Creative health: the arts for health and wellbeing

In this article, Lord Howarth of Newport, Co-Chair of the All-Party Parliamentary Group (APPG) on Arts, Health and Wellbeing, discusses the recommendations made by the inquiry into practice and research in the arts in health and social care conducted by the APPG and partners, and the growing momentum surrounding the arts and health movement.

In 2014, an All Party Parliamentary Group (APPG) on Arts, Health and Wellbeing was formed with the help of the National Alliance for Arts, Health and Wellbeing. The APPG decided to conduct an inquiry into the existing situation in regard to the arts in health and social care and there was a good response from parliamentarians in both the House of Commons and the House of Lords. It was understood from the outset that the Inquiry would lead to a report, which has now been published and can be downloaded online. ¹

Evidence, if it was needed, that arts and health is a movement whose time has come is provided in the remarkable support the APPG has had, and not only from the 40 parliamentarians who took part. The Special Interest Group (SIG) of the Royal Society for Public Health (RSPH) agreed to be the research partners to the Inquiry (with King’s College London researching and drafting the report), and hundreds of people were directly involved with its processes. A series of 16 round-table meetings were held, attended by people from all parts of the country to testify to Parliament and to debate key topics related to arts and health research and practice. Participants told the Inquiry that they also learnt from each other at the round tables, gained new insights and struck up new working relationships. Most striking and moving were the testimonies of patients and service-users, who, often with great courage, spoke of their personal experiences and the remarkable, transformational benefits they have gained from the arts for their own health and wellbeing. The key messages of the report to government and its agencies, the professions and the public are:

The report makes 10 specific recommendations. New legislation, regulation, organisational change and additional public expenditure are not asked for. As far as public funding is concerned, the report asks only that commissioners and other public funders take an informed and unbiased view of the value for money that arts interventions can provide in the pursuit of existing agendas.

The report proposes the creation, at national level, of a strategic centre for arts, health and wellbeing. There are government-led initiatives to promote the impact of the arts on health, wellbeing and quality of life in Sweden, Finland, Norway and Australia, and indeed, in Scotland, Wales and Northern Ireland cross-governmental programmes have been initiated. However, the report recommends that the initiative for a national centre in the UK should come from the arts, health and social care sectors themselves. The centre should be supported but not super-imposed by government. A strategic centre may not be a physical building but, rather, a gathering point, a network of networks. The centre would need to be genuinely collaborative, challenging sectoral boundaries and ensuring that patients and service-users are part of the decision-making process.

Work could be done by the centre to broker dialogue between arts organisations and the health and social care systems and make high-quality evaluation, of whatever appropriate kind, the norm. Making the evidence base more accessible to non-academics, identifying the gaps in evidence and influencing research policy to fill them, and promulgating research findings in order to influence health planning and decision-making are all areas that would benefit from agreement across sectors and stronger coordination. The centre could stimulate interest and demand. If the professions and public decision-makers are to be persuaded, they need to hear powerful stories about arts and health and a clamour for change. The centre could help develop international links so that we can learn continuously from practice and policy around the world.

The report argues, secondly, that what is needed is culture change. In the debates about the social determinants of health, the value of the arts and culture in improving people’s life chances has hitherto hardly been noticed. However, the arts and health movement has grown to the point at which it is ready to take on the establishment, just when the establishment may be ready to listen and respond.

Discussions with various agencies about the role that they might play were begun during the process of the inquiry. It is hoped that bodies such as Arts Council England, the Local Government Association, NHS England, Health Education England, Public Health England, RSPH, Healthwatch England, the Patients’ Association, the National Council of Voluntary Organisations and others will continue to support this initiative in ways that all concerned will feel to be appropriate. With this momentum developing, the Minister for the Arts has already made clear the Government’s recognition of the importance of the arts for health and wellbeing, and stated the intention of the Department for Digital, Culture, Media & Sport (DCMS) to develop a cross-governmental strategy in support of the work.

It seems that there have been a number of barriers to recognition and acceptance, among them: the heavily science-based bias of medical education; conventional medical research criteria that are ill suited to evaluation of arts in health; and the technical and bureaucratic culture of much healthcare. Discontinuities of funding from a range of sources have indeed made it very hard, if not impossible, for many arts organisations, however dedicated, to keep their arts and health work going. In the heyday of neoliberal economics, it was not expected that policy should be addressed directly to wellbeing, and it is only latterly that some in government and the economics profession have begun to think more seriously about wellbeing as a proper object of policy. Political leadership has been hesitant and inconsistent.

A different model of leadership is needed: leadership widely diffused throughout the complex systems of the arts, health and social care. Artists, clinicians, carers and service-users engaging together in dialogue, debate, collaboration and co-production across conventional boundaries, across the UK and international borders, will change the culture. Challenging the dominant medico-technical culture – not disparaging its virtues and its great achievements, but calling for something else in addition – will humanise it and open it to the possibilities of imagination, creativity and the spirit. Expert witness and public demand, combining and building, will prevail against group-think, vested interests and inertia. As more medical and care professionals who want the best for their patients accept this message, the managers will respond, and so will the policy-makers and the funders in the future.