Harnessing art and music to improve people’s health and wellbeing and promote better healthcare was the focus of the fourth seminar in the WHO Collaborating Centre’s series. During this seminar, Dr Diasy Fancourt, University College London, asked “Do the arts support our health? Results from basic, applied and population science studies; Professor Alastair MacDonald, The Glasgow School Art, asked ‘Who’s the real expert? Public participation in healthcare innovation and improvement through design and visualisation’; and Ms Ruth Cohen, Project Manager at Daisi spoke about a project she manages at Daisi; a not-for-profit arts education organisation creating and promoting inspiring artistic and cultural experiences which enable more children and young people to access the transformative and inclusive power of the arts.
Research suggest that involvement art or music can raise morale, promote a sense of community and improve personal resilience – but what exactly are the health benefits and how are they achieved? The following blog is a reflection on the points and discussion of this very engaging CCH Seminar.
What’s the evidence?
Evidence exists on the impact of arts on health alongside the increasing experience in delivering arts-health programmes. Music – for example – has a measurable impact on key biomarkers – such as levels of the stress hormone cortisol – with benefits for the immune system, as well as wellbeing.
Singing improves cognitive function in people with dementia, and leads to significantly faster recovery from post-natal depression. Drumming shows an effect on mental health, reducing anxiety and depression and enhancing wellbeing.
Magic has been used to improve the dexterity of children with cerebral palsy. Practising magic tricks works more effectively than conventional occupational therapy in improving hand function, and gives the children greater confidence.
To take part or not to take part?
It isn’t just the artistic experience. The level of involvement is crucial – the more involved the individual, the greater the effect on his or her health. Studies indicate that people who only occasionally engage in the arts are more likely to die prematurely than people who engage regularly.
Listening to music – rather than creating it – still has a psychological and biological impact but more passive forms of cultural engagement – such as visiting the cinema – seems to show no effect on cognition, even though they might be enjoyable experiences with other potential benefits as yet un-researched.
Clearly, there are no easy wins!
Settings play a part where participation is problematic. Television seems to speed up cognitive decline in older age, whereas using the internet in older adults supports cognition. In healthcare, background music prior to surgery has also been found to reduce the quantity of morphine needed post-surgery.
Participation through local arts projects is a way of improving the emotional health and wellbeing of vulnerable children and young people: daisi provides arts-inspired learning for young people and communities across Devon, improving self-expression, confidence and wellbeing.
Whose art is it anyway?
Co-production is key. The success of these programmes rests on moving away from a model where art is handed down by artists and experts to programme participants. All have a part to play.
Such co-production – or experience-based co-design – is the most effective model for improving health and wellbeing, not just through joining-in, but of actively shaping the project and working together to deliver it. This level of stakeholder engagement and negotiation – through such ‘competency groups’ – also helps resolve different ideas about the artistic activity.
A more targeted approach is needed for individuals and groups unable to contribute fully to the development of these programmes, such as stroke patients whose rehabilitation is assisted by the use of music.
Does “good” art matter?
Does the artistic activity have to be good aesthetically to benefit health? Ideally, producing good quality art should go hand-in-hand with a good level of participation, but it seems that the quality of the art is less important than the artistic process. Thus, it is not the quality of the dance that matters but the process of making the show – the experience of planning, rehearsing and performing.
This does not mean that the aesthetics of art should be sacrificed for functionality. Effective art – such as design projects – should try to embrace the instinctive ‘hardwired’ responses to life, personal experience, and cultural development of the participants. This offers the prospect of both better artistic results, such as in the materials used, and fuller health benefits from the engagement of all stakeholders.
Scaling-up such projects across the NHS requires demonstrating effectiveness and cost-effectiveness, especially at a time when all spending is under scrutiny.
£695m is the estimated potential annual saving to the NHS for GP visits and psychotherapy as a result of people engaging with the arts. In any case, most programmes – like daisi – are funded by arts organisations and charities, not the NHS.
The All-Party Parliamentary Group (APPG) on Arts, Health and Wellbeing report highlighted the importance of using arts strategies to address the social determinants of health and lessen the impact of health inequalities across the life course.
Innovative solutions – like social prescribing – can both lever community assets and relieve NHS pressures. Gloucester CCG’s Artlift project is for patients with chronic pain and low-level mental health conditions, who are referred to participatory arts workshops rather than prescribing medication or psychotherapy, saving an estimated £576 per patient over a 12-month period.
Culture change is already afoot. There is growing recognition of the need to work differently through staff, patient and community involvement. Arts and music in health can play its part in designing and delivering better services for patients and better health and wellbeing for all.
This blog was written by Kerry Dungay, Project Manager for CCH and Dr Ray Earwicker, Policy Advisor.