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Attention Health Promoters: It’s Time to Get Creative!

Contents

I Introduction
II What is Arts & Health?
III Opportunity in Canada
IV Conclusion
V Resources
VI References
VII Additional Resources

--Submitted by Kira Tozer, MPH, Knowledge Translation Coordinator, Arts Health Network Canada, and Nicki Kahnamoui, MA, PMP, Executive Director (Acting), Arts Health Network Canada

I Introduction

Our population is aging, our health care spending is increasing at an unsustainable rate, and leaders are constantly being asked to seek out creative solutions to health-related problems.  Perhaps, it is time we considered truly creative solutions. Enter: Arts & Health.

Arts & Health is a growing international field that embraces many forms of art to promote health and prevent disease in individuals and communities, enhance health service delivery and enrich research inquiry.

Growing research and experience in the United States, (1) the UK, (2) Australia, (3) and more recently in Canada (4), demonstrate that participation in arts activities has significant benefits for the health of individuals, populations and the sustainability of health care systems as it can:

  • Be used in the design and delivery of prevention and health promotion programs to address personal, social, and environmental factors that impact the health and wellbeing of individuals and communities (5,6)
  • Help to manage persistent pain and other chronic conditions, including mental health challenges (7,8,9)
  • Improve communication between medical staff and patients  (10,11)
  • Contribute to insight and compassion on the part of health care professionals when arts are used in health care education (12)
  • Reduce use of pharmaceuticals, their costs and complications (9,13)
  • Ease tension and fear during unpleasant or challenging medical treatments (14,15)
  • Reduce the cost and completion time for many medical procedures and increase successful completion rates (16)
  • Enhance research inquiry and dissemination. (17)

II What is Arts & Health?

In January 2014, Arts Health Network Canada released an infographic (18) that aims to summarize and succinctly explain the broad field of Arts &Health, based on a literature review and the comments and perspectives of over twenty leaders, champions and practitioners in the Canadian Arts &Health sector.

The infographic suggests that the arts can include everything from knitting to singing, gardening to filmmaking, writing to sculpting, and that health refers broadly to physical, mental, social, emotional and spiritual wellbeing and “not merely the absence of disease or infirmity.” (19) Further, it reinforces that Arts & Health activities can benefit everyone: across the lifespan, across cultures, and across the health continuum, and in a variety of settings: health care facilities, homes, workplaces, schools, recreation centres, galleries, parks, places of workshop, festivals, and even online.

Arts & Health can be viewed as comprising six main themes or subfields: recreational arts; arts in health care settings; community arts, health promotion and prevention; arts-based health research; arts-based health communication; and medical humanities.

Recreational Arts

People engage with the arts for a variety of reasons:  they go to the theatre for entertainment, they write short stories for expression, they play an instrument for enjoyment, they go to dance classes for exercise and to socialize with friends, and so on. For many people the connection to health is not named or recognized as a motivating reason for participating in or viewing an arts event; however, it is an unintended benefit.

A recent Canadian study (20) by Hill Strategies Research Inc., based on data from Statistics Canada’s 2010 General Social Survey, found a strong connection between participation in 18 cultural activities and eight indicators of health and wellbeing (such as health, mental health, feeling stressed, and overall satisfaction with life).

This is in line with studies conducted in Norway (21) and Sweden (22) finding that, even after controlling for other factors, participation in receptive and creative cultural activities was significantly associated with good health, good life satisfaction, low anxiety and depression scores, and increased longevity.

The associated health outcomes of recreational arts participation is particularly important with regards to older adults and the rising health and long-term care costs that are expected in association with Canada’s aging baby boomers. The landmark Creative Aging study by Dr. Gene Cohen found that older adults (65+, but average age 80) who participated in weekly professionally run arts programs had better reported health, fewer doctors visits, less medication use, less depression, improved morale and an increased activity level compared to a control group (23).This study illustrates the valuable impact that professionally run arts programs can have on maintaining seniors’ independence and reducing the risk factors that drive the need for long term care. (23)

Arts in Health Care

More intentional uses of arts to promote health are often found in healthcare facilities. Arts engagement, as a participant or observer, can positively impact the wellbeing of patients, families and caregivers.  Arts programs in health or long-term care settings are often run by professional creative art therapists (art, dance and movement, music, drama, play, photo, expressive, etc.) who use the arts to address specific therapeutic goals and clinical outcomes. Programs are also run by professional artists or Arts &Health practitioners who engage patients in the arts for reasons including enjoyment, education, entertainment, distraction from illness and pain relief, social connection, self-exploration, etc.  While such programs may have therapeutic benefits, they are not intended as therapy.  

A growing number of health care facilities are implementing Artists-in-Residence programs, like the Friends of University Hospitals’ Artists on the Ward program in Alberta (24) that brings professional musicians and visual or literary artists to the bedside to engage patients in art making. A few hospitals across the country have therapeutic clowns on staff, like David Langdon (aka  Hubert & Orni) at the Winnipeg Children’s Hospital, who use the medium of clown play and child-directed play activities to offer pediatric patients humorous and supportive experiences in hospital. (25)

Lastly, there is a growing appreciation for the role that art and design can play in the creation of therapeutic environments. Healing gardens, art installations and natural light can help with simple way finding and aesthetically improving a space, and can also positively affect patient outcomes. (26) A classic example is the 1984 study by Ulrich who noted that post-operative patients in rooms with a window overlooking a natural setting required less medication and shorter stays than those with windows looking at a brick wall. (27).

A more recent study found that the inclusion of visual art works in a lounge for psychiatric inpatients was associated with a reduction of patient anxiety and agitation as measured by PRN medication issued and qualitative feedback from nursing staff. (9)

Community Arts, Health Promotion and Prevention  

The arts can also be used in the design and delivery of community-based prevention and health promotion programs to address individual, social and environmental factors that impact health and wellbeing.  Arts activities are great focal points for programs working with hard-to-reach or marginalized populations, as they can widen social networks, reduce feelings of isolation, provide a sense of connection and belonging, facilitate a sense of self-mastery, and provide a mechanism to share health information.  In such programs, the process of art-making is often valued as much or even more than the final art product itself.

For example, the Creative Works Studio in Toronto, a community initiative of the Inner City Health Program of St. Michael’s Hospital, welcomes people living with severe and persistent mental illness and/or addictions to a community-based arts studio to help them find and maintain an active and meaningful life in the larger community. (28)

Increasingly, Canadian health associations are partnering with art galleries to develop programs similar to the New York Museum of Modern Art’s program, Meet Me at MoMa, (29) which offers facilitated art viewing and discussion groups for people with Alzheimer’s and their caregivers. A growing number of arts and Alzheimer’s programs are harnessing the notion that even with the loss of memory, the capacity for imagination remains in place (30) and that art programs can contribute to creative expression, emotional communication, social connectivity and quality of life for people living with dementia.

Arts-Based Health Research  

When the arts are mentioned in relation to health research, they are most commonly associated with knowledge translation: film, theatre, storytelling (etc.) used as tools to share research findings with a broad audience. To investigate the medium of arts-based knowledge translation itself, a recent Canadian study called “That’s Just Crazy Talk” (31) set out to evaluate the impact of a ‘lived experience’ theatrical performance on attitudes and understandings of mental health issues, among people with bipolar disorder and health care providers.  

It is less commonly acknowledged that the arts can also be used as a form of inquiry, a methodology, or a tool to collect and analyze data. In her book “Method Meets Art: Arts-Based Research Practice” (32), Patricia Leavy, provides an in-depth introduction to arts-based methods including narrative inquiry, script and performance-based research methods and visual arts-based participatory methods, among others.

It is timely to note that UBC Professor Susan Cox and colleagues at the University of Melbourne have recently released a set of ethical guidelines (33) for researchers and review boards considering visual research methods.

Arts-Based Health Communications

Art can contribute to different ways of knowing about, understanding and communicating human experiences of health and illness.  As such, health communication strategies often include arts-based components like graphic design, music, narrative storytelling, film, theatre (etc.) to shape and share messages, stimulate public engagement and prompt changes in attitude and behavior.

A wonderful example of arts-based health communication in action is the #4Eva Campaign, an organ donation and cystic fibrosis awareness effort, including the documentary 65 Red Roses, based on the life and work of BC’s Eva Markvoort.  The documentary, Eva’s online journal and “awareness art project” collaboration with her friend Cyrus McEachern for BC Transplant have had a marked impact on online organ donation registration rates in BC. (34)

Medical Humanities

Medical Humanities programs incorporate arts, humanities and social science perspectives into health professional education settings to help foster understanding, compassion, and empathy in learners. (12) Program activities can range from book clubs, poetry at rounds, creative writing courses, art gallery ‘lab’ work, life drawing classes, role play (interactive drama), illness-related dramatic performance, cinemeducation (etc.).  The first medical humanities program in Canada was established at Dalhousie University in 1992 and today there are programs at a number of Canadian medical schools. While the Canadian programs are largely elective and extra-curricular in nature, in the United States it is now estimated that 69 of 133 accredited medical schools require that medical students take a course in the medical humanities. (35)

III Opportunity in Canada

Despite the Canadian examples noted above, and the growing body of international research (36) that is pointing to the benefits of using arts with specific patient populations, and to improve population health more generally, it is important to note that Canada lags behind countries like Australia, the US and UK in acknowledging and implementing Arts & Health initiatives.

A review of international Arts & Health networks like the Global Alliance for Arts & Health-USA (37), Arts & Health Australia, (38) and National Alliance for Arts Health and Wellbeing-UK (39) illustrates the expanded scope and acceptance of Arts & Health activities abroad.  Further, a recent report from The Joint Commission and the Society for Arts & Healthcare determined that half of US health care institutions now have arts programming, 60% of which are funded by operating budgets. (1)

Like anything, the arts in isolation are not a fix for the health problems of populations; however, there is an untapped potential for the arts to positively impact health and wellbeing in Canada, and room within the population health framework to accept and explore the possible contributions of arts to health.  

IV Conclusion

Considering the many ways that art can intersect with health prevention and care provision, and the plethora of benefits to the health of individuals and communities, we encourage Canadian health promoters, to bring arts into the conversations about healthy living, make better and more widespread use of the arts for health promotion purposes, partner with artists, evaluate and publish those projects, and expand existing programs by promoting the health benefits of arts participation.

In the words of former Governor General of Canada, Michaelle Jean, “Art has the power to inspire, the power to heal, the power to transform, to rehabilitate, to bear witness, and to make us believe that there are better days ahead.”

V Resources

Questions for Health Promoters to ask themselves:

  • How can I bring the arts into this environment?
  • Where is there opportunity to bring art into our training, programming and services offered to students/clients/patients?  How might that benefit us/them in ways we are not already addressing?
  • How can we use art to share our information? What audiences might we reach via storytelling, an art show, or a documentary that we aren’t currently reaching?
  • Who are the local artists or art organizations that might be good partners for my project?

Arts Health Network Canada

Arts Health Network Canada is a non-profit organization that champions participation and engagement in the arts as a path to improved health, healing, and wellbeing for all Canadians.  As Canada's primary Arts & Health knowledge sharing, networking and capacity building hub, Arts Health Network Canada is helping to promote and facilitate the development and growth of Arts & Health initiatives across Canada. Visit the website to learn more, join the online community and sign up to receive the monthly e-newsletter: http://www.artshealthnetwork.ca.

AHNC Community Partners include:

  • Arts Health BC
  • Greater Ottawa Arts Health Network Canada (GO-AHNC)
  • Toronto and Area Arts and Health (TAAH)

VI References

  1. State of the Field Committee. State of the Field Report: Arts in Healthcare 2009. Washington, DC; 2009. Available at: http://www.thesah.org/doc/reports/ArtsInHealthcare.pdf.
  2. Clift S, M. Camic P, Chapman B, et al. The state of arts and health in England. Arts Health. 2009;1(1):6–35.
  3. Wreford G. The state of arts and health in Australia. Arts Health. 2010;2(1):8–22.
  4. Cox SM, Lafrenière D, Brett-MacLean P, et al. Tipping the iceberg? The state of arts and health in Canada. Arts Health. 2010;2(2):109–124.
  5. Silverman Y, Smith F, Burns M. Coming together in pain and joy: A multicultural and arts-based suicide awareness project. Arts Psychother. 2013;40(2):216–223.
  6. Stickley T, Duncan K. Art in Mind: implementation of a community arts initiative to promote mental health. J Public Ment Health. 2007;6(4):24–32.
  7. Nainis N, Paice JA, Ratner J, Wirth JH, Lai J, Shott S. Relieving symptoms in cancer: innovative use of art therapy. J Pain Symptom Manage. 2006;31(2):162–9.
  8. Hackney ME, Kantorovich S, Levin R, Earhart GM. Effects of tango on functional mobility in Parkinson’s disease: a preliminary study. J Neurol Phys Ther. 2007;31(4):173–9.
  9. Nanda U, Eisen S, Zadeh RS, Owen D. Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case. J Psychiatr Ment Health Nurs. 2011;18(5):386–93.
  10. Walsh SM, Martin SC, Schmidt LA. Testing the efficacy of a creative-arts intervention with family caregivers of patients with cancer. J Nurs Scholarsh. 2004;36(3):214–9.
  11. Ferszt G, Massotti E, Williams J, Miller J. The Impact of an Arts Program on an Inpatient Oncology Unit. Illness, Cris Loss. 2000;8(2):189–199.
  12. Brett-MacLean P. Use of the Arts in Medical and Health Professional Education. Univ Alberta Heal Sci J. 2007;4(1).
  13. Cohen G. New theories and research findings on the positive influence of music and art on health with ageing. Arts Health. 2009;1(1):48–62.
  14. Brice J, Barclay J. Music Eases Anxiety of Children in Cast Room. J Pediatr Orthop. 2007;27:831–833.
  15. Chlan L, Evans D, Greenleaf M, Walker J. Effects of a single music therapy intervention on anxiety, discomfort, satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy. Gastroenterol Nurs. 2000;23(4):148–56.
  16. DeLoach Walworth, D. (2005). Procedural-Support Music Therapy in the Healthcare Setting: A Cost–Effectiveness Analysis. Journal of Pediatric Nursing, 20(4), 276–284.
  17. Fraser KD, al Sayah F. Arts-based methods in health research: A systematic review of the literature. Arts Health. 2011;3(2):110–145
  18. Arts Heath Network Canada. Arts & Health Infographic. Vancouver, BC; 2014. Available at: http://artshealthnetwork.ca/ahnc/images/artshealthnetworkcanada-artsheal...
  19. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
  20. Hill Strategies Research Inc. The Arts and Individual Well-Being in Canada: Connections between Cultural Acitivites and Health, Volunteering, Satisfaction with Life and Other Social Indicators in 2010.; 2013:37. Available at: www.hillstrategies.com.
  21. Cuypers K, Krokstad S, Holmen TL, Skjei Knudtsen M, Bygren LO, Holmen J. Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: the HUNT study, Norway. J Epidemiol Community Health. 2012;66(8):698–703.
  22. Bygren LO, Konlaan BB, Johansson S-E. Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions. BMJ. 1996;313(7072):1577–1580.
  23. Cohen GD, Perlstein S, Chapline J, Kelly J, Firth KM, Simmens S. The Impact of Professionally Conducted Cultural Programs on the Physical Health, Mental Health, and Social Functioning of Older Adults—2-Year Results. J Aging, Humanit Arts. 2007;1(1-2):5–22.
  24. Artists on the Ward – Friends of University Hospitals.  Available at: http://www.friendsofuah.org/artists-on-the-wards/
  25. The Winnipeg Child Life Clown Program. Available at: http://artshealthnetwork.ca/initiatives/winnipeg-child-life-clown-program
  26. Ulrich RS, Zimring C, Zhu X, et al. A review of the research literature on evidence-based healthcare design. HERD. 2008;1(3):61–125.
  27. Ulrich RS. View through a window may influence recovery from surgery. Science. 1984;224(4647):420–1
  28. Creative Works Studio. A St. Michael’s Hospital Inner City Health program in partnership with the Good Shepard.  Available at: http://creativeworks-studio.ca
  29. Rosenberg F. The MoMA Alzheimer’s Project: Programming and resources for making art accessible to people with Alzheimer's disease and their caregivers. Arts Health. 2009;1(1):93–97
  30. Sierpina M, Cole TR. Stimulating creativity in all elders: a continuum of interventions. Care Manag J. 2004;5(3):175–82
  31. Using Theatre to Modify Stigma: A Knowledge Translation Study in Bipolar Disorder.  That’s Just Crazy Talk. Available at: http://www.crestbd.ca/dt_portfolio/stigma-and-bipolar-disorder/
  32. Leavy P. Method Meets Art: Arts-Based Research Practice. New York: The Guilford Press; 2008:286.
  33. Cox S, Drew S, Guillemin M, Howell C, Warr D, Waycott J. Guidelines for Ethical Visual Research Methods. Melbourne; 2014 Available at:  http://artshealthnetwork.ca/ahnc/ethical_visual_research_methods-web.pdf
  34. Live Life. Pass it On. BC Transplant. Available at:http://transplant.bc.ca/Live_life_pass_it_on.htm
  35. Banaszek A. Medical humanities courses becoming prerequisites in many medical schools. CMAJ. 2011;183(8):E441–2
  36. Arts Health Network Canada Mendeley Group.  Available at: http://www.mendeley.com/groups/3687871/arts-health-network-canada/
  37. Global Alliance for Arts & Health.  Available at: http://thesah.org
  38. Arts and Health Australia. Available at: http://www.artsandhealth.org
  39. National Alliance for Arts Health and Wellbeing.  Available at: http://www.artshealthandwellbeing.org.uk

VII Additional Resources

What is Arts and Health infographic explains art and health and how the two come together: http://artshealthnetwork.ca/ahnc/images/artshealthnetworkcanada-artsheal....

Arts Health Network Canada champions engagement in the arts for health and wellbeing: http://artshealthnetwork.ca/.
A list of community partners and contacts including Arts Health BC, Greater Ottawa Arts Health Network Canada (GO-AHNC), and Toronto and Area Arts and Health (TAAH) is available at http://artshealthnetwork.ca/about/community-partners.