presbyterian Peacemaking Program. This might include not only involvement in health promotion and health care mission at home and abroad as a means of shalom but also a recognition that the threat of nuclear war is the ultimate global public health problem, diverting resources that could bring a fuller life to people and polluting the environment with dangerous radioactive products.
4. Urges the Committee on Social Witness Policy, in cooperation with the Social Justice and Peacemaking Unit and its Washington Office, to monitor studies and proposed policies and legislation concerning the health status and health care needs of the nation and prepare recommendations for additional policy response as needed.
5. Requests the Church Vocations Unit to develop models and materials for worksite health promotion, and health risk intervention programs for church employees in the agencies, governing bodies, and institutions of the Presbyterian Church (U.S.A.), working in cooperation with other units and drawing on information concerning health care utilization and health risk factors supplied by the Board of Pensions.
6. Requests the Board of Pensions to:
   1. Study and develop appropriate policies and procedure, in consultation with pilot presbyteries, regarding the use of managed health care delivery systems (e.g., Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and other prevention-oriented prepaid plans) for the Benefits Plan members who wish to participate in such alternatives. The results of the study with any recommendations for appropriate changes should be reported to the 203rd General Assembly (1991).
   2. Analyze and report, on an annual basis, using the statistical capabilities of the board, the top ten health care utilization cost areas for Plan members. The report is to be addressed to the Church Vocations Unit and the Health Ministries Coordinating Group for the development of educational and health promotion programs.
   3. Evaluate the use and feasibility of various Health Risk Appraisals and implement, if appropriate, the use of HRA with pension plan members to gather data on risk factors that effect health and illness, which could be used to develop educational and health promotion programs as noted above, in consultation and with the cooperation of presbyteries.
   4. Continue to provide, in consultation with the Church Vocations Unit, a Retirement Planning Program which includes, but is not limited to, housing, health care, health promotion, entitlement programs, and retirement financial planning
7. Urges the Global Mission Unit to assist the Presbyterian Church (U.S.A.) to recognize and respond to the interconnections between health status and health issues in the rest of the world and in the United States, and to continue and expand efforts to link the people, congregations, and governing bodies of the church in the health and healing mission of the gospel around the world, both through financial support and through direct involvement.
8. Urges the Committee on Theological Education to explore with the theological schools the possibility of establishing one or more "seminary- or university-based Center(s) for Religion and Health." These would be centers of study and research, arenas for dialogue between theologians and health practitioners around ethical issues of medical research, technology, and practice, and locations of events, seminars, continuing education, and encounter for the people and pastors of the church and community.
9. Encourages the colleges and seminaries related to the Presbyterian Church (U.S.A.) to engage in worksite health promotion, sponsor student research and reflection on health issues and health ministries, and develop field education opportunities in health care settings, involve the health professionals in the church in college and seminary programs, and emphasize the Christian understanding of health as wholeness and the church's call to personal and social responsibility for health in the life and curriculum of the school.
10. Requests the Committees on Theological Education and Higher Education to explore with the seminaries and colleges respectively means by which the institutions may communicate and interact with each other on a continuing basis in considering the issues above and others related to health and healing.
11. Requests the Committee on Mission Responsibility Through Investment (MRTI) of the Social Justice and Peacemaking Ministry Unit to research the Presbyterian Church (U.S.A.)'s investments in for-profit health care corporations to ascertain their policies and practices in relationship to equal access to health care services for all regardless of their ability to pay and to take appropriate action to promote General Assembly policy with these corporations, based on its findings.
12. Instructs the Stated Clerk of the General Assembly to insure implementation of the 199th General Assembly (1987) Policy Statement on the Use of Tobacco in the planning for meetings of the General Assembly. This policy prohibits the use of tobacco products in the assembly hall, committee rooms, and eating place and limits the use of tobacco to designated areas.
13. Instructs the Office of the General Assembly, the General Assembly Council, and all the General Assembly units and committees related to it to implement the policy of the 199th General Assembly (1987) on the use of tobacco products in all their meetings and in the meetings of committees or task forces they may sponsor. Such implementation shall include smoke-free worksite regulation as implied in the policy statement.
14. Requests the Office of the General Assembly, the General Assembly Council, and all the General Assembly units and committees related to it to implement the policy of the 198th General Assembly (1986) on the Social and Health Effects of Alcohol Use and Abuse. Research demonstrates the serious threat to health, safety, and the quality of life in our nation related to alcohol-related problems. Total health and social costs are immense, and the attendant health services required are significant.

D. Because "certain functions impact the entire work of the Council and require regular and relatively permanent contact, collaboration and coordination with several other functions in order to provide information, advocacy and perspective," the Structural Design for Mission authorizes the General Assembly Council to "insure appropriate mechanisms, in consultation with the units involved, to provide interaction." Concern for health and health ministries is clearly such a function, therefore, the General Assembly Council is requested to coordinate health ministries among its various units and enable them to interact with, support, and respond to the staff and health ministries councils of presbyteries and synods.

1. In coordinating health ministries, at least three presbyteries should be invited to meet in consultation from time to time with representative of the appropriate ministry units.
   1. Two units, Global Mission and Social Justice and Peacemaking, have defined functions and staffing in health ministries and each envisions coordination with other units and governing bodies as part of the task. The General Assembly Council need not, therefore, consider the need to secure and assign additional staff to insure the effective discharge of this linkage responsibility.
2. In coordinating health ministries, the General Assembly suggests the following functions be considered:
   1. Provide an arena for exchange of information, development of direction, and coordination of effort on health concerns and health ministry issues among the units and committees of the General Assembly Council in interaction with presbytery partners.
   2. Provide a point of sponsorship for programs or events that need to be holistic or multi-unit in identity, such as consultations for lay health professionals, clergy and chaplains, and others in health-related business or academic settings; a "Health and Wholeness Newsletter"; or periodic curriculum reviews involving education and health professionals.
   3. Facilitate assistance and cooperation among units and committees of the General Assembly Council as they pursue their individual responsibilities (i.e., identifying writers for curriculum, furnishing overseas perspective in preparation of social policy recommendations, etc.).
   4. Develop a mechanism to review and evaluate the response of the church to the policy and recommendations adopted in this report and to prepare or coordinate preparation of a report on such response to the 203rd General Assembly (1991).

IV. Societal Responsibility

Life in community requires a just order, and collective institutions of government are important to the well-being of society. Like all human creation, however, they can act sinfully. Reformed Christians, therefore, hold governments accountable for their actions and engage in the task of civil reform that promise better results.

A. Affirming that medical care is only one of several determinants of health, which is also affected by genetic endowment, income, nurture, and education, how we lead our lives, and the quality of our physical and social environment, the 200th General Assembly (1988) recommends that local, state, and national governments:

1. Strengthen legislation and increase programmatic commitment to environmental protection and to work-site and agricultural safeguards (e.g., OSHA, EPA, NRC, FDA, etc.).
2. Expand and accelerate programs of health education, wellness promotion, and preventive medicine in both public and private sectors.
3. Develop policies and programs to assure access to adequate nutrition for every individual, based on scientifically established nutritional standards.
4. Strengthen and implement policies in other areas (e.g., housing, employment, education, transportation, income distribution) that will contribute to a more healthful living environment for all.
5. Implement programs that will encourage and assist individuals to take fuller responsibility for their own health, such as sex education, nutrition planning, lifestyle modification, stress management, etc. In such approaches, it is important to avoid the error of blaming individuals for health problems that are properly attributable to society at large.

B. Believing that policies in both the public and private sectors should affirm the central importance of health and should be comprehensive in design and implementation, assuring that no one is denied access to basic health care by reason of income, age disability, ethnicity, or geography, the 200th General Assembly (1988) reaffirms the call of the 183rd General Assembly of the United Presbyterian Church (1971) for "a national policy leading to a comprehensive system of health care which shall be accountable to the general public, make all services and benefits to all persons in the United States, and be administered" by an agency with power to enforce standards of quality care (Minutes, UPCUSA, 1971, Part I, pp. 586-587); and to that end, the General Assembly recommends that:

1. Every effort be made to establish reasonable and effective controls of cost in such a system without sacrificing universal access or quality of care.
2. The Congress define, by 1990, a National Health Standard of adequate, quality health care including prevention and health promotion; acute care; chronic care; long-term institutional care; rehabilitative care; and care for catastrophic illness.
3. The Congress enact legislation to assure universal access to health care by:
   1. Requiring all employers, public and private, to provide insurance or direct coverage for all employees and their dependents for health care that meets or exceeds the National Health Standard;
   2. Amending all current governmental and publicly subsidized health care programs to meet or exceed the National Health Standard.
   3. Providing subsidized health care coverage meeting the National Health Standard for all persons not otherwise covered by a and b above.
4. The Congress, by 1993, formulate policies and programs needed to develop and deploy the health resources required to implement the National Health Standard. These policies should provide for:
   1. An adequate supply of qualified health professionals, facilities, medications, and supplies;
   2. Guaranteed equal access to educational programs for individuals regardless of race, sex, or economic status;
   3. Adequate funding of biomedical research and studies relating to the delivery of health services;
   4. Appropriate distribution of health personnel and other resources by region and specialty;
   5. Licensing and regulatory systems which assure competence of providers, promote quality health care, and assure equitable compensation for all health providers.

C. Believing that responsible use must be made of the resources allocated to health and health care and that reasonable limits on health care expenditures can be justified when balanced against other needs of society, the 200th General Assembly (1988) asserts that these objectives must be met without compromising the critical objective of equal access to quality care, and to that end, calls upon the federal government to:

1. Establish a national clearinghouse to accumulate and disseminate information about the effectiveness and consequences of initiatives to contain health care costs.
2. Create a national program of health services research to establish practical standards of quality care and revise them as necessary, to develop measures and tools for assessing the quality of care and the outcomes of treatment, and to publish periodic reports on the effectiveness of the various components of the health system defined in the National Health Standard.
3. Strengthen and expand the national program of technology assessment to include larger questions of resource allocation among health activities, and between health and other social purposes.
4. Redouble congressional efforts to hold all health care providers responsible for meeting a fair share of the health services needs of the poor and uninsured and to seek new cost-effective ways to reimburse health care providers for the cost of caring for disproportionately large numbers of poor patients.
5. Create a national commission with representation from the religious community to address the problems of high-cost illness, particularly at the beginning and the end of life.
6. Review and reform laws and procedures pertaining to medical malpractice with the objective of reducing the costs associated with this problem and the consequent dissipation of health resources.