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Is There a Place for Arts in Health? - A blog by Daisy Fancourt

Dr Daisy Fancourt's recent blog post for the Oxford University Press website, where she explains that "in times of austerity, it is more important than ever that we look for creative ways to improve health."

Is there a place for the arts in health?

In a utopian world of abundant health budgets and minimal health challenges, it is probably fair to say that few would object to including the arts within hospitals or promoting them as a part of healthy lifestyles. Certainly, we have a long history of incorporating the arts into health (stretching back around 40,000 years), so it’s a concept many people are familiar with. But in an era of austerity, the value that the arts can bring comes under much closer scrutiny: do they really bring value or could they even be a distraction or a drain on limited funds? In fact, research is suggesting the opposite. In times of austerity, it is more important than ever that we look for creative ways to improve health.

 

The arts in medicine

The research evidence around the effects of the arts in healthcare settings is much larger than many realise. Not just ‘nice to have’, studies have shown how a range of art forms can have tangible health benefits. For example, music has been helping patients with Parkinson’s disease to walk, practising magic tricks has been found to improve hand function in children with cerebral palsy, the design of emergency departments has been shown to reduce violence towards staff , background music prior to surgery has been found to reduce the quantity of morphine needed post-surgery, video games have been shown to increase medication adherence in children with cancer, and songs have been found to improve cognitive function in people with dementia. Some of the most effective programmes are involving ‘problem-based solution’ models, whereby clinicians and health professionals are highlighting key challenges in their daily work and artists are devising creative solutions to these problems. Such work is showing that the arts are not just means of entertainment – they play functional roles within hospitals, hospices, and care homes.

 

The arts in public health

We find a similar, growing evidence base for the impact of the arts in preventing ill health. An article in the BMJ in 1996 showed that people who only engage with the arts and culture occasionally are more likely to die prematurely than people who engage regularly, even when accounting for factors such as socio-economic status. This finding has since been replicated eight further times in different population databases, not just for all-cause mortality but also for cancer mortality and cardiovascular mortality. But why do we find such an effect? There are a range of mechanisms at play here: psychological, physiological, social, and behavioural. For example, engaging with the arts supports mental health, reducing negative symptoms of mental illness such as anxiety and depression, and increasing positive aspects such as enhancing wellbeing. The arts also affect cognition, supporting temporal and spatial abilities, language, and memory, reducing our risk of dementia. The arts also support social identities and cohesion within society. And they can increase our agency and self-esteem, which in turn increase our ability to change behaviours in other aspects of our lives. As the emphasis on preventative health increases, there is a growing opportunity to harness these effects to help people live happier, healthier lives.

 

The arts in health communication

However, even if we acknowledge the role of the arts in public health and medicine, it can seem a stretch to suggest they have a role in extreme situations. Is there really a place for the arts in the context of global emergencies, such as epidemics? The Ebola outbreak of 2013-2016 demonstrated precisely how important the arts are in such situations. During the epidemic, there were abundant rumours and misunderstandings about the disease amongst locals, instances of people who were affected hiding from medical staff, Ebola survivors being outcast from their societies, and even healthcare workers being murdered. To combat this misinformation and raise public understanding, short films based on oral traditions of storytelling, radio serial dramas, and even electro-dance rap songs were created and went viral. Sensitive to local dialects and cultural traditions, these art forms became a route to communicate critical information in a way that people could trust, combatting the misinformation and helping health workers to carry out their work. Across the world there are programmes harnessing this power of the arts in health communication, from theatre productions to educate about diabetes, to schools crafts workshops to explain the risk factors for cancer. The arts can be direct and accessible ways of communicating crucial messages in ways that people from a wide range of backgrounds can relate.

 

In times of austerity, it is more important than ever that we look for creative ways to improve health.

The health economics of the arts

The examples given here are by no means the only ways that the arts can play a role in health: work in medical humanities, healthcare design, arts therapies, and arts-based training for staff provide further arguments for their importance. Yet despite the evidence, there can still be caution about the cost of engaging the arts in health. Should we be spending money on arts when such tight budgets mean there are staffing shortages or a lack of beds? Surprisingly, much of the spend on the arts in healthcare does not come from healthcare budgets; arts organisations, charities, and philanthropists fund a plethora of work around the UK and internationally. Further, many arts in health programmes have been shown to save money in health budgets. People who engage with the arts and culture in their communities are 65% more likely to report poor health, even when statistically controlling for socio-demographic and health-related factors. These people also make less use of health services. In fact, data from the Department for Culture, Media and Sport in the UK from 2015 shows that the estimated cost savings to the NHS for GP visits and psychotherapy alone as a result of people engaging with the arts and therefore using health services less is £695 million per year. In light of data such as this, Clinical Commissioning Groups in England have been trialling social prescribing and cultural commissioning programmes involving arts projects. Gloucester Clinical Commissioning Group runs a programme called Artlift whereby for certain health conditions such as chronic pain and low-lying mental health conditions, GPs have been referring people not for medication or psychotherapy, but to participatory arts workshops. The evaluation of the programme has found that, for people who took part, not only did they report improvements in their health, but over the following year the number of GP consultations and the number of hospital admissions dropped. This equated to a saving of £576 per patient, compared to a cost of just £360. The savings from 90 patients alone in the 12 months following involvement were over £42,000. These are just two examples. There are growing numbers of health economic evaluations that are providing more insight into how and where the arts can play a role in supporting health budgets, suggesting that far from being a drain on resources, the arts could be an additional means of support to healthcare.

 

The World Health Organisation defined health as a ‘state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. In times of austerity, it can be easy for us to forget everything that seems peripheral to the core mission of avoiding disease or infirmity. But keeping sight of the importance of creativity, arts, culture, and community engagement is critical. The arts are a powerful tool we should be harnessing.

 

 

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Dr Daisy Fancourt is a Senior Research Associate/Wellcome Resarch Fellow in the Department of Behavioural Science and Health, Institute of Epidemiology and Health Care at University College London. 

Daisy Fancourt's blog was written for the Oxford University Press Website

 

Image from Pixabay

 

 

Posted on 31 August 2017

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