Discussion

The main objective of this study is to assess the relationship between religion and health in Macau, a special administrative region of China with the largest commercial gambling market in the world [119]. 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 [120]. Compared to 36 percent in the United States and 72 percent in Indonesia for religious participation [121], roughly 11 percent of the respondents in our 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, we 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 our hypotheses. Our 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 study. Overall, consistent with our 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 [122,123]. The opposite seems to be true in Macau. 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 [124]. A correlational study conducted in Denmark indicated that women who reported lower religiosity had poorer self-rated health and higher illness severity [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 [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 [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 study 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 study were based on the respondents’ perceptions through self-reported data. Although self-reporting represents a reasonable way to measure health, given our 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 [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.

This entry is adapted from the peer-reviewed paper 10.3390/ijerph19095605