Our ministry is an enduring sign of health care rooted in the belief that every person is a treasure, every life a sacred gift, every human being a unity of body, mind and spirit. This vibrant video series shines a spotlight on the contributions of CHA member ministries in promoting human dignity and the common good.
Illustrations by Darlene McElroy
4 CALLED TO BE WITNESSES OF HOPE
Fr. Peter Fonseca, MA, MS, MDiv
7 MISSION FOR THIS MOMENT
Cory D. Mitchell, DBe
12 CATHOLIC THOUGHT CENTERS ON EXPANSIVE COMPASSION, HUMAN DIGNITY IN IMMIGRATION RESPONSE
Brett O’Neill, SJ, M Int.Law, STL, PhD
18 BUILDING CONNECTION AND COMMUNITY IN CARING FOR CREATION
Sr. Sharon Zayac, OP
24 SPONSORS SET STEADYING COURSE WITH EYE ON THE HORIZON
Sr. Teresa Maya, PhD, CCVI
30 WALKING EACH OTHER HOME THROUGH PILGRIMAGE
Judith Valente
36 PORTALS OF PRAYER: TENDING TO THE SPIRIT
Emily Southerton, BCC, MA
Fr. Joseph J. Driscoll, DMin
Demetre Skliris, MD, MS, MNS
Sr. Catherine O’Connor, CSB, PhD
Justin Hurtubise
46 NEW WAVE OF POTENTIALLY CURATIVE TREATMENT OFFERS HOPE FOR SICKLE CELL DISEASE: HOW CAN WE ELIMINATE HURDLES TO BUILD ON THE PROMISE?
Crawford Strunk, MD
2 EDITOR’S NOTE BETSY TAYLOR
52 MISSION
Together Along the Pilgrim Path JILL FISK, MATM
55 COMMUNITY BENEFIT
Nonprofit Hospital Community Benefit: What Counts and Why It Matters NANCY ZUECH LIM, MPH, BSN
61 FORMATION
Embracing Old Age and Our Future Selves DARREN M. HENSON, PhD, STL, and INDU SPUGNARDI
64 THINKING GLOBALLY
Catholic Social Teaching as a Compass for Catholic Health Care in a Fractured World BRUCE COMPTON
66 ETHICS
Forming Conscience in Health Care Settings
NATHANIEL BLANTON HIBNER, PhD
68 HEALTH EQUITY
Racism, Poverty and Structures of Sin KATHY CURRAN, JD, MA, and ALEXANDRA CARROLL, MTS
29 FINDING GOD IN DAILY LIFE
71 SERVICIO DE ORACIÓN
72 PRAYER SERVICE
IN YOUR NEXT ISSUE HEALTH CARE ACROSS AMERICA
Hope is active. It sounds passive, if you think about it in its dreamy sense — the feeling of wanting something to happen, or wishing for things to be different than they are.
But, as our Health Progress authors remind us, hope is more than a feeling. It can be the spur to lead us to unify and focus on a shared goal, the spark that takes us from musing about how things could be better to the action that leads us to bring them into being.
Prior to working on this issue, I don’t think most people would have pegged me as a Jubilee Year enthusiast. But I’m now all in on the Pilgrims of Hope Jubilee Year, and I hope (there’s that word again) that you will be, too. Because the ability to encourage authors to reflect on hope as they think deeply about its importance has been such a wonderful antidote to much of the flood of news around us.
Multiple writers explore the theological understanding of hope in this issue, and where Catholic social teaching points us today when considering care for immigrants and those who are poor and sick. Despite the policy importance of security, do we not live in a world crying out for more empathy toward one another?
Beyond that, what an opportunity this issue has provided for people to reflect on the importance of spiritual pilgrimage in their own lives. Authors don’t just write about it here, they provide ways for any Health Progress reader to take part in a pilgrimage. We’ve created online audio resources for the Prayer Service, so that people may meditate or walk for a brief personal pilgrimage. (The related
QR codes are found with the prayers on the last pages of this Health Progress.) This issue discusses how several CHA members engage in spiritual practice. It also details the Pilgrims of Hope for Creation effort involving dozens of Catholic organizations, and how people in community can plan a journey to respect, appreciate and advocate for the environment.
Similar to the game Six Degrees of Kevin Bacon (where people try to link other people to projects involving the actor), Americans have been playing a more pious version of Do You Have Ties to Pope Leo XIV? The announcement of a pope from Chicago made waves, soon followed by word that he had spent time in St. Louis. Who knew his first church was just around the block?
My daughter, my dog and I went on a brief pilgrimage of our own. I meant to show her a new coffeehouse and cabaret stage around the corner. We then found ourselves drawn to the up-for-sale and under-renovation church for the Immaculate Conception/St. Henry parish, where Robert Prevost was a novitiate for the Order of St. Augustine in St. Louis. Pope Francis was beloved for his close proximity to the people. The proximity of Pope Leo XIV’s former residence means it’s a place I’ll return to, as it reminds me that we are all one united, hopeful church.
VICE PRESIDENT, COMMUNICATIONS AND MARKETING
BRIAN P. REARDON
EDITOR
BETSY TAYLOR btaylor@chausa.org
MANAGING EDITOR
CHARLOTTE KELLEY ckelley@chausa.org
GRAPHIC DESIGNER
NORMA KLINGSICK
ADVERTISING 4455 Woodson Rd., St. Louis, MO 63134-3797, 314-253-3447; fax 314-427-0029; email ads@chausa.org.
SUBSCRIPTIONS/CIRCULATION Address all subscription orders, inquiries, address changes, etc., to Service Center, 4455 Woodson Rd., St. Louis, MO 63134-3797; phone 800-230-7823; email servicecenter@chausa.org. Annual subscription rates are: complimentary for those who work for CHA members in the United States; $29 for nonmembers (domestic and foreign).
ARTICLES AND BACK ISSUES Health Progress articles are available in their entirety in PDF format on the internet at www.chausa.org. Photocopies may be ordered through Copyright Clearance Center, Inc., 222 Rosewood Dr., Danvers, MA 01923. For back issues of the magazine, please contact the CHA Service Center at servicecenter@chausa.org or 800-230-7823.
REPRODUCTION No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission from CHA. For information, please contact copyright@chausa.org.
OPINIONS expressed by authors published in Health Progress do not necessarily reflect those of CHA. CHA assumes no responsibility for opinions or statements expressed by contributors to Health Progress.
Catholic Press Awards: Magazine of the Year — Professional and Special Interest Magazine, First Place; Best Special Section, First Place; Best Special Issue, First Place; Best Coverage — Political Issues, First Place; Best Essay, First and Second Place; Best Feature Article, Third Place; Best Reporting on Social Justice Issues — Dignity and Rights of the Workers, Second Place; Best Reporting on Social Justice Issues — Life and Dignity of the Human Person, First Place; Best Reporting on Social Justice Issues — Option for the Poor and the Vulnerable, Third Place; Best Reporting on Social Justice Issues — Rights and Responsibilities, Third Place; Best Writing — In-Depth, Honorable Mention.
American Society of Business Publication Editors Awards: All Content — Enterprise News Story, Regional Gold Award; All Content — Government Coverage, Regional Silver Award; All Content — Editor’s Letter, Regional Silver Award.
Produced in USA. Health Progress ISSN 0882-1577. Summer 2025 (Vol. 106, No. 3).
Copyright © by The Catholic Health Association of the United States. Published quarterly by The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797. Periodicals postage paid at St. Louis, MO, and additional mailing offices. Subscription prices per year: CHA members, free; nonmembers, $29 (domestic and foreign); single copies, $10.
POSTMASTER: Send address changes to Health Progress, The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797.
Trevor Bonat, MA, MS, chief mission integration officer, Ascension Saint Agnes, Baltimore
Sr. Rosemary Donley, SC, PhD, APRN-BC, professor of nursing, Duquesne University, Pittsburgh
Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Redeemer Health, Meadowbrook, Pennsylvania
Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Montana
Gabriela Robles, MBA, MAHCM, president, St. Joseph Fund, Providence St. Joseph Health, Irvine, California
Jennifer Stanley, MD, physician formation leader and regional medical director, Ascension St. Vincent, North Vernon, Indiana
Rachelle Reyes Wenger, MPA, system vice president, public policy and advocacy engagement, CommonSpirit Health, Los Angeles
Nathan Ziegler, PhD, system vice president, diversity, leadership and performance excellence, CommonSpirit Health, Chicago
ADVOCACY AND PUBLIC POLICY: Lisa Smith, MPA; Kathy Curran, JD, MA; Clay O’Dell, PhD; Paulo G. Pontemayor, MPH; Lucas Swanepoel, JD
COMMUNITY BENEFIT: Nancy Zuech Lim, RN, MPH
CONTINUUM OF CARE AND AGING SERVICES: Indu Spugnardi
ETHICS: Nathaniel Blanton Hibner, PhD; Brian Kane, PhD
FINANCE: Loren Chandler, CPA, MBA, FACHE
GLOBAL HEALTH: Bruce Compton
LEADERSHIP AND MINISTRY DEVELOPMENT: Diarmuid Rooney, MSPsych, MTS, DSocAdmin
LEGAL, GOVERNANCE AND COMPLIANCE: Catherine A. Hurley, JD
MINISTRY FORMATION: Darren Henson, PhD, STL
MISSION INTEGRATION: Dennis Gonzales, PhD; Jill Fisk, MATM
PRAYERS: Karla Keppel, MA; Lori Ashmore-Ruppel
THEOLOGY AND SPONSORSHIP: Sr. Teresa Maya, PhD, CCVI
PILGRIMS OF HOPE
FR. PETER FONSECA, MA, MS, MDiv Director of Continuing Formation for Priests, Archdiocese of St. Louis
The Vatican’s Year of Jubilee, themed Pilgrims of Hope, began this past Christmas Eve and continues until the celebration of Epiphany on Jan. 6, 2026. This tradition of celebrating a jubilee year traces its roots to the Jewish custom of observing a jubilee every 50 years, during which enslaved people and prisoners would be freed, debts forgiven and God’s mercy made manifest. Since the 1300s, popes have called jubilee years nearly every 25 or 50 years as a time for the Church to restore its relationship with God and one another. This year affords each of us, both as individuals and collectively as Catholic health care, an opportunity for renewal in our own journeys of faith and our important work of caring for the sick.
For this Year of Jubilee, the late Pope Francis invites each of us “to be tangible signs of hope for those of our brothers and sisters who experience hardships of any kind.” 1 He specifically highlights the importance of showing hope to the sick, acknowledging that the “care given to them is a hymn to human dignity, a song of hope that calls for the choral participation of society as a whole.” 2 In a particular way, Pope Francis extends an invitation to each of us, as health care workers, to become witnesses of hope so that through the ways that we care for the sick and suffering, hope may spread “to all those who anxiously seek it.”3
The Catechism of the Catholic Church teaches us that hope “keeps man from discouragement; it sustains him during times of abandonment; it opens up his heart in the expectation of eternal beatitude.”4 Hope allows us to profess with St. Paul, “I am convinced that neither death, nor life, nor angels, nor principalities, nor present
things, nor future things, nor powers, nor height, nor depth, nor any other creature will be able to separate us from the love of God in Christ Jesus our Lord.” (Romans 8:38-39)
When we offer this gift of hope, we create a sense of aliveness through a shared connection with the sick and suffering, which provides them with the assurance that they are not alone in their illness while helping them to experience peace with themselves and others. In the face of sickness and suffering, we are called to “fan the flame of hope that has been given us and help everyone to gain new strength and certainty by looking to the future with an open spirit, a trusting heart and far-sighted vision.”5
Since one cannot give what one does not have, this Year of Jubilee invites each of us to first open our own hearts to the hope offered by Christ before we can extend that hope to others. While most of us will not be able to travel to Rome to enter through the Holy Doors, each of our dioceses has designated jubilee sites where we can go on pilgrimage.
The Jubilee of Hope invites us to follow the path of Mother Teresa, by doing little things with great love. Those simple acts of charity, which reinforce the dignity of the person before us, can easily become the seeds of hope for those most in need.
Making a small pilgrimage to one of the holy sites in our dioceses can be a powerful moment of conversion in our lives, inspiring us to be ministers of hope in the health care ministry. Yet, for those unable to make a pilgrimage to an official local site, we can designate a place of pilgrimage within our institutions where people can come to “rejoice in hope, endure in affliction, persevere in prayer.” (Romans 12:12)
For those of us who care, day in and day out, for Christ in the sick among us, becoming a minister of hope does not require any drastic changes to the way we minister. Rather, each of us becomes ministers of hope through small practical acts.
In his letter announcing the Year of Jubilee, Pope Francis offers us concrete examples of how we can be ministers of hope. He encourages us that “each of us may be able to offer a smile, a small gesture of friendship, a kind look, a ready ear, a good deed, in the knowledge that, in the Spirit of Jesus, these can become, for those who receive them, rich seeds of hope.”6 The Jubilee of Hope invites us to follow the path of Mother Teresa, by doing little things with great love. Those simple acts of charity, which reinforce the dignity of the person before us, can easily become the seeds of hope for those most in need.
Summer is a time of growth and abundance. As the warmth of the season brings vitality to the world around us, we are reminded of the ultimate source of our hope: the resurrection of Jesus Christ. In the words of Pope John Paul II, “We are an Easter People and Alleluia is our song!”7 This jubilee year is our chance to proclaim that “Alleluia” by becoming witnesses of hope to all those we encounter. This summer, then, is the opportu-
nity for each of us to take up Pope Francis’ invitation to reflect on how we, both individually and as a community, can be witnesses of hope in our world today.
In calling for this Jubilee of Hope, Pope Francis exhorts, “All the baptized, with their respective charisms and ministries, are co-responsible for ensuring that manifold signs of hope bear witness to God’s presence in the world.”8 How, then, are we manifesting the resurrection? How are we manifesting God’s signs of hope? How are we participating in the Jubilee Year of Hope?
FR. PETER FONSECA is director of Continuing Formation for Priests in the Archdiocese of St. Louis.
1. Pope Francis, “Spes Non Confundit, Bull of Indiction of the Ordinary Jubilee of the Year 2025,” The Holy See, section 10, https://www.vatican.va/content/francesco/ en/bulls/documents/20240509_spes-non-confundit_ bolla-giubileo2025.html.
2. Francis, “Spes Non Confundit,” section 11.
3. Francis, “Spes Non Confundit,” section 25.
4. Catechism of the Catholic Church, Second Edition (Libreria Editrice Vaticana, 1997), section 1818.
5. Pope Francis, “Letter of the Holy Father Francis to Msgr. Rino Fisichella, President of the Pontifical Council for the Promotion of the New Evangelization, for the Jubilee 2025,” The Holy See, https://www. vatican.va/content/francesco/en/letters/2022/ documents/20220211-fisichella-giubileo2025.html.
6. Francis, “Spes Non Confundit,” section 18.
7. Pope John Paul II, “Angelus,” The Holy See, section 3, https://www.vatican.va/content/john-paul-ii/en/ angelus/1986/documents/hf_jp-ii_ang_19861130.html.
8. Francis, “Spes Non Confundit,” section 17.
CORY D. MITCHELL, DBe System Ethics Consultant and Adjunct Professor at Georgetown University and Loyola University Chicago
According to the evangelist and physician Luke, Jesus articulated his mission when he was filled with the Holy Spirit after fasting in the desert for 40 days and enduring the temptation to forsake love for fame, fortune and power. His inaugural mission statement was a repetition of the prophet Isaiah’s from another age:
“The Spirit of the Lord is upon me, because he has anointed me to bring glad tidings to the poor. He has sent me to proclaim liberty to captives and recovery of sight to the blind, to let the oppressed go free, and to proclaim a year acceptable to the Lord.” (Luke 4:18-19)
What is interesting here is the primacy of the poor in Jesus’ understanding of his call and mission. Most, if not all, of his healing was focused on poor and marginalized people. But even before his concern for the poor was expressed that day, a plethora of Hebrew prophets before him used the treatment of the poor as the hermeneutical key for critiquing the moral state of society. Islam does the same. Therefore, all the children of Abraham can agree that people who suffer from poverty are of critical concern for God and, by extension, his children. For the Christian tradition, we see how care for the poor as a mission imperative becomes a magnet, a draw to the ministry.
At that time, as the number of disciples continued to grow, the Hellenists complained against the Hebrews because their widows were being neglected in the daily distribution. So the Twelve called together the community of the disciples and said, “It is not right for us to neglect the word of God to serve at table. Brothers, select from among you seven repu-
table men, filled with the Spirit and wisdom, whom we shall appoint to this task, whereas we shall devote ourselves to prayer and to the ministry of the word.” The proposal was acceptable to the whole community, so they chose Stephen, a man filled with faith and the Holy Spirit, also Philip, Prochorus, Nicanor, Timon, Parmenas and Nicholas of Antioch, a convert to Judaism. They presented these men to the apostles who prayed and laid hands on them.
The word of God continued to spread, and the number of the disciples in Jerusalem increased greatly; even a large group of priests were becoming obedient to the faith. (Acts 6:1-7)
Note how this narrative in Acts of the Apostles reveals conflict and reconciliation. The Greeks and Hebrews were not getting along because of real or perceived unjust distribution of food for the poorest of the poor, the widows of gentiles who were not only deemed “unclean” but were also women who were without any property of their own, with no husbands or sons (property owners) to care for them. The Twelve Apostles heard the pleas of the marginalized and addressed the problem by welcoming wise men from those areas to serve their community’s needs.
This was essentially an early workforce development program. And notice how the entire community, not just the poor Greeks but Jews and
Greeks of privilege, were also pleased. The whole community became happy when the poorest of the members were served. The Church then grew greatly, and many of the priests became obedient to the faith. The mission that Jesus articulated still has the power to heal, reconcile and transform today.
As a Black system ethicist working in Catholic health care, I have seen the pushback against the concepts of diversity, equity and inclusion (DEI). I will refrain from using the acronym DEI in this article because it loses its meaning as a three-letter lightning rod. A social media post once said that when the words “diversity, equity and inclusion” are used, they are more likely to raise the question in the other person’s mind: “What am I fighting against, is it diversity, equity or inclusion?” Perhaps it is all three, but that is at least the basis for an honest discussion.
Clarity around terms and policies is critical. This became especially so when, in 2023, the U.S. Supreme Court ruled against the policy known as Affirmative Action, which some view as a quota system for admitting students, hiring personnel and selecting suppliers that violates the Equal Protection Clause in the U.S. Constitution.1 The Court did not rule against diversity, equity or inclusion as principles. That means there is no such thing as “illegal diversity, equity and inclusion,” which is evidenced by the fact that the White House continues to celebrate Black History Month in its own way.
But Catholic ministries are feeling dazed and confused because the word catholic means universal, which means that the Roman Catholic Church is global and welcomes everyone. Moreover, the Catholic Church and all its ministries are called to see the spark of the Divine in every man, woman and child, with no exceptions.
However, the current moment has ushered us into an age of “othering.” This can also be understood using the fuller meaning of the word apocalypse, which is an unveiling. Othering is the process of using real or perceived differences to distinguish in-group from out-group members, the worthy from the unworthy, the clean from the unclean, the Black from the white. I say unveiling because, since the founding of America, othering has been a driving force. It receded during brief periods of our collective history, but now it
is clearly manifest. How do we use the mission of Jesus to meet the moment of today as Catholic health care ministries?
BLESSING THE POOR BLESSES ALL
Structural or concentrated poverty is defined as when 30% or more of people residing in a census tract live at or below the federal poverty level. Structural poverty is harmful to health regardless of race or ethnicity. In fact, researchers found that the incidence of coronary heart disease is 2.5 times higher for Blacks and three times higher for whites who live in structural poverty compared to those who do not.2 Low birth rate, which is a risk factor for infant mortality, is also associated with structural poverty.3 A consistent ethic of life requires that Catholic health care be attentive to contexts where people who are made in the image and likeness of God are languishing. Directive 3 of Part One of the Ethical and Religious Directives for Catholic Health Care Services states:
In accord with its mission, Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn … racial minorities; immigrants and refugees.4
When communities are redeveloped to include mixed-use, mixed-income, more than adequate, affordable housing and walkable and/ or transit-oriented development that supports the lives, livelihoods and dignity of residents, what is currently called social determinants or drivers of health are ameliorated and health outcomes improve, even when personal income does not.5 A 2015 report found that roughly 8% of whites, 25% of Blacks and about 17% of Hispanics lived in structural poverty.6
People living in structural poverty have greater difficulty accessing primary and sometimes emergency care, behavioral health, nutritious food, quality education, meaningful employment, public transportation and services that enhance the quality of life. For this reason, the Church calls these communities of structural poverty “intrinsically evil” because they put lives at risk.7 Moreover, such contexts make it easy for infectious diseases to develop and spread from people
whose immune systems are compromised due to the chronic stress of structural poverty to others within and outside of those communities. Thus, care for the poor is care for everyone. Like the community in Jerusalem, the whole community is satisfied and healthy when the poor in their midst are supported and healthy.
As noted earlier, to continue the mission of Christ, the apostles recognized the importance of dealing with economic circumstances when they appointed the seven men filled with the Spirit of love and wisdom to address this need. Catholic health care can continue this apostolic work by addressing structural poverty. On any given day, a hospital may have several job openings, and many of these positions may require entry-level skills. Residents living in structural poverty can be recruited into these positions, and greater experience and additional education and training may lead them to more skilled roles. Roles like medical assistant and certified nursing assistant can be transformational to people living in structural poverty because health care, particularly nursing, is one of the top industries for potentially moving people from poverty to the middle class.8
Students in these communities should be exposed to health care careers and opportunities as early as elementary school. Failing to address
Finally, if Catholic health care can move people from structural poverty to employment, the financial strain on health systems serving these populations is reduced due to higher reimbursement from commercial insurance. Residents of communities of structural poverty are typically uninsured, underinsured or on Medicaid, which is perennially threatened by state and federal governments.
When this population is large enough, the hospital may become at risk for insolvency due to an adverse payor mix. The typical response is to close the hospital in these communities, but this approach does a disservice to mission and the health of all Americans because poor people go unserved, diseases worsen and spread, and health care costs rise for everyone. Therefore, we are called to remember what my previous executive vice president for mission integration at Trinity Health, Sr. Mary Ann Dillon, RSM, used to say: “We are a ministry that happens to be a business, not a business that happens to be a ministry.”
The Church’s social teaching tells us that dignity and the common good are the two great pillars that hold up the edifice of society. Along with solidarity and the preferential option for the poor, ministries can create health systems and communities where all people can thrive, especially the poor. There is no law against caring for the poor, and it has been our mission from the start. It worked for Jesus as our founder, and it can still work for Catholic health care today.
Along with solidarity and the preferential option for the poor, ministries can create health systems and communities where all people can thrive, especially the poor. There is no law against caring for the poor, and it has been our mission from the start. It worked for Jesus as our founder, and it can still work for Catholic health care today.
community economics collaboratively with other stakeholders while providing health care is tantamount to treating sepsis with vitamins. While vitamins are generally important to health, they do not treat the root cause of the illness, and therefore, vitamins alone will not help the patient get healthy and stay healthy.
As we saw in the Acts of the Apostles, a commitment to the poor is a magnet and recipe for growth, as well as the catalyst for reconciliation. If Luke were on earth today, I would like to think that, as a physician, he would write of us in the Acts of the Health Apostolates that all patients, residents, community members and employees — whether white, Black, Hispanic, Asian, female, male, citizen, immigrant, refugee, heterosexual, homosexual, nonbinary, transgendered, rich or poor — were all well cared for and pleased.
By living our collective vocation to continue the healing mission of Jesus Christ, especially for the poor, we can be the seeds of transformation and reconciliation. When we recognize that mission is catalyzed by chaos and crisis, we should not be discouraged. The late Pope Francis declared 2025 as the Jubilee Year of Hope, so let ministries respond to his call to be pilgrims of hope. We are called to mission for this moment.
CORY D. MITCHELL is the system ethics consultant for PeaceHealth and an adjunct assistant professor at the Georgetown University Medical Center/Pellegrino Center for Clinical Bioethics and the Neiswanger Institute for Bioethics and Healthcare Leadership at Loyola University Chicago Stritch School of Medicine.
1. “Students for Fair Admissions, Inc. v. President and Fellows of Harvard College,” Supreme Court of the United States, 2023, https://www.supremecourt.gov/ opinions/22pdf/20-1199_hgdj.pdf.
2. Dr. Ana V. Diez Roux et al., “Neighborhood of Residence and Incidence of Coronary Heart Disease,” The New England Journal of Medicine 345,
no. 2 (2001): 99-106, https://doi.org/10.1056/ NEJM200107123450205.
3. Judy Beal, “Race, Ethnicity, Concentrated Poverty, and Low Birth Weight Disparities,” MCN, The American Journal of Maternal Child Nursing 34, no. 2 (2009): https://doi.org/10.1097/01. NMC.0000347315.05648.68.
4. Ethical and Religious Directives for Catholic Health Care Services: Sixth Edition (Washington, DC: United States Conference of Catholic Bishops, 2018), 9.
5. Lisa Sanbonmatsu et al., “The Long-Term Effects of Moving to Opportunity on Adult Health and Economic Self-Sufficiency,” Cityscape: A Journal of Policy Development and Research 14, no. 2 (2012): 109-36.
6. Paul Jargowsky, “Architecture of Segregation,” The Century Foundation, August 7, 2015, https://tcf.org/ content/report/architecture-of-segregation/.
7. Second Vatican Council, “Gaudium et Spes,” section 27, https://www.vatican.va/archive/ hist_councils/ii_vatican_council/documents/ vat-ii_cons_19651207_gaudium-et-spes_en.html.
8. Marla Nelson and Laura Wolf-Powers, “Chains and Ladders: Exploring the Opportunities for Workforce Development and Poverty Reduction in the Hospital Sector,” Economic Development Quarterly 24, no. 1 (2010): 33-44.
Author and ethicist Cory D. Mitchell asks us to contemplate what mission means in this moment. When it can feel like news cycles pass so rapidly, it’s challenging to hang onto any one piece of information or focus long enough to work for change. He makes the point that Catholic teaching is resoundingly clear on caring for those most in need.
1. Do you know how much poverty exists in the area served by your health care facility or facilities? Why might it be important to know this information in your work?
2. Think for a moment about your preconceived notions about other people. Are there occasions when you reach a hasty conclusion or lose patience with patients? What are some techniques that may allow you to recognize and overcome these concerns?
3. What training, resources or support might your system offer to better educate about differences in the populations you serve, how people respond to health care matters based on culture or life experience, and how to best communicate across differences?
4. As you read Directive 3 from the Ethical and Religious Directives for Catholic Health Care Services,¹ what is your ministry doing to address the needs of those living at the margins who are particularly vulnerable to discrimination, such as those experiencing poverty, the uninsured and underinsured, children, racial minorities, immigrants and refugees?
NOTE
1. “Ethical and Religious Directives,” Catholic Health Association of the United States, https://www.chausa. org/focus-areas/ethics/ethical-and-religious-directives.
PILGRIMS OF HOPE
BRETT O’NEILL, SJ, M Int.Law, STL, PhD Contributor to Health Progress
Questions over immigration policy are increasingly prominent and morally fraught across Western democracies. Concerns over border security and fears of an overwhelming influx of undocumented migrants and asylum seekers were major themes in the 2024 U.S. presidential election; they have now become a key focus for the Trump administration, which has controversially carried out mass deportations without due process.1 Catholics and other people of faith have been divided over this polarizing topic. How do we balance the Gospel’s call to welcome the stranger with the legitimate need to uphold the stability and cohesion of one’s nation?
This political climate has been a difficult setting for Catholics to reflect on the morality of immigration policies and their enforcement, given heightened tensions and the vulnerabilities of undocumented migrants. We have seen immigration issues misconstrued in a way that significantly impacts vulnerable people. Public officials have unfairly conflated undocumented migration with criminality and have used public unease over undocumented border crossings to issue an executive order that suspends the lawful and much-needed refugee resettlement program.2 The motivations and courageous work of Catholic agencies engaged in this field have even been called into question.3
Yet this period also highlights how important it is for Catholics and other Christians to have a clear-headed discussion of immigration policy and border control in a way that can promote the interests of migrants and uphold their
dignity, while also recognizing the legitimate interests of communities affected by the loss or reception of new peoples. The ever-expanding forcibly displaced populations across the world and the increasing rate of deaths among irregular migrants (those attempting to cross borders without authorization) illustrate the urgent need for more nuanced and constructive ethical reflection.4
Calling upon the varied resources of our Catholic tradition, we need not resign ourselves to a fixed binary between an open welcome and harsh exclusion. Rather, these resources may help us reframe our approach, allowing us to balance the need for stable and secure national borders insofar as they enable greater hospitality toward immigrants.
MIGRANT HOSPITALITY AND THE ‘ORDER OF CHARITY’
In a January interview this year, Vice President JD
Vance appealed to the notion of the “ordo amoris” (the “order of charity”) to defend the administration’s focus on immigration enforcement and its reduction of foreign aid.5 This notion, explored by Sts. Augustine and Thomas Aquinas, provides a way for understanding how relationships of greater intensity and proximity, such as with family and fellow citizens, can have a greater claim on our love and sense of responsibility over those who are more distant, but who may well be just as needy.
It recognizes the limitations of our human finitude that prevent us from loving all others equally, as well as the bonds of kinship and those that arise from proximity or common endeavor, entailing particular obligations of care. It affirms that we are called to love real people in tangible ways, bearing responsibility for those within our realm of care, while also retaining degrees of love for our neighbors beyond. Vance’s use of this notion seemed to suggest that, under the order of charity, nations can justly limit their ambit of concern to their own citizenry, without necessarily considering the welfare of those beyond their borders.
In a pointed letter to the Catholic bishops of the United States, Pope Francis directly challenged this interpretation. Looking instead to the example of love modeled by the Good Samaritan, who offered generous concern and care for a total stranger in need, Pope Francis argued for this as the more authentic order of charity that better accords with the Gospel. While the order of charity may be a useful framework for recognizing our finitude and particular relationships within the Gospel’s universal call to love, this framework is not meant to limit our love and concern for others. Rather, our more immediate objects of love ought to help us love more expansively and contribute to a greater good; they set conditions for loving beyond. Hence, Pope Francis rightly argued that our love ought to be expansive, not limited in ever diminishing degrees over a series of concentric circles.6
The pope’s call for expansive love rather than a restrictive limitation to one’s own proximate circles of kinship sits well in line with modern magisterial teaching on migration. Immigration has been a recurring topic in modern social encyclicals. These magisterial reflections consider migration, when it is compelled by fear or mate-
rial need, as a lamentable tragedy that discloses the evils of global inequalities and sinful systems, given that so many people are forced to depart their homelands. Despite highlighting the injustices and evils related to migration, these teachings also recognize a sacramental value in migration movements.
The Vatican’s 2004 Instruction Erga Migrantes Caritas Christi remarkably described migration as “a sign of the times and of the presence of God in history and in the community of peoples, directed to universal communion.” Further, it suggested that the Church sees in migrants both the face of Christ, veiled under the stranger, and “a visible sign and an effective reminder of that universality which is a constituent element of the Catholic Church.”
Hence, migration can be seen as both a providential means (even by reappropriating unfortunate evils) toward universal communion, as well as a prophetic sign calling the Church and all peoples to exercise generous hospitality to better realize this communion. The migrant may be considered “God’s messenger who surprises us and interrupts the regularity and logic of daily life, bringing near those who are far away,” prophetically reminding the Church of its universal vocation, as “pilgrims on our way towards our true homeland.”7
Catholic social teaching thus consistently calls receiving communities to provide generous hospitality to incoming migrants. Pope Paul VI, in Populorum Progressio, insisted on “the duty of giving foreigners a hospitable reception. It is a duty imposed by human solidarity and by Christian charity.”8 In Octogesima Adveniens, Pope Paul VI called for nations to “go beyond a narrowly nationalist attitude,” assuring foreigners of their right to emigrate, and favoring their integration.9
Across his pontificate, Pope Francis powerfully emphasized the importance of host communities receiving migrants with generous hospitality, aiming to counteract prevailing populist cultures of exclusion. Indeed, Pope Francis made the needs and aspirations of migrants and refugees one of the defining priorities of his pontificate. This key priority was dramatically indicated by the choice of the pope’s first papal journey outside of Rome, in July 2013, to the Italian island of Lampedusa, a prominent arrival point for irregular migrant journeys across the Mediterranean Sea at the time, which would later become the site
PILGRIMS OF HOPE
of several large-scale maritime disasters involving irregular migrants. On behalf of receiving nations and those who contributed to situations driving their migration, the pope asked forgiveness, seeking to awaken the world to the “globalization of indifference.”10
Pope Francis’ 2020 social encyclical on social friendship, Fratelli Tutti, cohesively accumulated his many teachings related to immigration and global interdependence. The encyclical reaffirmed the Church’s traditional insistence on the dual rights not to have to emigrate and the right to migrate for just reasons. Yet it further enriched this teaching by situating it within a Christian anthropology that stresses the significance of human sociality. As the encyclical frames his argument on social friendship related to migration, “the human person, with his or her inalienable rights, is by nature open to relationship. Implanted deep within us is the call to transcend ourselves through an encounter with others.”11
Given these shared inalienable rights, “if all people are my brothers and sisters, and if the world truly belongs to everyone, then it matters little whether my neighbour was born in my country or elsewhere.” This means we are fundamentally in communion with the whole human family, as “the mutual sense of belonging is prior to the emergence of individual groups. Each particular group becomes part of the fabric of universal communion and there discovers its own beauty.”
ing nations to welcome migrants with generosity, respecting their fundamental, shared human dignity. In his 2018 Apostolic Exhortation, Gaudete et Exsultate, Pope Francis invited Christians to “stand in the shoes” of migrants “who risk their lives to offer a future to their children,” rather than simply view the challenges of migration as an abstract problem to be solved. The proper and primary response of Christians to the arrival of migrants is to appreciate their vulnerable position and see the challenge from their perspectives.13
In Fratelli Tutti , Pope Francis envisaged an actively generous response on the part of receiving nations, one that is gratuitous in offering a welcome, even if it brings no immediate tangible benefit to receiving states, imitating the gratuitous generosity of God, who gives freely. Such generosity stands in stark contrast to some nations’ immigration programs that selectively favor those prospective migrants who can bring significant benefits to their communities, such as “scientists or investors.”14
“Immigrants, if they are helped to integrate, are a blessing, a source of enrichment and new gift that encourages a society to grow.”
— POPE FRANCIS
Pope Francis pointed out that the welcome extended to immigrants is not just a matter of compassion but promotes the greater realization of our pre-existing global communion. Moreover, it even enhances the human dignity of both those who migrate and those who receive them, as Pope Francis’ encyclical notes: “The arrival of those who are different, coming from other ways of life and cultures, can be a gift … Indeed, when we open our hearts to those who are different, this enables them, while continuing to be themselves, to develop in new ways.” For receiving societies, immigrants can be a benefit rather than a liability: “Immigrants, if they are helped to integrate, are a blessing, a source of enrichment and new gift that encourages a society to grow.”12
Pope Francis consistently appealed to receiv-
While Pope Francis emphasized the need to extend a dignified welcome to immigrants and facilitate their integration (without threatening their particular identities), he conceded a need for receiving states to regulate their entry for good reason: “Prudence on the part of public authorities does not mean enacting policies of exclusion vis-à-vis migrants, but it does entail evaluating, with wisdom and foresight, the extent to which their country is in a position, without prejudice to the common good of citizens, to offer a decent life to migrants, especially those truly in need of protection.”15
The pope’s prophetic call for wealthy nations to generously receive and integrate migrants in need can sit in tension with such a responsibility to prudently regulate migrant admission in a way that promotes the welfare of their own
communities. When trying to make sense of national sovereignty and border enforcement, it may be fruitful to turn to our Catholic tradition’s teachings on private property and the universal destination of goods.
Like those holding private property, nations claim to have exclusive control over their bordered territory and exercise authority over migrant admission. In the Christian tradition, claims to exclusive control of property or territory sit in tension with the “universal destination of goods,” that is, the understanding that all created goods are intended for the benefit of all creation. This principle should not be confused with some socialist ideal of collective ownership or redistribution. Rather, it means that the goods of creation, regardless of how they are held, are meant to be used for the good and sustenance of all creation and for ongoing generations.16 As such, a person cannot exercise absolute, exclusive control of goods or land without concern for the greater good of all.
This problem of property has been a recurring theme across modern Catholic social teaching. This tradition responds to Jesus Christ, who the Gospels record challenging his followers to relinquish what they hold and give to the poor to be perfect, suggesting that property and wealth can be an obstruction to discipleship (Matthew 19: 16-30). The question of private property, in both its need for one’s own sustenance and the exercise of charity, as well as its danger to Christian perfection, has posed a rich creative tension throughout Christian social thought; one that can also illuminate its approach to national borders.
A key distinction that has emerged in the Christian tradition’s reflection on private property, and which has helped reconcile its tensions, has been between the “right” to hold private property and the proper “use” of such property. In distinguishing between the right and use of private property, this body of teaching orients the private holding of property toward a social use ordered to the universal destination of goods. This distinction places the onus of responsibility on possessors to discern an appropriate balance in how they use their privately held goods for their own selfpreservation (and that of any dependents) and for a social purpose oriented to the good of their communities and beyond. Correspondingly, nations are likewise challenged to use their territorial sovereignty, with accompanying control over borders
and migrant admission, for a social end in practicing generous hospitality and outreach to those in need beyond their borders.
Immigration will likely remain an intractable policy problem and a contentious issue in public discourse. Hence, it deserves sustained ethical reflection of depth. The Christian tradition, while primarily drawn to promoting the interests of prospective migrants, can recognize nations’ legitimate exercise of border controls and enforcement measures. Yet this holds only insofar as nations respect human dignity and use these measures to promote the interests of all: citizens, immigrants and those beyond their borders.
BRETT O’NEILL, SJ, is a former Australian immigration officer and is now a Jesuit priest. He recently completed a PhD at Boston College in theological ethics.
1. Tim Balk, “Cases Challenging the Trump Administration’s Deportations Hinge on Two Key Legal Terms,” The New York Times, April 20, 2025, https://www.nytimes.com/live/2025/04/20/us/ trump-news#due-process-habeas-corpus-trump; Myah Ward, “Behind Trump’s Push to Erode Immigrant Due Process Rights,” Politico, April 28, 2025, https://www.politico.com/news/2025/04/28/ trump-immigration-100days-due-process-00307435.
2. “Press Briefing by Press Secretary Karoline Leavitt,” The White House, January 29, 2025, https://www. whitehouse.gov/briefings-statements/2025/01/ press-briefing-by-press-secretary-karoline-leavitt; The White House, “Executive Order 14163 of January 20, 2025: Realigning the United States Refugee Admissions Program,” Federal Register 90, no. 19 (2025): https://www.govinfo.gov/content/pkg/FR-2025-01-30/ pdf/2025-02011.pdf.
3. Cara Tabachnick, “Vice President JD Vance Blasts U.S. Catholic Bishops Condemning ICE Entering Churches and Schools,” CBS News, January 26, 2025, https:// www.cbsnews.com/news/jd-vance-interview-face-thenation-catholic-bishops-ice-order/.
4. “Figures at a Glance,” UNHCR, https://www.unhcr. org/about-unhcr/overview/figures-glance; “Data,” International Organization for Migration, Missing Migrants Project, https://missingmigrants.iom.int/data.
5. Stephen J. Pope, “The Problem with JD Vance’s Theology of ‘Ordo Amoris’—and Its Impact on Policy,” America: The Jesuit Review, February 13, 2025, https:// www.americamagazine.org/faith/2025/02/13/
ordo-amoris-stephen-pope-vance-249926.
6. Pope Francis, “Letter of the Holy Father Francis to the Bishops of the United States of America,” The Holy See, February 10, 2025, https://www.vatican.va/content/ francesco/en/letters/2025/documents/20250210lettera-vescovi-usa.html.
7. “Erga Migrantes Caritas Christi,” The Holy See, https://www.vatican.va/roman_curia/ pontifical_councils/migrants/documents/rc_pc_ migrants_doc_20040514_erga-migrantescaritas-christi_en.html.
8. Pope Paul VI, “Populorum Progressio,” The Holy See, section 67, https://www.vatican.va/content/paul-vi/en/ encyclicals/documents/hf_p-vi_enc_26031967_ populorum.html.
9. Pope Paul VI, “Octogesima Adveniens,” The Holy See, section 17, https://www.vatican.va/content/paul-vi/en/ apost_letters/documents/hf_p-vi_apl_19710514_ octogesima-adveniens.html.
10. Pope Francis, “Visit to Lampedusa: Homily of Holy Father Francis,” The Holy See, July 8, 2013, https://www.vatican.va/content/francesco/en/ homilies/2013/documents/papa-francesco_20130708_
omelia-lampedusa.html.
11. Pope Francis, “Fratelli Tutti,” The Holy See, section 111, https://www.vatican.va/content/francesco/en/ encyclicals/documents/papa-francesco_20201003_ enciclica-fratelli-tutti.html.
12. Francis, “Fratelli Tutti,” sections 125, 133, 134, 135 and 149.
13. Pope Francis, “Gaudete et Exsultate,” The Holy See, section 102, https://www.vatican.va/content/francesco/ en/apost_exhortations/documents/papa-francesco_ esortazione-ap_20180319_gaudete-et-exsultate.html.
14. Francis, “Fratelli Tutti,” section 139.
15. Pope Francis, “Address of His Holiness Pope Francis to the Members of the Diplomatic Corps Accredited to the Holy See for the Traditional Exchange of New Year Greetings,” The Holy See, January 9, 2017, https:// www.vatican.va/content/francesco/en/speeches/2017/ january/documents/papa-francesco_20170109_ corpo-diplomatico.html.
16. Pope Francis, “Laudato Si’,” The Holy See, sections 93-95, https://www.vatican.va/content/francesco/en/ encyclicals/documents/papa-francesco_20150524_ enciclica-laudato-si.html.
PILGRIMS OF HOPE
SR. SHARON ZAYAC, OP Co-founder of Jubilee Farm
Pilgrims of Hope: What better words could the late Pope Francis have used to name this Year of Jubilee.
Pilgrims are seekers drawn to make pilgrimages. Pilgrimages are journeys to special and holy places, places that draw forth from within us a deeper sense of connection and belonging to something greater than ourselves. These places can be as far away as we wish, or as close as our backyards, as in my case, the acres of prairie land and woods known as Jubilee Farm. This ecology and spirituality center is sponsored by my congregation and located west of Springfield, Illinois. These spaces and the journeys themselves often inspire personal transformation, leaving us in a different place than we were before.
Hope is a necessary element of these journeys, as it often motivates the journey itself. Hope certainly keeps us on the path and then may itself be transformed into something totally unexpected. Hope is not a given. We cannot sit around waiting for hope to drop in our laps and make us feel better. It is a choice we intentionally make, not once but each and every time we are tempted to choose otherwise.
In her opening remarks for the launch of the Catholic Climate Covenant’s Pilgrims of Hope for Creation — a nationwide initiative that includes organizing pilgrimages to support living in right relationship with the Earth (see sidebar on page 20) — theologian Sr. Elizabeth Johnson, CSJ, likened hope to a muscle of resilience, a muscle of countercultural
resistance. We all know what happens to muscles when they are not regularly used or stretched just a bit beyond their normal routines. So it is with the muscle of hope. Hope itself needs to be used and
Hope is not a given. We cannot sit around waiting for hope to drop in our laps and make us feel better. It is a choice we intentionally make, not once but each and every time we are tempted to choose otherwise.
stretched often. And like all muscles, hope works not just in and of itself but in tandem with others. When we choose hope, we choose it not just for ourselves. Our individual hope must be joined with the collective hope of all those who choose
Pilgrims of Hope for Creation is a nationwide initiative launched by a coalition of Catholic and other organizations that care for creation. The initiative calls for Catholics and Catholic institutions to reflect on the profound relationship between God, humanity and creation and to take concrete steps toward healing the Earth and renewing their spiritual commitment to care for creation. The initiative culminates during the Season of Creation (Sept. 1 – Oct. 4, 2025), a time for prayer, reflection and action focused on the environmental crisis facing our world today.
In 2025, the Catholic Church marks a significant year in its history with three significant events: 1) a Jubilee Year; 2) the 10th anniversary of Pope Francis writing the encyclical Laudato Si’: On Care for Our Common Home; and 3) the 800th anniversary of St. Francis of Assisi writing the “Canticle of the Creatures,” a holy poem that served as one of the inspirational guides for Laudato Si’.
The Catholic tradition offers a beautiful way to honor such monumental anniversaries: pilgrimage. For individuals, pilgrimages foster spiritual growth, build community and deepen our connection to God. For Catholic institutions, pilgrimages are a formation opportunity to help colleagues understand and embrace the organization’s mission to be a steward of creation.
Partners in this effort, including CHA, are working through their networks to encourage pilgrimages around the country during the Season of Creation.
Nearly two dozen Catholic organizations across the United States have come together to oversee this effort.
it. Otherwise, it is all too easy to sink into despair, apathy and compliance with injustice.
In a March 2025 letter titled The End of the World? Crises, Responsibilities, Hopes , Pope Francis affirmed the need for collective hope. He wrote that hope “does not consist of waiting with resignation, but of striving with zeal towards true life, which leads well beyond the narrow individual perimeter.”1 Hope is a choice we make to meet the challenges in our personal lives and, when joined with others, works to build that mutually enhanc-
There are many ways to get involved in the Pilgrims of Hope for Creation initiative:
Sign up for the monthly training series to learn how to join or start your own pilgrimage, work with the media, and celebrate and continue your journey. For further details and to register, visit https://catholicpilgrimsofhope.org/. Consider becoming a pilgrimage leader in your community. You can also do this in Spanish. If you’re an organizational leader, consider collaborating with us. Visit https://catholic pilgrimsofhope.org/ for further details.
For more information for CHA members, please contact Indu Spugnardi, CHA’s senior director of community health and elder care, at ispugnardi@chausa.org.
Information provided by the nonprofit Catholic Climate Covenant.
ing world where living in right relationship with the entire Earth community is the norm and not the exception.
There is no doubt that our opportunities for stretching that hope muscle are exponentially multiplying. In that same letter, sent to the participants in the General Assembly of the Pontifical Academy for Life, Pope Francis addressed the current world’s “polycrisis.” It is not a new word but one that has now come into its own in a frighteningly apparent way. We witness it on the daily news and experience it within our local and global communities. We know that more than 100 wars
and armed conflicts are raging around the world,2 and that gun violence, food crises, massive migrations, loss of employment, deepening poverty and epidemics are escalating. And many more of us are accepting the science that shows that all of these calamities are either caused or exacerbated by climate disruption.
The increasing frequency and intensity of storms, floods, drought, heat and rising sea levels are altering the course of life on this planet.3 We see much of the world we have known literally deconstructing around us. We witness or even personally experience the consequences of these crises and the flagrant lack of compassion for our human and other-than-human sisters and brothers.
So how do we choose hope in these escalating crises? Why do we choose it? Where do we find it?
Very simply, we choose it because it is the human thing to do. Our survival as a species has been predicated on exploration, seeking out and moving into sometimes incredibly harsh landscapes that have daunted other species. Our capacity to always search for greater food security and safety and for more opportunity relies on the hope that they are there to be found. We are rational creatures. We are also spiritual creatures. Our innate belief that there is something much greater than ourselves feeds our hope that life can be better than it is and that we have a part in making that happen.
Our young people rally against book bans, challenge us about the consequences of the Doctrine of Discovery, and become climate activists who have moved judicial courts to act in their favor. These and many thousands of other efforts around the globe are building a community of hope that will not be squelched.
In concert with these actions is our growing understanding of how intimately we are all connected with one another, with the whole. Our actions, our lifestyle choices, our political and economic decisions are driving the planet’s chaos, and we are accountable for them. As humans and as people of faith, it is our role and obligation to live as responsible members of the Earth community. Living in right relationship with our human sisters and brothers, the rest of the Earth community and with God is essential to the entire planet’s health and well-being and is the foundation for living just lives.
Where do we find hope? We look for it. It is just as evident as the devastation and waste of life we hear of with each news report. We may just need to look harder to see it.
Where do we find hope? We look for it. It is just as evident as the devastation and waste of life we hear of with each news report. We may just need to look harder to see it. There is a growing wave of response, a countercultural resistance of hope to the polycrisis, either meeting it head-on or eroding it from underneath. Many of us are engaging in ways we never anticipated.
We march or speak out when we have never done so before. We form groups to meet with our local legislators about clean energy. We organize training sessions to teach immigrants their rights, and we advocate on behalf of Black and Indigenous farmers. We choose alternative ways to grow our food and to live more sustainably with the rest of the Earth community. We enact and implement our Laudato Si’ Action Platform plans, doing what we can with whatever capacity we have.
This growing awareness points to a major shift in human consciousness, a transformative shift. In the encyclical Laudato Si’: On Care for Our Common Home, Pope Francis, echoing both Pope John Paul II and Pope Benedict XVI, calls us all to a conversion of consciousness to move from an anthropocentric worldview to an ecological one. Such a worldview plants us solidly in the reality that we live in intimate relationship with the whole of life, as well as with all that supports life (like water, soil and air). Believing we are autonomous beings, separate from and superior to the rest of creation, perpetuates an unholy and even deadly arrogance. We are now living with those consequences. Pope Francis uses the term “integral ecology” to lift up the understanding that everything that happens on this planet affects the whole of us. Science teaches us that. Our faith in a loving Creator holds us to that. Pope Francis has rejoined the scientific term integral ecology with its spiritual nature; by re-membering, a play on the word
remembering, he reminds us that our connection with creation was something we once innately understood but have forgotten. It is not just that all of creation is integrated or whole in how it functions. Knowing and living that understanding underpins a spirituality that demands from us lifestyles and decision-making that benefit all — not just a very small chosen few.
We are all pilgrims. We are planetary pilgrims. That does not mean we are looking for a home of heavenly bliss off this Earth. It means we are on a pilgrimage to find the beauty and sanctity of Earth herself. We are to interiorize the depth of our relationship with her and, therefore, with her Creator, who continually pours Itself into all It creates.
Such pilgrimages are lifelong opportunities for transformation. We find them on our own, and we join others on their pilgrimages. And this year, we have a wonderful opportunity to make it a collective experience.
This year holds three significant events, all of which celebrate the themes of pilgrimage, hope, transformation and the sanctity of the Earth
community.
It is a Year of Jubilee. It is the 10th anniversary of Laudato Si’, and it is the 800th anniversary of St. Francis of Assisi’s “Canticle of the Creatures.”
Through the Catholic Climate Covenant’s Pilgrims of Hope for Creation initiative, organized by Catholic organizations, all of us — individuals and communities — are encouraged to journey to local or national places of beauty, healing or even desecration. These special, holy places are longing to have us re-member our intimate relationship with the greater whole to which we belong. It is this reconnecting that will motivate us to build the kind of community where the whole of creation is given the inherent respect and reverence with which it was lovingly created. What is created reflects the Creator. Creation is an expression, a manifestation of the Creator. It is in creation that we meet the Creator. It is in each created subject that we come to know a bit more about the One who crafted it. As Meister Eckhart, a 13th-century Dominican mystic wrote, every creature is a book about God.
Upon announcing the Year of Jubilee, Pope Francis reminded us that how we see the world
and how we interpret it and all its unprecedented, interrelated life forms can provide us with signs of hope. We continue to take to heart his compelling words in Laudato Si’ that the “ecological conversion needed to bring about lasting change is also a community conversion.”4 This conversion comes from the many small and often unknown efforts that call forth “a goodness which … inevitably tends to spread.”5 We are only asked to play our part. Embracing our role in this incredibly diverse and interrelated creation allows us, along with St. Francis of Assisi, to praise and celebrate the unique gift each part of creation offers to the whole.
May our individual and communal pilgrimages transform our minds and hearts as together we work to co-create a world where all might flourish.
SR. SHARON ZAYAC, OP, is co-founder of Jubilee Farm, her congregation’s center for ecology and
spirituality. She writes, speaks and leads retreats on ecology, spirituality, Laudato Si’ and the climate crisis.
1. Pope Francis, “Message of the Holy Father to Participants in the General Assembly of the Pontifical Academy for Life,” The Holy See, https://press.vatican.va/content/salastampa/en/ bollettino/pubblico/2025/03/03/250303a.html.
2. “Today’s Armed Conflicts,” Geneva Academy, https://geneva-academy.ch/galleries/ today-s-armed-conflicts.
3. For more information, see “Extreme Weather and Climate Change,” NASA, https://science.nasa.gov/ climate-change/extreme-weather/.
4. Pope Francis, Laudato Si’, The Holy See, paragraph 219, https://www.vatican.va/content/francesco/en/ encyclicals/documents/papa-francesco_20150524_ enciclica-laudato-si.html.
5. Francis, Laudato Si’, paragraph 212.
“In this our time, we still see too much discord, too many wounds caused by hatred, violence, prejudice, the fear of difference, and an economic paradigm that exploits the Earth’s resources and marginalizes the poorest. For our part, we want to be a small leaven of unity, communion and fraternity within the world.”
— Pope Leo XIV at his Inaugural Mass, May 18, 2025
SR. TERESA MAYA, PhD, CCVI Senior Director of Theology and Sponsorship, Catholic Health Association
Catholic health care has been blessed by the ministry of sponsorship. Sponsors have guided, nudged, accompanied, encouraged and, yes, sometimes redirected the ministry through many moments of “thick fog.” We are tempted to believe the uncertainty of our time is unique, but the veterans among us remind us that low visibility and headwinds have always been part of our story.
Each generation of sponsors must grapple with the uncertainty of its present reality. Uncertainty has always been the vocational space, the threshold space, where sponsors serve. When the ministries navigate through the thick fog, sponsors are the sentinels who, with sharpened senses and sight fixed on the horizon, trust that there is more ahead and challenge the ministry to keep sailing and to cross thresholds.
When we entertain questions about sponsorship in the quiet corners and busy hallways of our ministries, “What do sponsors do? What is sponsorship? Why do we have sponsors?” we must remember this faith-filled role, which calls us to a future full of hope.
After all, human flourishing is a long-term commitment! Sponsors hold space for the long view. The transformation of society is rarely achieved in a generation. That makes the sponsor ministry unique, the stubborn conviction that we must strive to do our best. The sisters, in my early years in community, described this as doing more: “Always more, always better, always with more love.” The “perpetuity” expected of a ministry of the Church is deeply related to this constant
striving.1 We need institutions committed to the long-term reweaving of a society where human beings can flourish.
The Church celebrates a jubilee every 25 years, and a pope can call an extraordinary jubilee more often, but why, I wondered, would the late Pope Francis open a Jubilee Year of Hope? These times are not just uncertain; they are breaking our hearts. We have witnessed human suffering on a scale that has only happened with the two world wars. We are tribalizing and fragmenting along political and theological divides. More people are on the move than at any other time in history.2
Calling for a Jubilee of Hope, Pope Francis’ magisterium finished his pontificate on the same note he started. He preached in the homily when he assumed the papacy that “amid so much darkness, we need to see the light of hope and to be men and women who bring hope to others.”3 Ours is precisely the time for hope. Hope is at the heart of the sponsor vocation. Sponsors remind us why we serve. Christian Brother Salvador Valle once explained that sponsors serve as “heart, memory and warranty” for the ministry. Sponsors serve from the heart of the ministry. Sponsor conver-
sations, discernment, prayer and direction flow from this deep connection to the heart. Sponsors remember for the future, ensuring the mission of the ministry continues unfolding true to its core identity.
Sponsors challenge us to listen to our better angels because they know with their heart and trust God’s promise. Pope Francis opened the jubilee door he would not close. Providence would have it this way; now it is up to us to finish the journey. Sponsors need to be the guides for our Catholic health care pilgrimage of hope.
Sponsorship is a future-focused, God-trusting and hope-building ministry. The DNA of Catholic health care is hope for the future. Clinics and hospitals opened because God hoped for human flourishing through our founders. The very existence of the ministry reminds us that those who came before us hoped them into being. Our ministries were created to trust in the transformation that happens through active hope. Sponsors steward this dream of a better future for each generation. Even as religious congregations projected fewer members, they knew the mission was bigger than them and that lay men and women, people of goodwill, all participated in this mission.
Sponsors are “cathedral builders.” They understand the horizon of hope is beyond themselves. Founders of religious institutes dreamed of us; they knew others would come after them to keep building a society of hope. Cathedral thinking is magnificently understood in the Basilica of the Holy Family in Barcelona. When Antonio Gaudí, a devout and recently named venerable Catholic, was interviewed about why he began a project he could not possibly see finished, he responded, “I know the personal taste of the architects that follow me will influence the works, but that doesn’t bother me. I think the Temple will benefit from it. Great temples have never been the work of just one architect.”4
When the light from the afternoon sun shines through the multicolored stained glass flowing through the basilica with pure majesty, you appreciate Gaudí’s vision. He trusted those who would come after him, and today, we find beauty and joy in this vision. The most intimate call of a sponsor is to believe in what is to come, in the infinite and incredible ways Catholic health care will promote human flourishing.
Pope Francis opened the jubilee door he would not close. Providence would have it this way; now it is up to us to finish the journey. Sponsors need to be the guides for our Catholic health care pilgrimage of hope.
The mission’s horizon of hope transcends any period of history, religious institute or individual’s attributes. Sponsorship, as the ministry we understand it today, evolved from this grounding. Religious institutes could have been tempted to think only men or women religious could steward the ministry. Instead, they trusted the relationships they had built and the commitment they had seen in the lay people of the ministry. This is why lay leadership has been so organic to Catholic health care and serves as proof that the synodal call for greater participation in the mission of the Church is prophetic and possible.
Sponsors are not the “historians” of the ministry; they are storytellers of the Gospel. They honor and embrace the founding stories, but more importantly, they embrace the future mission story. A sponsor explores the whole story, beyond the years of stagecoaches and frontier railroad hospitals, and they find in the unfolding story of Catholic health care that there are always amazing men and women engaged in the mission.5 They are lovers of the story of what has been, but they do not stay there. Sponsors take inspiration from what has been and then challenge the ministry to weave new narratives.
Sr. Nancy Shreck, OSF, has challenged generations of women religious to visualize the “not yet” of their mission. She often asks, “What if the most important contribution of religious life has not happened yet?” Sponsors need to heed her advice and, in turn, ask their ministries, “What if the most important contribution of Catholic health care has not happened yet?”
Sponsors need to challenge the ministry to appreciate and honor the journey that got us here,
to listen to the whispers of those who came before, and then to turn their gaze to what still needs to be done, to the creative and amazing possibilities of what can be. Sponsors today are challenged to have the courage, vision, sacrifice, creativity and perseverance of their forbearers so that a yet-tobe-seen response of compassion and mercy can be realized in ways we cannot even imagine today. Sponsors believe in the future of the ministry.
Sponsors are stewards of the future of our ministry, but what are the practical ways in which they exercise this responsibility? Nature, I believe, offers a glimpse into what is possible. Our ministry has been turning to creation for inspiration for several years now. We celebrate a Jubilee of Hope the same year that the call to care for creation in Laudato Si’ completes its first decade. We hope and care for creation because we care for future generations.6 Sponsors should urge our ministry to heed that call.
Has our culture shifted to embrace the diversity God has created? Have our decisions been influenced by concern for our common home? Have we been nourishing healthy ecosystems? Ecosystems of hope require more than ecological responses; they require integral approaches that sponsors must promote. We need to connect, listen and move! The Jubilee Year flows from the culture of encounter, the call to synodality and the invitation to pilgrimage that shaped Pope Francis’ papacy and guides the sponsor role as sentinel of hope.
Healthy ecosystems are communities of interactions. Sponsors ensure the ministry fosters healthy connections and an authentic culture of encounter. No one can hope alone. Philosopher Byung-Chul Han writes in The Spirit of Hope : “Fear and love are mutually exclusive. Hope, by contrast, includes love. Hope does not isolate. It reconciles, unites and forms bonds.”7 Gathering, convening and fostering connections is the first way we can live into the Jubilee Year of Hope.
Pope Francis, in the Papal Bull of Indiction for the Jubilee Year, Spes Non Confundit, wrote that “the Christian community should be at the forefront in pointing out the need for a social covenant to support and foster hope, one that is inclusive and not ideological.”8 The most resilient ecosystems are the most diverse, where difference is harmonized in interaction, respected and valued. Hope
is the gift of communion. Sponsors need to foster their own interactions and connections, building a community of trust because of their shared commitment to the mission.
Listening strengthens communities. The Jubilee Year of Hope opened as the Synod on Synodality entered the implementation stage. The final document concluded: “Practiced with humility, the synodal style enables the Church to be a prophetic voice in today’s world.”9 Listening is at the core of a synodal church. Sponsors need to call the ministries to embrace this synodal journey. Synodal listening lies at the heart of a community willing to discern the voice of the Spirit for our time:
The willingness to listen to all, especially those who are poor, stands in stark contrast to a world in which the concentration of power tends to disregard those who are poor, the marginalised, minorities and the earth, which is our common home. Synodality and integral ecology both take on the character of relationality and insist upon us nurturing what binds us together; this is why they correspond to and complement each other concerning how the mission of the Church is lived out in today’s world.10
Cardinal Michael Czerny, SJ, Prefect for the Dicastery for Promoting Integral Human Development, presenting remotely to theologians at the Synodality in America: People on the Move, Dialogue, and New Context conference in San Diego held earlier this year, explained that if we think we know how to listen, we have probably never truly listened before.
Ecosystems are constantly changing. The Jubilee Year is a pilgrimage of hope. Pilgrims first gather and build community through listening, but then they have to move. Sponsors are called to foster hopeful action, the movement and creativity that kindles the Spirit in the ministry. Han reminds us that “active and strong hope … inspire people to creative action.” 11 Sponsors serve as guides for this pilgrimage. First, they must kindle their own hope and then encourage the movement:
Hope is a searching movement. It is an attempt to find a firm footing and a sense of direction. By going beyond the events of the past,
beyond what already exists, it also enters into the unknown, goes down untrodden paths, and ventures into the open, into what-is-notyet. It is headed for what is still unborn. It sets off towards the new, the altogether other, the unprecedented.12
When sponsors commit to the future in hope, they challenge the ministry to search for, create and imagine what has not yet been.
The uncertainty we are living through will require new competencies for sponsors, both spiritual and practical. While uncertainty has always been part of the sponsor journey, the speed and liquidity of this time require spiritual alertness and a commitment to communal discernment that are unique.
This is probably why Pope Francis, in his final encyclical, Dilexit Nos (He Loved Us), reminded us that “In this ‘liquid’ world of ours, we need to start speaking once more about the heart and thinking about this place where every person, of every class and condition, creates a synthesis, where they encounter the radical source of their strengths, convictions, passions and decisions.”13 Sponsors will need an ongoing formation journey to deepen their commitment to serve as sentinels of hope and master the art of discerning in real time.
Conversations during CHA’s Sponsorship Institute in Albuquerque earlier this year made that quite clear. The findings from CHA’s recent sponsorship survey sparked the conversation. Consultants identified key areas where CHA and those interested in sponsorship should engage, including the recruitment and formation of new sponsors, the importance of a formation itinerary beyond initial orientation and preparation programs, as well as the increased need for sponsors to ensure their voice is effectively influencing the ministry.
The sponsor vocation requires a discerning disposition to serve as an effective sentinel for hope. A strengthened spiritual core, the ability to convene for communal discernment and deep listening, and the appreciative attention to what is emerging are all components of a sponsor’s ongoing formation journey. CHA will develop a framework for sponsor formation that accompanies individuals called to sponsorship from the
initial discernment to assume this role through the maturity arc of their service as they become wisdom mentors for future sponsors. At the same time, we will partner with members to create assessment opportunities and tools to help sponsors understand how effectively they are fulfilling their responsibilities.
We are grateful for the charism conversations during the Sponsorship Institute, where, reflecting on the legacy of Mother Frances Xavier Cabrini, we explored how the Holy Spirit inspires a future of hope. Fr. Joseph Driscoll, director of ministry formation and organizational spirituality for Redeemer Health, helped us remember that sponsors need to be alert to notice how the Spirit moves among us: “Every organization has a mission, only a ministry has a charism — charism animates what we do — it is invisible, real, active, alive. Moving and mysterious — it isn’t static — the Holy Spirit initiates, sustains, promises and is still moving.”
Uncertainty requires prophets of hope. Sponsors need to find their collective prophetic voice to remind our ministry that human flourishing is God’s still unrealized dream we are called to incarnate. Sponsors conspire with the Holy Spirit to ensure leaders and collaborators continue striving to make it possible and move this human pilgrimage another few steps closer to the Reign of God.
SR. TERESA MAYA, CCVI, is senior director, theology and sponsorship, for the Catholic Health Association, St. Louis.
1. The Code of Canon Law states in canon 114 that juridic persons in the Church “are aggregates of persons (universitates personarum) or of things (universitates rerum) ordered for a purpose which is in keeping with the mission of the Church and which transcends the purpose of the individuals.” More generally, a juridic person is to canon law what a corporation is to civil law. It is an entity within the Roman Catholic Church that enables a ministry to relate directly to the Church.
2. Kathleen Kingsbury, “To Understand Global Migration, You Have to See It First,” The New York Times, April 17, 2025, https://www.nytimes.com/interactive/2025/ 04/17/opinion/global-migration-facebook-data.html.
3. Pope Francis, “Homily of Pope Francis, The Holy See, March 19, 2013, https://www.vatican.va/content/ francesco/en/homilies/2013/documents/papa-
francesco_20130319_omelia-inizio-pontificato.html.
4. “Antoni Gaudí. Humanism and Spirituality,” Basílica de la Sagrada Familia, https://sagradafamilia.org/en/ antoni-gaudi-humanism-and-spirituality.
5. Zeni Fox, “Whose Ministry Is It? The Role of the Laity in the Story of Catholic Health Care,” in Incarnate Grace: Perspectives on the Ministry of Catholic Health Care, ed. Charles Bouchard (The Catholic Health Association of the United States, 2017), 231.
6. Laudato Si’ explains, “We lack leadership capable of striking out on new paths and meeting the needs of the present with concern for all and without prejudice towards coming generations.” See: Pope Francis, Laudato Si’, The Holy See, section 53, https://www.vatican. va/content/francesco/en/encyclicals/documents/ papa-francesco_20150524_enciclica-laudato-si.html.
7. Byung-Chul Han, The Spirit of Hope (Polity, 2024), 11.
8. Pope Francis, “Spes Non Confundit,” The Holy See, section 9, https://www.vatican.va/content/francesco/ en/bulls/documents/20240509_spes-non-confundit_ bolla-giubileo2025.html.
9. Pope Francis and XVI Ordinary General Assembly of the Synod of Bishops, “For a Synodal Church: Communion, Participation, Mission–Final Document,” USCCB, 2024, https://www.usccb.org/resources/ENG ---Documento-finale_traduzione-di-lavoro.pdf.
10. Francis and XVI Ordinary General Assembly of the Synod of Bishops, “For a Synodal Church.”
11. Han, The Spirit of Hope, 23.
12. Han, The Spirit of Hope, 5.
13. Pope Francis, “Dilexit Nos,” The Holy See, section 9, https://www.vatican.va/content/francesco/en/ encyclicals/documents/20241024-enciclica-dilexit-nos. html.
from
United Against Human Trafficking Networking Call
July 22 | 1 – 2 p.m. ET
Faith Community Nurses Networking Call July 30 | 1 – 2 p.m. ET
Global Health Networking Call Aug. 6 | 1 – 2:30 p.m. ET
Mission Leader Seminar — Embracing Hope: Our Courageous Path Forward Tuesdays starting Sept. 9 | 1 – 2:30 p.m. ET weekly
Community Benefit Networking Call Sept. 18 | 1 – 2 p.m. ET
Community Benefit 101 Oct. 21 – 23 | 2 – 5 p.m. ET daily
“
” May the God of hope fill you with all joy and peace in believing, so that you may abound in hope by the power of the Holy Spirit.
(ROMANS 15:13)
PILGRIMS OF HOPE
JUDITH VALENTE Contributor to Health Progress
“When in doubt, just take the next small step.” — Paulo Coelho, The Pilgrimage
There is a beautiful painting in warm, pastel colors by the artist Dorsey McHugh of seven figures we see only from behind. They are male and female, young and old. They walk with their arms across each other’s shoulders or clasp hands, all traveling in the same direction. The work is titled, “Walking Each Other Home.”
The painting beautifully distills the experience of being on a pilgrimage. The instinct to set out with a group of fellow sojourners toward a shared destination in search of some new knowledge remains embedded in the human psyche.
“There is within the human heart the need to set out on pilgrimage as if there is a power unlocked in the journey,” Catholic priest and author Fr. Dwight Longenecker writes in his “The Power of Pilgrimage” essay.1 “There is a sense of seeking and finding — that through one’s visit to the holy places there will be growth in grace, enlightenment and new inspiration.”
Such quests recall the allegorical figures Odysseus, St. Brendan the Navigator and the many other mythological characters philosopher Joseph Campbell describes as heroes “with a thousand faces,” who embark on an unknown path, stare down obstacles, and confront their doubts and fears to arrive at a newfound wisdom.2
Pilgrimages are unlike other travel experiences. Their principal goal isn’t sightseeing, relaxation or even a desire for a new adventure. Pil-
grimage is entwined with a spiritual aim. Muslims might set out for the Saudi city of Mecca, Jews for Jerusalem, and Christians for Rome and the Christian sites in the Holy Land. Buddhists travel to Bodh Gaya, India, where the Buddha is said to have attained enlightenment. Last year, nearly a half million pilgrims completed the Camino de Santiago in Compostela. It ends at the Cathedral of Santiago de Compostela in Galicia, Spain, where the remains of St. James the Apostle are buried.3
They walk, ride bicycles, ride horseback or travel by wheelchair. The number of people journeying along this sacred path has increased by 90% in the past decade, according to the Pilgrim’s Reception Office on the Camino.4
What is the lure of pilgrimage? It marks a time when we remove ourselves from our usual surroundings and step outside of what feels safe and familiar. We alert our senses to a new environment and to what might be stirring inside of us. We seek to discover new parts of ourselves or perhaps rediscover those parts that have become buried in the dust of ordinary duties and daily
routines. The goal is not information as much as transformation.
“Always in a pilgrimage, there is a change of mind and change of heart,” the Irish poet and philosopher John O’Donohue observed. 5 “We stand at the threshold, looking back and looking ahead,” is how Catholic author and Servite Sr. Joyce Rupp, OSM, describes the journey in one of her poems.6
I personally witnessed the transformative power of pilgrimage take hold among the people who joined me on two separate contemplative/cultural pilgrimages that I led at lesser-known sacred sites in Italy over the past two years. The Greek term heterotopia refers to being in a place that disturbs our usual perceptions. It is a necessary starting point for any pilgrimage. On the first evening we come together, I encourage each person to put aside expectations of what they think could be or should be and to put themselves “in the way of grace,” to borrow a favorite phrase of the poet Mary Oliver. Call it grace, call it magic, call it the work of the Holy Spirit, but significant changes begin unfolding. An 80-year-old woman joined us on the first year’s pilgrimage. She had been an early childhood specialist before her retirement. She told me before we left that she believed this trip would be her last. During our time together, she tried unfamiliar foods, walked farther than she thought she ever could, and made friends among people whose language she didn’t speak. She not only joined us again on the following year’s pilgrimage, but she has also signed up to come a third time.
confront a cancer diagnosis she learned of right before she left on the trip.
The 80-year-old woman on the pilgrimage regretted not being able to make the rigorous hike to the Benedictine monastery that first year. Returning home from the trip, she signed up for physical therapy. She shed some pounds. The result: She was able to complete the trek the second year with just the aid of a cane.
We are all just walking each other home.
Another woman told me that having the stamina to walk amid soaring gorges and complete an arduous uphill climb leading to a ninth-century Benedictine monastery gave her the courage to
While there is only scattered research documenting the physical well-being pilgrims experience, there is abundant anecdotal evidence. Many of the nearly half million people who walked parts of the 485-mile El Camino de Santiago last year surely suffered foot blisters, the occasional pulled muscle and sore joints. However, those who complete the journey also say they experience enhanced flexibility and balance, improved muscle and joint strength, and better cardiovascular health, including lower blood pressure and bad cholesterol.7 Weight loss is also a frequent by-product.
“Today, walking enthusiasts are dramatically expanding their horizons by exploring ancient pilgrimage trails, fueling a global trend as record numbers of travelers take up multiday hikes infused with spiritual exploration and cultural heritage in countries around the world.”
— 2024 GLOBAL WELLNESS SUMMIT REPORT
Because of these outcomes, the Global Wellness Summit cited walking pilgrimages as one of the key wellness trends of 2024.8 The summit is a four-day annual meeting that brings together those from medicine, science, business and academia who study wellness outcomes and trends.
“One silver lining that came out of the pandemic gloom is that people all around the world rediscovered the simple joys and health benefits that come from walking, and a purposeful connection with nature,” the group wrote in its 2024 report. “Today, walking enthusiasts are dramatically expanding their horizons by exploring ancient pilgrimage trails, fueling a global trend as record numbers of travelers take up multiday hikes infused with spiritual exploration and cultural heritage in countries around the world.”9
At the end of the Italy pilgrimage, I ask each person to share one thing they might do differently when they return to their usual routine. Several mention the desire to pause in the course of a day and pay attention to what is happening in the present moment to gain a better sense of having lived the day. Some said they intended to wake up earlier each day to see the sun rise. Others vowed to keep looking for examples of what one termed as “the good happening all around us.”
The bonding that occurs, which fosters a sense of community, is another important benefit and draw. There wasn’t a moment on the journeys I’ve led when an elderly member of the group didn’t have the arm of one of the younger members to lean on as we went on walks or hikes.
The impulse to form community led two young men — Will Peterson and David Cable — to found Modern Catholic Pilgrim, a nonprofit that organizes pilgrimages for mainly young people.10 The idea sprang from an experience the two friends had shortly after graduating from University of Notre Dame and went on a walking pilgrimage in
Kentucky, from Lexington to the Trappist Abbey of Gethsemani outside of Louisville. At the time, Peterson was working as a peace and justice intern at a parish in Lexington and Cable was teaching at a Catholic academy in Indianapolis.
While that organization is currently shifting its approach to provide resources rather than plan pilgrimages itself, the young people drawn to past Modern Catholic pilgrimages perhaps have more in common with the sojourners of the Middle Ages than today’s wilderness campers. They don’t carry tents or sleeping bags or rely on vehicles to transport them. Instead, they trust in the generosity of community members who volunteer in advance as hosts to receive, feed and house them along the journey.
“There is something empowering about walking alongside another person, having a shared destination, learning their story, hearing about their hopes and dreams, praying for and with each other,” says Sam Vargo, who went on a seven-day walking pilgrimage from St. Nicholas of Tolentine Church in the Bronx, New York, to the National Shrine of St. Rita of Cascia in Philadelphia and narrated a short video on the journey.
We are all just walking each other home.
The pilgrimage experience also has a way of alerting us, like an alarm bell, to what we need to change within ourselves. I’ve always been a perfectionist who grows impatient when things go wrong. On pilgrimage, lessons often arrive in unexpected ways. One day, the electricity went out in the part of town where I was lodging in Italy. I walked outside to see an elderly shopkeeper seated placidly on a wooden chair in front of her store. When I grumbled in Italian about the power outage, the woman simply smiled and said, “Pazienza,” which means “patience.”
The great Trappist monk and spirituality writer Thomas Merton once observed that the
physical journeys we take are but the “symbolic acting out of an inner journey.” The social justice activist Dorothy Day, co-founder of the Catholic Worker Movement, called her newspaper columns, “On Pilgrimage.” Though Day traveled widely, her inner journeys often took place as she observed life from the easy chair she kept positioned by her second-story room window at the Catholic Worker house of hospitality in lower Manhattan.
Is the pilgrimage experience possible for those who, for various reasons, cannot attempt a physical journey? What can be their chair, their window into a new perspective?
If we look at our lives as a pilgrimage, we really don’t have to travel anywhere. Each day that we live is like a stop at a shrine as we progress to our ultimate destination. We can stay home and still adopt a pilgrimage attitude. All that is necessary is to take a vow of wonder. In her essay, “The Necessity of Pilgrimage,” writer Kathleen Tarr notes that this can mean relishing our random encounters and everyday conversations, being a humble listener, and being open and receptive to people and experiences that might at first seem
“other.”11
By taking a vow of wonder, by looking at our lives as a pilgrimage, Tarr writes, “We can alleviate the empty feelings that we are nothing more than digital bits controlled and distracted by algorithms and the media gods … Pilgrimage reclaims something of what’s been trampled and lost.”
There is a wonderful legend about St. Brendan the Navigator, a Celtic saint who embarks with some fellow monks in a boat to find the “Island of the Saints,” which he has only seen in a vision. The monks sail in circles, visiting many of the same places again and again, each time seeing them from a different perspective.
Ultimately, St. Brendan realizes that what he was searching for was within him. “Only when his eyes are opened, does he see that this paradise he seeks is right with him,” writes Celtic expert Christine Valters Paintner in an essay on St. Brendan.12
To some extent, we all possess a veil that hides the paradise we hold within. Pilgrimage — whether moving or stationary — helps remove that veil. When we lift that blinder, Merton has said, we are better able to see ourselves and “the
stranger who is Christ, our fellow pilgrim and traveler.”
“I felt in need of a great pilgrimage, so I sat still for three days and God came to me,” the 15thcentury Indian mystic and poet Kabir said. What, then, is to stop us from living every day of our lives as a pilgrimage? Truly, nothing.
Wherever we are, we are all just walking each other home.
JUDITH VALENTE is a retreat leader, journalist and author, including the recently published book, The Italian Soul: How To Savor the Full Joys of Life (Hampton Roads Publishing). She has won numerous awards for her work as a former correspondent for PBS, two NPR stations, The Wall Street Journal and as the author of several spirituality titles. She is also president of the International Thomas Merton Society.
NOTES
1. “The Power of Pilgrimage,” The Imaginative Conservative, February 2019, https://theimaginativeconservative.org/2019/02/power-pilgrimage-dwightlongenecker.html.
2. Joseph Campbell, The Hero with a Thousand Faces (Princeton University Press, 1968).
3. Michelle La Rosa and Brendan Hodge, “Camino Sets Another New Record for Pilgrims in 2024,” The Pillar, January 8, 2025, https://www.pillarcatholic.com/p/ camino-sets-another-new-record-for.
4. “Camino de Santiago 2024 Pilgrim Statistics,” American Pilgrims on the Camino, https://american pilgrims.org/statistics/.
5. John O’Donohue, A Celtic Pilgrimage with John O’Donohue (Sounds True, 2011).
6. Joyce Rupp, Prayer Seeds: A Gathering of Blessings, Reflections and Poems for Spiritual Growth (Sorin Books, 2017).
7. Paul Donovan, “The Pilgrimage to Santiago — The Talking Walking Cure,” BHMA, July 30, 2018, https:// bhma.org/the-pilgrimage-to-santiago-the-talkingwalking-cure/; “Health and Wellbeing on the Camino:
3 Key Aspects to Achieve It,” Follow the Camino, August 21, 2024, https://followthecamino.com/en/health-andwellbeing-on-the-camino-3-key-aspects-to-achieve-it/.
8. “Global Wellness Summit Releases 10 Wellness Trends for 2024,” Global Wellness Summit, January 30, 2024, https://www.globalwellnesssummit.com/press/ press-releases/gws-trends-2024/.
9. “Global Wellness Summit Releases 10 Wellness Trends for 2024.”
10. Modern Catholic Pilgrim, https://www. moderncatholicpilgrim.com.
11. Kathleen Tarr, “The Necessity of Pilgrimage,” The Merton Seasonal 47, no. 3 (Fall 2022): 29-34.
12. Christine Valters Paintner, “Feast of St. Brendan the Navigator — A Love Note from Your Online Abbess,” Abbey of the Arts, May 13, 2018, https: //abbeyofthearts.com/blog/2018/05/13/feast-ofst-brendan-the-navigator-a-love-note-from-youronline-abbess/.
Author Judith Valente describes multiple ways a pilgrimage varies from a trip, hike or voyage. At its foundation, a pilgrimage involves a journey to a holy place that allows for a transformation of heart, mind and spirit.
1. Have you made a pilgrimage to a sacred place? Did you set off with expectations, or did you find it more helpful to begin with an open mind and without a plan for what might occur?
2. In a time when it can seem that we’re bombarded with information or that the world around us can be overwhelming, think about whether there’s a way to engage in a pilgrimage close to home. Is there somewhere significant you’ve been wanting to visit? Can you incorporate prayer or reflection? Set an intention or commit to a period of silence? What would be meaningful for you?
3. Think about ways a pilgrimage experience might lead to greater contentment or joy in your life. Please see additional resources throughout this issue of Health Progress related to pilgrimage. Would you and a group consider a pilgrimage on behalf of celebrating and protecting creation (see page 18)? What about a walking journey that involves prayer and reflection (see pages 71 and 72 for Spanish and English versions of Prayer Service)?
4. Are you ready and willing to embark on the inner journey of pilgrimage? To sit still and let God find you? To take a vow of wonder?
It’s so easy to cede our time and attention to everyday pressures, commitments and responsibilities. And while there is a lot of focus on the importance of building resilience and avoiding burnout in Catholic health care settings, Health Progress wanted to share some of the ways people attend to and strengthen their spiritual lives. Whether vowed religious or a layperson, Catholic or from another spiritual tradition, we asked several people to share aspects of their prayer and spiritual practice in hope that others may find it illuminating and to serve as a reminder of the importance of tending to our own spirits.
Mission Leader, Holy Cross Health, part of Trinity Health, Silver Spring, Maryland
What’s one spiritual practice you have integrated and consider core to your prayer and spiritual life?
Regularly, I practice a variety of spiritual practices — to name a few, journaling, a sacred pause, active listening and community service, but recently I have leaned into cultivating and honing a spiritual practice of extending hospitality at every touch point. Whether at work or among friends, often I am told that my “Midwest roots” of hospitality show themselves as I extend hospitality in various contexts. At its core, hospitality involves creating a sacred space where individuals feel valued, heard and cared for as a whole being — physically, emotionally and spiritually. I have found that extending or receiving moments of hospitality is a simple effort with profound impact that builds outstanding relationships.
The practice of welcoming others as they are and helping them feel comfortable is a simple gesture, found in sacred texts and amidst cultural and religious traditions, that leads to genuine connection while fostering personal growth. Extending hospitality has not only deepened my faith but, at times, provided me with a sense of
purpose and meaning. Viewing hospitality as a spiritual practice, like in the sacred text of Luke 10:38-42 with Martha, Mary and Jesus, transforms hospitality from a mere act into a pathway for spiritual enrichment and community building.
I have been surprised how encountering hospitality has helped me move beyond surface-level interactions and encouraged me to genuinely listen to others, embody servant leadership, and inspire hope within my spirit.
During my childhood, I spent a few years living in Galicia, Spain. I lived in a town that was on the Camino de Santiago pathway. I remember regularly seeing pilgrims journeying through Ferrol to Santiago de Compostela. These pilgrims would often ask for directions, lodging locations or grocery stores, and I would take joy in helping them fulfill their needs. Helping patients, strangers, new community members or pilgrims find their way in unfamiliar circumstances is the start to building trusting relationships and serving one another. At times, I have found that offering or seeing hospitality can touch a multitude of people, creating a ripple effect of culture change.
Is it helpful to engage in this prayer or spiritual act in a particular environment?
This practice of hospitality can be offered in a variety of environments. It can be as simple as helping community members find their way within the care setting or post discharge. Hospitality only takes a second or two, and is best engaged in offering or receiving, and by being fully present. I try to find new ways to offer hospitality, and that is what continues to help me feel rooted in this practice.
In addition to this, at least three times a year I try to volunteer with other community partners to strengthen relationships within the community and know deeply the needs of our neighbors. A professor once told me, “Theology without ministry is like work without purpose.” This phrase has stuck with me and has informed my understanding of hospitality and ministry.
Who/what do you focus on?
I focus on extending openness, support, creating connections and purpose. In focusing on the present and the person before me, I experience moments of sacredness and deeply rich encounters. For example, when previously work-
ing in downtown Los Angeles — 10 blocks from “Skid Row,” known as the most underserved and unhoused population in America — I have come to see hospitality not as a planned “tea or coffee party” with family or friends but more as a radical understanding that our duty to our community is to welcome and offer hospitality to all members of our community, even those who have been estranged or living without basic needs met. My understanding of hospitality means offering comfort to strangers and especially to those who depend on it for their livelihood.
How often do you engage in this spiritual practice?
I try to engage in this practice as a lived charism or as often as possible. It can be as simple as offering a caregiver or community member a glass of water or listening and accompanying a leader in their needs during instances of challenges, joys and transitions. As a department leader and with colleagues, I regularly organize formal and informal hospitality events. This practice derives from my experience working in a rural emergency department as a chaplain, where I often came in touch with members of the community who depended upon the services we offered. I realized that as a collaborative member of the community, we could do more together than individually.
How is it helpful for your personal growth or resilience and to others?
This practice has been tremendously helpful to me in my own personal growth because it has strengthened my understanding of community, purpose and identity. I have joined people in their reality and invited others to join me in moments of need — creating fluid relationships that build trust. Practicing hospitality as a spiritual practice is a moral responsibility. It means taking responsibility for more than oneself and seeing our connected nature as one.
What specific learnings do you find helpful that others may learn from?
There are several books that are written on hospitality as a spiritual tradition. I recommend reading Henri Nouwen’s Reaching Out: The Three Movements of the Spiritual Life and Christine D. Pohl’s Making Room: Recovering Hospitality as a Christian Tradition
Director of Ministry Formation and Organizational Spirituality, Redeemer Health, Huntingdon Valley, Pennsylvania
What one spiritual practice have you integrated that is core to your regular prayer and spirituality? Do you set aside dedicated time for this?
Journaling is at the heart of my daily prayer practice combined with, and concluded usually by, the Liturgy of the Hours (Morning Prayer). The actual writing in my journal can go anywhere from 20-90 minutes, averaging about 45 minutes. The spiritual rule guiding length of time in any prayer form came from a retreat long ago led by Fr. George Krieger, SJ, who said, “Pray always. Abbreviate it when you must, expand it when you can, but never omit.”
Is it helpful to engage in this prayer or spiritual act in a particular environment?
A long-standing and powerful metaphor from my early spiritual journey imagines and brings to life
the environment for my prayer: walking or running through a field. The field is endlessly wide open and free, and so are the pages of the journal. Like my pen, I just start walking across the pages. The journal itself is the environment for walking or writing. It is a specific, substantial hardcover book that I can hold in my hand after the practice, look at, and know that I just met the Divine in this sacred time and space. This imaginative setting allows me to write any time or place: on a plane, a park bench, a beach, beyond my “at home” spaces that are quiet and familiar.
Who do you focus on?
Jesus. One-to-one, second-person singular, addressed as “Lord.” I utilize a method akin to Julia Cameron’s “morning pages” in The Artist’s Way. She counsels the novice to fill three pages
I can tell the difference, and I suspect others can, too, when I am praying or not praying. When I begin the day this way, I know where I am in the moment, and I know my Lord knows and loves me right there.
every morning no matter what, sort of like a “free association” methodology. I often start simple, even mundane, and just follow my pen, my heart. I might write, “Lord, I am loving this quiet and the sun on my face,” or, “Lord, this person in the seat beside me wants to talk. I am getting aggravated. Help me to be kind.” And then, often, I go to places way past: to worries real and current, long-ago hurts surfacing, joy emerging seemingly out of nowhere. It is always conversational with the Lord.
How often do you engage in this spiritual practice?
Regularly, almost every day. There are two important specifics about this spiritual practice for me. First, over many years I have overcome the inner editor responding to “What if anybody ever reads these?” No editor. And second, I almost never go back to read the past entries of now dozens of journals.
How is it helpful for your personal growth or resilience? In what ways does it benefit you and others?
“You are what you eat,” as the saying goes. I am more spiritually grounded, reflective, available to myself, others and God. The end results are less important than the process. I can tell the differ-
ence, and I suspect others can, too, when I am praying or not praying. When I begin the day this way, I know where I am in the moment, and I know my Lord knows and loves me right there.
Can you provide some learnings or spiritual prompts that you find helpful that others may learn from?
The practice is rooted in the unknown. I intentionally try to do this first in my prayer, so that my unconscious, particularly, has the freedom to express the deeper conversations of the dreaming night, for example. Rooted in the unknown, the fruit is a surprise, more often than not. It is seldom dramatic but consistently revealing. Lots of emotion can, at times, stop my pen. God’s word, specifically familiar scriptures, will be spoken back to me. I capitalize them when writing, as they just come.
Recently, a six-page, tiny script entry went places I never imagined. Suddenly, the psalmist’s words, “in your light, we see light,” from Psalm 36:10. These words brightened all the darker pages of this atypical, longer time in prayer. The surprise? When I finished, closed the journal and went to Morning Prayer, the very first refrain on the page read, “In your light, we see light.” A very real, down-to-earth, two-way conversation developed. This always occurs.
Family Medicine physician at Avera W. Benson Road clinic, Sioux Falls, South Dakota; Avera McGreevy Executive Committee; Regional Medical Director of Clinic Quality
What one spiritual practice have you integrated that is core to your regular prayer and spirituality?
As an Orthodox Christian, a core spiritual practice for me is preparing for and participating in the Divine Liturgy. Prior to receiving the Divine Mystery (the Holy Eucharist), I prepare through
prayer, fasting, confession, repentance and daily Christian living. This involves striving to remain in a state of repentance by asking for forgiveness, forgiving others, and showing love and compassion. Especially during the Lenten season, I make an effort to read more spiritual books by the Church Fathers and the saints, focusing on
practicing humility while continually examining my life. The goal is to be spiritually ready to partake of the Divine Mystery, the Holy Eucharist.
Do you set aside dedicated time for this?
As a family, we pray our morning and evening prayers together whenever possible. We also pray before meals and before engaging in various tasks or activities, even if we are alone, and especially in starting our workday and before driving.
In the Bible, 1 Thessalonians 5:17-18 (ESV) states: “Pray without ceasing, give thanks in all circumstances; for this is the will of God in Christ Jesus for you.” In the morning, after praying and upon arriving at work, I make the sign of the Cross, asking for Christ’s blessing to enlighten my mind and heart so that I may serve Him and treat my patients appropriately. Throughout the day, I often use my prayer rope — a black wool bracelet made of 33 knots and a cross, used by Orthodox Christians and Eastern Catholics — to recite the Jesus Prayer, which is a brief prayer core to Orthodox Christianity, or to ask the Holy Virgin to intercede on our behalf, much like Catholics use a rosary.
Is it helpful to engage in this prayer or spiritual act in a particular environment?
Any place is a good place to pray. We often become busy and distracted in the world, so I make it a priority to redirect my focus through constant prayer. There are times when patients share difficult experiences, and while I’m actively listening, I may also be praying for them internally, or sometimes even praying with them. It is a wonderful opportunity to practice my faith at work.
What about the environment is beneficial to you?
There are times when it’s easier to pray in a quiet environment, whether I’m with family or alone, without distractions. I prefer being alone when reading books by the Church Fathers or the saints, as I like to underline, highlight and take notes, which is challenging to do amidst external distractions. However, I very much appreciate how I am able to live my faith at work and pray at work.
Who/what do you focus on?
I focus on reciting the Jesus Prayer, which serves as a reminder to seek God’s presence in my every-
PILGRIMS OF HOPE
day life while reflecting on repentance or praying for a patient and their family. Reciting the Jesus Prayer helps the words enter my heart and reinforces a spiritual habit that cultivates a more intimate relationship with Jesus Christ.
How often do you engage in this spiritual practice?
I engage in the Jesus Prayer or ask the Holy Virgin to intercede on our behalf frequently throughout the day. Regarding my passion for learning about Church history, I read books by the Fathers of the Church and the saints and visit monasteries to venerate the saints. I do this as often as I am able, particularly during Great Lent.
How is it helpful for your personal growth or resilience?
Prayer is a humble form of communication with God. Prayer leads to humility, which opens the door to many other blessings. I often ask myself, “Who am I without Christ?” If I am not growing spiritually, I feel spiritually thirsty, sensing that something is lacking in my life. By attending the Divine Liturgy and adequately preparing to receive the Holy Mysteries while striving to live a life in Christ, I can continue to grow in my faith and work toward communion with Him.
In what ways does it benefit you and others?
My spiritual obligation and passion are to grow in
Christ — for my own salvation, for my family and for my patients. I believe I can grow in my faith at work by serving Christ through my service to my patients, treating them while Jesus, the great physician, heals them.
Can you provide some specific learnings or spiritual prompts that you find helpful that others may learn from?
I have a beautiful icon carved in the shape of a cross in every exam room. Each cross features a colorful depiction of a Bible scene created by the nuns from a monastery we visit. Patients often comment on these vibrant icons, which I believe serve as beautiful reminders of our purpose here at Avera. Additionally, I have a large photo of my three children standing in the Church of St. Timothy in my mom’s home town in Greece, which is so beautifully decorated with iconography depicting scenes from the Bible.
I would guess that at least once a week, a patient will ask me about the icons or the photo of the church. I believe these icons and photos act as symbols of our Christian faith and serve as reminders of the Avera mission, while our acts of compassion and service will affirm in one’s mind the reason and purpose in why we are seeing them today. I appreciate being able to live and grow in my faith within the ethos that is Avera as I continue to serve Christ by serving my patients.
Congregational Leadership Team, Brigidine Sisters; Board of Directors, Covenant Health, Tewksbury, Massachusetts
What one spiritual practice have you integrated that is core to your regular prayer and spirituality?
On my journey thus far, there have been many influences which have shaped and changed my spiritual practice and have been a great source of hope. In a post-Vatican II environment and the deepening awareness of the call of the laity, a broader sense of spirituality has developed. I was very influenced by the Better World Movement, which invited us to a practical hope-filled living of the Vatican II call to be “The People of God.”
In recent years, a spiritual practice which I find
sustaining and hope-filled is Centering Prayer. I made a silent retreat some years ago where the retreatants were introduced to Centering Prayer. I was grateful to later attend a workshop given by Rev. Cynthia Bourgeault at Boston College, and one at St. Joseph’s Abbey in Spencer, Massachusetts, given by Thomas Keating, OCSO, the founder of the Centering Prayer method. The phrase “Silence is God’s first language. Everything else is a poor translation” is attributed to him.
The core understanding of Centering Prayer is freeing and hope-filled in itself: that with Baptism, we participate in the life of the Trinity through
grace. In spending time in Centering Prayer, we are connecting with the Divine life within us. We choose a word which represents our desire to surrender to God’s presence and action in our lives. We recall our sacred word as we gently breathe in and exhale.
Do you set aside dedicated times for this?
I generally spend 20 minutes in the morning and 20 minutes in the evening in Centering Prayer. I have a favorite place where I sit and have the Bible and a lighted candle on a coffee table. Distractions come, and as I become aware of them, I come back to my sacred word, which I recall slowly. I find that Centering Prayer keeps me grounded and growing in faith and self-knowledge. I am also more keenly aware of relationships, of people who are ill or perhaps experiencing challenging events
in their lives, and very conscious of the need for hope in our world. Centering Prayer invites me to continue on a hope-filled journey in life.
Are there particular spiritual prompts or experiences that you find helpful that others may learn from?
Pope Francis proclaimed the theme of the Jubilee Year 2025 as Pilgrims of Hope. The theme is an invitation to embark on a hopeful journey of faith and transformation. The theme is also an invitation to reconnect with our journey of faith and sources of hope thus far. I find myself recalling my family, where my journey of faith began, my religious community, and the many people whom I have met on life’s journey who have witnessed hope in their lives. The theme also invites me to reflect over a lifetime of vary-
I find that Centering Prayer keeps me grounded and growing in faith and self-knowledge. I am also more keenly aware of relationships, of people who are ill or perhaps experiencing challenging events in their lives, and very conscious of the need for hope in our world.
ing spiritual practices and how I developed a sense of the sacred.
I remember a clear October evening when I was about 7 years of age. I was walking home from the evening devotions in Church, and I gazed up at the sky. I found the star-filled night sky utterly amazing and was filled with a profound sense of awe and awareness of the God of Creation. Nature has continued to be a source of spirituality and hopefulness for me.
As in every person’s life, life has had its challenges. However, I have found life overall to be
hope-filled. I have been privileged to meet so many hope-filled people on the way as I served in education, parish ministry, seminary education and hospital ministry. In each of these ministries, I have encountered many people who have been models of hope for me, sometimes in the midst of major challenges. I recall a young man who was paralyzed from the waist down, due to spina bifida. I said to him one day, “D., you never complain.” He responded: “And what do I have to complain about?” He surely modeled being “a pilgrim of hope” on life’s journey.
Chief Mission Officer, Providence, Spokane, Washington
What one spiritual practice have you integrated that is core to your regular prayer and spirituality?
Described in a single word, it would be “silence.” Both physically and spiritually, quieting mind, body and soul to make myself available. Silence can be perceived as doing nothing, but it can be quite active. It involves practicing the hard work of listening well.
Do you set aside dedicated time for this? The goal is to always have dedicated time in silence. I used to be very rigid about this as a spiritual practice, scheduling a specific time each day to pray in silence. But then life got busier. I would find myself feeling guilty if I missed my scheduled time due to a personal or work commitment. Learning to integrate my spirituality into my day has been more helpful than trying to
compartmentalize my prayer life as something separate. I still seek time in silence but am more flexible as to when this happens.
Is it helpful to engage in this prayer or spiritual act in a particular environment?
The Gospel accounts of Jesus tell us that he frequently prayed outdoors in the mountains, wilderness and the garden. This resonates with me. Spending time in nature seems to clear away all distractions, and true spiritual rest can be achieved. At the Providence hospitals where I work, we have established healing gardens specifically for this purpose. We also have chapels in our ministries. When Jesus was missing as a child, he was found “in my Father’s house.” Chapels and churches also facilitate silent prayer; I particularly like Eucharistic adoration.
Who/what do you focus on?
In the spiritual exercises of St. Ignatius, founder of the Jesuits, the advice is provided that before prayer or meditation to pause and “consider how the Lord my God looks upon me.” St. Thérèse of Lisieux describes prayer as “a glance toward heaven.” I find this helpful.
How long/often do you engage in this spiritual practice?
Earlier in my life, the goal was to commit myself to a Holy Hour, but I started to beat myself up if I couldn’t make an entire hour. What used to be a Holy Hour has become more of Holy Moments. Whether I have one minute or 30, it is always worth it to pray. The Sisters of Providence are known as living by the saying, “The streets are our chapel,” and 1 Thessalonians 5:17 encourages “pray without ceasing”; this contemplative in-action mindset has been beneficial. That being said, I find I am my best self with dedicated time in prayer. It is like any relationship; it is hard to have a healthy relationship if you never spend time with that person. Prayer is no different, it is a relationship with the Divine. There is no substitute for time. However, I have become more open on how this time is spent, believing the Divine is found everywhere and in all things.
How is it helpful for your personal growth or resilience?
I really like [Abraham] Maslow’s Hierarchy of
Needs. For those not familiar, it is a pyramid of personal needs in order of priority with physiology (food and water) as the foundation, working up through safety, belonging, self-esteem and self-actualization (morality and creativity) as the top. However, if I were to revise the hierarchy of needs pyramid, I would put a larger base/foundation under physiological needs, called “spiritual needs.” Jesus in the Gospel of Matthew articulates that we “do not live by bread alone, but by every word that comes forth from the mouth of God.” When I get this order right in my life, resilience becomes easier.
In what ways does it benefit you and others? I wish I could easily point to how it benefits me and others, but this can be hard at times. I think we live in a very instant gratification-based culture, and only on rare and special occasions is prayer instantly gratifying. I think of it more like exercise and proper nutrition; it can be difficult in the moment. But if I take the long perspective, I notice changes in myself and in my interactions. It can be tempting to think prayer doesn’t work. There have been many times I have been hesitant or slow to pray, but I have never once regretted praying, even if the outcomes are different than I expected.
Can you provide some specific learnings that you find helpful that others may learn from?
When I was newer to my spiritual journey, I remember going to confession and the priest asking me if I was more of a “rosary or divine mercy chaplet kind of person.” I panicked; I didn’t know there was such a thing as a “rosary person” or “divine mercy chaplet person.” In fact, I had never even heard of the divine mercy chaplet. (It’s a Catholic prayer devotion based on Jesus’ revelations to St. Maria Faustina Kowalska.) This question haunted me: “Was I a rosary or divine mercy chaplet kind of person?” I thought I had to be one or the other and that I wouldn’t find peace until I discovered my unique charism. Ironically, I found peace when I gave up trying to answer that question. Maybe I am both a rosary and divine mercy chaplet kind of person, maybe I am rosary one day and divine mercy the other, or maybe I am neither. I have found the best spiritual practice is the one I actually practice. It is called “practice,” not “competition,” for a reason. We need to be kind to ourselves.
CRAWFORD STRUNK, MD Vice Chief Medical Officer, Sickle Cell Disease Association of America and Associate Medical Staff, Cleveland Clinic Foundation
In December 2023, more than 100,000 people in the U.S. affected by sickle cell disease received what was poised to be life-changing news: The first potentially curative gene therapies were officially approved by the U.S. Food and Drug Administration for the treatment of sickle cell disease. The sigh of relief at this new long-term treatment option was followed by a sense of widespread apprehension. With price tags in the millions, those who needed it most wondered how they could afford it. Health care systems looking to implement these therapies were entering uncharted territory. There was a new, incredible tool at our fingertips. The question was: How do we use it?
Gene therapy entered an already complicated treatment space. Since sickle cell disease was first described in medical literature in 1910, it has been a challenge to procure funding for research and development, overcome barriers to access and properly educate health care teams to provide consistent quality care. Understanding the difficulties faced by new advances like gene therapy — and discovering the solutions to those problems — starts by looking at the past.
Sickle cell disease is a rare, inherited blood disorder that disproportionately affects the Black community, but occurs in all ethnicities. It causes chronic, often excruciating, pain, along with complications in every organ system from head to toe.
The average life expectancy for someone with sickle cell disease is 20 years shorter than that of the general population; however, with current therapy, more than 98% of people living with the condition reach adulthood.1
Even though it is the most common genetic disorder worldwide,2 in the United States, it has historically received less attention than other rare diseases. In fact, a nationwide approach to improving care and treatment was not put into place until Congress passed the National Sickle Cell Disease Control Act of 1972. This act formed the National Sickle Cell Disease Program of the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health and called for the establishment of federally funded comprehensive sickle cell centers.3 This important bill created the necessary foundation to which we owe a great deal of
today’s progress.
The first breakthrough in identification and treatment followed shortly after. In 1975, New York was the first state to mandate newborn screening for sickle cell disease.4 This was a crucial step forward, as identification in infants allows hematologists to start education and treatment with penicillin prophylaxis early in life. By 2006, newborn screening for sickle cell disease was mandated in all 50 states, Puerto Rico and Washington, D.C., significantly decreasing the risk of mortality related to infectious complications, most often related to Strep pneumoniae.5
Today, there are a number of effective treatments available to individuals with sickle cell disease. All of them, however, come with costs, and only one, bone marrow transplant, is accepted as a cure. Gene therapy is considered potentially curative, as it is too early to determine its long-term effects and outcomes.
In 1998, hydroxyurea became the first medicine approved by the FDA to specifically treat sickle cell disease after it demonstrated a 50% reduction in painful crises and hospitalizations.6 Over the years, it has also demonstrated a more than 40% reduction in mortality. It has been proven to be safe and effective in patients as young as 6 months old. Hydroxyurea is FDA-approved for pediatric patients who are 2 years or older,7 but NHLBI recommends offering it to patients as young as 9 months old.8
For more than 25 years, hydroxyurea has been recognized as the front-line therapy for people living with sickle cell disease. However, several barriers to its use persist. Patient concerns regarding the risk of infertility or carcinogenicity, fears of harm due to a lack of physician experience in administering the treatment, risk to the fetus in pregnant women, the frequency of required lab monitoring and a lack of perceived benefit have all led to substantially fewer patients using hydroxyurea than should be prescribed.9
Since hydroxyurea was introduced, other therapies have been approved. In 2017, L-glutamine, an antioxidant used in glutathione production, was approved for patients 5 years old and above.10
In 2019, crizanlizumab, a P-selectin inhibitor, and voxelotor, a small molecule designed to reversibly lock hemoglobin in its oxygenated state, were approved for patients 16 and above (crizan-
lizumab) and 12 and above (voxelotor).11 Of note, voxelotor was then approved for children age 4 and above in January 2021.12
All of these medicines demonstrated clinical benefits; however, they all have challenges related to adherence and efficacy. L-glutamine is a powder that is challenging to take at its prescribed dose. Crizanlizumab can cause infusion pain similar to a pain crisis, and voxelotor was recently pulled from the market globally because of concerns for increased risk of infectious deaths in clinical trials in Africa and increased frequency of pain episodes in post-marketing studies completed in the United States.13
While disease-modifying therapy is the key to living as healthy a life as possible, curative therapy for people with sickle cell disease has been a goal for several decades. In 1984, a young girl with sickle cell disease also developed acute myeloid leukemia. Because of her leukemia, she underwent a bone marrow transplant using stem cells from her sister. The transplant not only cured her of her leukemia but also her sickle cell disease.14 Since then, more than 1,000 bone marrow transplants have been performed for people with sickle cell disease using a variety of donors (matched sibling, matched unrelated and haploidentical/ partial match donors) with varying degrees of success.15
Currently, the only transplant approved for sickle cell disease is a matched sibling donor transplant. Other forms of transplant are still considered experimental, and each comes with its own risks and complications, including graft failure, graft versus host disease and fertility concerns, especially when using a myeloablative conditioning regimen. In addition, not every patient is eligible for a bone marrow transplant, as few patients have a matched sibling who also does not have sickle cell disease.
Moreover, because most bone marrow transplants are considered experimental, the risk/ benefit ratio must be considered. Patients undergoing a bone marrow transplant must have some degree of disease severity but not be so sick that they cannot tolerate the transplant conditioning and subsequent recovery. Indeed, the only patients who meet the requirement for transplantation, even if they have no other organ toxicity, are those who have neurologic complications, including stroke, silent infarcts or neurocognitive deficits.
These advancements in treatment are exciting and life-changing for those who can access them. ... But, for many individual patients, it does not change the day-to-day reality of living with sickle cell disease. Pain is pain, and it’s worse when it’s an uphill battle to find relief.
The new approval of gene therapy in 2023 meant that another transformative (and potentially curative) treatment was finally available. The two medications, bluebird bio’s lovo-cel16 and Vertex’s exacel, were both approved for people with sickle cell disease without any qualification.17 Even though it has been more than a year since gene therapy has been commercially available, several factors have limited its accessibility to patients.
The Centers for Medicare and Medicaid Services (CMS) and private insurance companies cover the cost of the therapy. However, there are no clear criteria to determine which patients are candidates for the therapy nationally. Several patient groups were left out of the clinical trials for the approved treatments. Patients with Hemoglobin Sickle C (HbSC) disease were excluded from both studies, and only a small percentage of patients with stroke were included in the lovo-cel study.18 In addition, each state’s Medicaid and private insurance companies have their own criteria for who would be eligible for gene therapy.
The nature of gene therapy as a cellular therapy means there are also institutional requirements for providing gene therapy. These include being Foundation for Accreditation of Cellular Therapy-certified and being chosen by the pharmaceutical company supplying the therapy to be designated as a qualified treatment center. The narrow patient criteria and the relatively few centers that are considered “qualified treatment centers” have resulted in limits to the accessibility of gene therapy.
While gene therapy has the potential to be curative for people with sickle cell disease, it does have its limitations and risks. Because myeloablative conditioning is needed to receive gene therapy, there is the risk of developing clonal hematopoie-
sis (genetic changes that lead to abnormal growth of blood cells) and secondary myelodysplastic syndrome (preleukemic state as a result of the transplant conditioning regimen), and potentially acute myeloid leukemia. In addition, patients are instructed to stop hydroxyurea and start chronic transfusion therapy for the time required for the cells to be manufactured. Patients also need to be admitted for a central line and stem cell collection at least once and potentially up to three times. Ultimately, the whole process can take almost a year from the time that the patient starts transfusion therapy and stops hydroxyurea to the time the patient is able to undergo conditioning and receive his/her manufactured stem cells.
Currently, very few individuals with sickle cell disease have been treated with this exciting therapy, and the numbers do not look to significantly increase anytime soon. However, with the development of in vivo gene therapy, which does not require collecting patients’ stem cells to manufacture the cellular product, gene therapy may become more accessible. Additionally, CMS’s Innovation Center has authorized the Cell and Gene Therapy Access Model,19 which is anticipated to reduce health care spending over time by addressing the underlying causes of disease, specifically sickle cell disease. Funding would be provided through a cooperative agreement to help states cover the cost of participation in the model, including transportation and lodging.
These advancements in treatment are exciting and life-changing for those who can access them. Long term, these solutions have promising results. But, for many individual patients, it does not change the day-to-day reality of living with sickle cell disease. Pain is pain, and it’s worse when it’s an uphill battle to find relief.
Many individuals must occasionally seek care in the emergency department. There, they may encounter several problems, including a lack of timeliness and appropriate care, which are often a result of long-standing issues with systemic racism, implicit and explicit bias, and reluctance to provide adequate pain management amid the ongoing opioid epidemic.
A complex backdrop of other challenges complicates matters further, including the lack of effectively trained hematologists with experience and expertise in the management of sickle cell disease, the lack of a disease registry to track patient outcomes, and few, if any, well-known national advocates for the disease. Nationwide efforts led by the American Society of Hematology, the National Alliance of Sickle Cell Centers and the Sickle Cell Disease Association of America are working to correct these unmet needs.
Gene therapy, while an exciting step forward, remains out of reach for most individuals with sickle cell disease. As providers dedicate themselves to learning more about this new treatment option, they must also commit themselves to ensuring patients receive adequate care outside of gene therapy.
Local hospitals and medical staff are encouraged to learn about the care of people living with sickle cell disease and should reach out to their local community-based organization or the Sickle Cell Disease Association of America for the nearest center. In addition, communication between a center of excellence and the local medical staff could be employed to improve the care of these patients. Resources could include the Agency for Healthcare Research and Quality’s Project ECHO sessions,20 designed to guide local medical staff in caring for patients with sickle cell disease; a huband-spoke model of care, in which a local physician can discuss care with a sickle cell expert; or referral to a sickle cell specialist.
Increasing the accessibility of new treatments like gene therapy starts with addressing old problems. Identifying how to relieve invisible barriers like systemic racism and a lack of provider education is an important step to bringing life-changing therapies out of the lab and into the lives of patients, especially in the context of sickle cell disease. Much change is needed for these patients, and the time to start is now.
DR. CRAWFORD STRUNK is the vice chief medical officer for the national nonprofit Sickle Cell Disease Association of America and associate medical staff at the Cleveland Clinic Foundation in the Division of Pediatric Hematology Oncology and Bone Marrow Transplant.
1. Simon Pleasants, “Epidemiology: A Moving Target,” Nature 515 (2014): https://doi.org/10.1038/515S2a; Charles T. Quinn et al., “Improved Survival of Children and Adolescents with Sickle Cell Disease,” Blood 115, no. 17 (2010): https://doi.org/10.1182/blood-2009-07233700.
2. Frédéric B. Piel, Dr. Martin H. Steinberg, and David C. Rees, “Sickle Cell Disease,” The New England Journal of Medicine 376, no. 16 (2017): https://doi.org/10.1056/ NEJMra1510865.
3. A. F. Manley, “Legislation and Funding for Sickle Cell Services, 1972-1982,” American Journal of Pediatric Hematology/Oncology 6, no. 1 (1984): 67-71.
4. Cynthia S. Minkovitz et al., “Newborn Screening Programs and Sickle Cell Disease,” American Journal of Preventive Medicine 51 (2016): https://doi.org/10.1016/j. amepre.2016.02.019.
5. Minkovitz et al., “Newborn Screening Programs and Sickle Cell Disease.”
6. Dr. Samuel Charache et al., “Effect of Hydroxyurea on the Frequency of Painful Crises in Sickle Cell Anemia,” The New England Journal of Medicine 332, no. 20 (1995): https://doi.org/10.1056/NEJM199505183322001; John Strouse and Matthew Heeney, “Hydroxyurea for the Treatment of Sickle Cell Disease: Efficacy, Barriers, Toxicity, and Management in Children,” Pediatric Blood & Cancer 59, no. 2 (2012): https://doi.org/10.1002/ pbc.24178.
7. “FDA Approves Hydroxyurea for Treatment of Pediatric Patients with Sickle Cell Anemia,” U.S. Food & Drug Administration, December 21, 2017, https://www.fda. gov/drugs/resources-information-approved-drugs/ fda-approves-hydroxyurea-treatment-pediatricpatients-sickle-cell-anemia.
8. “Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014,” National Heart, Lung and Blood Institute, September 2014, https://www.nhlbi. nih.gov/sites/default/files/media/docs/sickle-celldisease-report%20020816_0.pdf.
9. Sarah L. Reeves et al., “Hydroxyurea Initiation Among Children with Sickle Cell Anemia,” Clinical Pediatrics 58, no. 13 (2019): https://doi. org/10.1177/0009922819850476.
10. “FDA Approved L-Glutamine Powder for the Treat-
ment of Sickle Cell Disease,” U.S. Food & Drug Administration, August 18, 2017, https://www.fda.gov/drugs/resourcesinformation-approved-drugs/ fda-approved-l-glutamine-powdertreatment-sickle-cell-disease.
11. Mariam Barak et al., “Current and Future Therapeutics for Treating Patients with Sickle Cell Disease,” Cells 13, no. 10 (2024): https://doi.org/10.3390/cells13100848.
12. Allison Inserro, “Voxelotor for Sickle Cell Disease Wins FDA Nod for Patients as Young as 4,” AJMC, December 17, 2021, https:// www.ajmc.com/view/voxelotor-for-sicklecell-disease-wins-fda-nod-for-patientsas-young-as-4.
13. Julie Kanter et al., “Expert Consensus on the Management of Infusion-Related Reactions (IRRS) Presenting with Pain in Patients Receiving Crizanlizumab,” HemaSphere 7, no. S1 (2023): https://doi.org/ 10.1097/01.HS9.0000928196.80128.ee.
14. Courtney D. Fitzhugh et al., “Hematopoietic Stem Cell Transplantation for Patients with Sickle Cell Disease: Progress and Future Directions,” Hematology/Oncology Clinics of North America 28, no. 6 (2014): https:// doi.org/10.1016/j.hoc.2014.08.014.
15. Monica Bhatia and Sujit Sheth, “Hematopoietic Stem Cell Transplantation in Sickle Cell Disease: Patient Selection and Special Considerations,” Journal of Blood Medicine 6 (2015): https://doi.org/10.2147/JBM. S60515.
16. It should be noted, however, that
lovo-cel did receive a black box warning secondary to the fact that two patients on the trial developed myelodysplastic syndrome and later died of acute myeloid leukemia.
17. Matt Hoffman, “FDA Approves Bluebird Bio’s Lovo-Cel Gene Therapy for Sickle Cell Disease,” AJMC, December 10, 2023, https://www.ajmc.com/view/fda-approvesbluebird-bio-s-lovo-cel-gene-therapyfor-sickle-cell-disease; “FDA Approves First Gene Therapies to Treat Patients with Sickle Cell Disease,” FDA, December 8, 2023, https://www.fda.gov/news-events/ press-announcements/fda-approves-firstgene-therapies-treat-patients-sickle-celldisease.
18. Dr. Haydar Frangoul et al., “Exagamglogene Autotemcel for Severe Sickle Cell Disease,” The New England Journal of Medicine 390, no. 18 (2024): https://doi.org/10.1056/ NEJMoa2309676; Julie Kanter et al., “LovoCel Gene Therapy for Sickle Cell Disease: Treatment Process Evolution and Outcomes in the Initial Groups of the HGB-206 Study,” American Journal of Hematology 98, no. 1 (2022): https://doi.org/10.1002/ajh.26741.
19. “Cell and Gene Therapy (CGT) Access Model,” Centers for Medicare & Medicaid Services, https://www.cms.gov/priorities/ innovation/innovation-models/cgt.
20. “Project ECHO,” Agency for Healthcare Research and Quality, https://www.ahrq. gov/patient-safety/settings/multiple/ project-echo/index.html.
“May the God of hope fill you with all joy and peace in believing, so that you may abound in hope by the power of the Holy Spirit.” (Romans 15:13)
We live in a world where the pursuit of happiness is blurred by individualistic efforts to thrive, one where societal structures fail to inform or embody a communal vision of flourishing. It is difficult to envision a world where human potential is nurtured, affirmed and fulfilled — a place where infinite love shapes a shared reality.
One might ask how long the center will hold. Who will carry the vision forward? Who will relentlessly advocate for human dignity wherever care is provided? Who will bear the burden to assure the common good of our neighbors? Is it our leaders? The Church? Community activists? Perhaps the better question is: What is ours to do?
For those of us called to Catholic health care, we know the abiding commitment to offer healing through Jesus’ ministry and the heritage of the founders. In the spirit of the sponsoring congregations and because of our enduring ministry of love, we are rooted in a tradition that refuses to waver in providing care and extending compassion to all. And while those who serve our ministries embody courage, faithfulness and hope every day, this tumultuous year offers a special invitation to travel deeper into the journey of hope.
Let us explore how this Jubilee Year might strengthen our Christian/Catholic notion of hope amidst today’s cultural crises.
Our tradition teaches that hope is more than wishful thinking or naïve optimism. Hope is within each of us, an accessible, eternal reality, even when it may seem imperceptible. God is the giver of hope, the source of hope and the object of hope.1 True to its nature as a gift, we cannot manifest hope ourselves. But in receiving it, we can be signs of hope for others.
When hope emerges, we are free to receive it and allow it to be our companion. Hope is united with love and faith, a mysterious triptych that can hardly be separated. (1 Corinthians 13:13) Hope is where our deepest longings lie secure in God, until they are fulfilled by God. Hope is an anchor for the soul, sturdy enough for us to cling to it in times of despair, for it holds hands with suffering. (Hebrews 6:18-19, Romans 5:3-5)
In Spes Non Confundit, the papal bull outlining the central message of the 2025 Jubilee Year, Pope Francis was clear: “Hope does not disappoint.”2 The Lord is “our hope,” he reminded us. (1 Timothy 1:1) “Hope is born of love,” overflowing from the power of death and resurrection through God’s son Jesus and enlivened by the continual renewal of the Holy Spirit working in and through us. In the perfect love of the Trinity, the light of hope illuminates our lives for the sake of love through the trials we face. But it is the dark of suffering, Pope Francis said, that creates the conditions for hope to be tested, and the cross of Christ to be our sustenance along our pilgrim way.
The late systematic theologian Jürgen Moltmann said that to be a theologian is to live theologically.3 Simply put, we embody what we believe, but our social location creates the conditions to pressure test what we profess. For us in Catholic health care, the conditions for hope to abound can be found around every corner — literally. Through hospital hallways, clinic corridors, break rooms and patient rooms, foyers, boardrooms and waiting rooms (virtual or real), the pilgrim path is ever
before us. On this path, the course is charted to foster a renewed vision of hope. But is this easier said than done?
Perhaps you can relate: The email notification dings, and suddenly, you find yourself receiving unwelcome news you need to deliver to your team. The impact will be profound: budgets will be cut, staffing reduced, travel halted, and productivity measures will seem inhumane. “Where is hope?” you ask.
You might experience a similar response when lab test results come back as you feared. Life as you know it with your loved one will now be different. A new season is here, and the weight of grief is overwhelming. How will you manage care and maintain your current workload? Hope is last on your mind.
When the shadow of darkness hovers, the human spirit naturally tends to turn inward. Doubt is powerful, and isolation can tempt us to drink from the cup of cynicism or lose consciousness, drunk on self-sufficiency. “Ease the pain,” echoes the black night.
In the dark, a woman stood crying. It had been three days since Jesus’ death. She knew every detail. It was slow; it was painful; it was brutal. She saw it all, the burial, too. Was her hope extinguished in Jesus’ death? Did it die with him?
As she wept in the darkness and peered into the tomb, she recognized she was not alone. Two angels in white were with her. They asked why she was crying. She told them he was gone; they took his body, and she did not know where he was. And
As you consider what it means to be a pilgrim of hope, reflect on how your hope is tested and strengthened, personally and communally, during times of need.
When searching for hope:
What do you love? What moves you to tears?
What are your dreams for our nation and the world?
What are you waiting for?
When renewing hope:
In whom or what do you put your trust?
How does prayer renew your hope?
What readings or reflections inspire a theology of hope?
What keeps you from fully embracing hope in the cross of Christ?
When hoping with others:
Which relationships in your life most foster hope?
How does the concept of pilgrimage shape your understanding of communal hope?
What might it mean for you to imagine that God hopes, too?
How are you a sign of hope for others?
“I have seen the Lord.” (John 20:1-18)
Through hospital hallways, clinic corridors, break rooms and patient rooms, foyers, boardrooms and waiting rooms (virtual or real), the pilgrim path is ever before us.
then, the Gospel of John says, “She turned around and saw Jesus there,” her resurrected Lord, assuming he was the gardener. Then he asked why she was crying, and he called her by name: “Mary!” She turned to him and called him, “Rabbouni” (which means teacher in Hebrew). He sent her on her way to the disciples, to whom she announced,
Fulfilled through the darkness of his crucifixion and the resplendence of his resurrection, Mary Magdalene saw hope as she looked right into the eyes of Jesus. The risen Christ, God’s ultimate hope as the giver, source and object of hope, was now revealed to the world. Hope was present to Mary not because of wishful thinking, naïve optimism, her own belief or desire to manifest it, but through the love of the Father revealed through Jesus, the hope of glory.
TOGETHER IN HOPE
Hope is not a solitary endeavor. It flourishes in community, in the shared struggles and
collective joys that define our human experience. In the healing ministry of Catholic health care, hope is an active presence, beckoning us to remain committed to the faithfulness of God in the midst of suffering for our patients, our loved ones and our world.
In his 2013 installation homily, Pope Francis offered a message of hope that did not disappoint, and one that brilliantly summed up his ministry: “Today … amid so much darkness, we need to see the light of hope and to be men and women who bring hope to others. To protect creation, to protect every man and every woman, to look upon them with tenderness and love, is to open up a horizon of hope; it is to let a shaft of light break through the heavy clouds; it is to bring the warmth of hope!”4
In this Jubilee Year of Hope, let us abound in hope together, not as individuals striving to maintain optimism, but as a community steadfast in faith, anchored in the cross of Christ, the hope of glory. As we walk along the pilgrim path, may we
We are all a spark of the divine. Along with our foundresses, the Sisters of St. Joseph of Peace, we extend heartfelt congratulations to Pope Leo XIV.
Together, our mission remains to serve those in need with dignity and respect.
open up a horizon of hope around every corner where care is provided and our colleagues serve.
JILL FISK, MATM, is director, mission services, for the Catholic Health Association, St. Louis.
1. Thomas Aquinas, The Summa Theologiae, First Part of the Second Part, question 62.
2. Pope Francis, “Spes Non Confundit,” The Holy See, section 1, https://www.vatican.va/content/francesco/ en/bulls/documents/20240509_spes-non-confundit_ bolla-giubileo2025.html.
3. Jürgen Moltmann and Miroslav Volf, “Theologian of Hope: Remembering Jürgen Moltmann (1926 – 2024),” For the Life of the World, Yale Center for Faith & Culture, June 5, 2024, https://faith.yale.edu/media/theologianof-hope-remembering-jurgen-moltmann-1926---2024.
4. Pope Francis, “Homily of Pope Francis,” The Holy See, https://www.vatican.va/content/francesco/en/ homilies/2013/documents/papa-francesco_20130319_ omelia-inizio-pontificato.html.
There is only one definition of community benefit: it is the Internal Revenue Service (IRS) definition. Other organizations, researchers and lobbyists, at times, will add or subtract categories to the way they define community benefit to fit their situation and the issues and policies they are promoting. They may also advance a false narrative that community benefit is not well defined to distract from the conversation that is needed: Ensuring that everyone has access to the affordable, high-quality health care needed to flourish.
In the 1980s, CHA brought together its members to share how they were working to improve health and well-being in their communities. From the discussions, CHA published the Social Accountability Budget: A Process for Planning and Reporting Community Service in a Time of Fiscal Constraint in 1989. It provided a list of categories of community benefit, including definitions and accounting standards. Guidelines were provided on what did and did not count as community benefit.
In 2006, when Congress and the Senate Finance Committee were interested in increasing the reporting of community benefit, Sen. Chuck Grassley, R-Iowa, gave CHA’s Social Accountability Budget to the IRS as guidance. The IRS, alongside CHA, the American Hospital Association (AHA), Healthcare Financial Management Association and others created Form 990 Schedule H, which became required reporting in 2008.
CHA’s Social Accountability Budget is now titled A Guide for Planning & Reporting Community Benefit. 1 The information and guidance in both CHA’s guide and the IRS Schedule H instructions align.
The IRS, through Form 990 Schedule H instructions, defines community benefit as activities or programs that address a demonstrated communi-
ty health need and “seek to achieve a community benefit objective, including improving access to health services, enhancing public health, advancing increased general knowledge, and relief of a government burden to improve health.”2 The IRS identifies eight categories of community benefit in the Schedule H, Part I, Line 7: Financial assistance at cost; Medicaid shortfall at cost; Costs of other means-tested government programs; Community health improvement services and community benefit operations; Health professions education; Subsidized health services; Research; and Cash and in-kind contributions for community benefit (see graphic on page 56).3 Additionally, to qualify as community benefit, activities must benefit the community more than the hospital organization.
Each community benefit category improves the health and well-being of communities.4 As noted in a recent report by AHA and CHA, hospitals tailor their community benefit activities to meet the unique needs of their communities.5 All community benefit activities are reported at cost, not charges or market rates. Any offsetting revenue received from the activity and any funds received specifically in support of the activity are also reported. This results in the reported net community benefit expense.
Financial assistance at cost is commonly referred to as charity care. Financial assistance is free
or discounted health care services provided to low-income individuals. The eligibility criteria are based on the hospital’s financial assistance.6 Through financial assistance, many patients can access care that they might not have otherwise been able to receive.
Medicaid is the United States’ health care program for low-income individuals and families. This program is means-tested with eligibility based on income and asset levels.7 Other meanstested government programs are another category of community benefit. Like Medicaid, these programs are sponsored by a government agency and are means-tested, with eligibility based on need, typically low income. The State Children’s Health Insurance Program is an example of a government means-tested program.
Medicaid continues to be vital to providing ac-
Community health improvement services are activities and programs provided by the hospital to improve the health and well-being of its community.10 These programs extend beyond routine care and provide health education, clinically Categories of Nonprofit Hospital Community Benefit
cess to affordable, high-quality care. Across the U.S., 41% of all births are covered by Medicaid, and 1 in 5 Americans have access to affordable health care because of Medicaid.8 Forty-nine percent of children are covered by a means-tested government program (Medicaid or Children’s Health Insurance Program).9 Most hospitals’ Medicaid reimbursement does not cover the cost of providing services. Yet, despite this shortfall, nonprofit hospitals, in alignment with their mission to care and commitment to their communities, persist and provide care to all regardless of ability to pay or insurance type. Medicaid and other means-tested programs increase access to health care services.
based services, support services, and activities that address the social and environmental factors of health. Examples of community health improvement services include mobile health units, health screenings, vaccination clinics, assistance for enrollment into government means-tested health and social service programs, transportation, violence prevention and lead abatement in housing. Also included in this category are the costs of community benefit operations, which include conducting the community health needs assessment and community benefit program administration costs.
Health Professions Education
Health professionals, during their education, are required to receive clinical training to obtain their degrees and to be certified or licensed within their state to practice. The health professions education category of community benefit reports the cost incurred by hospitals to provide this training to health professions students, including graduate medical education and training of student nurses and other allied health professionals.11 Health professions education does not include training provided exclusively to hospital staff, annual staff training or if there is a work requirement as a result of receiving this training. Currently, there is a shortage of doctors, nurses and other health professionals, and this shortage is worsening. The National Center for Health Workforce Analysis estimates a shortage of nearly 208,000 RNs and approximately 187,000 physicians by 2037.12 Educating our future doctors, nurses and other health professionals benefits our nation and communities, building the workforce for our future health needs.
Subsidized health services are clinical services provided at a loss. If the hospital did not provide
this service, it would be unavailable or at insufficient capacity to meet the community’s care needs. In calculating the reportable community benefit, hospitals must remove the losses associated with bad debt, financial assistance, Medicaid and means-tested programs.13 Providing unprofitable services to meet community needs differentiates tax-exempt hospitals from for-profit hospitals.14 Subsidized health services increase access to needed care.
Research qualifying as community benefit must aim to increase general knowledge, have its results made available to the public and only include research funded by a government or tax-exempt entity.15 Research advances knowledge and treatments of disease so that people can live longer and live well. Diagnoses that were once devastating and a life sentence are now treatable, and some are even curable, because of research. Without research, diseases flourish, and emerging diseases take hold and threaten how well and how long we live.
Cash and in-kind contributions are contributions made that are “restricted, in writing, to one or more of the community benefit activities” described in IRS Schedule H instructions.16 Nonprofit hospitals partner with and support community organizations to improve the health and well-being of their communities, especially organizations that are more suited to addressing priority needs and health activities.
The IRS is the federal agency that has defined community benefit and has oversight and enforcement of community benefit, Revenue Ruling
Despite the clear role of the IRS, researchers are increasingly citing Medicare Cost Reports as the data used to review tax-exempt hospitals’ charity care spending. This not only confuses the scope and purpose of the cost report but also effectively redefines community benefit by removing many of the community benefit categories.
69-545 and Internal Revenue Code (IRC) 501(r). Hospitals, through Form 990 Schedule H, annually report on compliance with the regulations. Section 9006 of IRC 501(r) requires the IRS to review nonprofit hospitals no less than every three years for compliance with the regulations.17 Additionally, Section 9007(e)(1) of the Affordable Care Act requires the IRS to annually provide Congress with a report that includes tax-exempt hospital community benefit. However, despite the clear role of the IRS, researchers are increasingly citing Medicare Cost Reports as the data used to review tax-exempt hospitals’ charity care spending. This not only confuses the scope and purpose of the cost report but also effectively redefines community benefit by removing many of the community benefit categories.
Through community benefit, nonprofit hospitals not only provide an incredible benefit to their communities, but they also contribute more substantially to them than the value of tax exemption. In 2020, nonprofit hospitals provided $94 billion in community benefit in accordance with the IRS definition.18 Recently, the estimated tax benefit for nonprofit hospitals was $37.4 billion.19 When considering IRS Form 990 Schedule H, Part I, community benefit alone, nonprofit hospitals invest more than twice the benefits they receive from tax exemption in the community.
IRS Form 990 Schedule H community benefit is just one of the ways nonprofit hospitals impact the health of their communities. Nonprofit hospitals also impact the health and well-being of their communities through their primary charitable purpose of providing acute, emergent, chronic and preventive health care. Additionally, nonprofit hospitals conduct programs and make additional investments in community health and well-being that go above and beyond their primary charitable purpose and community benefit, including investments in housing and economic development, along with purchasing strategies. When looking at the full picture and considering all the ways nonprofit hospitals impact the health and well-being of their communities, it is clear that nonprofit hospitals are a key asset to our health and well-being.
Nonprofit hospital community benefit is well defined by the IRS. The IRS also has oversight and enforcement over community benefit. All eight
categories of IRS Form 990 Schedule H community benefit are important to the health and wellbeing of our communities.
Nonprofit hospitals are a cornerstone of their communities’ health and well-being. They tailor their community benefit activities to respond to their communities’ unique needs. Nonprofit hospitals’ investments in community health and well-being far exceed the value of their tax exemption.
ZUECH LIM, MPH, BSN, is director of community health improvement for the Catholic Health Association, Washington, D.C.
1. “A Guide for Planning and Reporting Community Benefit,” Catholic Health Association, https://www.chausa. org/communitybenefit/a-guide-for-planning-andreporting-community-benefit.
2. “2024 Instructions for Schedule H (Form 990),” Internal Revenue Service, https://www.irs.gov/pub/ irs-pdf/i990sh.pdf.
3. “Schedule H (Form 990),” Internal Revenue Service, https://www.irs.gov/pub/irs-pdf/f990sh.pdf.
4. “Community Benefit Categories Quick Reference Guide,” Catholic Health Association, https://www. chausa.org/focus-areas/community-benefit/resources/ resource/community-benefit-categories-quickreference-guide.
5. “Nonprofit Hospital Community Benefits: Addressing Each Community’s Unique Needs,” American Hospital Association, https://www.aha.org/nonprofit-hospitalcommunity-benefits-addressing-each-communitysunique-needs.
6. The IRS definition of financial assistance at cost: “Financial assistance includes free or discounted health services provided to persons who meet the organization’s criteria for financial assistance and are unable to pay for all or a portion of the services.”
7. The IRS definition of Medicaid is, “… the United States health program for individuals and families with low incomes and resources.” “Other means-tested government programs” are defined as “government-sponsored health programs where eligibility for benefits or coverage is determined by income or assets.”
8. Alice Burns, Elizabeth Hinton, Robin Rudowitz, and Maiss Mohamed, “10 Things to Know About Medicaid,” KFF, February 18, 2025, https://www.kff.org/medicaid/ issue-brief/10-things-to-know-about-medicaid/.
9. “AAP Analysis: 49% of Children Insured by Medicaid or CHIP,” AAP, February 27, 2025, https://
publications.aap.org/aapnews/news/31491/ AAP-analysis-49-of-children-insured-by-Medicaid-or.
10. The IRS definition of community health improvement services is “activities or programs, subsidized by the health care organization, carried out or supported for the express purpose of improving community health. Such services don’t generate inpatient or outpatient revenue, although there may be a nominal patient fee or sliding scale fee for these services.” The IRS definition of community benefit operations is “activities associated with conducting community health needs assessments, community benefit program administration, and the organization’s activities associated with fundraising or grant writing for community benefit programs.”
11. IRS Schedule H defines health professions education as “educational programs that result in a degree, a certificate, or training necessary to be licensed to practice as a health professional, as required by state law, or continuing education necessary to retain state license or certification by a board in the individual’s health profession specialty. It doesn’t include education or training programs available exclusively to the organization’s employees and medical staff or scholarships provided to those individuals.”
12. “Nurse Workforce Projections, 2022-2037,” HRSA, November 2024, https://bhw.hrsa.gov/sites/default/ files/bureau-health-workforce/data-research/ nursing-projections-factsheet.pdf; “Physician Workforce: Projections, 2022-2037,” HRSA, November 2024, https://bhw.hrsa.gov/sites/default/files/bureauhealth-workforce/data-research/physicians-projectionsfactsheet.pdf; “Health Workforce Projections,” HRSA, November 2024, https://bhw.hrsa.gov/data-research/ projecting-health-workforce-supply-demand.
13. IRS Schedule H defines subsidized health services as “clinical services provided despite a financial loss to the organization. The financial loss is measured after removing losses associated with bad debt, financial assistance, Medicaid, and other means-tested government programs. In addition, in order to qualify as a sub-
sidized health service, the organization must provide the service because it meets an identified community need. A service meets an identified community need if it is reasonable to conclude that if the organization no longer offered the service:
The service would be unavailable in the community,
The community’s capacity to provide the service would be below the community’s need, or
The service would become the responsibility of government or another tax-exempt organization.”
14. Jill R. Horwitz and Austin Nichols, “Hospital Service Offerings Still Differ Substantially by Ownership Type,” Health Affairs 41, no. 3 (2022): https://doi.org/10.1377/ hlthaff.2021.01115.
15. IRS Schedule H defines research as any “study or investigation the goal of which is to generate increased generalizable knowledge made available to the public. The organization cannot include in Part I, line 7h, direct or indirect costs of research funded by an individual or an organization that isn’t a tax-exempt or government entity.”
16. IRS Schedule H defines cash and in-kind contributions as “contributions made by the organization to health care organizations and other community groups restricted, in writing, to one or more of the community benefit activities described in the table in Part I, line 7.”
17. “Legal Requirements for Section 501(c)(3) Hospitals,” Congress.gov., https://www.congress.gov/crs-product/ R48027.
18. “Estimates of the Value of Federal Tax Exemption and Community Benefits Provided by Nonprofit Hospitals, 2020,” American Hospital Association, https:// www.aha.org/2024-09-23-estimates-value-federaltax-exemption-and-community-benefits-providednonprofit-hospitals-2020.
19. Elizabeth Plummer, Mariana P. Socal, and Ge Bai, “Estimation of Tax Benefit of U.S. Nonprofit Hospitals,” JAMA 332, no. 20 (2024): https://doi.org/10.1001/ jama.2024.13413.
Navigating the complex ethical realities of health care can be a challenge.
WE’RE HERE TO HELP.
Access a variety of resources to help understand and apply the Ethical and Religious Directives. CHAUSA.ORG/ETHICS
DARREN M. HENSON, PhD, STL, and INDU SPUGNARDI
The headlines jumped off the screen. One paired the words, “Pope Francis” and the “Magisterium of Fragility.”1 Another read, “Pope Francis’s Preferential Option for Elders: Our Penchant for Disposability, Especially of Our Elders, Is Sinful.”2 As the pope’s lung condition took a toll on his overall physical health and led to a weeks-long hospitalization, he pressed forward with what he could do as he exerted his intrinsic dignity.
For example, he maintained a daily ritual of calling the Holy Family Church in Gaza each evening. Like a loving grandparent inquiring to know the day’s activities of his own family, their struggles, their sources for food and shelter, and especially their safety, he expressed through his words and actions his desire to be close to them, even when geographically removed.3
Those headlines aptly captured an essence not merely of this pontiff’s style but also of the broader theological tradition, grounded in the Gospels. The word magisterium refers to authority related to teaching the Catholic faith. The headline mentioning this term suggests that individuals experiencing the frailty of human life, especially those of advanced age, carry an authority that the rest of us ought to heed. Stated differently, the lives of elders have a claim on our lives.
The other headline aptly riffs off liberation theology’s preferential option for those who are poor. It suggests deep connections in the lived experience between those enduring poverty and those advanced in age. Society tends to see both as problems to “solve,” an inconvenience pushed to the peripheries. Their voices are often muffled, if heard at all — literally and figuratively. And yet, the theological and spiritual depths of the Catholic tradition reflect how people who are poor and advanced in age enjoy recognition as a place for God’s activity in the world. The Lord hears the cry of the poor (Psalm 34). God grants an elderly couple, Abraham and Sarah, children and descendants as numerous as the stars (Genesis 22:17-18), and Elizabeth, in her old age, bears a son (Luke 1:13).
During Pope Francis’ last months, he embraced the dignity of an elder. He exemplified what he had been teaching and preaching in places such as his encyclical on fraternity, an initiative by the Pontifical Academy for Life titled “Old Age: Our Future: The Elderly After the Pandemic,” and a 2021 Netflix miniseries on people 70 and over, titled Stories of a Generation — With Pope Francis. 4 His experience with serious illness and prolonged hospitalization in the acute and intensive care setting put him in a spotlight where, years prior, he had previously shone a light on old age.
By most accounts, the late pontiff adapted to the limitations and realities of his physiological conditions. His example stands out against a driving quest among intellectuals, scientists and tech elites to “solve” for death.5 There’s no secret that our American culture places a premium on youthfulness, antiaging diets and fitness regimens. A well-documented denial of death has expanded to a disdain for the ordinary and natural transition of the human experience of aging.6
Embracing and normalizing the human experience of aging does not come easily. It requires systemic structures to ease the way, as well as individual shifts in a person’s perception of old age. These shifts necessitate spirituality and a formation of the human heart.
The rapid aging of the U.S. population makes this shift more urgent than ever. The number of Americans age 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050 (a 47% increase), and the 65 and older age group is
projected to rise from 17% of the total population to 23%.7 Most older people have at least one chronic health condition, and many suffer from multiple health issues.8
In health care, innovations such as Age-Friendly Health Systems, Program of All-Inclusive Care of the Elderly (PACE), palliative care and geriatric emergency departments recognize that the current delivery system must be changed to meet the unique needs of older adults and to ensure and
resources, including “Ministry Formation for All Workers,” provide guidance.9 They often remind caregivers why they originally felt called to this work. As one formation leader used to say, “And when we remember, we recommit.”
Having a critical mass of caregivers who sincerely see with a lens that Pope Francis offered — that being elderly is a gift from God — will not happen on its own. It happens with a commitment to cultivating an acute awareness of the multiplicity of gifts that older people shower upon us, our families and society.
honor their right to care. But providers face many challenges in making these innovations widespread: changing established practices, ageism and a scarcity of resources. This is why formation is so important; it provides the inner motivation and strength needed to push through these barriers to build a system of care that honors the dignity of older people.
We offer thoughts on formation activities that could support the work and ministry of those caring for older people. These suggestions can support outpatient clinical settings and other parts of the care continuum, as older adults access multiple points of care delivery (primary care, pharmacies, physical therapy, etc.) at higher rates than younger adults. Creating a welcoming environment is one step, and fostering a sensitive and empathetic workforce to the experiences of older people requires more. Progress can be made with support from formative experiences.
First, ministries can continue commitments to formation touchstones for hourly associates. These entail simple routine reflections and prayer integrated into team huddles. These formative moments aim to connect personal meaning and values with the work at hand. New CHA
Similarly, a short formative reflection can draw upon stories from the past. By remembering our roots, especially stories of how the founding congregation cared for widows, elders and others ostracized by society, we can reimagine our work today. While work in today’s care environment involves the complexities of technology, documentation and regulatory compliance, the actual care for elders is not that different from how this ministry began. Lastly, formation in these care settings can highlight multiple dimensions of the inestimable dignity of life, especially as it pertains and applies to older people. This is significant in a society that may unfairly value people for their work productivity or digital activity, rather than their innate dignity. This recognition also increases older adults’ visibility in social spaces and allows them further opportunities to think, talk and socialize. Having a critical mass of caregivers who sincerely see with a lens that Pope Francis offered — that being elderly is a gift from God — will not happen on its own. It happens with a commitment to cultivating an acute awareness of the multiplicity of gifts that older people shower upon us, our families and society. The heightened awareness may spawn growth in patience, a slower pace or enlarged compassion for elders.
Whatever the year of our birth, all of us are called to recognize and accept that we, too, will likely advance in years ourselves. Our bodies and appearances will change. Our mobility will likely slow and shorten. Our awareness of and dependence on others will increase. The question becomes, how might we experience and perceive the subtle changes that will unfold, likely over very long stretches of time? What kind of older person do we hope to become?
Drawing forth that inner desire of who we
hope to become will require intentionality. Attending to the shape and rhythms of our life — our habits — will form our future selves. Here are four considerations:
“We must not fear old age,” wrote the late pontiff.10 As is said and is true, Jesus’ most frequented words were “Do not be afraid!” Growing old is an ordinary aspect of being human. It is perhaps one of the most natural things for us to do.
Second, curtailing fears may entail noticing our thoughts, assumptions and judgments about older people. Instead of caving to the mind’s fixation on negative attributes, shift the attention to the goodness and blessings of advanced years. As the pope suggested, old does not mean worthless. Instead, allow “old” to reference “experience, wisdom, understanding, discernment, prudence, attentiveness, slowness — all values we desperately need!”11
Third, do things with older people. Take them to dinner. Check in with them. Send cards in the mail. Reminisce and ask them about their lives and experiences. Demonstrate and tell them how much they are cherished. Look intently at them and consciously see and reverence their dignity, even as their own life may be changing and impacting their mind, mobility and more. All the while, recognize that one day we will likely inhabit this space. In other words, do to them what you would want others to do to you when you are advanced in years.
Lastly, decide now who you want to become. How might we foster a disposition that counteracts a natural tendency toward crankiness or resistance to change? How might we foster characteristics marked by trust in oneself and others, and gratitude, faith, hope, love and so forth? Human will can lead us to where we want to go. And our own formation can help us get there.
DARREN M. HENSON is senior director of ministry formation at the Catholic Health Association, St. Louis. INDU SPUGNARDI is senior director, community health and elder care, for the Catholic Health Association, Washington, D.C.
NOTES
1. Andrea Tornielli, “The Voice of Pope Francis and the Magisterium of Fragility,” Vatican News, March 12, 2025, https://www.vaticannews.va/en/pope/ news/2025-03/a-weak-voice-and-the-magisteriumof-fragility.html.
2. Carmen M. Nanko-Fernández, “Pope Francis’s Preferential Option for Elders: Our Penchant for Disposability, Especially of Our Elders, Is Sinful,” Commonweal, March 3, 2025, https://www.commonwealmagazine.org/popefrancis-nanko-fernandez-elders-preferential-option.
3. Kate Quiñones, “CNA Explains: Pope Francis Still Calls Gaza Parish Every Night,” Catholic News Agency, February 28, 2025, https://www.catholicnewsagency. com/news/262479/cna-explains-pope-francis-stillcalls-gaza-parish-every-day.
4. Pope Francis, “Fratelli Tutti,” The Holy See, https:// www.vatican.va/content/francesco/en/encyclicals/ documents/papa-francesco_20201003_enciclicafratelli-tutti.html; Pontifical Academy of Life, “Old Age: Our Future: The Elderly After the Pandemic,” The Holy See, https://www.vatican.va/roman_curia/pontifical_ academies/acdlife/documents/rc_pont-acd_life_ doc_20210202_vecchiaia-nostrofuturo_en.html.
5. Ester Bloom, “Google’s Co-founders and Other Silicon Valley Billionaires Are Trying to Live Forever,” CNBC, March 31, 2017, https://www.cnbc.com/2017/03/31/ google-co-founders-and-silicon-valley-billionaires-tryto-live-forever.html; Tad Friend, “Silicon Valley’s Quest to Live Forever,” The New Yorker, March 27, 2017, https:// www.newyorker.com/magazine/2017/04/03/siliconvalleys-quest-to-live-forever; Ernest Becker, The Denial of Death (Free Press, 1997).
6. “Older Population and Aging,” United States Census Bureau, https://www.census.gov/topics/population/ older-aging.html. This demographic increased by nearly 39% from 2010 to 2020, to reach almost 56 million, reflecting a rate not seen since the late 19th century.
7. Mark Mather and Paola Scommegna, “Fact Sheet: Aging in the United States,” PRB, January 9, 2024, https://www.prb.org/resources/fact-sheet-aging -in-the-united-states/.
8. “Aging in America: Get the Facts on Older Americans,” National Council on Aging, June 1, 2024, https://www. ncoa.org/article/get-the-facts-on-older-americans/.
9. “Ministry Formation for All Workers,” Catholic Health Association, https://www.chausa.org/focus-areas/ ministry-formation/resources/resource/formation-forall-workers (CHA website login required to access).
10. Junno Arocho Esteves, “Vatican Releases Unpublished Papal Reflection on Old Age,” America: The Jesuit Review, April 23, 2025, https://www.americamagazine. org/faith/2025/04/23/vatican-releases-unpublishedpapal-reflection-old-age-250455.
11. Esteves, “Vatican Releases Unpublished Papal Reflection.”
Now, perhaps more than ever, the world’s most vulnerable populations are in the crosshairs of geopolitical turmoil, and leaders worldwide, including representatives of the Catholic Church, are calling us to action. As we continue our service to the Church through the Catholic health ministry, it is timely to highlight how Catholic social teaching guides the necessary adaptations of Catholic health care to meet the rapidly evolving global health landscape.
Over the past few years, Catholic health organizations have increasingly recognized the importance of ethical practices, responsible resource allocation and equitable partnerships in their global endeavors. At the same time, several health systems have shifted their global health priorities, reorganized and, in some cases, reduced the resources allocated to global health. These factors and the surrounding geopolitical climate that exacerbate vulnerabilities worldwide illuminate the need for us to carefully consider our path forward, particularly in how we scale our global health initiatives to reflect our continued commitment to the principles of Catholic social teaching.
The United States Conference of Catholic Bishops describes Catholic social teaching as “a rich treasure of wisdom about building a just society and living lives of holiness amidst the challenges of modern society.”1
In an interview earlier this year, Cardinal Michael Czerny, SJ, Prefect for the Dicastery for Promoting Integral Human Development, described the U.S.’s recent cuts to foreign assistance as an “injustice” in conflict with Church teaching. He indicated that foreign assistance is a response to those in need and a call on our conscience as Christians and human beings.2
As we navigate the complex global health land-
scape, we must examine our responses and recognize the impact our actions — or inaction — will have on poor and vulnerable people. The principles of Catholic social teaching and the example of the courageous religious founders of Catholic health care serve as a guiding light and an inspiration. This wisdom of the Church’s social tradition and those who came before us in the ministry impel us to take part in filling the gap between the Gospel’s demand for justice and the urgent realities of our fractured world.
In Fratelli Tutti, Pope Francis underscored this tension and highlighted the need for bold action: “Solidarity means much more than engaging in sporadic acts of generosity. … It means confronting the destructive effects of the empire of money.”3 In other words, Catholic social tradition is not a set of abstract ideals. It is a radical call to action.
Its pillars — human dignity, solidarity, the common good and the preferential option for the poor and vulnerable — demand that health care transcends borders and transactional care. When a child in sub-Saharan Africa dies of malaria while U.S. hospitals discard perfectly usable but unused supplies, or when nurses from countries red-listed by the World Health Organization are recruited to staff our facilities while their home clinics crumble, do we violate these principles? These are questions CHA’s Global Health Advisory Council believes sponsors and leaders of Catholic health care need to ponder together.
The advisory council has urged us to be bold in highlighting these questions and the issues
surrounding them. More importantly, they have requested that we be bold in presenting these messages to executives and sponsors of Catholic health in the U.S. Then, more fully informed, Catholic health care can take appropriate action collectively, institutionally and individually.
Catholic health care is a ministry of the Church, and the richness of the Church’s social tradition calls us to action. Solidarity requires us to more fully understand these realities and the Church’s response locally, regionally and globally. We must move beyond transactional charity and dismantle structures that harm the vulnerable. Only then can we define our role in eliminating systems that treat human health as a commodity and position ourselves to act in support of the Gospel mandate and Pope Francis’ call to a culture of encounter.
Therefore, we must determine how we act accordingly to uphold Catholic social teaching in our global health activities:
Preferential Option for the Poor: Allocate our limited resources appropriately.
The Common Good: Advocate for ethical policies.
Solidarity and Human Dignity: Develop mutually beneficial and bidirectional partnerships.
The Gospel compels us to act now to address the need for a new dynamism in our collective response as the Catholic health ministry in the United States. The world’s suffering is palpable,
and we cannot claim to uphold the tradition of Catholic social teaching while sitting on the sidelines. By living the culture of encounter that Pope Francis urged us to embrace, we can best live out these goals. In his inaugural Mass, Pope Leo XIV reinforced many of these messages and called for a “united Church, a sign of unity and communion, which becomes a leaven for a reconciled world.”4 His vision echoes the urgency of our mission — one that refuses to retreat in the face of suffering.
The marginalized are waiting. The world is watching. Our faith leaves no room for retreat.
BRUCE COMPTON is senior director, global health, for the Catholic Health Association, St. Louis.
1. “Seven Themes of Catholic Social Teaching,” United States Conference of Catholic Bishops, https://www.usccb.org/beliefs-and-teachings/ what-we-believe/catholic-social-teaching/ seven-themes-of-catholic-social-teaching.
2. Eric Reguly, “A Key Canadian Cardinal Is Speaking up Against Trump’s Foreign Aid Cuts,” The Globe and Mail, March 10, 2025, https://www.theglobeandmail.com/ world/article-catholic-church-condemns-trumperadication-foreign-aid/.
3. Pope Francis, “Fratelli Tutti,” The Holy See, paragraph 116, https://www.vatican.va/content/francesco/en/ encyclicals/documents/papa-francesco_20201003_ enciclica-fratelli-tutti.html.
4. Pope Leo XIV, “Homily of the Holy Father Leo XIV,” The Holy See, https://www.vatican.va/content/leo-xiv/en/ homilies/2025/documents/20250518-iniziopontificato.html.
Connect with Bruce Compton to join or recommend someone to take part in discussions on how Catholic health can further uphold Catholic social teaching in its global health initiatives, https://www.chausa.org/focus-areas/global-health/staff/bruce-compton
In medicine, ethical dilemmas are not theoretical; they are real and immediate. Questions about end-of-life care, reproductive technologies, or resource distribution don’t allow for spiritual autopilot.
For the Catholic health care professional, forming the conscience is not a one-time decision; it’s a pilgrimage of discernment. We are called to shape our moral compass through prayer, Scripture, professional formation, reflecting on experience and the teachings of the Church. A well-formed conscience allows us to stay faithful to our values, even when the cultural winds shift.
In a field full of complexity, conscience formation becomes an act of hope. It is the conviction that God’s wisdom still speaks, and that truth is not only possible but essential for healing. We test our conscience through the rigor of experience. We make decisions that attempt to meet the needs of the patient while upholding the truth underlying all creation. Then we take the time to reflect on our decision-making and see whether new insights emerge that will aid us in future encounters. Every patient we see, every colleague we support and every decision we make becomes a chance to extend God’s mercy. We don’t just treat symptoms, we serve our neighbor.
feel ill-prepared to handle, we are invited to seek advice from our colleagues. Our shared ministry is filled with healers who have decades of reflective experience from which we can draw light into the haziness of the new and the unknown. Hope is not a feeling; it’s a choice. Every time we advocate for a vulnerable patient, offer a moment of comfort, or stand firm in a moral decision, we become signs of hope for a world that desperately needs it.
Bringing about the Kingdom of God isn’t about grand gestures. It’s about the quiet, consistent witness of love and justice. For those of us in Catholic health care, the hospital or clinic isn’t separate from our faith. It is where our faith is lived. This might look like ensuring equitable care for the
In a field full of complexity, conscience formation becomes an act of hope. It is the conviction that God’s wisdom still speaks, and that truth is not only possible but essential for healing.
underserved, pushing for policies that respect life and dignity, or shaping a culture of compassion in our departments.
In an era of institutional strain and staff burnout, conscience formation is no small feat. Yet the Catholic tradition urges us to persevere. Doing good means listening with empathy, treating every person with dignity, and upholding the sacredness of life.
When we face a difficult situation, one that we
We do not do this work alone, but in community — the community of our health ministry and the community of partners who share our mission of hope. Whether we’re clinicians, chaplains, administrators or support staff, we are kingdom builders when we help create spaces where Christ’s healing is made real.
But how do we continue this work when we fail or falter? We remember that this is a pilgrimage,
not a sprint. What matters is that we keep walking. We know the act of reflection is critical to the formation of our conscience. We must take the time to examine our past to find the way to the future. To live our baptism in health care is to walk with purpose. We are not lone travelers. We are part of a pilgrim Church called to carry light into darkness, to serve with courage and to believe that grace still breaks through.
Pope Francis reminded us that the Church is a community of pilgrims of hope. For Catholic
health care professionals, this means that every chart reviewed, every wound dressed and every ethical stand taken is part of a much larger journey — one that leads us and those we serve toward the heart of God.
So let us walk on with faith, with love and with hope.
NATHANIEL BLANTON HIBNER, PhD, is senior director, ethics, for the Catholic Health Association, St. Louis.
KATHY CURRAN, JD, MA, CHA SENIOR DIRECTOR, PUBLIC POLICY, and ALEXANDRA CARROLL, MTS, DIRECTOR OF THE CATHOLIC CAMPAIGN FOR HUMAN DEVELOPMENT, USCCB
Pope John Paul II wrote forcefully of the existence of structures of sin and our responsibility to correct them. “Structures of sin,” he wrote in the encyclical Sollicitudo Rei Socialis, “are rooted in personal sin, and thus always linked to the concrete acts of individuals who introduce these structures, consolidate them and make them difficult to remove. And thus they grow stronger, spread and become the source of other sins, and so influence people’s behavior.”1 The cumulative effects of personal sins contribute to the creation of structures of sin, leading to unjust institutions and relationships in society contrary to the common good.2
The personal sin lies not just in those who commit overt acts of sinful injustice but also in those “who are in a position to avoid, eliminate or at least limit certain social evils but who fail to do so out of laziness, fear or the conspiracy of silence, through secret complicity or indifference; of those who take refuge in the supposed impossibility of changing the world and also of those who sidestep the effort and sacrifice required, producing specious reasons of higher order.”3
RACIAL INJUSTICE: A STRUCTURE OF SIN
The U.S. bishops have also called us to recognize how sin can become embedded in our social structures and institutions. In their November 2018 document, “Open Wide Our Hearts: The Enduring Call to Love, A Pastoral Letter Against Racism,” the bishops call us to awareness of how the effects of the sins of racism and racist attitudes manifest in unjust social structures and are embedded in the practices and policies of social, political and economic institutions. “Many of our institutions still harbor, and too many of our laws still sanction, practices that deny justice and equal access to certain groups of people.”4
In CHA’s Confronting Racism by Achieving Health Equity pledge, the Catholic health ministry acknowledges the effects of structural sin on the health of individuals and communities. This 2020 pledge by CHA members strengthened Catholic health care’s commitment to achieve eq-
uity in health systems, facilities and communities and advocate for systemic change.
We have an obligation to identify and address how the effects of racism and racist attitudes have been embedded in health care structures. CHA and the Catholic health ministry are committed to addressing the systemic causes of health disparities among underserved and vulnerable populations. We do this by looking at internal practices and how they may perpetuate health disparities or unjust outcomes; by advocating to end policies that exacerbate or perpetuate economic and social inequities; and by working in just relationship with our communities for sustainable change in the social conditions that result from and shore up systemic racism.
Poverty is one of the social inequities intertwined with racism. In an earlier pastoral letter on racism, the bishops began by stressing that racial and economic justice are inextricably linked.5 To break the cycle of poverty and racism, in 1970, the U.S. bishops created the Catholic Campaign for Human Development (CCHD).6
Poverty is not merely a lack of money. It’s a deeply complex and interconnected issue perpetuated by systemic barriers, such as limited access to quality education, stable employment, affordable health care and safe housing. Each factor reinforces the others, creating a self-sustaining
cycle that traps individuals and families across generations. Structural barriers in employment, housing, health care and education make it exceedingly difficult to break free. They disproportionately affect communities of color and other marginalized groups, deepening cycles of poverty and inequality.
Many urban and rural communities have also been overlooked when it comes to resources and opportunities. This ongoing lack of investment has left families facing significant challenges: struggling local economies, few employment opportunities, lack of quality and/or affordable housing, underfunded schools and limited access to health care. These structural barriers don’t exist in isolation — they build on each other, creating a cycle that makes it harder for people to thrive and break free.
Policies like redlining, the discriminatory practice in which financial services are withheld in certain neighborhoods, have entrenched poverty in marginalized communities, particularly among communities of color. And poor neighborhoods are disproportionately located near industrial zones, landfills or other environmental hazards, exposing residents to pollutants that increase rates of chronic diseases.7
poverty and racism can adversely affect mental and physical health. Studies have shown that people who report they have experienced instances of racism are at higher risk of adverse psychological and physical conditions.9 Some experts believe the long-term stress of anticipating and managing racial injustice in our culture can have harmful physiological effects, which may help explain why African American mothers and infants have significantly worse birth-related outcomes.10
Through their community benefit work, and following the example of their founders, Catholic health care systems seek to meet the needs of the time among those they serve, especially the needs of those who are vulnerable and disenfranchised. This work is done in collaboration with the community by fostering and sustaining authentic, just relationships and working toward mutually agreed-upon goals.
CCHD, through its work as the national antipoverty program of the U.S. Catholic bishops, also empowers local communities to advocate for policy changes, develop businesses and invest in local economic and social justice initiatives that tackle the systemic roots of poverty. These can include creating affordable housing through economic development programs like community land trusts and advocating for things like workers’ rights and safer neighborhoods.
These structural barriers don’t exist in isolation — they build on each other, creating a cycle that makes it harder for people to thrive and break free.
These stressors create environments that hinder social mobility and economic progress. For example, children raised in poverty are less likely to graduate from high school or access higher education, reducing their future economic opportunities. These same families often remain trapped due to inadequate resources, lack of opportunity and systemic inequities.
The Catholic health care ministry is well familiar with the effects of poverty and racism on health. People with incomes at or near the poverty level are more likely to be uninsured or underinsured, especially in states that have not expanded Medicaid, as are Black and Hispanic adults, leading to delayed medical care, poor health outcomes and higher personal health care costs.8
Exposure to chronic stress from the effects of
CCHD also funds economic development projects like worker-owned cooperatives, which empower communities to take ownership of local businesses and resources. Many CCHD-funded organizations focus on addressing the systemic disparities that disproportionately affect communities of color, ensuring that marginalized groups have a voice in decision-making processes.
Here are just a few examples of projects CCHD has supported:
The Chicago Coalition to Save Our Mental Health Centers is working to preserve and expand access to vital mental health services in underserved Chicago neighborhoods. Their work addresses mental health disparities by advocating for and reopening mental health facilities in underserved areas, including leading the passage of state laws allowing neighborhoods to fund mental
health through referendums.
Centro de Trabajadores Unidos en la Lucha, based in Minneapolis, seeks to protect worker rights by addressing wage theft and other workplace injustices and providing essential protections for both unionized and nonunionized workers.
Together New Orleans’ Community Lighthouse Project transforms churches and other neighborhood institutions into solar-powered facilities where people can shelter when natural disasters, such as hurricanes, cause power outages. In addition, the program implements solar power training programs at community lighthouses while working with local government to reform regulations, thereby making solar power more available to low- and middle-income residents.
Breaking the cycle of poverty requires a multifaceted approach that addresses structural issues such as racism, education, economic opportunities and health disparities simultaneously. CCHD is one way the Church in the United States works to address this through its commitment to systemic change, active grassroots participation and solidarity.
Through the work of CCHD, individuals and parishes can play a vital role in transforming communities and ensuring a future where all can thrive. Catholic health care also carries forward this work of the Church through clinical care, community benefit, advocacy and the Confronting Racism pledge.
CCHD and Catholic health care are two ministries leading the Church’s efforts to end sinful structures of poverty and racism in our nation. Reach out to your local diocese to learn more about what CCHD is doing in your community, how your facility can support its work and how CCHD can draw on its own community connections to contribute to community benefit planning. Together, we can bring the healing power of Jesus to our country’s structural wounds and elevate the flourishing of our sisters and brothers.
KATHY CURRAN is senior director, public policy, for the Catholic Health Association, Washington,
D.C. ALEXANDRA CARROLL is director of the Catholic Campaign for Human Development for the USCCB.
1. Pope John Paul II, “Sollicitudo Rei Socialis,” The Holy See, section 36, https://www.vatican.va/content/johnpaul-ii/en/encyclicals/documents/hf_jp-ii_enc_ 30121987_sollicitudo-rei-socialis.html.
2. U.S. Catholic Church, Catechism of the Catholic Church: Second Edition (Double Day, 2003), 457.
3. Pope John Paul II, “Reconciliation and Penance,” The Holy See, section 16, https://www.vatican.va/content/ john-paul-ii/en/apost_exhortations/documents/hf_ jp-ii_exh_02121984_reconciliatio-et-paenitentia.html.
4. Committee on Cultural Diversity in the Church of the United States Conference of Catholic Bishops, “Open Wide Our Hearts, The Enduring Call to Love: A Pastoral Letter Against Racism,” USCCB, 2018, https://www. usccb.org/resources/open-wide-our-hearts_0.pdf.
5. U.S. Catholic Bishops, “Pastoral Letter on Racism,” USCCB, 1979, https://www.usccb.org/committees/ african-american-affairs/brothers-and-sisters-us.
6. “The Catholic Campaign for Human Development,” USCCB, https://www.usccb.org/resources/catholiccampaign-human-development.
7. Christopher Dunagan, “Why Is So Much Pollution Found in Disadvantaged Communities?,” Encyclopedia of Puget Sound, April 12, 2021, https://www.eopugetsound.org/magazine/IS/ pollution-disadvantaged-communities.
8. Jesse C. Baumgartner, Sara R. Collins, and David C. Radley, “Inequities in Health Insurance Coverage and Access for Black and Hispanic Adults,” The Commonwealth Fund, March 16, 2023, https://www.commonwealthfund.org/publications/issue-briefs/2023/mar/ inequities-coverage-access-black-hispanic-adults.
9. David R. Williams, “Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors,” Journal of Health and Social Behavior 59, no. 4 (2019): https://doi. org/10.1177/0022146518814251; “Fact Sheet: Health Disparities and Stress,” American Psychological Association, https://www.apa.org/topics/ racism-bias-discrimination/health-disparities-stress.
10. Elleni M. Hailu et al., “Structural Racism and Adverse Maternal Health Outcomes: A Systematic Review,” Health & Place 78 (2022): https://doi.org/10.1016/ j.healthplace.2022.102923.
GEORGE AVILA, MURP, MAHCM, SHRM-CP, COLABORADOR PARA HEALTH PROGRESS
INTRODUCCIÓN
“La esperanza podría llamarse una memoria del futuro”, según el difunto filósofo francés Gabriel Marcel. Esta cita favorita me inspira en los mejores momentos y me consuela en momentos de angustia. Habla de movimiento hacia un lugar futuro con nuevas posibilidades. Nos recuerda que el amor inquebrantable de Dios no cesa nunca; sus misericordias nunca terminan: se renuevan cada mañana (Lamentaciones, 3:22-23). El camino y el destino no están claros, pero confiamos que la gracia de Dios nos guía hacia lo que es posible.
¿Con cuánta frecuencia nos encontramos en una situación imposible, tratando de comprender el significado de las circunstancias de nuestra vida y buscando desesperadamente algo nuevo? En esos momentos nos sentimos solos, pero nos damos cuenta de que la Gracia de Dios está con nosotros y que la esperanza en Dios no decepciona.
Sin claridad, pero confiados en el amor de Dios, avanzamos en una peregrinación de búsqueda, fortalecidos por la esperanza de encontrar algo nuevo que renueve el significado de nuestras vidas. En este progreso, a veces caminamos solos y a veces nos acompañan otros peregrinos de la esperanza que nos ayudan a abrir los ojos y que son la presencia de Dios en momentos de duda. Nos guían a este nuevo lugar de conversión, donde permitimos que todo lo que siempre estuvo dentro de nosotros crezca y encuentre nueva vida.
PAUSA Y REFLEXIÓN
Mientras celebramos este año con nuestra fe anclada en la esperanza, te invito a iniciar tu propia peregrinación de búsqueda para entender cómo estás llamado a servir como faro de esperanza para tu familia, tu ministerio o tu comunidad. Toma un momento para reflexionar sobre las personas que te han formado y pregúntate: ¿Cuál es la fuente de su sabiduría? ¿Qué luz aportan a tu vida? ¿Cómo te impulsan hacia delante? ¿Cómo te ayudaron a llevar esperanza a los demás?
ORACIÓN DE CIERRE
Dios del camino:
Bendice mis pasos mientras camino como peregrino de la esperanza. Ilumina mi camino y guía mis
pasos conforme me acerco a Ti y a las personas que me guían en el recorrido.
Abre mi corazón a la sabiduría que cada momento me puede inspirar. Mientras camino, permíteme reconocer a los peregrinos que me acompañan y acercarme a quienes necesitan Tu luz sagrada, para que se unan a esta comunidad.
Ayúdame a aceptar los momentos de Tu gracia que me conducen a ese lugar nuevo de esperanza y conversión.
Descarga una versión de audio extendida de esta oración para una caminata de meditación o una reflexión estando sentado.
“Servicio de Oración”, un departamento regular en Health Progress, puede ser copiado sin permiso previo.
“Hope … might be called a memory of the future,” according to the late French philosopher Gabriel Marcel. This favorite quote inspires me in the best of times and provides comfort in times of distress. It speaks to forward movement toward a future place of new possibilities. It is a reminder that the steadfast love of God never ceases; his mercies never come to an end; they are renewed every morning (Lamentations 3:22-23). The journey and destination are not clear, but we trust in the grace of God to guide us to what is possible.
How often have we found ourselves in an impossible place — trying to understand the meaning of things in our life and desperately seeking a place of newness and understanding? In these moments, we might feel alone, but we come to realize that the Grace of God is with us and that hope in God does not disappoint.
Without clarity but with certainty in the love of God, we step forward on a pilgrimage of discovery, strengthened by the hope of finding something that will bring new meaning to our lives. In this progression, at times, we walk alone, and, at times, we are joined by other pilgrims of hope who help open our eyes and serve as the presence of God in moments of doubt. They guide us to this new place of becoming, where we allow what has always been within us to grow and find new life.
As we celebrate this year of our faith anchored in hope, I invite you to embark on your own pilgrimage of discovery to understand how you are being called to serve as a beacon of hope for your family, ministry or community. Take a moment to reflect on the people who have shaped you, and ask yourself: What wisdom do they hold? What light did they bring to your life? How are they prompting you forward? How have they helped you bring hope to others?
CLOSING PRAYER
God of the Journey: Bless my steps as I travel on this spiritual pilgrimage of hope. May You bring light to my journey, guiding my every step as I grow
closer to You and to the people who have guided me on my way.
Open my heart to the moments that I will experience and the wisdom that they bring.
As I journey, let me recognize the pilgrims who travel with me and reach out to those who need Your sacred light, bringing them into community.
Help me to embrace the moments of Your grace that are leading me to a new place of hope and becoming. Be with me now and forever. Amen.
Download an extended audio version of this prayer service for a walking meditation or seated reflection.
Duquesne University offers an exciting graduate program in Healthcare Ethics to engage today’s complex issues.
Courses are taught face-to-face on campus or through online learning for busy professionals.
The curriculum provides expertise in clinical ethics, organizational ethics, public health ethics and research ethics, with clinical rotations in ethics consultation.
Doctoral students research pivotal topics in healthcare ethics and are mentored toward academic publishing and conference presentation.
MA in Healthcare Ethics (Tuition award of 25%)
This program requires 30 credits (10 courses). These credits may roll over into the Doctoral Degree that requires another 18 credits (6 courses) plus the dissertation.
Doctor of Philosophy (PhD) and Doctor of Healthcare Ethics (DHCE)
These research (PhD) and professional (DHCE) degrees prepare students for leadership roles in academia and clinical ethics.
MA Entrance – 12 courses
BA Entrance – 16 courses
Graduate Certificate in Healthcare Ethics
This flexible program requires 15 credits (5 courses). All courses may be taken from a distance. The credits may roll over into the MA or Doctoral Degree (PhD or DHCE).