The health of the Amish

Amish life centers on church, family, home and work. Involvement with the health care system is approached with the belief that medicine helps, but God alone heals. The ability to work and provide for family is the motivation for maintaining good health.

Fundamentally, babies are believed to be a gift from God. Going further, Amish believe that their body is the temple of God and that as human beings they should be good stewards of their bodies, which are given as a gift to do God’s work. Good health is also considered a gift from God and deserves to be taken care of. Family relationships are highly valued, thus taking care of the health of loved ones is of importance.

Health conscious behaviors are considered the norm among the Amish. As a population, they use less tobacco, less alcohol, less salt, and more vitamin and mineral supplements. With increased income among the Amish, as in many American sub cultures, there is increasingly more packaged food purchased for home consumption and more meals eaten outside the home than compared to a decade ago.

The Amish religion does not restrict people from seeking modern medical care. For the most part, Amish use local doctors and dentists and will go to specialists and hospitals as determined. Which health care services the Amish deem useful versus which services the English deem as necessities results in the cultural differences and values about modern health care.

The Amish are very cautious health care consumers. They pay for most of their medical procedures out-of-pocket and in cash. All forms of insurance are generally discouraged, including medical health care coverage. Purchasing insurance shows a lack of faith in God who provides.

Given that the Amish are economical in their health care choices, they prefer to self-medicate or remedy an ailment by recommendation from family and friends before seeing health professionals. Some recommendations are considered to be folk medicine and include practices of faith healing, herbal treatments and other non-traditional medical remedies. The use of folk remedies for minor ailments is based on the need of the Amish to remain self-sufficient.

If there does not seem to be improvement as a result of their own remedies, then they will usually turn to health care providers for service. Thus, when an Amish person does show up in the emergency room, the provider often assumes that the person has already experienced much pain and may be advanced in their medical condition. The expression of physical symptoms may be minimized, since this might be interpreted as complaining against God’s will.

Preventative health care is not as widely accepted as in the U.S. population norm. Again, the cultural norm of faith in God as well as consciousness of ability to pay out-of-pocket for medical procedures without burdening the family or the larger Amish community is considered prior to accepting professional medical support. In America today, those with less ability to pay for health care are offered options to attend free clinics or receive government support. The Amish would deem offers of this kind to be inappropriate and would refuse to accept them.

The larger Amish community provides resources for health care needs beyond the ability of the family to provide. Thus, the collection of resources to support hospital stays, organ transplants, treatment of disease or extended illnesses are a communal decision. With the emphasis on communal care rather than individual care, the decision is often made to forgo a procedure that is deemed too costly – and may burden the community too much. It is common for Amish to reject extraordinary measures to save a life, as such measures may attempt to interfere with God’s will.

“Bear one another’s burdens” (Galations 6:2) represents the Amish belief of taking care of the sick, elderly and feeble in their community. This responsibility is highly regarded as Amish church members often make bank payments and perform farm chores for family members that are sick or without income. Amish and English often work alongside each other when a neighbor falls ill or needs to be away from their farm to care for a failing family member.

Is it possible for the modern health care system to meet the needs of the Amish today? Many hospitals and health care providers in Ohio, Indiana and Pennsylvania provide unique services to accommodate their Amish customers. Knowing that traditional horse and buggy transportation is inconvenient for appointments and visitations, transportation shuttle services and overnight accommodations are arranged. Knowing that the Amish prefer to stay at the bedside of a loved one during a hospital stay, nontraditional visitation hours are commonly accepted. Knowing that the Amish prefer to pay cash – fee reductions for cash, payment are the norm.

Not surprising were the content analysis results of survey responses from Amish individuals about their definition of health and health behaviors. Jane Armer (2006) noted that six categorical themes developed including 1) the ability to work hard; 2) the importance of being healthy; 3) a sense of freedom to enjoy life; 4) family responsibility; 5) physical well-being; and 6) spiritual well-being.

Except for one’s early childhood years, Amish are expected work, contributing to the family and community. Contributions are measured by one’s ability to work. Milking cows, weeding the garden and harvesting produce are examples of highly valued work contributions by family members. Community work contributions include barn raisings, frolics, neighborhood grain harvests and quilting bees. Work-related physical activity was the most frequently mentioned health-maintaining behavior by both males and females (Armer, 2006).

Professionals are sometimes surprised that the health care concerns among Amish families often mirror those of the larger population. Topics identified often center on agricultural safety practices, nutrition, health care, child care, and family-life issues. Topics can also be very specific to their own community, such as buggy safety.

Most Amish have an interest in learning and participate in workshops about health and nutrition, subscribe to magazines, and rely heavily on the local library and bookmobile. Amish families also like to learn through participating in community events such as auctions and picnics. Professionals who have a history of working with the Amish utilize a variety of approaches when they wish to introduce a new program or idea to Amish people.

Amish seeking information on health care concerns are most likely to heed the advice from a source in which they have trust and confidence. A beloved nurse practitioner or a country doctor may hold more weight than a university medical researcher. At the same time, recommendations and word of mouth acceptance from community members can build the relationship of an outsider rather quickly when needed.

Nutritious meals, less stress, and care of the sick and elderly creates an atmosphere emphasizing a quality of life often missing in mainstream America today. Predicted costs versus benefits related to one’s quality of life after a medical procedure primarily influences the health care decisions of Amish individuals and community. As a result, Amish will continue to be prudent consumers of health care services. This unique view offers a slightly different perspective from which health care providers can make decisions of how to treat and make recommendations to Amish community members based on their beliefs and faith in God alone to heal.