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 Table of Contents  
Year : 2018  |  Volume : 62  |  Issue : 4  |  Page : 251-252  

Spiritual health: Need for its mainstreaming in health-care delivery in India

1 Former President, Indian Public Health Association; Former Head of the Department; Regional Coordinator, Iodine Global Network (South Asia); President, Association for Indian Coalition for Control of Iodine Deficiency Disorders, All India Institute of Medical Sciences, New Delhi, India
2 Assistant Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication11-Dec-2018

Correspondence Address:
Chandrakant S Pandav
Former President, Indian Public Health Association; Former Head of the Department; Regional Coordinator, Iodine Global Network (South Asia); President, Association for Indian Coalition for Control of Iodine Deficiency Disorders, All India Institute of Medical Sciences, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.IJPH_319_18

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How to cite this article:
Pandav CS, Kumar R. Spiritual health: Need for its mainstreaming in health-care delivery in India. Indian J Public Health 2018;62:251-2

How to cite this URL:
Pandav CS, Kumar R. Spiritual health: Need for its mainstreaming in health-care delivery in India. Indian J Public Health [serial online] 2018 [cited 2022 Jan 25];62:251-2. Available from:

The World Health Organization (WHO) defines health as “a state of complete physical, social and mental well being and not merely the absence of disease or infirmity.”[1] Although not included in this definition of health, there has long been a realization that spiritual well-being is a key component of complete health. The WHO in the year 2005, through Bangkok Charter for Health Promotion in a Globalized World, outlined the centrality of spiritual well-being in attainment of highest standards of health.[2] There has been a renewed push to include spiritual well-being in the definition of health.[3] Many commentators in India have also suggested that spiritual well-being should be included in the definition of health as its fourth dimension.[4],[5]

Spiritual well-being is intricately linked to all three dimensions of health. Although the role of spiritual well-being in social and mental health was already known for long, evidence has been mounting on its importance in physical well-being. Spirituality has shown to achieve better health outcomes and faster recovery and cope with pain and the loss of health of self and near ones. India has gone through a phase of epidemiological transition with noncommunicable diseases becoming more common and contributing to most of the burden of disease and mortality.[6] Most of the noncommunicable diseases can be attributed to lifestyle factors. Spirituality, by bringing in positive changes in lifestyle, can help address the growing burden of noncommunicable diseases. A study in Bhutan found that spirituality reduces the risk of common mental disorders significantly.[7] Studies have found that spirituality may have a role in improving adherence to medication in the treatment of hypertension, and the role of yoga in reducing systolic and diastolic blood pressure is well documented.[8],[9] Spirituality has been found to be inversely correlated to fatigue and pain in a patient with cancer. In a study in Mumbai, India, spiritual well-being score emerged as a significant primary negative predictor for fatigue scores.[10] Spirituality has also shown to decrease end-of-life despair among terminally ill patients.[11] Spirituality has also shown to empower an individual deal better with bereavement with faster and more complete resolution of grief reported in persons with stronger spiritual beliefs.[12] Considering the positive impact of spiritual well-being in palliative care, the National Institute for Health and Care Excellence recommends it to be included as an integral part of cancer care.[13] Spiritual well-being is also found to improve outcome in many other chronic diseases.

In view of the proven role of spiritual well-being in achieving better health outcome, it is important to mainstream it as an integral part of health-care delivery at all levels of care. A study among health-care providers in Northern India found that 55% and 80% of participants appreciated the role of spirituality in preventive and curative care, respectively.[14] A study among physicians from Brazil, Indonesia, and India found that Indian physicians are less likely to discuss spiritual issues with their patients.[15] Role of yoga and meditation in achieving spiritual well-being is well documented. They should be promoted at primary care level in routine health promotion activities by grass-root level workers, and the assessment of spiritual needs must be incorporated in routine curative care, especially among those with chronic diseases.

Although there is an abundance of research which explored the effect of spirituality on health, many of them are hamstrung by the heterogeneity in the definition of spiritual well-being. Besides, the relationship between spirituality and religiosity is also an area of confusion. Authors in India have variously defined spirituality to include inner peace and tranquility, concern for the good of others, and environmental concern as part of spirituality and yoga and other performing arts as an excellent way to achieve spiritual well-being.[5] Others have suggested more formal definition of spirituality and suggested domains such as self-evolution, self-actualization, and transcendence as part of spiritual well-being.[16] However, it is a challenge to define and measure precisely an abstract concept like spiritual well-being, though many scales have been formulated. It is important for organizations such as the WHO to come forward and propose a universally acceptable definition of spiritual well-being and develop measurement scales.

Spiritual well-being is an important, though often under-recognized domain, of health. Spirituality helps in the prevention of many illnesses and predicts better coping with disease and bereavement and has been reported to hasten recovery. Hence, it is suggested that health care providers must be trained in the assessment of spiritual well-being in a culturally appropriate manner and promote activities such as yoga and meditation to prevent many chronic illnesses. In a time, when noncommunicable diseases including psychiatric illnesses have become more common due to lifestyle factors, focus on spiritual well-being is even more pertinent.

   References Top

Preamble to the Constitution of the World Health Organization. International Health Conference. Representatives of 61 States. New York: Official Records of the World Health Organization; 1946, 1948. p. 100.  Back to cited text no. 1
The Bangkok Charter for Health Promotion in a Globalized World; 2005. Available from: [Last accessed on 2018 Feb 22].  Back to cited text no. 2
Charlier P, Coppens Y, Malaurie J, Brun L, Kepanga M, Hoang-Opermann V, et al. A new definition of health? An open letter of autochthonous peoples and medical anthropologists to the WHO. Eur J Intern Med 2017;37:33-7.  Back to cited text no. 3
Dhar N, Chaturvedi SK, Nandan D. Spiritual health, the fourth dimension: A public health perspective. WHO South East Asia J Public Health 2013;2:3-5.  Back to cited text no. 4
Ali SM. Spiritual well-being: The fourth dimension of health. Indian J Public Health 2012;56:257-8.  Back to cited text no. 5
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India State-Level Disease Burden Initiative Collaborators. Nations within a nation: Variations in epidemiological transition across the states of India, 1990-2016 in the global burden of disease study. Lancet 2017;390:2437-60.  Back to cited text no. 6
Sithey G, Li M, Wen LM, Kelly PJ, Clarke K. Socioeconomic, religious, spiritual and health factors associated with symptoms of common mental disorders: A cross-sectional secondary analysis of data from Bhutan's gross national happiness study, 2015. BMJ Open 2018;8:e018202.  Back to cited text no. 7
Lewis LM. Medication adherence and spiritual perspectives among african american older women with hypertension. A qualitative study. J Gerontol Nurs 2011;37:34-41.  Back to cited text no. 8
Tyagi A, Cohen M. Yoga and hypertension: A systematic review. Altern Ther Health Med 2014;20:32-59.  Back to cited text no. 9
Lewis S, Salins N, Rao MR, Kadam A. Spiritual well-being and its influence on fatigue in patients undergoing active cancer directed treatment: A correlational study. J Cancer Res Ther 2014;10:676-80.  Back to cited text no. 10
McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 2003;361:1603-7.  Back to cited text no. 11
Walsh K, King M, Jones L, Tookman A, Blizard R. Spiritual beliefs may affect outcome of bereavement: Prospective study. BMJ 2002;324:1551.  Back to cited text no. 12
National Institute for Health and Care Excellence (NICE). Improving Supportive and Palliative Care for Patients with Cancer; 2004. Available from: [Last accessed on 2018 Feb 22].  Back to cited text no. 13
Bansal R, Maroof AK, Parashar P, Pant B. Spirituality and health: A knowledge, attitude and practice study among doctors of North India. Spiritual Health Int 2008;9:263-9.  Back to cited text no. 14
Lucchetti G, Ramakrishnan P, Karimah A, Oliveira GR, Dias A, Rane A, et al. Spirituality, religiosity, and health: A Comparison of physicians' attitudes in Brazil, India, and Indonesia. Int J Behav Med 2016;23:63-70.  Back to cited text no. 15
Dhar N, Chaturvedi S, Nandan D. Spiritual health scale 2011: Defining and measuring 4 dimension of health. Indian J Community Med 2011;36:275-82.  Back to cited text no. 16
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