The link between religion and health has received increasing attention in recent decades. Most of the research has indicated that religious commitment serves as a protective factor for one’s overall health. Religion is an important component of many people’s lives, and it is represented by individuals’ beliefs and practices that make them feel connected to God or Sacred figures [1]. By health, pweople mean “a state of complete physical, mental and social wellbeing” that is defined by the World Health Organization [2]. Some studies have discovered a positive relationship between religiosity and body functioning ^[3][4][3,4], self-rated health ^[5][6][7][5,6,7], life satisfaction ^[8][9][8,9], hope ^[10][11][10,11], optimism ^[12][13][12,13], and positive traits ^{[14][15][16][17]}[14,15,16,17]. Religion has also been found to be negatively related to depression ^[18][19][20][18,19,20], anxiety ^[21][22][21,22], suicide ^[23][24][23,24], and substance abuse ^[25][26][25,26]. Furthermore, religious involvement is considered to provide “a favorable impact on a host of physical diseases and the response of those diseases to treatment” [27] (p. 9). This statement is supported by a host of studies showing that religion is negatively related to the presence of coronary heart disease ^[28][29][28,29], hypertension ^[30][31][30,31], cerebrovascular disease [32], Alzheimer’s disease or dementia ^[33][34][33,34], and cancer ^[35][36][35,36]. For instance, research that correlated religion with cancer treatments indicates that the provision of religious support to cancer patients can improve their recovery and reduce their malign symptoms [35]. The importance of religion to health is acknowledged in the suggestive adoption of religious practices in health care systems ^[37][38][37,38], and many countries have emphasized the integration of religious and spiritual aspects into nursing and health treatments.

In fact, much of the prior research about the relationship between religion and health is undertaken in the continents of the world that contain the greatest proportion of religious believers. The understanding of religiosity and health is largely based on the evidence from western cultures, where a large segment of the population holds strong religious identities and beliefs. For example, in the United States (U.S.), about 65% of Americans consider religion an important part of their life; over 90% of them believe there is God or a higher being; 83% of them pray to God each week, and 43% of them report having attended religious services almost every week ^[39][40][39,40]. Some studies about the relationship between religion and health in the U.S. show that infrequent religious attenders are more likely than frequent attenders to have impaired physical functioning, chronic health conditions, and fair or poor self-rated health ^[5][41][5,41]. Furthermore, people with consistent religious service attendance display greater health outcomes and lower mortality rates ^[40][42][40,42].

Comparable research in Europe has also explored the positive correlation between attending religious activities and health [43]. These studies add to the findings above, which present that individuals who have more religious service participation will have lower odds of chronic disease attacks, fewer functional impairments, higher health ratings, fewer hospitalizations, and better coping with diseases than those with lower religious service attendance ^{[44][45][46][47][48]}[44,45,46,47,48]. A few related studies indicate that the practice of religion by any individuals with or without illnesses is beneficial because it provides them with a greater sense of mission, broader mindset, greater self-care, healthier lifestyles, and more positive emotional support for coping with unexpected health problems ^{[40][49][50][51]}[40,49,50,51].

Conversely, in non-Western settings, like China, a limited number of studies have examined the relationship between religion and health. Examples of these studies are based on small or religiously homogenous samples, which undermines the generalizability of the findings. Macau, located in the south of the Pearl River Delta area, is a special administrative region (SAR) of China, and it is recognized by many as the “Las Vegas of the East” because it arguably holds the world’s largest commercial gambling operation ^[52][53][52,53]. Indeed, Macau is a secular society that relies on commercial gambling for its government revenue and personal income. For people living in Macau, personal wealth and material success are highly valued due to the casino culture of reward-seeking and auspiciousness from wins and losses.

Alongside Macau’s casino culture, religiosity exists in the lives of many Macau residents, even though it is a predominantly secular society. Macau was a former Portuguese colony that embraced both Western and Eastern traditions. Besides the religions originating from the East, like Buddhism, Daoism, and Mazuism, Macau also contains many followers of religions originating from the West, such as Catholicism and Protestantism. However, research on the relationship between religion and health among Macau residents is very limited because there are few studies relevant to the current topic. One of them describes the relationship between religious beliefs and sleep disturbance [54], while the second examines the mediating effect of religious belief and religious school attendance on death anxieties among adolescents [55]. According to prior surveys, at least 30% of Macau residents identify themselves as religious, and over 35.7% of them report attending religious activities at least once a week [56]. Additionally, Macau has a relatively high life expectancy of 84 years old [57], and its secular nature, along with its religious diversity, makes it an explorable context for delving into the relationship between religion and health.

Because of the confluence of Eastern and Western traditions, Macau has the most diverse population in China in terms of religious commitment and participation. Over 30 percent of the population aged 16 and above identified themselves as affiliated with at least one religion, with Buddhism, Catholicism, and Protestantism being the most frequently affiliated religions. While this percentage is high in the Greater China Region consisting of mainland China, Taiwan, Hong Kong, and Macau, it is considerably lower than many other regions in the world. For instance, about 75% of adults possess a religious faith in the U.S ^[58][120]. Compared to 36 percent in the United States and 72 percent in Indonesia for religious participation ^[59][121], roughly 11 percent of the respondents in theour survey reported attending religious activities at least once a week. Therefore, Macau is a predominantly secular society with great cultural and religious diversity, making it a unique place to study the potential influences of religion on health.

Prior research has documented interrelationships among religiosity, life satisfaction, and health, but there is more to be learned about the mechanisms underlying these relationships. Thus, to provide a better understanding of the ways in which religion might influence health, reswearchers proposed a theoretical model incorporating both direct and indirect effects of religiosity on health through altruism and prejudice. The findings obtained from the analysis of the data collected in the Macau Social Survey largely supported theour hypotheses. The researchOur study results showed that religiosity was positively related to altruism and negatively related to prejudice among the residents in Macau. Moreover, those who had stronger altruistic attitudes and less prejudice also reported higher levels of satisfaction with life and overall health. Hence, altruism and prejudice operated as important mechanisms linking religiosity to health. While altruism and prejudice mediated much of the relationship between religiosity and satisfaction with life, they showed a lesser contribution to the link between religiosity and health, suggesting that religiosity might promote health conditions through other forms that were not accounted for in this researchstudy. Overall, consistent with theour theoretical expectations, religiosity could contribute to individual health in multiple ways.

The mediating role of prejudice is noteworthy. In many predominantly religious societies, such as the Islamic societies in the Middle East and selected regions of the United States, religious followers tend to uphold more conservative values, including a higher level of prejudice against non-religious people, individuals who maintain unconventional moral beliefs, or groups who engage in different lifestyles involving drug use and homosexuality ^[60][61][122,123]. The opposite seems to be true in Macau. The Our results demonstrated that Macau residents who were more religious had a lower level of prejudice. This finding is consistent with the prior research showing that the minority status of religious believers fosters the acceptance of socially disadvantaged groups in Macau [56]. As a minority living in a society dominated by consumerism from the gambling industry, they felt that their ways of life and their value systems were increasingly marginalized, which led to more sympathy and acceptance for other minority groups who might have also experienced social or cultural marginalization. Moreover, the attempt to bring into harmony religious beliefs and moral values to neutralize the experience of social marginalization indicates that most Macau residents tend to be intrinsically religious believers. It is perhaps because of these reasons that religion serves to curtail prejudice and thereby contribute to overall health among Macau residents. Thus, the link between religion and prejudice in varying contexts and its effect on health are worthy of further exploration.

Much of the knowledge about the relationship between religion and health is based on studies conducted in the societies where a large portion of the population is affiliated with only a few dominant religions. It is unclear if the results obtained from these societies apply to other societies that are either predominantly secular or more religiously diverse. Macau fits both descriptions because nearly 70 percent of its population self-identify as non-religious, with the rest considering themselves as religiously affiliated with many different kinds of Eastern and Western religions. Despite the secular context and the religious diversity, religion still contributed significantly to health among the residents in Macau. These findings are in line with the results of several other studies showing that religion might have a salutary effect on health outcomes in secular cultures. For instance, a longitudinal study of a Danish cohort born in 1914 found a negative correlation between church attendance and mortality among these elders in the secular culture ^[62][124]. A correlational study conducted in Denmark indicated that women who reported lower religiosity had poorer self-rated health and higher illness severity ^[63][125], whereas men displayed an inverse relationship between religious practice and health. The discrepancy is due to the fact that Danish women were more religiously attached than men, indicating that intrinsically religious individuals were more likely to benefit from religious commitment in terms of health outcomes ^[64][126]. Other research conducted in secular cultures also demonstrated that individuals who participated in religious activities developed more positive meaning-making systems, healthier dietary patterns, and lesser involvement in risky health behaviors, which could all contribute to improved health conditions ^[65][66][127,128]. These overlaps between the research findings from Macau and those from other regions lend credence to the proposition that religion can promote individual health in cultures that are secular in nature.

Despite the contributions that it has made to the understanding of the relationship between religion and health, the results of the current researchtudy should be taken with caution. First, the research design was cross-sectional. Therefore, the relationships identified in the analysis are correlational in nature and should be interpreted as such. Second, the measures of overall health used in this researchstudy were based on the respondents’ perceptions through self-reported data. Although self-reporting represents a reasonable way to measure health, given theour focus on overall health as a state of physical, mental, and social well-being [2], it may be biased by respondents’ interpretation of their own health status, especially when it needs to be compared with others. Third, confirmation bias could have played a role in influencing the respondents’ responses to the survey questions on prejudice and altruism, as some of them might have interpreted the questions in a way that partially reflected their existing beliefs or expectations ^[67][129]. Future research should employ a longitudinal design with an improved ability to draw a causal inference based on empirical findings to address these limitations. Furthermore, they should consider incorporating reports of multi-informants such as doctors, friends, and family members to improve the reliability of the health measures.